The use of negative pressure wound therapy in the fixation of split-thickness skin grafts
Authors:
J. Ulianko 1; J. Janek 2; Ľ. Laca 3
Authors‘ workplace:
Klinika plastickej chirurgie SZU FNsP FDR Banská Bystrica
primár: MUDr. J. Ulianko
1; Oddelenie cievnej chirurgie FNsP FDR Banská Bystrica
primár: MUDr. J. Janek
2; Chirurgická klinika a transplantačné centrum UNM Martin
prednosta: prof. MUDr. Ľ. Laca, PhD.
3
Published in:
Rozhl. Chir., 2017, roč. 96, č. 1, s. 18-24.
Category:
Original articles
Overview
Introduction:
Negative pressure wound therapy is one of the latest methods of dealing with complicated healing wounds. It promotes granulation, mechanically attracts the edges of the wound, removes secretions, reduces the number of bacteria in the wound and reduces swelling. In addition to its use to start and enhance the healing process, this method is also important in the fixation of split-thickness skin grafts in non-ideal conditions. The goal of this article is to establish basic indications for negative pressure fixation of meshed split-thickness skin grafts in non-ideal conditions in the wound and to assess the impact of contamination of wounds on engraftment using vacuum therapy. Additional goals are to verify the use of this method of fixation in defects of various etiologies (trauma, ischemia), to optimize and determine the advantages and disadvantages of fixation of grafts using this method in clinical practice, and to evaluate the effectiveness of fixation of meshed split-thickness skin grafts.
Methods:
Set of 89 operated patients of both sexes, various ages, etiologies of defects, in non-ideal conditions; statistical evaluation of the percentage of engraftment, depending on the etiology of the defect, microbial contamination and location of the defect. Measured in vivo using a centimeter measure at the point of maximum length and width.
Results:
Our set of 100% engraftments of StSG included 68 persons, 65 males and 24 females, in the following age groups: up to 30 years 11 persons; 30−50 years 19 persons; 50−70 years 38 persons; and above 70 years 21 persons, with negative microbial contamination of the defect in 20 cases, contamination with one germ in 33 cases, contamination with two germs in 22 cases and contamination with three germs in 14 cases. We obtained 100% engraftment in 68 cases, 90−99% engraftment in 7 cases, 80−89% engraftment in 5 cases, 70−79% engraftment in 7 cases, and the 60−69% and 50−59% sets of engraftment were combined because of the low number of patients in this set. 51 of the patients had a traumatic origin of their defect, 22 had an ischemic origin of their defect and 16 had a different origin of their defect. We found a significant relationship between contamination and the percentage of engraftment, as well as dependence between patient age and the percentage of engraftment.
Conclusion:
Negative pressure fixation of meshed split-thickness skin grafts seems to be a convenient method of fixation in patients with defects of various origins in non-ideal conditions; this method increases the percentage of engraftment and apparently reduces the time required for fixation of the graft and the length of hospitalisation. We obtained 100% engraftment of StSG using negative pressure fixation. We concluded that traumatic origin had no effect on the percentage of engraftment, while ischemic origin had a significant effect on engraftment. Also, negative contamination of the defect had a positive effect on StSG engraftment, and contamination wit three microbial germs had a significant negative effect on the percentage of StSG engraftment using negative pressure fixation.
Key words:
negative pressure therapy – NPWT − plastic surgery − skin grafts − complicated wounds
Sources
1. Seyhan T. Split-thickness skin grafts, skin grafts indications, applications and current research. On line, Available from: http://www.intechopen.com/books/skin-grafts-indications-applications-and-current-research/split-thickness-grafts.
2. Giraudoux P. Data analysis in ecology. R package version 1.6.4.2016; On-line, Available from: www: https://cran.r-project.org/ web/packages/ pgirmess/ pgirmess.pdf>
3. Hothorn T, Hornik K, Mark A, et al. Implementing a class of permutation tests: the coin package. J Stat Softw 2008;28:1−23.
4. Bischoff M, Maier D, Sarkar M, et al. Vacuum-sealing fixation of mesh grafts. Eur J Plast Surg 2003;26:186−90.
5. Llanos S, Danilla S, Barraza C, et al. Effectiveness of negative pressure closure in the integrationof split thickness skin grafts: a randomized, double-masked, controlled trial. Ann Surg 2006;244:700−5.
6. Stone P, Prigozen J, Hofeldt M, et al. Bolster versus negative pressure wound therapy for securing split-thickness skin grafts in trauma patients. Wounds Wounds. 2004;16:219–23
7. Azzopardi EA, Boyce DE, Dickson WA, et al. Application of topical negative pressure (vacuum-assisted closure) to split-thickness skin grafts: a structured evidence-based review. Ann Plast Surg 2013;70:23−9.
8. Chong SJ, Liang WH, Tan BK. Use of multiple VAC devices in the management of extensive burns: total body wrap concept. Burns 2010;36:e127−e129.
9. Scherer SS, Pietramagiori G, Mathews JC, et al. The mechanism of action of vacuum-assisted closure device. Plast Reconstr Surg 2008;122:786−97.
10. Ngo Q, Vickery K, Deva AK. PR24. Effects of combined topical negative pressure (TNP) and antiseptic instillation on pseudomonas biofilm. ANZ J Surg 2007;77(suppl 1):A67.
11. Thorne C, Grabb WC. Grabb and Smith‘s plastic surgery. 6th ed. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins 2007.
12. Blackburn JH 2nd, Boemi L, Hall WW, et al. Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 1998;40:453−7.
13. Körber A, Franckson T, Grabbe S, et al. Vacuum-assisted closure device improves the take of mesh grafts in chronic leg ulcer patients. Dermatology 2008;216:250−6.
14. Šimek M, Bém R. Podtlaková léčba ran. Praha, Maxdorf 2013.
15. Evangelista MS, Kim EK, Evans GR, et al. Management of skin grafts using negative pressure therapy: the effect of varied pressure on skin graft incorporation. Wounds 2013;25:89−93.
16. Fabian TS, Kaufman HJ, Lett ED, et al. The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. Am Surg 2000;66:1136–43.
17. Gabriel A, Shores J, Bernstein B, et al. A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series. Int Wound J 2009;6( suppl 2):1−25.
18. Vistnes LM. Grafting of skin. Surg clin North Am 1977;57:939–60.
19. Krtička M, Ira D, Nekuda V, et al. Primární aplikace podtlakové terapie u otevřených zlomenin III. Stupně a její vliv na vznik infekčních komplikací. Acta Chir Orthop Traumatol Čech 2016;839:117–22.
20. Krtička M, Mašek M. Využití podtlakové terapie v traumatologii. In Šimek M, Bém R. Podtlaková léčba ran. Praha, Maxdorf 2013:108–24.
21. Core R Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna 2016; on line, Available from www.R/project.org>. ISBN 3-900051-07-0.
22. Davydov IuA, Larichev AB, Abramov Aiu. [Wound healing after vacuum drainage. [rus] Khirurgiia 1992;21–6.
23. Jeffery SL. Advanced wound therapies in the management of severe military lower limb trauma: a new perspective. Eplasty 2009;9:e28.
24. Kiyokawa K, Takahashi N, Rikimaru H, et al. New continuous negative-pressure and irrigation treatment for infected wounds and intractable ulcers. Plast Reconstr Surg 2007;120:1257–65.
25. Malmsjö M, Ingemansson R, Martin R, et al. Negative-pressure wound therapy using gauze or open-cell polyurethane foam: similar early effects on pressure transduction and tissue contraction in an experimental porcine wound model. In Wound Repair Regen 2009;17:200–5.
26. Morykwas MJ, Faler BJ, Pearce DJ, et al. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Ann Plast Surg 2001;47:547–51.
27. Kamolz LP, Andel H, Haslik W, et al. Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences. Burns 2004;30:253–8.
28. Fraccalvieri M, Zingarelli E, Ruka E, et al. Negative pressure wound therapy using gauze and foam: histological, immunohistochemical and ultrasonography morphological analysis of the granulation tissue and scar tissue. Preliminary report of a clinical study. Int Wound J 2011;8:355–64.
29. Calderon, WL, Llanos S, Leniz P, et al. Double negative pressure for seroma treatment in trocanteric area. Ann plast surg 2009;63:659–60.
30. Hira M, Tajima S. Biochemical study on the process of skin graft take. Ann Plastic Surg 1992;29:47–54.
31. Walgenbach KJ, Starck JB. Induction of angiogenesis following vacuum sealing. Z Wundheil 2000;13:9–10.
32. Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997;38:553–62.
33. Mouës CM, Vos MC, van den Bemd GJ, et al. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 2004;12:11–7.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2017 Issue 1
Most read in this issue
- Internal hernia as a cause of small bowel obstruction
- Colorectal cancer − the importance of primary tumor location
- Iatrogenic biliary tract lesions requiring surgical reconstruction – presentation and classification of the lesions, their reconstruction and evaluation of the results
- Experience with hepatoblastoma treatment in small children – the use of preoperative 3D virtual analysis MeVis for liver resections