Securing split-thickness skin grafts using negative-pressure wound therapy without suture fixation
Abstract
Objective:
Negative-pressure wound therapy (NPWT) is generally applied as a bolster for split-thickness skin grafts (STSG) after the graft has been secured with sutures or skin staples. In this study, NPWT was applied to secure STSGs without any sutures or staples. Surgical outcomes of using NPWT without sutures was compared with a control group.
Methods:
Patients with STSGs were divided into two groups: a ‘no suture’ group using only NPWT, and a control group using conventional fixings. In the no suture group, the grafts were covered with meshed wound dressing and ointment. The NPWT foam was placed over the STSG and negative pressure applied. In the control group, grafts were fixed in place using tie-over bolster, securing with fibrin glue, or NPWT after sutures.
Results:
A total of 30 patients with 35 graft sites participated in the study. The mean rate of graft take in the no suture group was 95.1%, compared with 93.3% in the control group, with no significant difference between them. No graft shearing occurred in the no suture group. Although the difference did not reach statistical significance, mean surgical time in the no suture group (31.5 minutes) tended to be shorter than that in the control group (55.7 minutes).
Conclusion:
By eliminating sutures, the operation time tended to be shorter, suturing was avoided and suture removal was not required meaning that patients could avoid the pain associated with this procedure. Furthermore, the potential for staple retention and its associated complications was avoided, making this method potentially beneficial for both medical staff and patients.
To ensure a successful take of split-thickness skin grafts (STSG), a well-granulated wound bed and close contact between the graft and the recipient wound bed are essential. In general, STSGs are secured using sutures and tie-over bolsters. However, when applying these methods, it has been reported that the larger the size of the grafted area, the higher the rate of graft loss.1 A possible cause for this is that pressure can not be uniformly applied over the graft area with tie-over cotton gauze and sutures.1 In addition, when STSG was applied to large wounds or irregular surfaces by conventional methods, surgical time was long and postoperative suture removal was painful for patients and imposed a burden on medical staff.2
Since Argenta described the efficacy of negativepressure wound therapy (NPWT) in 1997,3 its application as a bolster for STSGs has been widely adapted.1,4–7 Using NPWT, it is possible to prevent fluid collection beneath the graft and ensure uniform contact between the graft and the recipient wound bed. The tendency for a higher rate of successful graft survival when using this approach compared with that of the conventional method has been reported.4 It has also been shown that NPWT improves the quality of the grafted skin and graft take, and shortens the length of hospital stay.1,5
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