Negative‐pressure closure was superior to tie‐over technique for stabilization of split‐thickness skin graft in large or muscle‐exposing defects: A retrospective study

Abstract

Skin grafts are frequently used for the reconstruction of skin defects, and optimal stabilization of the graft is essential for successful reconstruction. Although the tie-over technique has been widely used as a standard method in Japan, we sometimes encounter cases with significant graft loss due to suboptimal stabilization of the graft. Reported risk factors for increased graft loss include the following: defects of a large size, with muscle exposure, and located in the trunk and extremities. Recent studies have demonstrated the usefulness of negative-pressure closure (NPC) for the stabilization of skin grafts due to the uniform pressure it provides across the graft. Therefore, since March 2017, we have used NPC for skin graft stabilization in patients with defects in the trunk and extremities of more than 10 cm in size or with muscle exposure. We carried out a retrospective comparative study of the outcome of the conventional tie-over technique versus NPC. Mann-Whitney U-test revealed that NPC showed significantly higher graft survival rate than tie-over method (P = 0.0012). In addition, NPC showed a tendency toward shorter operative times (from skin graft harvest to the completion of the graft stabilization) than the tie-over method (P = 0.0931). These results suggest that NPC may be superior to the tie-over method for stabilization of skin grafts especially in large or muscle-exposing defects in the trunk or extremities.

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

“…Additionally, they demonstrated that VAC could be used in locations that were anatomically challenging for the placement of conventional bolster dressings, such as the trunk, thighs, and other contoured areas [18]. The SFSG take rates of VAC and conventional bolster dressings were reported to be 96% and 89%, respectively by Scherer et al [19] and 97.9% and 79.2%, respectively by Nakamura et al [20]. In another study, VAC was reported to improve the SFSG rate by improving the revascularization process and preventing the accumulation of seroma or exudate (which can interfere with adhesion) beneath the graft [8].…”

“…Shin et al retrospectively reviewed 10 FTSG cases from the anterolateral thigh (ALT) with the aid of a postoperative VAC, and reported that the thick skin of the FTSG possessed more tension than that of the STSG, resulting in uneven pressure on the wound bed and subgraft fluid accumulation; thus, the use of VAC is feasible for improving FTSG outcomes [21]. The decrease in operative time using VAC compared with the tie-over bolster technique was demonstrated in a study by Nakamura et al [20]. Nonetheless, the limitations of VAC include additional short-term medical costs and adhesion during dressing removal.…”

“…Furthermore, a systematic review and meta-analysis by Cheng H et al showed that a reduction in operative time can significantly reduce the overall costs of the surgical procedure [24]. Thus, both time-and cost-effectiveness are crucial for the clinician while making surgical decisions [20].…”

“…Akihiko et al suggested the use of a polyurethane foam and elastic tapes to shorten the operative time, reduce medical waste, and produce likely graft outcomes, instead of using the conventional continuous sutures and knots on bolsters [25]. The superiority of VAC over the tie-over bolster technique (better skin graft survival and reduced operative time) was demonstrated in a recent study [20]. A similar finding was observed in the current study, wherein the installation time for VAC was shorter than that for the conventional tie-over bolster technique (p < 0.05) due to the straightforward application procedure for the VAC system.…”

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

“…2 Recently, we conduced retrospective study to compare NPC and the conventional tie-over method for skin graft stabilization using data of patients with defects in the trunk and extremities of >10 cm or with muscle exposure, because no such comparative studies had been reported. 3 In this study, NPC showed not only higher survival of the skin graft, but also shorter operative time, suggesting that NPC may be superior to tie-over methods for stabilization of skin graft. However, the usefulness of NPC for graft stabilization is yet to be fully established.…”