Back to Basics: Daily Saline Wet Dressings as a Turning Point in Recurrent Pediatric Split-Thickness Skin Graft Failure.

Split-thickness skin grafting (STSG) is a widely used reconstructive technique for managing traumatic soft tissue defects. Successful graft take depends on adequate wound bed preparation and effective infection control. Multidrug-resistant infections remain a major cause of graft failure, particularly in complex pediatric trauma cases. We report the case of a 12-year-old previously healthy male presenting with bilateral thigh soft tissue defects complicated by multidrug-resistant infections and repeated graft failure. Persistent graft necrosis occurred despite multiple surgical debridements, targeted antibiotic therapy, and negative pressure wound therapy. A modification in postoperative wound care was implemented, including earlier dressing changes and the use of daily saline wet dressings. This approach resulted in successful graft take and complete wound healing, emphasizing the potential role of simple, low-cost wound care strategies in improving outcomes in complex infected wounds. This case underscores the importance of fundamental wound care principles in the management of complex infected wounds. Early and frequent wound assessment, combined with saline-based dressings, may play a critical role in achieving graft success, even in the setting of multidrug-resistant infections.