Vacuum-Assisted Closure Therapy as A Pretreatment For Split Thickness Skin Grafts

Objective: To evaluate the effect of vacuum-assisted closure (VAC) therapy on wound management by measuring the graft take, wound healing time, need for any re-grafting and duration of hospitalization. Study Design: Single blinded randomized controlled trial. Place and Duration of Study: This study was carried out in the Department of Plastic and Reconstructive Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from October 2007 to December 2009. Methodology: A total of 100 adult patients of either gender with acute traumatic wounds were included. Patients who needed flap coverage as the primary intervention, and those with Diabetes, malignancy, bleeding diathesis were excluded. Half of the patients were randomly assigned to the intervention group and the rest to the control group with lottery method. All wounds were initially subjected to thorough excision. Wound bed preparation for STSG (split thickness skin graft) was achieved using 10 days pre-treatment with VAC dressings in the intervention group while employing normal saline gauzes in the control group. All patients were subsequently treated with STSG. The primary outcome measure was graft take while the secondary outcome measures included wound healing time, need for any re-grafting and duration of hospital stay. Results were compared in both groups using chi-square test. Results: Marked differences were found in favour of the VAC therapy group with respect to the various wound management outcome measures studied. i.e. graft take (greater than 95% graft take in 90% of VAC therapy group vs. 18% of controls), wound healing time (2 weeks postgrafting in 90% of VAC therapy group vs. 18% of controls), need for regrafting (none among VAC therapy group vs. 8% of controls) and duration of hospital stay (less than 3 weeks in 90% of VAC therapy group vs. 18% of controls). Conclusion: VAC therapy should be employed in the pre-treatment of wounds planned to be reconstructed with STSG, since it has marked advantages in the wound bed preparation compared with the traditional normal saline gauze dressings.