An Alternative Treatment Strategy for Complicated Chronic Wounds: Negative Pressure Therapy over Mesh Skin Graft

Abstract

Extensive skin defect represents a real problem and major challenge in plastic and reconstructive surgery. On one hand, skin grafts offer a practical method to deal with skin defects despite their unsuitability for several complicated wounds. On the other hand, negative pressure wound therapy (NPWT), applied before skin grafting, promotes granulation tissue growth. The aim of the study is to evaluate the improvement in wound healing given by the merger of these two different approaches. We treated 23 patients for large wounds of multiple factors. Of these, 15 were treated with the application of V.A.C.® Therapy (KCI Medical S.r.l., Milan, Italy), in combination with skin grafts after a prior unsuccessful treatment of 4 weeks with mesh skin grafts and dressings. Another 8 were treated with only mesh skin graft. Pain reduction and wound area reduction were found statistically significant (p < 0.0009, p < 0.0001). Infection was resolved in almost all patients. According to our study, the use of the negative pressure wound therapy over mesh skin grafts is significantly effective especially in wounds resistant to conventional therapies, thereby improving the rate of skin graft take.

Skin cancers and dermal substitutes: Is it safe? Review of the literature and presentation of a 2‐stage surgical protocol for the treatment of non‐melanoma skin cancers of the head in fragile patients

“…Skin grafts are easy to perform and show reliable results . Typical colour mismatch due to basal hyperpigmentation can be observed but can be reliably treated with intense pulsed light …”

Application of Negative Pressure Wound Therapy on Closed Incisions

“…Maruccia et al described faster healing, fewer dressing changes, and quicker maturity of mesh skin grafts when combined with NPWT. This combined treatment provides higher integration, better immobilization of the graft, expulsion of f luids, and a moist clean wound bed [35].…”

“…Maruccia et al, in 2016, reported a statistically significant reduction in pain scores and wound area in skin graft patients. This could be explained by faster healing and improved uptake of the graft, along with less frequent need for dressing changes [35].…”

Sestrinska skrb za bolesnika liječenog VAC terapijom

“…Liječenje rana terapijom negativnog tlaka (NPWT) pomoću vakuumom potpomognutog zatvaranja (VAC-a) pokazalo je dobre rezultate u liječenju kroničnih rana. Radi se o posebnom uređaju koji u rani stvara negativni tlak ispod 125 milimetara žive, a djeluje preko posebnih spužvi koje se umeću u ranu te se prema njoj i oblikuju 5 .…”