Lower Extremity Graft Study (LEGS): A Multicentre Randomised Controlled Trial of Negative Pressure Wound Therapy Versus Conventional Dressings for Split-thickness Skin Grafts After Lower Leg Skin Tumour Excision

Inclusion Criteria: * Adults aged 18 years or older * Undergoing excision of a skin tumour on the lower leg with planned coverage using split-thickness skin grafting (STSG) * Eligible procedures include primary excision, secondary excision, or extended excision performed at the same site as a previous tumour surgery * Ability to provide written informed consent * Ability to comply with postoperative instructions and follow-up visits Exclusion Criteria: * Inability to follow postoperative instructions due to cognitive impairment, dementia, or significant language barriers * Inability to provide informed consent * Severe systemic illness, including: * Ongoing sepsis * Advanced heart failure * End-stage renal or liver disease * Active chemotherapy within the previous three months * Ongoing treatment with immunosuppressive medications, including: * Systemic corticosteroids (e.g., prednisone \>20 mg/day or equivalent) * Calcineurin inhibitors (e.g., cyclosporine, tacrolimus) * Antimetabolites (e.g., methotrexate, azathioprine, mycophenolate mofetil) * mTOR inhibitors (e.g., sirolimus, everolimus) * Biologic therapies (e.g., rituximab, TNF inhibitors, IL-6 inhibitors, IL-1, IL-17, IL-23 inhibitors) * Targeted molecular therapies (e.g., JAK inhibitors such as tofacitinib, baricitinib) * Other immunosuppressive drugs * Previous radiation therapy to the surgical site * Presence of severe skin disease affecting the planned graft recipient site (e.g., advanced psoriasis)