NEGATIVE-PRESSURE DRESSINGS AS A BOLSTER FOR SKIN-GRAFTS

Contoured wounds needing closure with skin grafts are often located in complex anatomic regions or are in unusual positions, which make conv entional skin graft stabilization techniques cumbersome and ineffectiv e. Often after 72 hours, a skin graft covered with a bolstered dressin g has poor take secondary to shear stresses, as well as hematoma forma tion or serum collection, negating the effectiveness of the stabilizin g dressing. The Food and Drug Administration has recently approved vac uum-assisted closure (V.A.C.), an innovative technique using negative pressure, for closure of chronic wounds. This reportedly leads to enha nced granulation tissue formation and consequently more rapid reepithe lialization of wounds compared with conventional packing with saline-m oistened gauze. Experimental studies have demonstrated increased oxyge n tension, decreased bacterial counts, and increased granulation forma tion occurring under negative-pressure systems. Extending the use of t his concept, we have coupled skin grafting with negative-pressure dres sings for closure of large, complex open wounds. Our results indicate greater than 95% graft take in all patients in this study, This techni que is extremely efficacious, with increased graft take due to total i mmobilization of the graft, thereby limiting shear forces, elimination of fluid collections, bridging of the graft, and decreased bacterial contamination. Moreover we have noted decreased edema in rotated muscl e flaps, improved contour conformity, and shortened hospitalizations.