Sat., 10/6/12 General Interest, PAPER #101, 1:50 pm OTA-2012
Conventional Compressive Dressings Superior to Negative-Pressure Dressings for Split-Thickness Skin Graft Coverage of Traumatic Extremity Wounds
Laurence B. Kempton, MD; Timothy Larson, MD; Harvey Montijo, MD; Stephen H. Sims, MD; Madhav A. Karunakar, MD; Stanley Getz, MD; James F. Kellam, MD, Michael J. Bosse, MD;
Carolinas Medical Center, Charlotte, North Carolina, USA
Purpose: Negative-pressure dressings (NPDs) are commonly used to cover split-thickness skin grafts (STSGs) due to their reported high success with graft healing. Multiple clinical studies have shown their efficacy; however, they have not been proven to be superior to conventional compressive dressings (CDs). Our purposes were to determine whether there is any difference in clinical outcomes of STSGs when using an NPD versus CD and to determine the average cost difference at our institution between these two dressing types.
Methods: We reviewed charts for all patients who underwent STSG surgery for extremity wounds from 2006 to 2010 by five surgeons (four orthopaedic trauma surgeons and one plastic surgeon). STSG splaced on flaps and burn wounds were excluded. All patients either received an NPD or a CD. Initial dressings were removed after 5 days, and the STSGs were rewrapped with a nonadherent dressing. Patients were assigned one of four possible outcomes based on postoperative documentation: completely healed, incompletely healed (any area of persistent drainage or small area of failed graft not requiring surgical intervention), failed (complete loss of the STSG or return to operating room for any reason related to the STSG), or lost to follow-up. To determine the cost differences between the dressing types, the costs associated with the dressings for the 5 postoperative days were compared.
Results: 35 of 195 STSG were lost to follow-up, leaving N = 120 STSG-NPD and N = 40 STSG-CD. Of the 120 STSGs treated with an NPD, 91 completely healed, 23 incompletely healed, and 6 failed. Of the 40 STSGs treated with a CD, 37 completely healed, 1 incompletely healed, and 2 failed. Using ordered logistic regression, patients treated with CDs had higher rates of healing (either complete or incomplete) relative to the NPD (P = 0.018). Analyzing the outcomes as failed versus “not failed” (ie, either completely or incompletely healed) revealed no significant difference between the groups (P = 1.00). There were no significant differences between the compared groups with respect to patient age, tobacco use, past medical history, body mass index, graft location, wound size, wound bed tissue type, cause of wound, or presence of associated infection. In this series, the mean cost associated with NPD compared to compressive dressing was $2370 more per patient. No patients were readmitted to the hospital prior to the first dressing change in either group.
Conclusion: There is a high rate of successful healing of STSGs for traumatic extremity wounds. Despite the increased cost of NPD compared to CD, there was no improvement in clinical outcomes with the NPD in our population. STSGs receiving a CD had significantly higher rates of healing compared to those receiving NPDs.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.