Efficacy and Cost of Negative Pressure Wound Therapy (NPWT) Dressing versus Tie-Over Bolster Dressing on Integrating Split-Thickness Skin Grafts

Abstract

Objective: This study aimed to compare two dressing methods used as skin graft bolsters. The two dressings were compared as to efficacy (% graft take), ease of application, pain scores, safety (complication rate) and cost. Methods: This is a prospective randomized controlled trial involving 34 patients. The basis of comparison between the two dressing methods included: efficacy determined by percentage of graft take on the 7th and 14th day post-Split Thickness Skin Grafting; ease of the application (amount of time to apply dressing); pain (VAS) scores at 1st, 7th and 14th day post-Split Thickness Skin Grafting; complications and costs. Results: The NPWT group has statistically significant differences from the Tie-Over Bolster group. NPWT took less time to apply the dressing (1-10mins vs 6-15mins), had a higher percentage of graft take (99.05% vs 96.52%), had lower pain scores overall, had lower complication rates (infection: 0% vs 2.94%), and cost less (Php 2,917.00 vs Php 3,684.00). Discussion: The Low-Cost NPWT system was developed in this institution due to the exorbitant cost of commercial NPWT pump and dressing systems. Thus, a week-long NPWT therapy using commercial NPWT systems may cost as much as Php 24,000.00, while the low-cost NPWT alternative only costs Php2,917.00. Conclusions: The locally-developed, low-cost NPWT dressing has been proven to be faster to apply, more effective in integrating split thickness skin grafts, has less discomfort and complications, and is actually cheaper than the conventional tie-over bolster dressings Key words: Negative pressure wound therapy, Tie-over bolster dressing, Split thickness skin grafting