title: Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: vacuum-assisted closure and gauze suction.
abstract: Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors' institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. The authors report a randomized controlled trial comparing the efficacy of the GSUC vs the VAC in securing STSG. A prospective, randomized, controlled trial was conducted in 157 wounds in 104 patients requiring STSG from August 2009 to July 2012. All wounds were randomized to VAC or GSUC treatment and assessed for skin graft adherence/take. At postoperative day 4 or 5, NPWT was discontinued, and the size of the graft and any nonadherent areas were measured and recorded. Concomitant comorbidities, wound location, etiology, study failures, and reoperative rates were also reviewed. In all, 77 and 80 wounds were randomized to the GSUC and VAC study arms. Patient demographics were similar between both groups in terms of age, sex, comorbidities, etiology, and wound location. In all, 64 of 80 wounds in the GSUC group and 60 of 77 wounds in the VAC group had full take of the skin graft by postoperative day 4 or 5 (P = .80). The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.
authors.affiliation: From the *Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Illinois; †Department of Therapy Services, University of Chicago Medicine, Illinois; and ‡Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
authors.forename: Trang Q
authors.initials: TQ
authors.lastname: Nguyen
authors.forename: Mieczyslawa
authors.initials: M
authors.lastname: Franczyk
authors.forename: Justine C
authors.initials: JC
authors.lastname: Lee
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Greives
authors.forename: Annemarie
authors.initials: A
authors.lastname: O'Connor
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D009779:Occlusive Dressings; D010147:Pain Measurement; D011446:Prospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult