An improved alternative to vacuum-assisted closure (VAC) as a negative pressure dressing in lower limb split skin grafting: a clinical trial.

BACKGROUND: The use of negative pressure in the dressing of split skin grafts has been shown to promote healing by a variety of mechanisms, including a decrease in interstitial oedema, an increase in perfusion and a decrease in bacterial colonisation. Vacuum-assisted closure (VAC) dressings have, until now, been used as the archetype for negative pressure dressings and have been reflected as such in the literature. However, patient mobility and cost are still an issue with these dressings, and alternatives have been keenly sought. We describe an alternative method of negative pressure dressing, which we have found to be a safe and successful alternative in the setting of lower limb split skin grafts.

MATERIALS AND METHODS: A prospective cohort investigation was performed on nine consecutive patients at Monash Medical Centre undergoing split-skin grafting for a lower limb soft tissue defect. The dressing comprised a single cut foam sheet, a conventional disposable closed-system suction drain and an adhesive dressing.

RESULTS: In all nine patients, there was a 100% take of the graft, with no partial or complete loss. There were no complications encountered. Cost analysis demonstrated a minimum treatment cost of $577 over 5 days compared to $3180 for commercial VAC dressed wounds: a net saving of $2603 per patient.

CONCLUSIONS: The use of a simple suction drain is a cheap and safe alternative to commercial VAC dressings for the treatment of lower limb split skin grafts. Length of hospital stay and cost are superior to VAC, with no diminished clinical outcome.