A New and Reliable Method of Securing Skin Grafts to the Difficult Recipient Bed

Schneider, Andrew M.; Morykwas, Michael J.; Argenta, Louis C.

doi:10.1097/00006534-199809040-00045

Cited by 117 publications

(82 citation statements)

References 4 publications

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“…Poor take of skin graft may be due to improper bed, irregular surface, big cavities, shearing, hematoma and seroma collection 21, 22. The cost of VAC can be forgotten in circumstances where the risk of skin graft failure is warranted.…”

Section: Discussionmentioning

confidence: 99%

Negative pressure wound therapy: An update

El-Sabbagh

2017

Chinese Journal of Traumatology

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PurposeTo get the maximum benefit of vacuum-assisted closure (VAC) in the management of acute and chronic wounds without abuse or misuse.MethodsFourty one patients were included in the study. Among them, 9 patients had chronic wounds and the rest 32 patients had acute wounds. In acute wounds, 19 patients had co-morbid conditions. Seven patients had gaped wounds, 4 patients had necrotizing fasciitis and 2 patients had enterocutaneous fistula.ResultsThe hospitalization period varied from 1 to 6 weeks. The follow-up period was up to 6 months. No mortality was recorded during this study. All skin grafts showed complete healing. Necrotizing fasciitis was managed with good outcome. Wounds with enterocutaneous fistula have improved. In chronic wounds, good healing and excellent outcome were obtained.ConclusionThe VAC therapy is an essential element for the management of problematic acute and chronic wounds.

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Section: Discussionmentioning

confidence: 99%

Negative pressure wound therapy: An update

El-Sabbagh

2017

Chinese Journal of Traumatology

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“…12 The reduced separation between the recipient bed and graft created by the VAC encourages faster fibroblast and collagen deposition. 12 Schneider and colleagues 13 reported the use of VAC to secure skin grafts in more than 100 patients over five years in various areas of the body, including feet, lower extremities, perineum, genitalia, trunk, hands, face and scalp. They found no case of skin graft loss due to fluid build up beneath the graft, which had been a common problem with tie-over bolster dressing.…”

Section: Discussionmentioning

confidence: 99%

“…13 When the wounds involve surfaces that are irregular, exudative, or subject to repeated motion, grafting becomes more difficult, and VAC is the more effective technique in securing grafts onto recipient beds. 13 The device consists of an open-cell foam with an embedded evacuation tube. When subatmospheric pressure is applied through the evacuation tube, the pliable sponge ensures even pressure distribution over the site, and allows for movement in the recipient site.…”

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Scrotal lymphangiomatosis: a case report

Wong

Melnyk

Tang

et al. 2013

CUAJ

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Lymphangiomas are benign tumours of the lymphatic system, and there are several reported cases of scrotal lymphangioma in the literature to date. We report a rare case of multilocular cutaneous lymphangiomatosis treated with surgical excision (total scrotectomy and reconstruction using split-thickness skin grafts with vacuum-assisted closure dressing). Case reportA 39-year-old healthy male presented with a 20-year history of recurrent, complicated scrotal lymphangiomatosis. The lesions had previously been treated with local excision and cauterization, laser ablation and cryotherapy, but the lymphangiomas recurred quicker and denser in number following each treatment. The patient was referred to our urology clinic in 2007 with complaints of perineal pain. Physical examination demonstrated the scrotum itself was nodular and thickened with innumerable cutaneous lymphangiomas, with complete sparing of the penile skin. Following discussion with the patient, a continued conservative approach was initially exercised with antibiotic treatment and suppression of chronic scrotal cellulitis without surgical consideration of the lesions themselves. Despite this, the patient continued to suffer from recurrent infections of spontaneously ruptured lesions. Given the ineffectiveness of conservative therapy, the notable confinement of lymphangiomas to the scrotal skin ( Fig. 1), and the ongoing psychological impact of the condition on the patient, a decision was made to escalate to surgical management consisting of total scrotectomy with reconstruction.The patient was brought to the operating room, and following induction of general anesthesia, a "W" incision was made along the baseline such that the entire scrotum was incorporated while leaving skin 1 cm above the anus intact, thus forming a shape resembling the letter "W" (Fig. 2). The scrotum, including the epithelium, dermis, and superficial subcutaneous tissues, were dissected off using a combination of #15 blade and the Metzenbaum scissors (Fig. 2). While the scrotectomy was being performed, the split-thickness graft was harvested from a shaved area on the right donor thigh. The Zimmer dermatome (Zimmer Inc., United Kingdom) set to 12/1000 of an inch was used to harvest the skin graft, which was then meshed in a 1.5:1 fashion, and used to cover the area of defect. The borders of the graft were stapled in place, and then further quilted into place using 4-0 Vicryl sutures (Fig. 3). A vacuum-assisted closure (VAC) sponge was conformed to the skin-grafted area and reinforced with additional OpSite (Smith & Nephew Healthcare, United Kingdom) dressings.At one-month follow-up, there were a few small areas of delayed healing, overall good take of the graft, and no recurrence of scrotal lymphangiomatosis (Fig. 4). The shaft of the penis appeared to remain well-vascularized. The patient reported little pain, and was able to have normal erections with no chordee or deviation. The six-month follow-up showed almost complete healing, and no recurrence was observed (Fig. 5). Dis...

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“…TNPT has also been used following split thickness skin grafting in the treatment of burns and is claimed to be particularly useful for body sites with irregular or deep contours such as the perineum, hand or axilla [12,13] as it increases graft bed contact by reduceing the chance of fluid accumulation under the graft and effectively splints the graft.…”

Section: Introductionmentioning

confidence: 99%

Life Can’t Be Any Easier than This—Introduction of the Portable and Disposable V.A.C. Machines

Hussain¹,

Kuruppu²,

Jhattu³

et al. 2012

MPS

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The application of controlled levels of negative pressure on to a wound has been shown to accelerate evacuation of dead cells, debris and fluid which eventually encourages wound healing in a verity of surgical wounds. Vacuum Assisted Closure (V.A.C.) therapy-KCI Medical Limited, the terminology by which this is widely known, became popular, especially among the plastic surgery professionals in America and soon gained recognition worldwide. It is now widely used in the UK to manage and assist healing in a wide variety of wounds. Although KCI's V.A.C. machines were the only ones on the market for a number of years, several wound management companies have now brought out their own machines and these are now known collectively as topical negative pressure therapy (TNPT). Traditional TNPT is often considered a relatively costly procedure. It is often used in patients with large wounds to facilitate dressing management and promote rapid cleaning and granulation. This may also allow them to be discharged to the community when they would otherwise remain inpatients, thereby saving bed days. Capital purchase of the machines is expensive and hospitals often rent or lease them on a short or long term basis. This can lead to difficulties in arranging the finances for discharge to the community. Subsequent dressing changes (recommended every 48 -72 hrs) also incur high costs and involvement of the trained medical or nursing staff. As we all know; "Need is the mother of invention". The disposable TNPT machine (V.A.C. Via™, KCI Medical Ltd.) has been introduced to help to solve these problems. It is a single use machine, inclusive of a dressing and canister and available off the shelf. It is very cost effective, easy to use and is used for small to moderate sized wounds. Senior author is using this machine which excellent results and illustrated the use of this machine with pictures in this paper.

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A New and Reliable Method of Securing Skin Grafts to the Difficult Recipient Bed

Cited by 117 publications

References 4 publications

Negative pressure wound therapy: An update

Negative pressure wound therapy: An update

Scrotal lymphangiomatosis: a case report

Life Can’t Be Any Easier than This—Introduction of the Portable and Disposable V.A.C. Machines

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