Negative Pressure Wound Therapy on Split Skin Grafts: Procedure
Apply NPWT directly over the split-thickness skin graft at 75-125 mm Hg continuous negative pressure for 4-5 days postoperatively to secure the graft and optimize take rates.
Technical Setup and Application
Graft Preparation and NPWT Assembly
- Place a non-adherent interface dressing directly on the freshly applied split-thickness skin graft to prevent foam adherence and minimize trauma during removal 1, 2.
- Apply NPWT foam over the interface layer, ensuring complete coverage of the grafted area 2.
- Seal the entire assembly with an occlusive adhesive drape, creating an airtight seal 3.
- Suture or staple fixation of the graft is optional when using NPWT, as the negative pressure itself provides adequate graft stabilization and prevents shearing 2.
Pressure Settings and Duration
- Set continuous negative pressure at 75-125 mm Hg depending on patient tolerance and wound characteristics 1, 4.
- Maintain NPWT continuously for 4-5 days postoperatively before the first dressing change and graft assessment 3, 4.
Mechanism of Action
- NPWT promotes graft adherence by removing fluid accumulation (seroma/hematoma) between the graft and recipient bed 5.
- Enhances microcirculation at the graft-bed interface, facilitating neovascularization 5.
- Provides uniform pressure distribution that immobilizes the graft and prevents shearing forces 2.
Expected Outcomes and Assessment
- Expect 95-97% graft take rates at day 4-5 when NPWT is properly applied 3, 2, 4.
- At the first dressing change (postoperative day 4-5), measure adherent versus non-adherent graft areas to assess take percentage 3.
- Complete healing typically occurs within 5-8 days with NPWT, compared to 9-11 days with conventional dressings 5, 4.
Cost-Effective Alternative
- A gauze-based system using standard surgical gauze, occlusive dressing, and wall suction produces equivalent results to commercial VAC devices at significantly lower cost 3.
- This approach achieves 96% graft take, identical to proprietary NPWT systems 3.
Clinical Advantages Over Conventional Dressing
- Eliminates need for multiple dressing changes during the critical first 4-5 days 4.
- Reduces operative time by approximately 24 minutes when sutures are omitted 2.
- Decreases pain associated with suture removal and frequent dressing changes 1, 2.
- Particularly valuable for less-than-ideal wound beds, complex wounds, or patients with comorbidities 1, 4.
Common Pitfalls to Avoid
- Do not use NPWT foam directly on the graft without an interface layer, as this causes significant trauma and graft loss during removal 1, 2.
- Avoid pressure settings above 125 mm Hg, which increase pain without improving outcomes 1.
- Ensure complete seal of the occlusive dressing; air leaks compromise the negative pressure and reduce efficacy 3.
- Do not discontinue NPWT before 4 days unless infection or other complications develop, as premature removal reduces graft take 3, 4.