Negative Pressure Wound Therapy for Split-Skin Grafts
Apply NPWT immediately after placing split-thickness skin grafts to maximize graft take, which consistently achieves >95% adherence rates and accelerates healing by 3+ days compared to traditional tie-over dressings.
What NPWT Does for Skin Grafts
NPWT enhances split-thickness skin graft (STSG) survival through three critical mechanisms:
- Eliminates fluid accumulation (seroma/hematoma) between the graft and recipient bed that would otherwise prevent graft adherence 1, 2
- Improves microcirculation at the graft-bed interface, promoting rapid neovascularization and nutrient delivery 1
- Provides continuous, uniform pressure that maintains tight contact between graft and wound bed without the shearing forces that occur with traditional bolster dressings 3
Standard NPWT Application Technique
Interface Layer Selection
- Place a non-adherent contact layer directly on the graft (meshed wound dressing with ointment or petroleum-impregnated gauze) to prevent foam incorporation into the graft 3
- Apply foam or gauze over the contact layer - both achieve equivalent results (96.1% vs 96.2% graft take) 2
- Standard wall suction with gauze sealed by occlusive dressing performs identically to commercial VAC systems at significantly lower cost 2
Pressure Settings and Duration
- Set continuous negative pressure at 75-125 mmHg - lower pressures (75 mmHg) reduce pain while maintaining efficacy 4
- Maintain NPWT for 4-5 days postoperatively before first dressing change 1, 2
- This duration allows sufficient graft adherence and early neovascularization 1
Fixation Strategy
- NPWT alone can secure grafts without sutures or staples, eliminating fixation-related pain and reducing operative time from 55.7 to 31.5 minutes 3
- The negative pressure itself provides adequate graft immobilization without shearing 3
Clinical Outcomes
Graft Take Rates
- NPWT achieves 95-98% graft take at day 5 compared to 84% with traditional tie-over dressings 1
- Complete healing occurs in 5.8 days with NPWT versus 8.9 days with conventional dressings 1
Advantages Over Traditional Methods
- Eliminates need for multiple dressing changes (3.2 fewer dressing changes on average) 1
- Reduces patient immobilization and activity restrictions 1
- Disposable NPWT systems provide cost-effective alternatives for outpatient management, particularly valuable for peripheral arterial disease wounds 5
Critical Pitfalls to Avoid
- Never place foam directly on the graft - always use a non-adherent interface layer to prevent foam incorporation and graft damage upon removal 3
- Avoid excessive negative pressure (>125 mmHg) which increases pain without improving outcomes 4
- Do not remove NPWT before day 4 - premature removal risks graft loss before adequate adherence develops 1, 2
Special Populations
For complex wounds with comorbidities (diabetes, peripheral arterial disease, irradiated tissue), NPWT demonstrates particular value by promoting granulation tissue formation before grafting and maintaining 100% graft uptake despite compromised wound beds 4, 5