SLR - January 2010 - James Kinchsular
Reference:
Rozen W.M., Shahbaz S, Morsi A (2008). An improved alternative to vacuum-assisted closure (VAC) as a negative pressure dressing in lower limb split skin grafting: A clinical trial. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61, 334-337.
Scientific Literature Reviews
Reviewed by: James Kinchsular, DPM
Residency Program: Kaiser North Bay Consortium, Vallejo
Podiatric Relevance:
Negative pressure wound therapy (NPWT), or vacuum assisted closure (VAC), has shown to be beneficial in the healing of chronic wounds, diabetic wounds, dysvascular wounds, traumatic soft tissue injuries, open fractures, split thickness skin grafting, and even over surgically closed incisions following high energy trauma. This small study investigates a low cost alternative to the commercial wound VAC system for split thickness skin grafting.
Methods:
In this small prospective study, nine patients underwent split thickness skin grafting for a lower extremity wound. All graft sites were subsequently dressed with Jelonet (a low-adherent gauze), disposable white foam (similar to that used for commercial VAC dressings), and a disposable closed system suction drain with tubing. The tubing with drain was affixed to the foam padding with an adherenttop dressing to create a seal. Dressings remained in place for 5-7 days Primary outcomes assessed included graft take and complication rate. Cost analysis was also performed based on a five day treatment period. The cost comparison was made between a commercial VAC, portable VAC, and disposable suction drain systems.
Results:
All nine grafts took without complication. The authors note the dressings were “universally well tolerated”. Cost analysis revealed a cost savings of $1113 for the disposable suction drain compared to the portable VAC system. The latter system included the costs for one inpatient day, home health care, and additional dressings.
Conclusions:
Several articles have investigated the benefits of commercial wound VAC systems. One limiting factor of this commercial modality is cost. While a closed suction system as described in this article may not be appropriate or beneficial in larger wounds, it may be a relatively inexpensive alternative dressing option.