Outcome of Vacuum-Assisted Closure Technique in Skin Grafting Over Anatomically Challenging Areas

Background Vacuum-assisted closure (VAC) therapy is a well-established method that uses negative pressure to promote wound healing and enhance skin graft adherence. While globally accepted, outcomes following its use in anatomically challenging wound sites within the Bangladeshi population remain underexplored. This study aimed to assess graft take and postoperative complications following VAC-assisted skin grafting in anatomically challenging wound sites. Methods A prospective observational study was conducted at the National Institute of Burn and Plastic Surgery, Dhaka, from September 2020 to August 2021, involving 50 patients undergoing split-thickness skin grafting over difficult anatomical regions. VAC therapy was applied postoperatively at -90 to -125 mmHg for five days. Graft take was assessed on the 5th and 14th postoperative days and categorized as good (<10% loss), satisfactory (10%-25% loss), or poor (>25% loss). Postoperative complications were recorded. Statistical analyses included the chi-square test, Fisher's exact test, and Pearson's correlation, with p<0.05 considered significant. Results Complete (100%) graft take was achieved in 31 (62%) patients, while 41 (82%) demonstrated good overall graft outcomes. Complete graft take was more frequently observed in well-vascularized wound beds than in less vascularized wound beds (25/32 vs. 6/18, p=0.005). No significant correlation was observed between wound size and graft loss (r=0.0418, p=0.773). Younger patients (2-19 years) showed significantly better graft outcomes, whereas poor outcomes were confined to patients aged ≥40 years (p<0.001). Postoperative complications were minimal and transient. Conclusion VAC-assisted dressing was associated with favorable graft take and few short-term postoperative complications in anatomically challenging wound sites. However, due to the observational design, small sample size, absence of formal power analysis, and lack of a standard dressing control group, these findings should be interpreted cautiously and cannot establish relative efficacy compared with conventional dressing methods.