Keep wound vac or get a skin graft?

[honda_rider_ky]

I currently have a wound vac on my leg to heal a wound from a compound fracture.Its not a huge wound, currently about 6cm by 5cm and about 1/2cm deep at this point. My doctor has been changed and the new one wants to do a skin graft and wont really discuss anything or any options. The one I was dealing with said I wouldn't need one then a week later the "new" doctor wants to do a graft.  My home health nurse tells me that wound vacs can pull the flesh up to the surface which it is doing and once it is up to where it needs to be it can be wrapped with bandages and will heal the skin over on itself without the vac.  I don't want a skin graft if I don't absolutely need it since its then two wounds that could get infected, plus my insurance has already been trying to skip out on paying a big part of my previous surgeries for this but I need a second opinion on my options.  Do I have to have a skin graft?  I don't care what it looks like after its healed as long as its healed. I'm just trying to get some additional info.

[honda_rider_ky]

Thank you for that info.  My wound as of now is about 6cm x 5cm and 1/2cm to 3/4cm deep at its deepest point.  The wound vac has pulled flesh up a lot from where it was and I'm very impressed by it. The doctor is trying to convince me to do the surgery but I'm not comfortable with it or with him for that matter so Ive pretty well decided not to go through with the surgery.  They have called me twice wanting to know my reason why and telling me its what I need but when I tell them I don't want it and want to let it heal with the vac and on its own they get all mad and end the call rather abruptly.  Kind of unprofessional I think.

[karmazrevenge]

Hi.  I have worked in orthopaedics for 16 years.  I'm not a doctor, but I'm very familiar with what you're going through.  First, NO...you do not HAVE to have a skin graft.  It's your body and ultimately you are the only one who can decide what will happen with it.  Secondly, I've seen wound vacs do amazing things for wounds....that machine is a little miracle worker!   I don't know what your injury looks like, so I can't really direct you there.  There are times when a wound vac won't work and skin grafts are necessary.  I don't know if this applies to you or not.  You are correct that a graft requires borrowing skin and tissue from another part of your body (usually the thigh). Keep in mind that you had a bone puncture through your skin.  That means you have a lot of damage to the soft tissues deep into your leg.  Wound vac healing may not be strong enough to hold up.  Ultimately it's your leg, and only you have the say so.