Effectiveness of negative pressure wound therapy as a fixator in split thickness skin graft applied diabetic patients: evaluation of 25 cases

Abstract

Objective: Microangiopathies expose diabetic patients to lower extremity wounds at certain stages of their lives. Split-thickness skin grafting (STSG) has an important place in the surgical treatment of such wounds. The aim of the present study is to evaluate the effects of negative pressure wound therapy (NPWT) on STSG survival. Methods: A total of 25 diabetic patients (M = 20, F = 5) with acute or chronic lower extremity open wounds were included in the study. All patients underwent wound debridement under regional anesthesia. STSG was applied after wound debridement. NPWT was applied to STSG to increase graft survival. Results: The hospitalization times of the patients ranged from 1 to 2 weeks. The mean follow-up period of the patients was 6 months. All wounds healed on the 14th postoperative day. There was no recurrence in the 6-month follow-up period. Conclusion: We objectively demonstrated the positive effects of NPWT application on STSG and graft survival.

Keywords

• Diabetic foot
• wound
• negative pressure
• therapy

References

1. Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum‐assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631-6. doi: 10.2337/dc07-2196.
2. Lone AM, Zaroo MI, Laway BA, Pala NA, Bashir SA, Rasool A. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case-control study. Diabet Foot Ankle. 2014:5. doi: 10.3402/dfa.v5.23345. eCollection 2014.
3. Chong SJ, Kwan TM, Weihao L, Joang KS, Rick SC. Maintenance of negative-pressure wound therapy while undergoing hyperbaric oxygen therapy. Diving Hyperb Med 2011;41(3):147-50.
4. Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KJ, Thompson MM, et al. Lower extremity amputations-a review of global variability in incidence. Diabet Med. 2011;28(10):1144-53. doi: 10.1111/j.1464-5491.2011.03279.x.
5. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563-76.
6. Chen P, Vilorio NC, Dhatariya K, Jeffcoate W, Lobmann R, McIntosh C, et al. Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review. Diabetes Metab Res Rev. 2024;40(3):e3786. doi: 10.1002/dmrr.3786.
7. Mosquera C, Weyh A, Malik M, Fernandes R, Bunnell A, Nedrud S. Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: A systematic review. Microsurgery. 2024;44(1):e31126. doi: 10.1002/micr.31126.
8. Landau AG, Hudson DA, Adams K, Geldenhuys S, Pienaar C. Full-thickness skin grafts: maximizing graft take using negative pressure dressings to prepare the graft bed. Ann Plast Surg. 2008;60(6):661-6. doi: 10.1097/SAP.0b013e318146c288.

9. Petkar KS, Dhanraj P, Kingsly PM, Sreekar H, Lakshmanarao A, Lamba S, et al. A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients. Burns. 2011;37(6):925-9. doi: 10.1016/j.burns.2011.05.013.
10. El-Sabbagh AH. Negative pressure wound therapy: An update. Chin J Traumatol. 2017;20(2):103-7. doi: 10.1016/j.cjtee.2016.09.004.
11. Nuutila K, Eriksson E. Moist Wound Healing with Commonly Available Dressings. Adv Wound Care (New Rochelle).2021;10(12):685-98.doi: 10.1089/wound.2020.1232.
12. Azzopardi EA, Boyce DE, Dickson WA, Azzopardi E, Laing JH, Whitaker IS, et al. Application of topical negative pressure (vacuum-assisted closure) to split-thickness skin grafts: a structured evidence-based review. Ann Plast Surg. 2013;70(1):23-9. doi: 10.1097/SAP.0b013e31826eab9e.
13. Hanasono MM, Skoracki RJ. Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device. Ann Plast Surg. 2007;58(5):573–6. doi: 10.1097/01.sap.0000237638.93453.66.
14. Isago T, Nozaki M, Kikuchi Y, Honda T, Nakazawa H. Skin graft fixation with negative-pressure dressings. J Dermatol. 2003;30(9):673-8. doi: 10.1111/j.1346-8138.2003.tb00456.x.
15. Scherer LA, Shiver S, Chang M, Meredith JW, Owings JT. The vacuum assisted closure device: a method of securing skin grafts and improving graft survival. Arch Surg. 2002;137(8):930-3;.doi: 10.1001/archsurg.137.8.930.
16. Liu Z, Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, et al. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev. 2018;10(10):CD010318. doi:10.1002/14651858.CD010318.pub3.
17. Schaum KD. Disposable Negative-Pressure Wound Therapy Reimbursement Simplified for Home Health Agencies. Adv Skin Wound Care. 2024;37(2):65-6. doi: 10.1097/ASW.0000000000000100.
18. Sun H, Si S, Liu X, Geng H, Liang J. Evaluation of a new low-cost negative pressure wound therapy in the treatment of diabetic foot ulcers. J Wound Care. 2024;33(Sup2a):xli-xlvii. doi: 10.12968/jowc.2024.33.Sup2a.xli.
19. Keenan C, Obaidi N, Neelon J, Yau I, Carlsson AH, Nuutila K. Negative Pressure Wound Therapy: Challenges, Novel Techniques and Future Perspectives. Adv Wound Care (New Rochelle). 2024 Mar 27. doi: 10.1089/wound.2023.0157.