NPWT in skin transplantation: Promising, but is the jury still out?

When a chronic wound has healed, the patient, the family and the physician may feel very relieved.Especially, ulcers located on the lower leg often take months to years to close.The impact on quality of life is significant: Patients often report pain, sleep disturbances and impaired mobility.They may become frail and deteriorate in their ability to perform daily activities. 1 Treatment directed at the underlying cause should be started as soon as possible.Then the chances of rapid closure increase.2 For example, in the case of a venous leg ulcer, endovenous thermal ablation is used in cases of an insufficient saphenous vein.Subsequently, the ulcer may be covered with dressings or with autologous punch or splitskin grafts.It is of special interest to read the systematic review performed by M. Gamel et al. in this Issue.3 The article highlights the possibility of skin grafting for chronic leg ulcers and the use of negative-pressure wound therapy (NPWT).Although pain scores were not systematically evaluated in this review, it is important to note that skin grafts often reduce pain and the use of pain medication.4,5 When pain is reduced, proper wound care and compression therapy may again be possible.From 1381 articles, 21 publications with 1861 patients were included for the review.The study designs included 12 clinical case reports, 4 case series, two retrospective comparative studies and only three prospective randomized controlled trials.The mean age of the included patients was 66 years, and the mean duration of ulcers with a surface of 165 cm 2 was 27 months.It is striking to read that it took more than 2 years to apply skin grafts with NPWT in the included publications.The aetiologies of the chronic ulcers varied, with venous ulcers (54%), pyoderma gangrenosum (19%) and arterial ulcers (9.7%) being the most common causes.The authors report a graft take of ≥90% in 77% of the patients (125/162).Complete wound healing was achieved in 79% of patients (110/140), with a mean healing time of 73 days.