Split thickness skin graft compression: a scoping review.

Background: Split thickness skin graft (STSG) is a routine reconstructive manoeuvre, particularly after excision of cutaneous lower limb malignancies. While surgical technique is well established, evidence supporting the postoperative management of these grafts is less robust. Compression therapy after the index procedure may be an important adjunct for graft take and minimizing complications, particularly in patients susceptible to oedema from a concurrent lymph node procedure. Methods: An initial PubMed literature search was performed using the terms "split thickness skin graft", "compression" and "oedema" yielding no results, hence a broader search was performed combining the terms "compression", "pressure" and "split thickness skin graft" providing 383 results. One hundred articles remained for abstract review after an initial screen. Results: The literature on compression therapy to promote split thickness graft take is modest, with only 12 articles described (12/100, 12.0%). Even then, none of these were in the setting of grafting after oncological resection. Many of the articles promote negative pressure wound therapy (NPWT) as an established adjunct to promote graft take (80/100, 80.0%). Conclusions: There is limited demonstrated efficacy of postoperative compression therapy for lower limb STSG let alone in patients with an ancillary lymph node procedure. Further large-scale trials ideally in a prospective fashion are warranted to validate this as a simple, widely available and cost-effective adjunct to STSG in this particularly susceptible population of reconstructive patients.