Single-stage Biomatrix and Skin Graft Under a Single-patient Portable Negative Pressure Wound Therapy Device Decreases Hospital CostsCharles Lee, MD
Aim: This study assessed the economic savings when using a single-stage, single-patient negative pressure wound therapy (NPWT; Invia Motion NPWT; Medela, McHenry, IL) system over an advanced biomatrix (Integra Bilayer Wound Matrix; Integra LifeSciences Corp, Plainsboro, NJ) and skin graft for accelerating the wound healing process by avoiding a second operation and evaluating ease of transition from inpatient to outpatient status. Advanced biomatrix is normally performed as a 2-stage procedure, with one operation to place the biomatrix and another performed 3 weeks later for the split-thickness skin graft (STSG). The authors demonstrate their technique and results in 10 consecutive patients.
Methods: Biomatrix (Integra Monolayer Wound Matrix; Integra LifeSciences), STSG, and NPWT (-125 mm Hg) were utilized in patients for complex radial forearm free flap donor site reconstruction in a single-stage procedure. The authors assessed the cost stemming from the single-stage procedure versus the standard 2-stage procedure.
Results/Discussion: Patients treated with the single-stage biomatrix, STSG, and NPWT were all discharged on postoperative day 5. They were easily transitioned from the inpatient status to the outpatient/home setting and had the NPWT device removed in 10 to 14 days. Mean graft take was 98% with no infections. A second operation was not necessary for the STSG and there was no delay in discharge. The cost of the second STSG operation ($10 000) and potential 1 to 2 days in the hospital for discharge ($1500/day) were avoided.
Conclusions: Use of single-stage biomatrix, STSG, and NPWT resulted in successful reconstruction of large, complex radial forearm free flap donor sites used in phalloplasty. Using the portable, single-patient NPWT device allows for easy discharge of the inpatient and avoids a costly second operation to place a STSG. The single-stage procedure can be considered a superior, cost-effective alternative to the current 2-stage procedure.
*This abstract was presented as an Oral Abstract at the 2019 Symposium on Advanced Wound Care Fall.
Additional Oral and Poster Abstracts are Available on the Wound Care Learning Network.