Wound Healing Clinical Trial
Official title:
Comparison of Two Methods of Securing Skin Grafts Using Negative Pressure Wound Therapy: VAC and GSUC
The purpose of this study is to compare how well two methods (VAC and G-SUC) of securing skin grafts using negative pressure wound therapy work. Negative pressure wound therapy is a commonly used method of applying suction on wounds to remove fluid from wound and to promote healing. The VAC system is widely used and consists of a foam dressing and a portable computerized suction pump. The G-SUC method uses commonly available dressing supplies attached to vacuum (suction) pump located on the wall above a hospital bed. The investigators have frequently used both methods over the past 10 years and have not observed any specific negative side effects of either.
STUDY DESIGN: A prospective, randomized study will be conducted. The investigators expect
the duration of data collection to be 2 years.
1. PATIENT SELECTION
Adult patients of any sex, hospitalized at the University of Chicago Medical Center,
requiring split thickness skin autografts with wounds that are amenable to placement of
an occlusive dressing for negative pressure therapy will be eligible to participate in
the study. If both the patient and the primary treating surgeon agree to participate,
they will receive informed consent. Pregnant women, children under 18 years of age and
other patients who are "vulnerable" as defined by the Institutional Review Board will
not be eligible for the study.
2. STUDY PROCEDURE
Preoperative Procedures:
Patients with wounds requiring skin grafting will enter the trial upon consent of the
patient and the preoperative decision by the surgeon to secure the skin graft with negative
pressure therapy. Upon entry, the primary physical therapist will be immediately informed of
a study participant and will place either the G-SUC or VAC dressing at the conclusion of the
operation. The randomization scheme will be prepared by the study statistician using
computer generated random numbers. The surgeon will be blinded to the treatment modality
until the primary physical therapist places the randomized therapy.
Intraoperative Procedures:
Wounds will undergo debridement using standard techniques to a healthy, viable wound bed.
Split thickness skin grafts harvested from the patient will be obtained between 0.008-0.010
inches using an electric dermatome. In addition to standard methods of achieving hemostasis,
Tisseel (Baxter, Deerfield, IL) will be used as an adjunct for the preparation of the wound
bed. All grafts will be secured with N-Terface Interpositional Material (Winfield
Laboratories, Richardson, TX) and a single layer of Acticoat (Smith and Nephew, Quebec,
Canada).
Patients with skin grafts undergoing VAC therapy will be managed with continuous negative
pressure delivered by the computerized VAC suction unit at 75-125 mm Hg. The suction will be
applied to a standard open cell VAC foam dressing supplied by KCI, Inc and sealed with an
occlusive cover.
Patients with skin grafts undergoing G-SUC therapy will be managed with negative pressure
delivered by low continuous wall suction at 75-80 mm Hg. The suction will be applied to
standard gauze dressing and sealed with an occlusive cover.
Postoperative Procedures:
Patients on either therapy will remain on continuous negative pressure therapy from the
conclusion of their surgery until dressing takedown. Patients undergoing VAC therapy will be
transported with the computerized VAC suction unit. Maintenance of negative pressure during
transport of patients undergoing G-SUC therapy will be accomplished by clamping the
connection tubing with hemostats prior to disconnection to wall suction units.
All dressings will be discontinued on post operative day #4 or 5 and graft take will be
assessed with two methods in the following manner:
1. Areas of non-take will be clearly marked with a pen by a researcher blinded to the
treatment modality
2. Images of the graft with a ruler for scale will be taken by a digital camera
3. The entire graft area will be determined in pixels
4. The areas of non-take will be determined in pixels
5. The percentage of non-take will then be calculated
6. The areas will also be measured and recorded
Image analysis will be conducted by a researcher blinded to the treatment modality. Wound
size will also be calculated as per Xakellis & Frantz method (1997): wound surface area =
length x width x 0.783.
If a G-SUC or VAC dressing cannot be maintained because of either persistent fluid or
suction leaks, the attending physical therapist will attempt to reinforce the dressing. If
after 2 attempts per 24-hour period, the dressing still cannot be maintained, that patient
will be considered to have failed negative pressure wound therapy. Patients who fall into
this category will be able to crossover into the other treatment arm, but additional data
regarding their treatment will not considered in the results of the study.
The cost of VAC rental, supplies and time performing dressing changes will be recorded for
the duration of negative pressure wound therapy for each patient.
The attending physical therapist will collect and maintain the database.
Wound Specific Procedures:
Upper Extremity. All skin grafts on mobile structures, such as those crossing joints or
directly on muscle, will be splinted to prevent shear. Otherwise, patients will be allowed
to move about ad lib.
Lower Extremity. All skin grafts on mobile structures, such as those crossing joints or
directly on muscle, will be splinted to prevent shear. Patients will remain on bedrest with
leg elevation to prevent lower extremity edema until negative pressure therapy is
discontinued.
Chest, Abdomen, Back, Head, Neck. Mobility will be allowed ad lib.
Perineum. Patients will remain on bedrest until discontinuation of negative pressure therapy
to prevent shear.
3. STUDY RECORDS
Completed case report forms will be confidential and kept in a secured file by the principal
investigator.
4. RISKS & BENEFITS TO PATIENTS
The investigators are not aware that there are specific risks associated with negative
pressure wound therapy, and the technique has not been associated with specific adverse
outcomes at our hospital or in the published literature. Negative pressure wound therapy
allows for more rapid and reliable wound healing for many patients. Data from this study may
help us to expand the indications for negative pressure wound therapy.
There will be no payment to the subjects.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment
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