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Reply: Suction Drain-Assisted Split-Thickness Skin Grafting: A Simple Procedure to Improve Skin Graft Take.

Reply: Suction Drain-Assisted Split-Thickness Skin Grafting: A Simple Procedure to Improve Skin Graft Take Sir: We thank Dr. Xue and Dr. Zhao for their interest in our procedure,1 and we will respond point by point to all of these authors’ questions. In fact, it is sometimes difficult to fully explain a procedure in a short report, and we are very pleased to provide some clarifications. First, above all, one should try to restrict this procedure to the least exudative wounds, to limit the frequency with which vacuum canisters need to be changed. In our experience, for large areas, the vacuum canister has to be changed regularly (up to three times per day). This could be done by a nurse at home, but we often prefer to keep patients in the hospital for the first 4 or 5 days. We put off changing the dressing until the compresses are saturated, because there is a significant risk that the graft will become detached, despite the presence of the interface. We are fortunate to work with a network of nurses who are expert in wound healing, all of whom hold a relevant university qualification. Second, we think there are several causes for loss of suction. It can be explained not only by an increase in the amount of liquid in the suction canister but also by leaks, even of small dimensions, around the edge of the adhesive film. To reduce these, one might consider a very close shave for the patient. We do not have a really standardized protocol, but it appears that suction is already too weak when the vacuum canister is half full and that it must be changed at this point. Third, patients must stay immobile for the first 4 or 5 days as with a conventional graft. In any case, the pain caused as the graft (which is usually at the thigh level) takes often limits movement for the first 5 days. Fourth, we have never noted any problem with blockage of the device, but should this occur, we think it would be necessary to stop the suction system and opt for conventional healing. To reduce pain on removal of the dressing, we prescribe premedication for 1 hour before removal, and we stop suction in advance. Fifth, the wall suction is a good solution, but it is necessary to use a manometer to maintain a constant pressure. At present in France, the practice of using a medical vacuum linked to a dressing to achieve a negative-pressure dressing is contraindicated. Significant pressure can increase the risk of hemorrhage. Finally, we consider that cushioning is beneficial in limiting lymphoceles, and we often do this when fitting a suction drain. We would like to offer our thanks to Dr. Xue and Dr. Zhao for their interest in this procedure, and we hope that our response meets their expectations. Innovations in negative-pressure wound therapy continue to be developed, and miniaturization together with falling costs will make these systems accessible to less fortunate institutions. DOI: 10.1097/PRS.0000000000001424