Negative-pressure therapy versus conventional therapy on split-thickness skin graft: A systematic review and meta-analysis. (February 2018)

• Record Type: Journal Article
• Authors: Yin, Yingchao; Zhang, Ruipeng; Li, Shilun; Guo, Jialiang; Hou, Zhiyong; Zhang, Yingze
• Is Part Of: International journal of surgery. Volume 50(2018)
• Page Start: 43
• Page End: 48
• Publication Date: 2018-02
• Subjects: Negative-pressure therapy -- Conventional therapy -- Split-thickness skin -- Meta-analysis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.12.020
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Objective: To compare the clinical outcomes of negative-pressure wound therapy (NPWT) versus conventional therapy on split-thickness skin after grafting surgery. Design: Meta-analysis. Background: Split-thickness skin grafts are widely used in reconstruction of large skin defects. Conventional therapy causes pain during dressing changing. NPWT is an alternative method to cover the wound bed. Methods: The Pubmed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) or cohort studies for articles published between 1993 and April 2017 comparing NPWT to conventional wound therapy for split-thickness skin grafts. The rate of graft take was the primary outcome of this meta-analysis. Wound infection and reoperation rate of the wound were secondary outcomes. Data analysis was conducted using the Review Manager 5.3 software. Results: Five cohort studies and seven RCTs including 653 patients were eligible for inclusion. Patients treated with NPWT had a significantly higher rate of graft take compared to those treated with conventional therapy [MD = 7.02, (95% CI 3.74, 10.31)] (P = .00). NPWT was associated with a reduction in reoperation [RR = 0.28, (95% CI 0.14, 0.55)] (P = .00). The reduction in wound infection was not significant [RR = 0.63, (95% CI 0.31, 1.27)] (P = .20). Conclusion: Compared with conventional therapy, NPWT significantly increases the rate of graft take and reduces the rate of reoperation when applied to cover the wound bed with split-thickness skin graft. No significant impact on wound infection was found in this study. Highlights: Split-thickness skin grafts are widely used in reconstruction of large skin defects. Conventional postoperative skin recipient site care includes saline-moistened gauze with a protective layer of petroleum gauze and tie-over technique. However, this method causes pain while changing the dressing. The technique of negative-pressure wound therapy (NPWT) has been claimed to be a good alternative for the conventional dressing for the split-thickness grafts. The aim of this systematic review was to compare the clinical outcomes of negative-pressure wound therapy (NPWT) versus conventional therapy on split-thickness skin after grafting surgery.