The perifascial areolar tissue and negative pressure wound therapy for one-stage skin grafting on exposed bone and tendon

Background : Factors such as exposed bones or tendons can inhibit wound healing and make it a lengthy process unless aggressive debridement or vascularized flap surgery are performed. We have developed a new procedure involving simultaneous application of a skin graft and perifascial areolar tissue (PAT) and negative pressure wound therapy. Methods : Of 8 patients with wounds, bones, tendons, and thick fascia were exposed in 4, 2, and 2 cases, respectively. These wounds were adequately covered with PAT, and split-thickness skin grafts were applied simultaneously on the PAT with a VAC® device. Results : In 6 of 8 cases, the skin graft and PAT were successful, and epithelialization was achieved within 4 weeks. PAT adapted but skin graft was unsuccessful in one case, and both the skin graft and PAT failed to adapt of a pressure ulcer. Using the PAT to overlap more than 400% of the exposed areas resulted in better adaptation. Conclusions : This procedure contributed to reducing the burden on the patients because we were able to use a skin graft on the exposed areas, without the need for removal of bone or tendons. This potentially means patients avoid loss of function in the affected areas and achieve better outcomes.