scholarly journals Flap Viability after Direct Immediate Application of Negative Pressure Wound Therapy on Free Flaps: A Systematic Review and Pooled Analysis of Reported Outcomes

2019 ◽  
Vol 04 (02) ◽  
pp. e77-e82
Author(s):  
Jude L. Opoku-Agyeman ◽  
David V. Matera ◽  
Jamee E. Simone ◽  
Amir B. Behnam
Keyword(s):  
Systematic Review ◽  
Free Flap ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Free Flaps ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Wound Therapy ◽  
Flap Failure ◽  
Flap Loss

Abstract Background The use of negative pressure wound therapy (NPWT) devices has gained wide acceptance in the management of wounds. There have been a few reported cases of its use immediately after free tissue transfer. This is the first systematic review and pooled analysis on the immediate use of NPWT for free flaps with emphasis on the rate of free flap loss. Methods The authors performed a systematic review that focused on the rate of total free flap loss after immediate application of NPWT. EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, and PubMed databases were searched from 1997 to April of 2019. Peer-reviewed articles published in the English language were included. Results Ten articles were included in the review, yielding 211 free flap procedures. All studies were retrospective cohort studies except for two that were prospective studies and one that was a case series. The overall complete flap failure rate was n = 7 (3.3%). The most commonly reconstructed area was the lower extremity (n = 158 [74.9%]) followed by head and neck (n = 42 [19.9%]) and upper extremity (n = 11 [5.2%]). The vacuum pressure ranged from 75 to 125 mm/Hg. The time of application of the NPWT ranged from 5 to 7 days. The etiologies of wound defects were from trauma (n = 82 [63.6%]), tumor extirpation (n = 43 [33.3%]), and infection and burn (n = 4 [3.1%]). Conclusion The immediate application of NPWT on free flaps does not seem to be associated with an increased risk of flap failure.

Osteoradionecrosis and microvascular free flap failure managed with negative pressure wound therapy: A case report

2021 ◽  
pp. 1-6
Author(s):  
Michael J. Gigliotti ◽  
Neel Patel ◽  
Caroline McLaughlin ◽  
Alexis Rothermel ◽  
Cathy Henry ◽  
...  
Keyword(s):  
Case Report ◽  
Free Flap ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Flap Failure ◽  
Microvascular Free Flap

Use of Incisional Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer

2017 ◽  
Vol 34 (03) ◽  
pp. 200-205 ◽  
Author(s):  
Hongda Bi ◽  
Mija Khan ◽  
Ivo Pestana ◽  
Junhui Li
Keyword(s):  
Free Flap ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Free Tissue Transfer ◽  
Tissue Loss ◽  
Wound Therapy ◽  
Tissue Transfer ◽  
Flap Loss ◽  
Clinical Scenarios ◽  
Increased Risk

Background Negative pressure wound therapy (NPWT) was initially introduced for wound management, but its benefits have stimulated the investigation of its use in new clinical scenarios. Most recently, incisional NPWT has been shown to be a benefit. Incisional NPWT applied to skin-containing free tissue transfer has not been well defined. This may originate from concerns of dressing material obscuring frequent examination of the newly transferred tissue or risk of pedicle compression and potential for increased risk of tissue loss. We aim to describe incisional NPWT in cutaneous free tissue transfer. Methods An institutional review board-approved retrospective review of consecutive free tissue transfer patients was completed over a 3-year period. Free tissue transfer procedures were performed in standard manner. After fixation of the flap to the donor site with interrupted sutures, one or two drainage tubes were inserted in the subflap position. The surface of the flap was protected with Vaseline gauze followed by a 1 cm thick layer of sterile cotton. The vacuum-assisted closure (VAC) sponge (KCI, TX) was then placed in the standard fashion and negative pressure at −125 mm Hg was initiated in a continuous mode. A window was routinely made over the flap's distal region to allow for serial flap examination. For extremity procedures, no splints were utilized, and patients were limited to motion in the hospital bed. NPWT was employed continuously for 7 days and subsequently removed along with operative drains. Results A total of 24 consecutive patients underwent free tissue transfer. The average patient age was 39.8 years with a mean body mass index of 23. Tobacco use was noted in 58% of patients in the series. The indication for the free tissue transfer included trauma (N = 21), malignancy (N = 2), and burn reconstruction (N = 1). The areas of reconstruction included scalp (N = 5), lower extremity (N = 11), and upper extremity (N = 8). Skin-containing free flaps employed consisted of the latissimus dorsi myocutaneous free flap (N = 16), anterolateral thigh free flap (N = 6), thoracodorsal artery perforator free flap (N = 1), and radial forearm free flap (N = 1). The average defect size reconstructed was 238.3 cm2 with a mean operative time of 501 minutes. Postoperatively, patients remained in the hospital an average of 15.5 days (range: 9–32 days) with a mean follow-up of 8.1 months. No hematomas, seromas, surgical-site infections, or deep vein thrombosis/pulmonary embolism occurred in the series. None of the flaps required return to the operating room. There were no documented cases of partial or complete flap loss. Conclusions NPWT may be employed in a fashion similar to the standard incisional application. With this technique, serial flap examination remains possible and is not associated with pedicle compression or increased rates of flap loss. Interestingly, no splints were utilized with the VAC device which itself may serve as a relative immobilizer of an extremity.

Combination of Three Different Negative Pressure Wound Therapy Applications and Free Flap for Open Elbow Joint Injury With Extensive Burns

2021 ◽  
Author(s):  
Junya Oshima ◽  
Kaoru Sasaki ◽  
Yukiko Aihara ◽  
Masahiro Sasaki ◽  
Yoichiro Shibuya ◽  
...  
Keyword(s):  
Free Flap ◽  
Negative Pressure ◽  
Elbow Joint ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Perioperative Period ◽  
Wound Therapy ◽  
Joint Injury ◽  
Left Limb ◽  
Effective Option

Abstract Negative pressure wound therapy (NPWT) for treating burns has a variety of therapeutic applications. Here, we present a case of a 53-year-old woman with self-inflicted burn injuries in whom NPWT was applied for three different purposes. The injured sites were the anterior neck, bilateral arms from the wrists upwards to the chest, and back. The left arm was deeply injured, and the elbow joint cavity was opened during treatment. First, NPWT was used for bridge to skin grafting on the entire upper left limb. Second, NPWT was used as a bolster dressing for the autograft after skin grafting was performed on the left arm except the open part of the joint. Third, NPWT over flap was used on the subsequent flap surgical site to address prolonged exudate from the flap margin. The exudate resolved after about a week. Good results were obtained using NPWT during the perioperative period of free flap transplantation for extensive open elbow joint burns. The use of NPWT is an effective option in the treatment of burns.

The Effectiveness of Negative Pressure Wound Therapy Versus Conventional Dressing in the Treatment of Open Fractures: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 34 (5) ◽  
pp. 223-230 ◽  
Author(s):  
Marc C. Grant-Freemantle ◽  
Éanna J. Ryan ◽  
Sean O. Flynn ◽  
Darren P. Moloney ◽  
Michael A. Kelly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Meta Analysis ◽  
Open Fractures ◽  
Wound Therapy
Sign in / Sign up

Export Citation Format

Share Document