Full-thickness skin graft fixation techniques: A review of the literature

Abstract

Multiple techniques for skin graft fixation have been proposed, but the evidence underlying these techniques is unclear. This study aimed to review the literature for full-thickness graft fixation techniques. PubMed was electronically searched to identify relevant studies. The search strategy identified 91 relevant articles. These consisted of 2 randomised controlled trials (RCTs), 10 observational cohort studies (8 retrospective, 2 prospective), and 79 descriptive studies (case series, case reports, or expert opinion articles). Both identified RCTs compared the tie-over dressing against a modified tie-over dressing. The tie-over dressing was also included in all identified observational studies, and comparisons were made against quilting/mattress suturing (4 studies, 181 grafts in total), simple pressure dressings (3 studies, 528 grafts), non-tie-over dressings non-specifically (1 study, 71 grafts), hydrocolloid dressings (1 study, 62 grafts), and double-tie over dressings (1 study, 43 grafts). No significant differences were found between fixation methods for graft take, haematoma rate, and infection rate. No studies have found a significant difference between tie-over dressings and alternative graft fixation technique, with the most evidence for simple pressure dressings and quilting/mattress suturing. However, the evidence base consists mostly of small, retrospective observational studies. This article describes the current evidence base and this should be considered when planning future reports in the field.

Skin graft fixation with negative pressure wound therapy with instillation and dwelling (NPWTi-d) for contaminated complex wounds of the extremities

“…Postoperative fixation is important for successful survival of skin grafts with various methods such as tie-overs with cotton balls and gauze often used. 1 Originally intended for wound healing, the fixation of skin grafts by NPWT was first reported by Schneider et al. in 1998.…”

“…Skin grafting contaminated wounds caries a risk of wound infection and graft loss during the fixation period which typically ranges from 3 to 10 days. 1 Negative Pressure Wound Therapy (NPWT) has become a major alternative method for graft fixation, however regular NPWT is contraindicated for contaminated and infected wounds. 2 , 3 To overcome this challenge, we report the use of NPWT with Instillation and Dwelling (NPWTi-d) for skin graft fixation and dressing in contaminated complex wounds.…”

Skin grafts: A survey study of Australasian Mohs surgeons

“…6 Multiple methods have been described including basting or quilting sutures, tie-over and non-tie over boluses, sponge bolster, negative pressure dressings and cyanoacrylate adhesive. 3,6,7 Several studies have shown that traditional tie-over boluses are not essential, as other fixation techniques have been shown to have comparable results in terms of graft survival, aesthetics and complication rates. 6,7 Traditionally, bolus dressings are removed after 5-7 days.…”

“…3,6,7 Several studies have shown that traditional tie-over boluses are not essential, as other fixation techniques have been shown to have comparable results in terms of graft survival, aesthetics and complication rates. 6,7 Traditionally, bolus dressings are removed after 5-7 days. This was reflected in the results of our survey with the majority removed at 1 week.…”

Mechanism of Origin of Positive Tissue Pressure During Negative-Pressure Wound Therapy

“…Mechanism of action of this highly effective method remains not completely understood. 1 Skin graft fixation 2 and muscle flap edema reduction 3 by means of NPWT suggest that its beneficial effects are rather due to compression than due to depressurization. The initial belief that NPWT diminishes tissue pressure and improves blood circulation has appeared inconsistent with experimental findings which show an increase in the pressure 4-6 and reduction in perfusion.…”