The vacuum assisted closure device - A method of securing skin grafts and improving graft survival

Hypothesis: Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. Design: Consecutive case series. Patients and Setting: Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an 18-month period. Main Outcome Measure: Repeated skin grafting due to failure of the initial graft. Secondary outcome measures included dressing-associated complications, percentage of graft take, and length of hospital stay. Results: Sixty-one patients underwent STSG placement. Indications for STSG were burn injury (n=32), soft tissue loss (n=27), and fasciotomy-site coverage (n=2). Patients were treated with the VAC (n=34) or the bolster dressing (n=27). The VAC group required significantly fewer repeated STSGs (1 [3%] vs 5 [19%]; P=.04). Two additional graft failures occurred in the no-VAC group, but repeated STSGs were refused by these patients. No difference was seen between the groups in age, percentage of graft take, or hospital length of stay. The no-VAC group had significantly larger grafts (mean +/- SD, 984 996 vs 386 573 cm(2); P=.006). The patients requiring repeated STSGs (n=6) did not have significantly larger grafts than those not requiring repeated STSGs (mean +/- SD, 617+/-717 vs 658+/-857 cm(2); P=.62). No dressing-associated complications occurred in the VAC group. Conclusions: The VAC provides a safe and effective method for securing STSGs and is associated with improved graft survival as measured by a reduction in number of repeated STSGs.