The Efficacy of Negative Pressure Wound Therapy for Split-thickness Skin Grafts for Wounds on the Trunk or the Neck: A Randomized Controlled Trial

초록

Introduction. Because applying a splint for a wound on a patient's trunk or neck (including areas such as the shoulder, chest, buttock, axilla, and abdomen) is considerably difficult, grafted skin may not firmly affix at the wound site. Objective. A study was conducted to compare negative pressure wound therapy (NPWT) to conventional bolster dressings in facilitating firm split-thickness skin graft (STSG) attachment and allowing relatively easy removal of exudates. Materials and Methods. A randomized controlled trial was conducted among 57 patients with wounds on the trunk or the neck who received STSGs between January 2013 and December 2017. Prospective and retrospective data were used for analysis in this study. Patients who were pregnant, immunocompromised, or had severely infected wounds were excluded from the study. Due to discomfort, splints were not used. Patients were divided into 2 groups. Group 1 was provided a NPWT dressing; NPWT was applied continuously for 6 days between -75 mm Hg and -100 mm Hg with dressing changes at postoperative days 3 and 6. After postoperative day 6, antibiotic cream and a nonadherent foam dressing were used on the wounds. Group 2 was provided a conventional bolster dressing for the same time frame. The Mann-Whitney U test was used to compare the variables and outcomes between the 2 groups. Differences were considered statistically significant for P<.05. Results. Among the 57 patients, 27 received NPWT and 30 received the bolster dressing. The size of the wounds in these patients ranged between 100 cm(2) and 400 cm(2). In group 1, the average survival score for the skin graft was more than 80 in all patients after postoperative day 7. In group 2, major graft loss occurred in 5 patients, requiring a second STSG. The average score of STSG survival on postoperative day 7 in group 2 was lower than that of group 1. The differences observed between the 2 groups were overall statistically significant (P < .01) based on the results of the Mann-Whitney U test. Conclusions. Owing to the flexibility and elasticity afforded by the transparent adhesive film that is used in NPWT technique, patients were more mobile and felt little discomfort compared to conventional procedures. The negative pressure dressing increased the percentage of graft survival and may reduce need for a second STSG.

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