Conventional Bolster Dressing Versus Vacuum-Assisted Closure Device for Securing Split-Thickness Skin Graft in Contoured Wide Raw Area Reconstruction: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 The Departments of Plastic Surgery, Faculty of Medicine, Benha University

2 The Departments of General Surgery, Faculty of Medicine, Benha University

3 The Departments of Pathology, Faculty of Medicine, Benha University

Abstract

Background: Contour wounds that require skin graft closure
are frequently situated in unique or complicated anatomical
areas, making it difficult and inefficient to stabilize them
using traditional bolsters.
Objective: The aim of this work is to compare vacuumassisted
closure (VAC) with Conventional bolster dressing in
terms of graft take, histology of wound healing, hospitalization
duration, and expenses.
Patients and Methods: In the current study 62 patients were
reconstructed using a split thickness skin graft and supported by
a VAC (Group A n=31) or a traditional bolster dressing (Group < br />B n=31). The following characteristics were assessed in both
groups; operative time, hospital stay. Complications, graft take
as well as histological assessment of the skin.
Results: The mean age of the included patients in the current
study was 42.3±9.34 and 41.1±8.92 in group A and B respectively.
Post-operative complications showed statistically
significant seroma and hematoma in patients who received
conventional bolsters. The histopathological assessment
showed that the Hyperkeratosis, pigmentation, neovascularization,
collagen deposition and fibroblastic activity were more
evident in patients who used VAC (p < 0.001*).
Conclusion: VAC device is an effective methos for securing
split-thickness skin grafts in contoured wide raw area reconstruction
with minimal postoperative complications, better
healing and favorable aesthetic outcome.

Keywords

Main Subjects

References

Sheridan R.: Closure of the excised burn wound: autografts,
semipermanent skin substitutes, and permanent
skin substitutes. Clin. Plast. Surg., 36: 643-51, 2009.
2- Hazani R., Whitney R. and Wilhelmi B.J.: Optimizing aesthetic
results in skin grafting. Am. Surg., 78: 151-4, 2012.
3- Wolf Y., Kalish E., Badani E., Friedman N. and Hauben
D.J.: Rubber foam and staples: do they secure skin grafts?
A model analysis and proposal of pressure enhancement
techniques. Ann. Plast. Surg., 40: 149-55, 1998.
4- Hansbrough W., Doré C. and Hansbrough J.F.: Management
of skin-grafted burn wounds with Xeroform and layers
of dry coarse-mesh gauze dressing results in excellent
graft take and minimal nursing time. J. Burn Care Rehabil,
16: 531-4, 1995.
5- Blackburn II J.H., Boemi L,. Hall W.W., Jeffords K.,
Hauck R.M., Banducci D.R. and Graham III W.P.: Negative-
pressure dressings as a bolster for skin grafts. Ann.
Plast. Surg., 40: 453-457, 1998.
6- Moisidis E., Heath T., Boorer C., Ho K. and Deva A.K.: A
prospective, blinded, randomized, controlled clinical trial
of topical negative pressure use in skin grafting. Plast. Reconstr.
Surg., 114: 917-22, 2004.
7- Draaijers L.J., Tempelman F.R., Botman Y.A., Tuinebreijer
W.E., Middelkoop E., Kreis R.W. and Van Zuijlen P.P.:
The patient and observer scar assessment scale: A reliable
and feasible tool for scar evaluation. Plastic and Reconstructive
Surgery, Jun. 1, 113 (7): 1960-5, 2004.
8- Sabry M., El-Sherif A., Amr A., Tawfik H., Darwish A.
and Ahmed El-Shahat A.: Evaluation of the Healing of
Meshed Skin Auto Grafts of 1:3 Meshing Size Covered
by Fresh Amniotic Membrane Dressings: A Prospective
Multicenter Study. Egypt, J. Plast. Reconstr. Surg., 43 (2):
267-274, 2019.
Egypt, J. Plast. Reconstr. Surg., July 2024 235
9- Langtry J.A., Kirkham P., Martin I.C. and Fordyce A.:
Tie-over bolster dressings may not be necessary to secure
small full thickness skin grafts. Dermatol. Surg., 24: 1350-
1353, 1998.
10- Kromka W., Cameron M. and Fathi R.: Tie-Over Bolster
Dressings vs Basting Sutures for the Closure of Full-
Thickness Skin Grafts: A Review of the Literature. J.
Cutan. Med. Surg., 22: 602-606, 2018. [CrossRef] [Pub-
Med].
11- Waltzman J.T. and Bell D.E.: Vacuum-assisted closure device
as a split-thickness skin graft bolster in the burn population.
J. Burn Care Res., 35, e338-e342, 2014. [Cross-
Ref].
12- Körber A., Franckson T., Grabbe S. and Dissemond J.:
Vacuum assisted closure device improves the take of mesh
grafts in chronic leg ulcer patients. Dermatology, 216:
250-256, 2008. [CrossRef].
13- Scherer L.A., Shiver S., Chang M., Meredith J.W. and Owings
J.T.: The vacuum assisted closure device: A method
of securing skin grafts and improving graft survival. Arch.
Surg., 137: 930-933, 2002. [CrossRef].
14- Nakamura Y.; Fujisawa Y.; Ishitsuka Y., Tanaka R.,
Maruyama H., Okiyama N., Watanabe R. and Fujimoto
M.: Negative-pressure closure was superior to tie-over
technique for stabilization of split-thickness skin graft in
large or muscle-exposing defects: A retrospective study. J.
Dermatol., 45: 1207-1210, 2018. [CrossRef].
15- Kantak N.A., Mistry R. and Halvorson E.G.: A review of
negative-pressure wound therapy in the management of
burn wounds. Burns, 42: 1623-1633, 2016. [CrossRef].
16- Shin S.H., Kim C., Lee Y.S., Kang J.W. and Chung Y.G.:
Feasibility and Advantages of Full Thickness Skin Graft
from the Anterolateral Thigh. J. Hand Surg. (Asian Pac.
Vol.), 22: 497-502, 2017. [CrossRef].
17- White R. and Morris C.: Mepitel: A non-adherent wound
dressing with Safetac technology. Br. J. Nurs., 18: 58-64,
2009. [CrossRef].
18- Chou P.R., Wu S.H., Hsieh M.C. and Huang S.H.: Retrospective
Study on the Clinical Superiority of the Vacuum-
Assisted Closure System with a Silicon-Based Dressing
over the Conventional Tie-over Bolster Technique in Skin
Graft Fixation. Medicina, 55: 781, 2019. doi:10.3390/medicina55120781
19- Gonzalez A.C., Costa T.F., Andrade Z.D. and Medrado
A.R.: Wound healing-A literature review. Anais brasileiros
de dermatologia, Oct., 91 (5): 614-20, 2016.
20- Van De Kar A.L., Corion L.U., Smeulders M.J., Draaijers
L.J., Van Der Horst C.M. and Van Zuijlen P.P.: Reliable
and feasible evaluation of linear scars by the Patient and
Observer Scar Assessment Scale. Plastic and Reconstructive
Surgery, Aug. 1, 116 (2): 514-22, 20

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