Prospective Randomized Controlled Trial Comparing Two Methods of Securing Skin Grafts Using Negative Pressure Wound Therapy

Abstract

Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors' institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. The authors report a randomized controlled trial comparing the efficacy of the GSUC vs the VAC in securing STSG. A prospective, randomized, controlled trial was conducted in 157 wounds in 104 patients requiring STSG from August 2009 to July 2012. All wounds were randomized to VAC or GSUC treatment and assessed for skin graft adherence/take. At postoperative day 4 or 5, NPWT was discontinued, and the size of the graft and any nonadherent areas were measured and recorded. Concomitant comorbidities, wound location, etiology, study failures, and reoperative rates were also reviewed. In all, 77 and 80 wounds were randomized to the GSUC and VAC study arms. Patient demographics were similar between both groups in terms of age, sex, comorbidities, etiology, and wound location. In all, 64 of 80 wounds in the GSUC group and 60 of 77 wounds in the VAC group had full take of the skin graft by postoperative day 4 or 5 (P = .80). The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.

Cost-effective Alternative for Negative-pressure Wound Therapy

“…Eventually, several prospective and randomized studies were performed to formally compare the efficacy of this method to the VAC system, which demonstrated therapeutic equivalence. 18,19,27 In a prospective randomized trial of 87 patients from 2006 to 2008, Dorafshar et al (July 2012) demonstrated therapeutically equal efficacy of GSUC dressings when compared to that of commercialized VAC. Outcomes were primarily compared in respect to changes in wound surface area and volume over time.…”

“…Comparative results were demonstrated with 96.12% in the GSUC group and 96.21% in the VAC arm. 19 Given the simple, inexpensive component materials used for the method, these studies also demonstrated great potential for cost savings even just on a per diem, per therapy basis. With that, the next natural progression was to review the long-term cost savings at an institutional level, as we have done here.…”

“…7,16–18 In the inpatient setting, NPWT can reduce the need and complexity of surgical therapy in some situations and improve the clinical outcome of operations in others. 17,19–23 It can also help expedite patients’ transition to outpatient settings more quickly as many types of chronic and acute wounds can be managed at home with NPWT. 24–26 Overall, patients benefit from quality of life improvement from decreased need for painful dressing changes, faster healing time, and an earlier return to normal function.…”

“…16,18,19,27–29 In this study, we review strictly from a financial stand point a 15-year experience and present the potential cost impact at an institutional level when comparing the use of GSUC against commercialized system like the VAC.…”

Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery

“…NPWT requires fewer dressing changes and less resource use than standard dressings. If split‐thickness skin grafting of the fasciotomy is necessary, it may be preferable to use the less adherent polyvinyl alcohol dressing (white foam) as a wound filler on top of the split‐thickness skin graft.…”