title: Complex lower extremity wounds treated with skin grafts and NPWT: a retrospective review.
abstract: OBJECTIVE
  To evaluate a single centre experience with the use of NPWT for securing split-thickness skin grafts in the management of specifically lower extremity chronic wounds, including revascularised arterial wounds, amputations, diabetic and venous leg ulcers.
  
  
  METHODS
  A seven-year retrospective review of a prospectively maintained database of all the patients who underwent primary split-thickness skin grafts (STSGs) with immediate postoperative NPWT for at least 96 hours was carried out. The percentage graft take after removal of NPWT device and clinical follow-up date were reviewed.
  
  
  RESULTS
  A total of 59 skin grafts procedures had adequate follow up to be reviewed. This included 39% post-debridement/ amputation wounds in patients who presented with diabetic foot infection/gangrene, 31% venous leg ulcers, and 31% other post-surgical wounds (arterial ulcers that had undergone revascularisation). The mean percentage graft survival after removal of V.A.C. was 94%; 63% of cases had complete graft survival, 25% had 90-99% survival, and 8.5% had 80-89% survival. Outpatient follow up ranged from 2 weeks to 5 years (mean of 10 months). Fifteen per cent of patients were lost to follow up, and, of the remaining patients, 76% remained completely healed, 10% remained partially healed, and 14% lost the entire STSG.
  
  
  CONCLUSIONS
  Patients with STSGs secured with NPWT required fewer repeated grafting procedures, had very high initial graft survival with complete recipient bed coverage, and had good long-term wound closure rates compared with historical controls. While retrospective reviews, such as this, support NPWT as a good method of STSG affixation, the paucity of reviews with other study designs does not allow for good historic comparison, so a well-enrolled prospective trial would be of use.
  
  
  BACKGROUND
  Dr J.C. Lantis is a member of the speakers' bureau, has been a site principal investigator of four multicentre trials and has been a consultant for KCI Inc. The same author has no equity in the company and has no financial benefit from positive results for the company's product(s). No external funding was sought nor obtained for this study.
authors: Division of Vascular/Endovascular Surgery, St. Luke's -- Roosevelt Hospital Center, Columbia University College of Surgeons and Physicians, New York, NY, USA.
authors: R E
authors: RE
authors: Ross
authors: P
authors: P
authors: Aflaki
authors: C
authors: C
authors: Gendics
authors: J C
authors: JC
authors: Lantis Ii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery / Q000628:therapy*; D007871:Leg Ulcer / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012189:Retrospective Studies; D016038:Skin Transplantation