Management of skin grafts using negative pressure therapy: the effect of varied pressure on skin graft incorporation.

INTRODUCTION Optimal pressure settings have been suggested in the use of negative pressure wound therapy (NPWT) in wound dressings. When used as a bolster for skin grafting, an NPWT setting of 125 mm Hg was initially suggested, but not validated through studies. The objective of this study is to report findings on the effect of varied pressure settings on the incorporation of split thickness skin grafts when using an NPWT bolster. METHODS From 2007 to 2010, 48 inpatients underwent split thickness skin grafting using a negative pressure system as a bolster under the care of 2 surgeons at 2 academic institutions. Twenty-two patients were evaluated retrospectively who were treated using NPWT bolsters at 75 mm Hg and 125 mm Hg based on the surgeon's discretion. Twenty-six patients were evaluated prospectively and were randomized to 50 mm Hg, 75 mm Hg, 100 mm Hg, and 125 mm Hg pressure settings. Graft incorporation was assessed at time of bolster removal, 2 weeks, and 4 weeks, per standard protocol. RESULTS At each assessment point, incorporation of each skin graft was > 95% in all study subjects, at all pressure settings. CONCLUSION Whereas initially postulated to be 125 mm Hg, ideal pressure settings for NPWT, when used as a bolster for split thickness skin grafts, may be lower. This study suggests that pressures as low as 50 mm Hg can be tolerated without compromise of skin graft incorporation. Study findings were presented at the Plastic Surgery Research Council Meeting in San Francisco, CA in April of 2010. .