Comparison of Skin Graft Take with and Without Post Grafting Topical Negative Pressure Dressing

Abstract

Background: Skin grafting is a critical surgical technique for lower limb wound coverage, yet graft failure remains a significant challenge due to factors such as seroma, haematoma, shear forces, and infection. Negative pressure wound therapy (NPWT) has emerged as a promising adjunct to improve graft survival by promoting graft adherence, reducing fluid accumulation, and optimizing wound microenvironments. However, robust local evidence supporting NPWT in this context is limited. Objective: To compare the percentage of skin graft take and associated clinical outcomes between patients treated with NPWT and those receiving conventional postoperative dressings following split-thickness skin grafting for lower limb wounds. Methods: A single-center randomized controlled trial was conducted at Combined Military Hospital, Rawalpindi, from March to August 2025. Eighty patients undergoing lower limb grafting were randomized into NPWT (n = 40) or conventional dressing (n = 40) groups. The primary outcome was percent graft take at day 8–10 postoperatively. Secondary outcomes included time to complete wound healing and length of hospital stay. Statistical analysis was performed using independent t-tests and stratified analyses, with p ≤ 0.05 considered significant. Results: Mean percent graft take was significantly higher in the NPWT group (95.3 ± 4.2%) compared to the conventional dressing group (78.5 ± 8.7%; p < 0.001). Differences in length of stay (7.2 ± 3.2 vs 8.4 ± 2.6 days; p = 0.084) and healing time (9.4 ± 1.5 vs 9.9 ± 2.1 days; p = 0.179) favored NPWT but were not statistically significant. Conclusion: NPWT significantly improves skin graft take following lower limb grafting, supporting its routine clinical use to optimize graft survival and wound healing outcomes.