One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study

Abstract

Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation.

Keywords: leg ulcer; skin graft; vac therapy; wound healing.

Figure 1

Graphic showing the aetiology of leg wounds in the No VAC group.

Figure 2

Graphic showing the aetiology of leg wounds in the VAC group.

Figure 3

(A) Grafted surface was significantly bigger in the VAC group (55 ± 7 cm² vs. 24 ± 6 cm² in the No VAC group, p < 0.001, ***); (B) In terms of graft take, the No VAC group presented a graft take rate of 72% ± 8 (mean ± SEM), while in the VAC group it was 92% ± 2 (p < 0.05, *); (C) Mobilisation resulted in being significantly improved in the VAC group, with patients starting mobilisation at 2.6 ± 3 days vs. 4.4 ± 0.5 in the No VAC group (p < 0.01, **).