Increased Cost of Negative Pressure Dressings Is Not Justified for Split-Thickness Skin Grafting of Low-Risk Wounds

Kempton, Laurence B.; Larson, Timothy B.; Montijo, Harvey E.; Seymour, Rachel B.; Getz, Stanely B.; Bosse, Michael J.

doi:10.1097/bot.0000000000000259

Cited by 13 publications

(7 citation statements)

References 34 publications

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“…Another similar retrospective study performed by Kempton et al showed no significant difference between NPWT and CBD in the success of STSG take, and based on this data and a cost analysis concluded that NPWT is not a viable alternative to CBD; however, the patients included in this study were treated only for low risk wounds with a low STSG failure rate, and the cost analysis did not account for the monetary expense of an extended stay in the hospital needed for CBD. 9 From our analysis, NPWT has a significant benefit over CBD, reducing risk of STSG failure in a wide range of wound types and sizes, and thus has both the statistical and clinical significance necessary to be deemed appropriate to use in the case of most wounds over bolster dressing. A prospective, randomized study on the effect of NPWT versus CBD on wounds with varying levels of acuity from low to high risk of STSG failure could be helpful in determining a distinct guideline for when it is most appropriate to use NPWT.…”

Section: Discussion Npwtmentioning

confidence: 91%

Major Risk Factors Contributing to Split Thickness Skin Graft Failure

Turissini

Elmarsafi

Evans

et al. 2019

Georgetown Medical Review

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A retrospective review was done for each wound (n = 223) in all patients (n = 191) who underwent Split Thickness Skin Graft (STSG) placement in the Wound Division at Georgetown University Hospital from January 2014 to March 2017 in order to determine the factors that significantly affect STSG take. In doing so, these factors that prove to significantly affect STSG take can be used to predict the possibility of graft failure, and, thus, determine if additional measures must be taken in order to improve the success of the skin graft. Patient medical records were examined for patient demographics, comorbidities, wound parameters, wound bed prep, post-operative dressing, 30 day graft outcomes, and 60 day graft outcomes. Statistical analysis was performed to determine the significance of each factor, and further analysis was done to determine the association and risk of the statistically significant factors. Statistical analysis showed a significant association between Negative Pressure Wound Therapy (NPWT) for wound bed dressing after STSG placement and successful STSG outcome compared to use of bolster only for the post-surgical wound (χ2 = 4.66, p=0.0308). The odds of STSG failure in patients who underwent NPWT were approximately 80% less than those who had bolster dressing used for their post-surgical dressing (OR = 0.203). These results indicate that NPWT after skin graft placement yields a greater success rate for split-thickness skin grafts than conventional bolster dressing. In terms of comorbidities, there was also a significant association between congestive heart failure (CHF) and STSG failure (χ2 = 4.12, p=0.0422). Patients with CHF were approximately 2.55 times more likely to have their STSG fail (OR = 2.55), indicating that CHF is a good predictor of split-thickness skin graft failure. It was also found that bacterial presence and STSG failure also showed an association (χ2 = 4.66, p=0.0308), in which patients with bacterial presence on the wound prior to debridement were approximately 2.89 times more likely to have STSG failure (OR = 2.89). Although bacterial presence prior to debridement showed an association with STSG failure, bacterial presence after debridement just prior to STSG placement did not show a significant correlation with STSG failure [nf = 52 (73.2%) versus ns = 95 (62.5%), (p = 0.1150)]. These results suggest that bacterial presence may also be a good predictor of graft failure, however it is possibly the strain of bacteria, not the presence of bacteria that predominantly affects skin graft take. In order to elucidate the role that bacteria plays in the success of STSG take, further experimental analysis is warranted.

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Section: Discussion Npwtmentioning

confidence: 91%

Major Risk Factors Contributing to Split Thickness Skin Graft Failure

Turissini

Elmarsafi

Evans

et al. 2019

Georgetown Medical Review

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“…27,28 However, Kempton et al examined differences in cost and outcomes between NPC and conventional compressive dressings for STSG stabilization of traumatic extremity wounds, which were regarded as low risk defects for skin graft loss, and demonstrated that the mean cost associated with NPC was significantly higher than that of conventional compressive dressings whereas the outcomes of NPC for skin grafts were not superior to those of conventional compressive dressings. 26 Therefore, given the expense, we suggest that NPC for skin graft stabilization should be applied only for high risk defects of skin graft loss, such as large or muscle-exposing defects as conducted in our study.…”

Section: Discussionmentioning

confidence: 91%

“…Although favorable results were obtained in this study, the cost of NPC is generally high. 26 The high cost of NPC, however, might be offset by the benefits of improved skin graft survival and reduced complications. 27,28 However, Kempton et al examined differences in cost and outcomes between NPC and conventional compressive dressings for STSG stabilization of traumatic extremity wounds, which were regarded as low risk defects for skin graft loss, and demonstrated that the mean cost associated with NPC was significantly higher than that of conventional compressive dressings whereas the outcomes of NPC for skin grafts were not superior to those of conventional compressive dressings.…”

Section: Discussionmentioning

confidence: 99%

A prospective, phase II study on the safety and efficacy of negative pressure closure for the stabilization of split‐thickness skin graft in large or muscle‐exposing defects: The NPSG study

Nakamura

Ishitsuka

Sasaki

et al. 2021

The Journal of Dermatology

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Several studies have demonstrated the usefulness of negative pressure closure (NPC) for the stabilization of skin grafts because it provides a uniform pressure to the graft.The results of our previous retrospective study also suggested the superiority of NPC over tie-over methods for the stabilization of split-thickness skin graft (STSG) in large or muscle-exposing defects. However, the usefulness of NPC for graft stabilization is yet to be fully established. This prospective, phase II clinical study was conducted to investigate the safety and efficacy of NPC for the stabilization of STSG in large or muscle-exposing defects. Patients who would require STSG for reconstruction of defects in the trunk and extremities other than hands and feet measuring >10 cm in the longest diameter or with muscle exposure were enrolled. NPC was applied for skin graft stabilization. Seven patients who had received wide excision of malignant tumors and resulted in muscleexposed skin defects were included. All patients underwent meshed STSG. The mean size of the defect was 94.5 cm 2 (range 63.6-164.9). The mean time from the skin graft harvesting to the NPC stabilization was 15.6 min (range 10.7-19.5). The mean survival rate of the skin graft at postoperative day 7 and 10 was 98.7% (range 97-100) and 96.5% (range 89.4-98.4), respectively. No adverse events associated with the procedure were observed. This prospective study provided further evidence of the safety and efficacy of NPC for STSG stabilization in patients with large or muscle-exposing skin defects.

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“…Lastly, and importantly, in low-risk wounds, the price associated with VAC may not be justified, and in this setting simpler methods of compression are better indicated (20). The argument of using compression over NPWT from a cost effectiveness standpoint was also supported in one study for the closure of radial forearm donor sites (21).…”

Section: Discussionmentioning

confidence: 99%

Split thickness skin graft compression: a scoping review

Kavanagh¹,

Singhal²,

Rozen³

2023

Gland Surg

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Background: Split thickness skin graft (STSG) is a routine reconstructive manoeuvre, particularly after excision of cutaneous lower limb malignancies. While surgical technique is well established, evidence supporting the postoperative management of these grafts is less robust. Compression therapy after the index procedure may be an important adjunct for graft take and minimizing complications, particularly in patients susceptible to oedema from a concurrent lymph node procedure.Methods: An initial PubMed literature search was performed using the terms "split thickness skin graft", "compression" and "oedema" yielding no results, hence a broader search was performed combining the terms "compression", "pressure" and "split thickness skin graft" providing 383 results. One hundred articles remained for abstract review after an initial screen. Results:The literature on compression therapy to promote split thickness graft take is modest, with only 12 articles described (12/100, 12.0%). Even then, none of these were in the setting of grafting after oncological resection. Many of the articles promote negative pressure wound therapy (NPWT) as an established adjunct to promote graft take (80/100, 80.0%).Conclusions: There is limited demonstrated efficacy of postoperative compression therapy for lower limb STSG let alone in patients with an ancillary lymph node procedure. Further large-scale trials ideally in a prospective fashion are warranted to validate this as a simple, widely available and cost-effective adjunct to STSG in this particularly susceptible population of reconstructive patients.

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Increased Cost of Negative Pressure Dressings Is Not Justified for Split-Thickness Skin Grafting of Low-Risk Wounds

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 13 publications

References 34 publications

Major Risk Factors Contributing to Split Thickness Skin Graft Failure

Major Risk Factors Contributing to Split Thickness Skin Graft Failure

A prospective, phase II study on the safety and efficacy of negative pressure closure for the stabilization of split‐thickness skin graft in large or muscle‐exposing defects: The NPSG study

Split thickness skin graft compression: a scoping review

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