The opening of the foam dressing prevents compression over the path of the vessel pedicles to flap. ( B) U-shaped foam dressing was applied along the suture line of the flap. ( A) The defect was managed with fasciocutaneous flap coverage, and surgical closure had been completed. The NPWT machine was set at a negative pressure of 100 mmHg under intermittent suction mode (5 min of negative pressure followed by 2 min without negative pressure). The opening of the U-shaped foam was placed at the exact path of the vessel pedicle to the flap, so compression over the vessel pedicle could be prevented when negative pressure causes the foam to collapse (Fig. Long strips of gauze dressing impregnated with framycetin sulfate were placed along the suture line to prevent direct injury and skin maceration and avoid adhesion during the subsequent removal of the foam dressing.Ī reticulated open cell foam dressing was fashioned into a U shape and then applied directly over the suture line. No drainage tube was inserted underneath the flap. NPWT was immediately applied after fasciocutanous flap coverage and surgical closure had been completed. It also describes our own standard practice of NPWT application in a case series. This study evaluates the effectiveness of immediate postoperative application of NPWT following fasciocutaneous or muscle flap coverage for lower leg reconstruction. However, its safety and standard practice of application over flaps immediately after surgery remain unclear. Since NPWT can improve postoperative venous congestion, which is one of the most common causes of flap failure, immediate postoperative application of NPWT coupled with flap coverage can be considered 17– 19. Use of NPWT may resolve venous congestion by promoting local blood flow and venous return from the wound edge to reduce interstitial blood congestion, facilitating revascularization between the transferred flap and the recipient wound bed through neoangiogenesis, and reducing the interstitial space and using pressure to remove excess fluid and infectious material from the wound bed. Several recent studies have reported that NPWT can be used to promote salvage when flap survival is in doubt 15, 16. In most reported cases, NPWT was applied as a staged treatment before soft-tissue coverage. Moreover, NPWT has also been used to enhance the integration of artificial skin and dermal substitutes and reinforce skin grafts 13, 14. Therefore, NPWT has been widely used in the treatment of large and chronic wounds, including those of the chest 4– 6, abdomen 7, extremities 8– 10, pharynx 11, and head and neck 12. This method promotes wound healing by enhancing the blood supply to the wound bed before flap reconstruction, which is especially beneficial in the case of exposed fractures, highly contaminated wounds, chronic wounds with reduced healing potential, and burns 3. NPWT can provide cover for wounds under sterile conditions and potentially delay flap coverage until a healthier wound bed is formed. Furthermore, this method eliminates any concerns of vascular pedicle compression under negative pressure.įirst described by Morykwas et al., negative pressure wound therapy (NPWT) is the use of a gentle vacuum for the management of persistent wounds 1, 2. The U-shaped design allows easy flap observation and temperature check. Therefore, the use of immediate incisional NPWT is an alternative for wound care following flap coverage. All flaps survived except for those in two patients with venous congestion on postoperative day 1, which needed further debridement and skin grafting. Two patients had been treated with free anterolateral thigh flaps, 11 with pedicle flaps, and three with muscle flaps. Nine patients had trauma-related soft-tissue loss, six had subsequent soft-tissue defects after debridement, and one had burn injury. Sixteen patients, with an average age of 51.2 years, were included in the study. 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. We evaluate the effectiveness of immediate postoperative application of NPWT following fasciocutaneous or muscle flap coverage for lower leg reconstruction. However, immediate postoperative application of NPWT over the flap coverage is seldom reported. Negative pressure wound therapy (NPWT) is usually applied in wound management and soft-tissue salvage after the development of complications.
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