Effectiveness of Skin Graft Fixation Techniques in Plastic Surgery: A Systematic Review and Meta-Analysis

Background: Skin grafting remains a cornerstone of reconstructive plastic surgery. Graft failure, particularly due to shear forces, hematoma, or fluid accumulation, necessitates reliable fixation. Numerous techniques exist, including traditional tie-over dressings, tissue adhesives, negative pressure wound therapy (NPWT), and sealed vacuum dressings, but their comparative effectiveness is unclear. This systematic review and meta-analysis aimed to compare the effectiveness of different skin graft fixation techniques regarding graft take rate, complication profile, and operative time.Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) conducted from inception to December ۲۰۲۵. Randomized controlled trials (RCTs) and prospective comparative studies comparing at least two skin graft fixation methods in adult patients undergoing split- or full-thickness skin grafting were included. The primary outcome was graft take rate (>۹۵% take). Secondary outcomes included hematoma/seroma formation, infection, patient-reported comfort, and operative time. Pooled risk ratios (RR) and mean differences (MD) with ۹۵% confidence intervals (CI) were calculated using random-effects models.Results: Fourteen studies (n=۱,۰۴۲ patients) met inclusion criteria. Compared to conventional tie-over dressings, NPWT significantly improved complete graft take (RR ۱.۱۴, ۹۵% CI ۱.۰۶–۱.۲۳, p<۰.۰۰۱) and reduced hematoma/seroma rates (RR ۰.۳۲, ۹۵% CI ۰.۱۸–۰.۵۷). Tissue adhesives showed shorter operative time (MD -۱۸.۵ minutes, ۹۵% CI -۲۵.۱ to -۱۱.۹) but no difference in graft take. Sealed vacuum dressings were non-inferior to NPWT but cheaper. Infection rates did not differ significantly between techniques.Conclusion: NPWT and sealed vacuum dressings significantly enhance graft take and reduce fluid complications compared to tie-over dressings. Technique selection should balance efficacy, cost, and clinical setting.

کلیدواژه ها:

Skin graft fixation ، negative pressure wound therapy ، graft take rate ، tie-over dressing ، and reconstructive surgery