From the Guidelines
Negative Pressure Wound Therapy (NPWT) is the appropriate dressing for a split-thickness skin graft (STSG).
Key Points
- NPWT should be used to enhance split skin graft take in the abdomen, as it promotes a significantly higher degree of graft take in various non-abdominal indications 1.
- The use of NPWT to bolster STSG has been systematically reviewed, and several case reports suggest its positive effect in open abdomen wounds 1.
- A wound contact layer, such as a non-adherent silicon adherent layer, should be placed between the NPWT wound filler and the wound bed to prevent growth of newly formed granulation tissue into the foam NPWT wound filler 1.
- The promotion of granulation tissue by NPWT is widely reported, but direct extrapolation of this data to the specific indication of open abdomen is not appropriate due to the additional risks posed by having vulnerable bowel structures in close proximity to the granulating bed 1.
- NPWT should be used to enhance split skin graft take at the abdomen, with a Grade B recommendation 1.
From the Research
Dressing Options for Split-Thickness Skin Graft (STSG)
The choice of dressing for STSG donor sites is crucial for optimal healing and patient comfort. Several studies have investigated various dressing options, including:
- Transparent film 2
- Closed dressings 3
- DuoDERM (hydrocolloid) 4
- Xeroform (petrolatum gauze) 4
- Polyurethane film 5
- Opsite (polyurethane film) 4
- Kaltostat (calcium sodium alginate) 4
- Aquacel (hydrofiber) 4
- Mepilex (silicone foam) 4
Key Findings
Studies have shown that:
- Transparent film is associated with fast healing rates, low infection rates, and minimal pain 2
- Closed dressings promote rapid and painless healing, with superior patient comfort 3
- DuoDERM and Xeroform are effective in promoting reepithelialization, with DuoDERM showing the greatest percent reepithelialization after 3 days 4
- Polyurethane film, when modified to allow controlled leakage, is a comfortable and cost-effective option for STSG donor sites 5
Comparison of Dressing Materials
A study comparing six dressing materials found that: