Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

Abstract

Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the past decade, negative-pressure wound therapy (NPWT) has been increasingly applied to facilitate flap transfer and salvage flaps threatened by complications. It has achieved some success, but its efficacy and safety remain controversial because of the limited number of reports and lack of systematic reviews. English-language articles describing the application of NPWT on flaps were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the purpose of NPWT application. The complication rate, success rate, and salvage rate were obtained. Among the 3,395 articles searched, 16 articles describing 137 flaps were eligible. NPWT was applied on 105 (76.4%) newly transferred flaps to facilitate flap attachment and on 32 (23.4%) complication-threatened flaps to relieve flap infection and venous congestion. In total, complications developed in six flaps, three of which were lost; thus, the complication rate was 5.7% (6/105) and the success rate was 97.1% (102/105). Only 1 of the 32 threatened flaps was not successfully salvaged; thus, the salvage rate was 96.9% (31/32). NPWT may facilitate flap transfer with few side effects and help to rescue flaps threatened by infection and venous congestion with a high salvage rate. Further studies are needed to test the safety of NPWT application on flaps with arterial compromise.

The role of intermittent negative pressure wound therapy combined with a mesh incision in the salvage of perforator flap with venous congestion, a case report

“…In these cases, reconstruction of physiological venous out ow is essential to avoid continuous pathophysiologic changes in microcirculation. Once the mechanical obstruction is lifted, different non-surgical methods could be used as salvage treatments for congested aps, such as anticoagulant therapy (heparin and prostaglandin E1), manual massage to encourage drainage of the congested blood, placement of external catheters for venous drainage, subcutaneous injection of low-molecular-weight heparin or recombinant tissue plasminogen activator, blood-letting with intermittent needle puncture, and the prescription of medical leeches (11). However, the salvage rate of non-surgical methods above is less than 80% according to Yu, et al (11).…”

“…Referring to literatures reported, we decided to apply NPWT on aps threatened by venous congestion, as soon as a sign of compromise was noted and right after exploration was done. At present, the selection of NPWT pressure is still not uni ed, ranging from − 50 mmHg to -150 mmHg, and the treatment mode is mainly continuous while some researchers also use intermittent treatment mode (11). Our current plan is intermittent treatment with a -125 mmHg pressure.…”

“…As a salvage treatment for post-surgery complications including ap venous congestion, NPWT plays an important role with a high success rate of 96.9% (11). Although, we still consider prevention as the rst priority.…”

“…Short cuts through full-thickness skin created an observation window from which we could carefully determine whether the blood color was bright red or dull and the fat tissue necrosis or not to evaluate the circulation under the skin. This procedure is similar to blood-letting method, which has been a mature treatment for venous stasis (11). We combined this method with NPWT here was because besides checking the blood circulation, this kind of mesh incision that aimed for blood-letting also had a function of skin tension releasing.…”

Free flap salvage from venous thrombosis by creation of a venocutaneous fistula: Case report and review of the literature

“…Besides prompt surgical intervention and revision microvascular anastomosis, numerous treatments have been reported including medicinal leech therapy, mechanical leeching, and negative-pressure wound therapy. 4,5 The creation of a venocutaneous fistula has been reported in digital replantation, but has not been extensively described within the head and neck reconstructive literature. 6 We report the first successful use of this technique to salvage a radial forearm free flap for head and neck reconstruction.…”