Seventeen trials were included (n=730).
From the tables it appeared that nine studies were retrospective reviews, four were observational studies, and four were randomised controlled trials. However, the text indicated that only three studies were RCTs. Sample size ranged from nine to 100. Study quality was generally poor with PEDro scores ranging from 0 to 5. Methodological flaws included small sample size, lack of control group and absence of reporting of statistical tests.
Nine studies investigated immediate ambulation in patients with skin grafting for various reasons. The only RCT did not find a significant difference in graft take (93% versus 90%) in patients with one week's bed rest compared to immediate ambulation. Two studies reported on hospitalisation; one study were maximum hospitalisation was four days; in the other study, 64% of patients were discharged after 3 days and 81% were discharged after one week. Two studies reported on function, with all patients in one study achieving full joint range of movement, and patients in the other study walking independently 30ft by 1.7 days post-operatively. Studies reported graft take of 100% in between 67 and 100% of patients (seven studies) after varying periods of time (range where reported 15 days to three weeks).
Five studies investigated the effects of commencing ambulation one day after lower limb graft surgery. Two RCTs reported no difference between early and late ambulation (at five days and 10 days) in graft healing rates (one study), or mean time to graft take and hospital stay (one study that did not report statistical values). One study reported no difference in wound healing between ambulation one day post-operatively and bed rest. Of the remaining uncontrolled studies, one reported a range of 85 to 100% (average 97%) for graft take; the other reported that graft take was 90 to 100% complete in 80% of patients. One study had an average hospital stay of 0.9 days (range 0 to 3), the other of 3.8 days.
One study found complete healing in 50% of patients after two weeks when commencing ambulation two days post-operatively, with complete healing in all patients after six weeks. One study found significantly shorter durations of bed occupancy for patients commencing ambulation after nine days, compared to those commencing ambulation after 11 or more days (12.5 days versus 18.6 days, p<0.05).