Comparison of Efficacy and Complications Between Negative Pressure Wound Therapy and Conventional Mechanical Fixation in Skin Grafts

A Retrospective Analysis

Xiao Shen, MD; Tianfu Zhan, MD; Dayong Wei, MD; Hengshu Zhang, MD


Wounds. 2019;31(8):213-218. 

In This Article

Abstract and Introduction


Introduction: Graft fixation is critical for the successful survival of a skin graft. Conventional mechanical fixation may induce inappropriate pressure and increase wound complications. Negative pressure wound therapy (NPWT) could be utilized to secure a skin graft and improve drainage. Limited quantitative data exist on the efficacy of NPWT for skin grafting.

Objective: This retrospective study compares the efficacy and complications between NPWT and conventional mechanical fixation in skin grafts.

Materials and Methods: Patients who underwent skin graft surgery from January 2015 to December 2016 at a large university hospital in southwest China were retrospectively analyzed. Characteristics, including wound pattern, skin graft type, surgical procedure, survival rate, and postoperative complication, were statistically analyzed by Pearson chi-square or Fisher's exact test.

Results: A total of 186 patients were included in the study; 72 received NPWT and 114 received conventional mechanical dressing fixation after skin grafting. Overall survival rate of full-thickness skin grafts was significantly higher in the NPWT group than the dressing group (P < .01). The NPWT group showed a higher survival rate than the dressing group for each anatomic site, but only patients who had skin grafts of the hand exhibited statistically significant results.

Conclusions: This study reports a quantitative analysis of the efficacy of NPWT on skin graft fixation with NPWT providing consistent pressure and better drainage than conventional mechanical fixation. In addition, the use of NPWT also could increase graft take on the hand region.


Skin grafting is the primary reconstructive measure used to cover small and large soft tissue defects. Graft fixation is essential for the successful survival of a skin graft. Conventionally, a skin graft could be secured by means of elastic dressing or tie-over bolsters.[1] Inappropriate pressure on the skin graft may lead to hematoma, infection, dislocation, or graft loss, reducing graft survival significantly.[2] Negative pressure wound therapy (NPWT) initially was introduced for suction therapy of various wounds. This technique could provide negative pressure to seal the space and secure the adherence of a skin graft with persistent, uniform pressure. It also offers continuous drainage of blood and exudate, minimizing infection and hematoma, and firm graft fixation on a complex wound surface.

In this study, in order to illuminate an appropriate fixation method for skin grafting, the outcomes of skin graft surgery with different types of fixation were retrospectively analyzed.