Skin graft fixation with negative-pressure dressings

The tie-over bolster dressing is the most commonly used method for securing skin grafts. However, it requires surgical skill and experience to make a skin graft adhere closely to a grafting site when the site has a complicatedly curved surface. The lack of appropriate tension and pressure on the skin graft may produce hematoma, dislocation, or wrinkles in the graft. The grafting site for the dorsum of a hand is particularly complicated and irregular and requires delicate changes in pressure when the tie-over bolster dressing is used for sites supported and not supported by bones. We have obtained a high survival rate at such difficult sites by managing skin grafts with negative-pressure dressings. This paper describes the details of the technique with case reports. We have used this technique for skin graft fixation in 10 patients and confirmed its high utility as evidenced by a survival rate of 95% or higher of the grafted areas. Unlike existing techniques that apply pressure on skin grafts, this technique applies a negative pressure to the space between the skin graft and the grafting site to remove hematomas and pull the whole skin graft onto the grafting site with uniform force for adhesion.