Full-thickness skin grafts: maximizing graft take using negative pressure dressings to prepare the graft bed.
BACKGROUND
Full thickness skin grafts (FTSGs) remain a good option for resurfacing defects of the face, neck, and dorsum of the feet. It results in soft, pliable, functional skin with minimal contraction. However, FTSG may result in patchy or irregular "take" resulting in recurrent contractures and pigmentary discrepancies. This study examines the use of a negative pressure dressing (NPD) to increase FTSG take.


METHODS
Wounds resulting from trauma, postburn contracture release, and an excision of a congenital nevus were included in the study. The wounds were prepared by surgical excision or debridement. A NPD was then applied for a period of 7 days, at which time the wounds were inspected and, if there was sufficient granulation tissue, covered with a FTSG. If the wound had not yet granulated sufficiently another NPD was placed and reassessed in 7 days. The FTSGs were harvested from the groin and abdominal area exactly to the size of the defect. A sponge bolster dressing was then applied. The take of the FTSG was judged using a grid of 1 x 1-cm squares. The wounds were measured and the amount of graft take was calculated as a percentage of the wound size. Complications in both the wound as well as the donor sites were noted.


RESULTS
Twenty-four patients were included in the study. The mean age was 6 years (range 1-14 years), including 9 burn contracture excisions, 14 road traffic accident-related injuries, and 1 excision of a congenital nevus. The site involved was the foot (6 patients), ankle (9 patients), axilla (2 patients), forearm (4 patients), face (2 patients), and the neck (1 patient). The average surface area of the defect was 78 cm2 (range 18-264 cm2). Groin skin was harvested in all the cases. The NPD was applied on average for 8 days (range 7-15 days). The mean graft take was 95% (range 70%-100%). Only 1 patient had significant graft loss of 30%. Donor site morbidity was low, attaining primary closure in all but 2. Mean follow-up was 9 months.


CONCLUSIONS
The results of this study confirm that the use of NPD enhances FTSG take.
Department of Plastic Surgery, Grootte Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Alex G
AG
Landau
Don A
DA
Hudson
Kevin
K
Adams
Stuart
S
Geldenhuys
Conrad
C
Pienaar
D000293:Adolescent; D001365:Axilla; D001458:Bandages; D002056:Burns / Q000150:complications; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology; D003286:Contracture / Q000209:etiology / Q000601:surgery; D003646:Debridement / Q000379:methods; D005145:Face; D005151:Facial Injuries / Q000601:surgery; D005260:Female; D018409:Foot Injuries / Q000601:surgery; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007223:Infant; D007866:Leg; D008297:Male; D009333:Neck; D009506:Nevus / Q000151:congenital / Q000601:surgery; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology; D014945:Wound Healing; D014947:Wounds and Injuries / Q000601:surgery*