From the Guidelines
Negative Pressure Wound Therapy (NPWT) is the appropriate dressing for a split-thickness skin graft (STSG) to cover and secure the graft.
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.
- NPWT may be used to encourage granulation tissue formation to support split closure by split thickness skin graft, but extreme caution is necessary during dressing changes to minimize the impact of dressing changes and prevent fistula formation 1.
- The degree of graft-take depends on the quality of the recipient wound bed, and NPWT can help promote granulation tissue formation to create a suitable surface for rapid grafting 1.
Recommendations
- Use NPWT to enhance split skin graft take in the abdomen, with a Grade B recommendation 1.
- Apply a wound contact layer to protect the granulation tissue and underlying organs during NPWT 1.
- Exercise extreme caution during dressing changes to minimize the risk of fistula formation and damage to the underlying tissue 1.
From the Research
Dressing for Split-Thickness Skin Graft (STSG)
To cover and secure a split-thickness skin graft (STSG), the appropriate dressing is crucial for promoting healing and preventing complications. The following are some key points to consider:
- A special compression dressing is used to cover the STSG, which should be left in place for 5 days to promote healing 2.
- After removal of the compression dressing, daily changes are done using double layers of fatty gauze, alternated with periods without dressing 2.
- Transparent film has been found to be an effective dressing for STSG donor site wounds, associated with fast healing rates, smooth epithelialized surface, low infection rate, and minimal pain 3.
- Polyurethane film dressings have also been found to be effective, with advantages including reliable and rapid rate of epithelization, minimal pain, and cost-effectiveness 4.
- Negative pressure dressing has been shown to improve graft survival and reduce complication rates compared to traditional wound dressing methods 5.
Types of Dressings
Different types of dressings have been studied for use on STSG donor sites, including:
- Open dressings
- Semiopen dressings
- Occlusive dressings
- Semiocclusive dressings
- Biological dressings 6 Each type of dressing has its advantages and disadvantages, and the choice of dressing may depend on the specific clinical situation.