Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: VAC and GSUC

Abstract

Introduction Negative pressure wound therapy (NPWT) revolutionized complicated wound management and contributed a new modality for securing skin grafts. However, the industry standard in NPWT, the VAC device, has limited accessibility due to the cost of utilization. In the past decade, we accumulated experience using gauze sealed with an occlusive dressing and wall suction (GSUC) as our primary method for NPWT. We now report a randomized controlled trial comparing the efficacy of GSUC versus VAC in securing skin grafts. Methods 81 wounds requiring split thickness skin grafts were prospectively enrolled from August 2009 to February 2011 and randomized to VAC or GSUC. Wounds were assessed 4 to 5 days postoperatively for adherence and re-evaluated 7-18 days postoperatively for graft take. Study failures and reoperative rates were reviewed. Results 42 wounds and 39 wounds were randomized to the GSUC and VAC study arms, respectively. Patient demographics were similar between groups. Wound size averaged 238 cm2 and received 4.39 days of NPWT. Skin graft take averaged 97.8% (p=0.03) for GSUC and 97.3% (p=0.04) for VAC. Reoperation was required for one wound in the VAC arm and three wounds in the GSUC arm. Two wounds were study failures due to loss of suction by the VAC system. Both wounds were salvaged by conversion to wall suction. Conclusions NPWT is a useful method for promoting adherence and healing of skin grafts. We demonstrate that a low cost, readily accessible system utilizing standard gauze dressings and wall suction (GSUC) results in comparable skin graft take to the VAC device.