Skin graft fixation with negative pressure wound therapy with instillation and dwelling (NPWTi-d) for contaminated complex wounds of the extremities

Objective: Negative Pressure Wound Therapy (NPWT) is increasingly being used as a major method of skin graft dressing and fixation. Negative Pressure Wound Therapy with Instillation and Dwelling (NPWTi-d) further enhances wound care over regular NPWT. However, only a few reports have been made on its use for skin graft fixation due to concerns of graft maceration or detachment. We used NPWTi-d to fix skin grafts for 4 cases of severely contaminated complex posttraumatic wounds. Methods: The age ranged from 37 to 72 years, and included trauma of the lower leg, forearm dog bite and incomplete amputations of the upper arm and hand respectively. The mean instillation saline volume per wound size was 0.21 ml/cm(2) and the dwelling time reduced to 3 min. The NPWTi-d skin graft fixation was removed after about a week. Results: All the grafts healed well and no complications such as infection or contracture were observed. Follow-up time was 1 -8 months. Conclusions: NPWTi-d may be a useful option for fixing skin grafts particularly in contaminated wounds with a high risk of infection. (c) 2022 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.