Comparison of vacuum-assisted closure device versus bolster dressing for securing skin grafts: a randomized controlled trial
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Abstract
OBJECTIVE: To compare the percentage of graft take and short-term post-operative complications between using a vacuum-assisted closure (VAC) device and a traditional bolster dressing for securing split-thickness skin grafts (STSGs) in traumatic wounds.
METHODS: This single-blinded, randomized controlled trial was conducted at the Department of Plastic and Reconstructive Surgery, Civil Hospital, Karachi, Pakistan, from October 21, 2021, to June 20, 2022. Patients aged 18 to 60 with soft tissue injuries undergoing skin grafting were included. After STSGs, participants were randomly assigned to either the VAC group or the bolster dressing group using a sequentially numbered opaque sealed envelope protocol. On the fifth post-operative day, the dressings were removed under consultant supervision, and the percentage of skin graft take and post-operative complications were assessed. Data were analyzed using SPSS version 21.
Results: There were no significant differences in baseline characteristics like age (p=0.082), body mass index (p=0.770), comorbidities (diabetes, p=0.583; hypertension, p=0.237), graft site (p=0.583), and graft size (p=0.09) between the groups. Post-operative complications, including hematoma (8.6%), seroma (14.3%), and infection (5.7%), were more common in the Bolster group compared to the VAC group. A statistically significant difference in seroma formation was observed between the two groups (p=0.001). Additionally, the proportion of graft take was significantly higher in the VAC group than in the Bolster dressing group (94.3±4.2% vs. 85.6±4.4%, p=0.001).
Conclusion: The use of the VAC device resulted in fewer post-operative complications and a significantly higher percentage of successful graft take compared to the conventional Bolster dressing method.
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