Outcomes of skin graft reconstructions with the use of vacuum assisted closure (VAC®) dressing for irradiated extremity sarcoma defects

Background: Flaps are currently the predominant method of reconstruction for irradiated wounds. The usefulness of split-thickness skin grafts (STSG) in this setting remains controversial. The purpose of this study is to examine the outcomes of STSGs in conjunction with VAC therapy used in the treatment of irradiated extremity wounds. Methods: The records of 17 preoperatively radiated patients with extremity sarcomas reconstructed with STSGs in conjunction with VAC® therapy were reviewed regarding details of radiation treatment, wound closure, and outcomes. Results: STSGs healed without complications (>95% of the graft take) in 12 (71%). Minor loss (6% - 20% surface) was noted in 3 patients (17.6%) and complete loss in 2 (11.7%). Two patients (11.7%) required flap reconstructions and 12 (88%) healed without further operative procedures. Conclusion: Although flap coverage is an established treatment for radiated wounds, STSG in conjunction with liberal utilization of VAC therapy is an alternative for selected patients where acceptable soft tissue bed is preserved. Healing of the preoperatively radiated wounds can be achieved in the vast majority of such patients with minimal need for additional reconstructive operations.