Wound Vacs versus Compressive Dressings for Skin Grafts

Increased Cost of Negative Pressure Dressings Is Not Justified for Split-Thickness Skin Grafting of Low-Risk Wounds

Kempton, Laurence B. MD*; Larson, Timothy B. MD*; Montijo, Harvey E. MD*; Seymour, Rachel B. PhD*; Getz, Stanely B. MD; Bosse, Michael J. MD*

July 2015 JOT

These authors should be congratulated for a nice study that shows us all that new technologies (in this case negative-pressure dressings (NPD)) are not always better than tried and true “old-fashioned” methods (compressive dressing).  This study is especially valuable because it also indicates that the substantial added expense of the new technology is not justified.  I agree with the invited comments of Dr.’s Sanders and Sagi that advantages of the compressive dressing protocol for STSG’s are limited if inpatient management is required.  Their proposed alternative, outpatient use of NPD, would certainly reduce costs associated with the inpatient stay but still have associated costs of the NPD device.  Our protocol is to use a compressive dressing and overlying splint that are removed in the outpatient setting 5-7 days after application.  Patients are not required to have an inpatient stay nor do they have the expense of a NPD.  The dressing is critical and consists of multiple layers: Xeroform; moist fluffed 4×4’s to fill all nooks and crannies; dry 4×4’s; ABD pad(s); Webril; then an ACE wrap.  A splint is then applied over this ACE.  We have been very pleased with the results of this protocol, however, a rigorous study would be required to substantiate virtually 100% take.

William M. Ricci, MD
Professor of Orthopaedic Surgery
Vice-Chair, Department of Orthopaedic Surgery
Chief, Orthopaedic Trauma Service
Director, Orthopaedic Clinical Operations
Washington University Orthopedics

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