Outcomes Following Use of Negative-Pressure Wound Therapy Over Autologous Meshed and Non-Meshed Skin Grafts
Alap U. Patel, BA, Derek E. Bell, MD.
University of Rochester Medical Center, Rochester, NY, USA.
Background: Negative pressure wound therapy (NPWT) over complex wounds can control exudate, decrease infections, and improve revacularization. Despite these results with use of a NPWT over skin grafts, no study specifically addresses differences in outcomes between meshed and non-meshed skin grafts dressed with NPWT. Out study aims to characterize patient outcomes with respect to two groups: meshed and non-meshed split and full thickness autologous skin grafts.
Methods: Patients undergoing autologous skin grafting with or without a NPWT dressing for any burn injury over a three-month period were included. Xenografts were excluded. Through retrospective chart review, data on injury etiology, use of NPWT, graft take and type (full or split thickness), meshed or non-meshed, graft size, seroma incidence, and length of hospital stay were collected.
Results: Our study had 23 subjects consisting of 57% males, 57% Caucasian, and an average age of 41. Burn injury etiologies consisted of scald (55%), chemical (25%), flame (15%), and contact (5%). Average 2nd degree TBSA in our cohort was 2.34%, 3rd degree TBSA 1.15%, and total TBSA 2.81%. Ninety-one percent of patients received a split-thickness skin graft (STSG), and 9% received a full-thickness skin graft (FTSG). The average graft size in our cohort was 120.5 square centimeters. There was 100% graft take in all patients. Of FTSGs, 100% received a NPWT dressing and had an average length of stay (LOS) of 15 days. Of STSGs, 38% received a NPWT dressing. Those with the dressing had an average LOS of 14.8 days, whereas those without the NPWT dressing had an average LOS of 11.7 days. Of those with a STSG, 66.7% were non-meshed and these patients had an average LOS of 11.7 days versus 33.3% meshed with an average LOS of 13.8 days. There was a 0% seroma formation rate with non-meshed skin grafts even with a NPWT dressing over it.
Conclusions: There exist many options for dressings after repair of burn injuries, each with its own unique advantages. Using a NPWT over a STSG, and using a meshed graft resulted in a slightly longer LOS than their respective counterparts in our study. There were, however, no differences in graft take in using a NPWT dressing. Some surgeons may be hesitant in using a NPWT dressing over a non-meshed graft because it may be more difficult to extract any residual fluid, but our data shows that there is no increased seroma rate by this method.
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