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Case Study/Series
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Combining skin grafting and negative pressure therapy in difficult wounds to achieve healing: a case study approach First Author: Cindy Ambrose Authors: Cindy Ambrose and Nancy Vaughan Historically closing a wound with split thickness skin graft (STSG) has required a great deal of time, cost and effort for the patient and care giver and we were frustrated with mixed outcomes. In our wound center, we have increased the overall success rate by implementing a care pathway that includes negative pressure therapy to prepare the wound bed and stabilize the graft post-op. We follow a care pathway to optimize the body's ability to heal. The pathway guides the care team through a review of co-morbidities that impede healing. We assess and treat conditions including arterial supply, infection, nutrition, edema and pressure. In addition to systemic and topical care, the wound is excised and negative pressure therapy is applied to stimulate growth of granulation tissue. When a beefy granulation bed is ready, surgeons apply a STSG and re-apply negative pressure therapy to enhance graft take. Case number one is a 76 year old diabetic male who presented to our center with limb threatening infection and open wound on his leg. Case number two involves a 73 year old male with PVD secondary to diabetes that presented with gangrene and osteomyelitis of the left foot. Case number three presented with a large hematoma on her leg secondary to a fall. In all three of these cases, we incorporated negative pressure therapy pre and post grafting with excellent results. |
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