Comparison of Efficacy and Complications Between Negative Pressure Wound Therapy and Conventional Mechanical Fixation in Skin Grafts: A Retrospective Analysis.
For any skin graft surgery, graft fixation is especially critical for graft survival. It requires appropriate pressure, stable tension and adequate drainage. Negative pressure could be utilized to secure a skin graft, improving the drainage as an alternative mechanism to fix the graft that could generate an inappropriate pressure, increasing wound complications. An inappropriate pressure on the skin graft may lead to hematoma, infection, dislocation, or graft loss, reducing graft survival significantly.
Negative-pressure wound therapy (NPWT) is a therapeutic technique using a suction dressing to remove excess exudation and promote healing in acute or chronic wounds and second-and third-degree burns.
Shen X and Coll conducted this retrospective study in which they evaluated 186 patients with acute and chronic wounds due to trauma, soft tissue infection, burn injury, tumour resection, and scar plastic surgery from January 2015 to December 2016. Seventy-two of them received NPWT (The vacuum mode was set at continuous -100 mm Hg for Full-thickness skin grafts and continuous -75 mm Hg for Split-thickness skin grafts) and 114 received conventional mechanical dressing fixation after skin grafting (the grafts were fixed with a bolster or elastic bandage). The overall survival rate of full-thickness skin grafts was significantly higher in the NPWT group than in the dressing group.
NPWT applies negative pressure to the space between the skin graft and recipient site. It removes space and pulls the entire skin graft with uniform pressure, increasing wound blood flow, oxygen concentration and granulation tissue formation. Negative pressure wound therapy could stabilize the skin graft and conform well to the shape of the recipient bed, removing fluid, decreasing bacterial counts.
In conclusion, this study confirms that the NPWT offers consistent pressure, better drainage, and less operation time, in comparison with conventional tie-over bolster ore dressing methods.
Authors: Shen X, Zhan T, Wei D, Zhang H.
Newspaper: Wounds. 2019 Aug;31(8):213-218. Epub 2019 Jun 30