Abstract
Objective: Negative-pressure wound therapy (NPWT) can reduce the incidence of exudate and haematoma beneath a split-thickness skin graft (SSG) compared with traditional standard dressings. However, NPWT has not been universally adopted for lower limb SSGs despite evidence that its use is linked with improved graft take and a tendency towards early mobilisation. PICO (Smith and Nephew®), an ultra-lightweight NPWT device now available in Australia, can provide a smaller, more manageable NPWT dressing. The primary objective of this study was to compare lower limb graft take rate in PICO versus standard dressing groups, and a secondary objective was comparing quality of life (QOL) in these groups. Method: A prospective, randomised control trial was conducted of 71 lower limb wounds from 59 patients, with 36 wounds randomised to standard dressings and 35 to PICO dressings. Graft take was measured and expressed as a percentage of total wound area. Postoperative mobilisation day, patient comfort, complication frequencies, ease of dressing removal and QOL scores were also recorded. Results: The graft area percentage was not statistically significantly different between the PICO and standard dressing groups (p=0.054). All patients in the PICO group were mobilised by postoperative day one, but 8 per cent in the standard dressing group were still not mobilised by postoperative day five (PICO vs standard, p=0.003). There was no statistically significant difference in patient comfort, patient QOL or complication frequency in the PICO versus standard dressing group at any postoperative visit, but the PICO dressings were statistically significantly easier to remove (p=0.04). Conclusion: PICO dressings are not inferior or superior to standard dressings for lower limb SSGs.
Highlights
Split-thickness skin grafts (SSGs) are a fundamental reconstructive technique for wounds of the lower limb
Negative-pressure wound therapy (NPWT) has not been universally adopted for lower limb split-thickness skin graft (SSG) despite evidence that its use is linked with improved graft take and a tendency towards early mobilisation
All patients in the PICO group were mobilised by postoperative day one, but eight per cent in the standard dressing group were still not mobilised by postoperative day five (PICO vs standard, p = 0.003)
Summary
Split-thickness skin grafts (SSGs) are a fundamental reconstructive technique for wounds of the lower limb. Exploring the most effective dressing for SSGs of the lower limb to maximise the rate of graft take will minimise patient discomfort, improve postoperative QOL and decrease hospital expenses. Lower limb SSGs are dressed with a non-adherent dressing and a foam or gauze bolster that is secured by sutures, an elastic bandage or both.[1] The bolster dressing immobilises the graft, preventing shearing between the graft and the wound. Dressing choice for skin grafts has been broadened with the introduction of negativepressure wound therapy (NPWT). With NPWT, a non-adhesive perforated layer is applied over the skin graft followed by foam or gauze and a polyurethane film dressing. A suction device is attached which maintains a constant negative pressure of between -125 and -80 mmHg
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