Negative pressure wound therapy versus conventional tie-over dressing for split-thickness skin graft fixation: A...

BackgroundSplit-thickness skin grafting (STSG) is commonly used for traumatic soft-tissue defects; however, graft instability and suboptimal scar outcomes remain concerns. Negative pressure wound therapy (NPWT) has emerged as an alternative fixation method to the conventional tie-over dressing. This study compared clinical outcomes between NPWT and tie-over fixation and evaluated whether defect size influenced their comparative effectiveness.MethodsSeventy-five patients who underwent STSG for traumatic soft-tissue defects between March 2020 and February 2025 were retrospectively reviewed. Patients were divided according to fixation method into NPWT (n = 38) and tie-over dressing groups (n = 37). Outcomes included operative time, complete graft-take rate, postoperative complications, and Vancouver Scar Scale (VSS) scores at 2 weeks and 6 months. Subgroup analysis was performed according to defect size (<100 cm² vs ≥100 cm²).ResultsAt 2 weeks postoperatively, the NPWT group demonstrated significantly lower VSS scores for vascularity, pliability, and height compared with the tie-over group (p < 0.05). At 6 months, significantly lower pliability scores were observed in the NPWT group; in the ≥100 cm² subgroup, NPWT also showed a significantly lower height score (p < 0.05). Operative time was significantly shorter in the NPWT group than in the tie-over group (p < 0.001). Complete graft-take rates were comparable overall; however, in defects ≥100 cm², NPWT achieved a significantly higher complete graft-take rate (p = 0.048).ConclusionsNPWT was associated with shorter operative time and early scar-related outcomes, particularly in larger defects. However, given the retrospective design and limited subgroup size, these findings should be interpreted cautiously, and NPWT may be considered as a useful option in selected mechanically demanding cases rather than a universal fixation method.