Circumferential Negative Pressure Wound Therapy with Instillation and Dwell Prior to Delayed Flap Coverage for a Type IIIB Open Tibia Fracture

AbstractNegative pressure wound therapy (NPWT) is usually applied in wound management and soft-tissue salvage after the development of complications. However, immediate postoperative application of NPWT over the flap coverage is seldom reported. We evaluate the effectiveness of immediate postoperative application of NPWT following fasciocutaneous or muscle flap coverage for lower leg reconstruction. A retrospective review of patients who underwent either fasciocutaneous or muscle flap coverage of lower leg soft-tissue defects applied with NPWT immediately after surgery was conducted in a level I trauma center. Sixteen patients, with an average age of 51.2 years, were included in the study. Nine patients had trauma-related soft-tissue loss, six had subsequent soft-tissue defects after debridement, and one had burn injury. Two patients had been treated with free anterolateral thigh flaps, 11 with pedicle flaps, and three with muscle flaps. All flaps survived except for those in two patients with venous congestion on postoperative day 1, which needed further debridement and skin grafting. Therefore, the use of immediate incisional NPWT is an alternative for wound care following flap coverage. The U-shaped design allows easy flap observation and temperature check. Furthermore, this method eliminates any concerns of vascular pedicle compression under negative pressure.

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Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1709528 ◽

2020 ◽

Vol 53 (01) ◽

pp. 090-096

Author(s):

Ravikiran Naalla ◽

Smriti Bhushan ◽

Minhaj Ul Abedin ◽

Ashish Dhanraj Bichpuriya ◽

Maneesh Singhal

Keyword(s):

Dead Space ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Care ◽

Wound Dehiscence ◽

Suture Line ◽

Wound Therapy ◽

Flap Coverage ◽

The Mean ◽

Complex Wounds

Abstract Background Persistent dead space following flap cover is a frequently encountered challenge following the reconstruction of complex wounds. It may lead to a hematoma, seroma, wound infection, and wound dehiscence. Wound dehiscence could be a devastating complication. Closed incisional negative pressure wound therapy (ciNPWT) over the surgical incisions was found to reduce surgical site infection (SSI) and wound dehiscence. We applied this principle at the closed flap suture line and through this article, we share the indications, technique, and outcomes. Methods A retrospective analysis (January 2018–June 2019), in which selected high-risk patients who underwent ciNPWT at the flap suture following complex reconstruction (pedicled or free flap) were included in the study. The indications include deep incisional/organ SSI after debridement and flap coverage, persistent dead space following flap coverage, chronic osteomyelitis. Patients were analyzed in the follow-up period in terms of complications, wound healing. Results Nine patients underwent ciNPWT over the flap suture line. The mean age was 32.2 years (range: 10–48 years). The mean duration of the NPWT application was 7.3 days (range: 3–21 days). Three of the nine patients had flap-related minor complications. One patient had marginal flap necrosis and required skin grafting, one patient had minor wound dehiscence (1 cm) which required secondary skin suturing and one patient had chronic discharging sinus related to osteomyelitis of ischium, which subsequently healed with antibiotics and local wound care. None of the patients had NPWT-related complications. Conclusion Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.

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Negative Pressure Wound Therapy Tied to Complications

Internal Medicine News ◽

10.1016/s1097-8690(10)70078-0 ◽

2010 ◽

Vol 43 (2) ◽

pp. 6

Author(s):

ROBERT FINN

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Therapy

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Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332488 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

O Grauhan ◽

A Navasardyan ◽

M Hofmann ◽

P Müller ◽

J Stein ◽

...

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Obese Patients ◽

Wound Infections ◽

Wound Therapy

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Fragen zum Artikel: M. C. Nolff; A. Meyer-Lindenberg: „Vakuum – assistierte Wundbehandlung (Negative Pressure Wound Therapy, NPWT) in der Kleintiermedizin”

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.1055/s-0037-1618341 ◽

2016 ◽

Vol 44 (01) ◽

pp. 38-38

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Therapy

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Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽

10.33235/wcet.39.2.9-18 ◽

2019 ◽

Vol 39 (2) ◽

pp. 9-18

Author(s):

Wai Sze Ho ◽

Wai Kuen Lee ◽

Ka Kay Chan ◽

Choi Ching Fong

Keyword(s):

Wound Healing ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Assessment Tool ◽

Wound Care ◽

Wound Therapy ◽

Treatment Pathways ◽

Wound Assessment ◽

One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

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The effects and use of negative pressure wound therapy – a set of case reports

Perspectives in Surgery ◽

10.33699/pis.2020.99.4.183-188 ◽

2020 ◽

Vol 99 (4) ◽

pp. 183-188

Keyword(s):

Wound Healing ◽

High Risk ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Chronic Wounds ◽

Wide Spectrum ◽

Case Reports ◽

Modern Medicine ◽

Wound Therapy ◽

Basic Set

Modern medicine offers a wide spectrum of wound healing resources for acute or chronic wounds. Negative pressure wound therapy (NPWT) is a very effective method, allowing complicated defects and wounds to heal. The basic set is usually provided with various special accessories to facilitate the use and support safe application of NPWT to high-risk tissue. Selected case reports are presented herein to document the special use and combinations of materials in negative pressure wound therapy.

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