Single-Stage Biomatrix and Skin Graft Under a Single-Patient Portable Negative Pressure Wound Therapy (NPWT) Device Decreases Hospital Costs

Aim: We assess the economic savings when using a single-stage, single-patient NPWT system over an advanced biomatrix 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 two-stage procedure, with one operation to place the biomatrix and then another performed in three weeks for the STSG. We demonstrate our technique and results in 10 consecutive patients.

Methods: Biomatrix, STSG, and NPWT (-125 mmHg) were utilized in patients for complex radial forearm free flap donor site reconstruction in a single-stage procedure. We assessed the cost stemming from the single stage-procedure versus the standard two-stage procedure. 

Results/Discussion: Patients treated with the single-stage biomatrix, STSG, and NPWT therapy 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 10–14 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 1–2 days in hospital for discharge ($1,500/day) was avoided.

Conclusions: Single-stage biomatrix, STSG, and NPWT results 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 two-stage procedure.