Negative-pressure dressings in lower limb skin grafts: a randomised controlled trial of PICO versus standard dressings

Objective: Negative-pressure wound therapy (NPWT) can reduce the incidence of exudate and haematoma beneath a split-thickness skin graft (SSG) compared with traditional standard dressings. However, NPWT has not been universally adopted for lower limb SSGs despite evidence that its use is linked with improved graft take and a tendency towards early mobilisation. PICO, an ultra-lightweight NPWT device now available in Australia, can provide a smaller, more manageable NPWT dressing. The primary objective of this study was to compare lower limb graft take rate in PICO versus standard dressing groups, and a secondary objective was comparing quality of life (QOL) in these groups. Method: A prospective randomised controlled trial was conducted of 71 lower limb wounds from 59 patients, with 36 wounds randomised to standard dressings and 35 to PICO dressings. Graft take was measured and expressed as a percentage of total wound area. Postoperative mobilisation day, patient comfort, complication frequencies, ease of dressing removal and QOL scores were also recorded. Ethics approval for the trial was granted by the Human Research Ethics Committee at Peninsula Health [HREC/14/PH/25]. Results: The graft area percentage was not statistically significantly different between the PICO and standard dressing groups (p = 0.054). All patients in the PICO group were mobilised by postoperative day one, but eight per cent in the standard dressing group were still not mobilised by postoperative day five (PICO vs standard, p = 0.003). There was no statistically significant difference in patient comfort, patient QOL or complication frequency in the PICO versus standard dressing group at any postoperative visit, but the PICO dressings were statistically significantly easier to remove (p = 0.04). Conclusion: PICO dressings are not inferior or superior to standard dressings for lower limb SSGs.