Split thickness skin graft healing : comparing negative pressure therapy with conventional therapy

Abstract

Overview of the topic: The aim of this dissertation was to investigate the difference between negative pressure therapy and conventional pressure dressings in the treatment of split thickness skin grafts. A Skin graft is a cutaneous tissue which is transferred from one part of the body to another, mostly used to cover deep wounds that are usually treated with conventional pressure dressings (Braza & Fahrenkopf, 2019). Modern studies have investigated the use of negative pressure therapy on chronic wounds. A study conducted by Shirakawa & Isseroff (2005) compared the outcomes of six different randomized controlled trials, which investigated the percentage volume decrease of chronic wounds when topical negative pressure was applied. All six studies showed a decrease of more than 30% wound size after 6 weeks of commencing the treatment. The research Question: In patients with split thickness skin grafts, does negative pressure therapy, compared to conventional pressure dressings, improve graft take? PICO Elements: The population (P) which was studied were patients with split thickness skin grafts. The intervention (I) was the use of negative pressure therapy. The comparison (C) observed was conventional pressure dressings. The final outcome (O) was improvement in graft take. Method: The key words of the PICO question were used in order to find alternative terms. These terms were then merged with truncation symbols and Boolean Operators. The search was narrowed down with the application of limiters, which provided more accurate results. EBSCO and PubMed databases were utilized to search for the key terms and duplicate or unrelated studies were eliminated by the PRISMA checklist. Additionally, an inclusion and exclusion criteria were applied so as to evaluate the relevance of the articles. In order to critically appraise the selected key studies, the Critical Appraisal Skills Programme (CASP) was used. Results: A total of five key studies were chosen, of which one was a Meta-analysis, two were Randomised Controlled Trials (RCTs) and two were cohort studies. Four studies were coherent and approved negative pressure therapy as the better treatment in improving the graft take. The last study did not support negative pressure therapy over conventional dressing therapy. However, this study contained several limitations throughout its method. Conclusion: A specific conclusion cannot be given. Although further research is required, it is still safe to begin promoting the use of negative pressure therapy for split thickness skin grafts. The evidence drawn promotes further research towards a better understanding of the treatment, which provides a better vision into the medical application of negative pressure therapy in split thickness skin grafts. Implications and Recommendations: It is recommended that more legal amendments are presented. Additionally, further research and education in the area is necessary to advance EBP and safeguard the effectiveness of negative pressure therapy on improving the graft take in split thickness skin grafts. Healthcare management should provide guidelines and training opportunities for healthcare members. In addition, staff nurses could be encouraged to apply for the role of tissue viability nurses.