title: The vacuum assisted closure device: a method of securing skin grafts and improving graft survival.
abstract: OBJECTIVE
  Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings.
  
  
  METHODS
  Consecutive case series.
  
  
  METHODS
  Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an 18-month period.
  
  
  METHODS
  Repeated skin grafting due to failure of the initial graft. Secondary outcome measures included dressing-associated complications, percentage of graft take, and length of hospital stay.
  
  
  RESULTS
  Sixty-one patients underwent STSG placement. Indications for STSG were burn injury (n = 32), soft tissue loss (n = 27), and fasciotomy-site coverage (n = 2). Patients were treated with the VAC (n = 34) or the bolster dressing (n = 27). The VAC group required significantly fewer repeated STSGs (1 [3%] vs 5 [19%]; P =.04). Two additional graft failures occurred in the no-VAC group, but repeated STSGs were refused by these patients. No difference was seen between the groups in age, percentage of graft take, or hospital length of stay. The no-VAC group had significantly larger grafts (mean +/- SD, 984 +/- 996 vs 386 +/- 573 cm(2); P =.006). The patients requiring repeated STSGs (n = 6) did not have significantly larger grafts than those not requiring repeated STSGs (mean +/- SD, 617 +/- 717 vs 658 +/- 857 cm(2); P =.62). No dressing-associated complications occurred in the VAC group.
  
  
  CONCLUSIONS
  The VAC provides a safe and effective method for securing STSGs and is associated with improved graft survival as measured by a reduction in number of repeated STSGs.
authors.affiliation: Department of Surgery, University of California-Davis Medical Center, 2315 Stockton Blvd, Room 4209, Sacramento, CA 95817, USA. lynette.scherer@ucdmc.ucdavis.edu
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Scherer
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiver
authors.forename: Michael
authors.initials: M
authors.lastname: Chang
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Meredith
authors.forename: John T
authors.initials: JT
authors.lastname: Owings
mesh_terms: D000328:Adult; D002056:Burns / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D009779:Occlusive Dressings; D011182:Postoperative Care; D016038:Skin Transplantation / Q000295:instrumentation*; D017695:Soft Tissue Injuries / Q000601:surgery; D014618:Vacuum; D014945:Wound Healing