Dr Derek Liang1, Dr Aruna Wijewardena1, Dr John Vandervord1
1Royal North Shore Hospital, St Leonards, Australia
Split-thickness skin grafts are used extensively for burns reconstruction. However, grafts can fail due to shearing forces, poor apposition or collections between the graft and graft bed. Vaccuum-assisted closure (VAC) is a popular method to facilitate skin graft take. Compressive bandaging, like VAC therapy, is a post-graft dressing that can mitigate factors for poor graft take. Our study was undertaken to ascertain if graft healing rates, and complication profiles were comparable between these two groups.
A retrospective analysis was conducted for all patients from the Burns Department at Royal North Shore Hospital who had leg skin grafts performed with <10% TBSA, between May 2018 and January 2020. Our post-operative graft dressings had changed in late 2018 from VAC therapy to CobanTM (3M Australia) compressive bandages. Statistical analysis was used to compare length of stay, and post-operative complications such as graft loss, infection and rate of regrafting between the two cohorts.
Of the 109 patients, 19 received VAC therapy and 90 received Coban therapy. One VAC patient required regrafting and only two from the Coban group (p=0.404). Five VAC patients experience some form of graft loss compared to 19 in the Coband cohort (p=0.76). The average length of stay for VAC patients were 2.1 days compared to 0.9 days in the Coban group (p=0.064)
VAC therapy is costly compared to compressive bandage therapy. From this study, we found similar graft take rates between the two therapies. Given this, our post-lower limb graft dressing is now compression bandaging.
Derek Liang is currently a SET 1 Plastic and Reconstructive Surgery registrar at Royal North Shore Hospital