Extra-wound fixation: a modified tie-over dressing technique for skin graft

Abstract

Objective: Tie-over dressing is the most frequently used technique of skin grafting. However, many deficiencies affecting the outcome have been reported. We hereby introduce a modified method, termed the ‘extra-wound fixation technique’, for skin dressing, and evaluate the complications and clinical outcomes. Method: In this retrospective cross-sectional study we analysed the medical records of patients treated between January 2012 and December 2017. All patients received full thickness skin grafts. Patients were divided equally into to groups: patients were treated using the extra-wound fixation technique, and the remaining, randomly selected patients treated using the traditional tie-over method. The extra-wound fixation technique uses the traditional tie-over dressing method followed by additional stitches made in healthy skin locating 0.5-1.0 cm laterally to the wound edge. The follow-up outcomes between the two groups were compared using the Chi-square test. Results: A total of 38 patients took part (19 patients in each group). The follow-up duration was 1–6 months. No raised edges were observed in any of the patients. Prolonged follow-up demonstrated that the grafted skin texture became soft with a thin layer of adipose tissue, and elasticity was gradually improved along with the regeneration of dermoelastic fibre. The colour was similar to the normal skin with a smooth surface. Compared with the traditional method, the extra-wound fixation technique significantly improved the survival of the grafted skin (p=0.008), reduced the risk of laceration of the skin (p=0.001), and eliminated crater rim-like appearances (p=0.020). Conclusion: The extra-wound fixation technique could be used for different skin grafts and improve clinical outcomes compared with the traditional tie-over dressing method.