Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device

We performed microvascular free muscle flaps on 5 patients using the vacuum-assisted closure (VAC) device (KCI, San Antonio, TX) to secure a split-thickness skin graft to the external surface of the flap in each case. This method of skin-graft fixation was selected in each case because of the complex 3-dimensional shape of the flap or because of concerns of inadequate fixation provided by conventional tie-over bolster techniques in regions that experience a significant amount of shear stress. All 5 flaps remained viable throughout the treatment course and all 5 patients experienced excellent skin-graft take. Also, decreased edema was noted in all 5 flaps. We conclude that the VAC device is a useful tool in the fixation of skin grafts to microvascular free flaps and that its use does not compromise free-flap viability.