Comparison of negative pressure wound therapy and conventional dressing methods for fibula free flap donor site management in patients with head and neck cancer

Bach, C.; Guilleré, L.; Yildiz, Sinasi; Wagner, I.; Darmon, S.; Chabolle, F.

doi:10.1002/hed.23952

Cited by 14 publications

(17 citation statements)

References 16 publications

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“…Previous groups have recommended that donor sites with width of less than 4 cm can be closed safely without tension although this will vary with skin laxity [ 5 , 6 ]. Other techniques to reduce wound healing problems include using negative pressure wound therapy over skin grafts and the harvest of a fat-fascia only flap in order to enable primary closure [ 7 , 8 ].…”

Section: Resultsmentioning

confidence: 99%

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

Kearns

Ermogenous

Myers³

et al. 2018

Arch Plast Surg

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With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

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Section: Resultsmentioning

confidence: 99%

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

Kearns

Ermogenous

Myers³

et al. 2018

Arch Plast Surg

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“…Open healing of the fibular donor site and meshing of the surrounded tissue has been reported as a modification to decrease the wound area and avoid the morbidity associated with graft and resulted in a good cosmetic outcome ( 99 ). The use of vacuum-assisted closure allows patients to be mobilized sooner, assures greater graft acceptance, and reduces healing time up to 50% ( 100 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning

et al. 2022

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BackgroundVirtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success.MethodThis retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply.ResultA total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs’ vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP.ConclusionIn general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome.

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“…Additionally, though the use of negative-pressure therapy has resulted in a shortened healing period, they also demonstrated that the time of total healing of skin grafts can still be extensive, and has been reported from 67 days to as long as 163 days. 25 The use of a wound vac can also add a significant amount of cost to the postoperative care, with cost of the devices themselves, as well as home health care nurses for vac and/or dressing changes, and the cost of the dressing materials themselves. The use of PFPFs has been used extensively in lower extremity reconstruction, 26 and since its introduction has undergone multiple modifications and adaptations for different uses in reconstructive surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of propeller flaps versus skin grafts for coverage of osteocutaneous fibula free flap donor site defects

Kaleem¹,

Patel²,

Schubert³

et al. 2022

Head & Neck

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Background Authors compare use of propeller flaps versus skin grafts in defect coverage after fibula flap harvest. Materials and Methods Retrospective review of patients who received either PFPF or STSG. Primary predictor variable was technique, and secondary predictor variables were comorbidities. Primary outcome variable was flap/graft healing, and secondary outcome variables were cosmesis, adverse events, effect on activities of daily living (ADLs), pain, additional procedures, and cost. Statistical analysis performed via independent sample t tests, ANOVA, and χ2 tests. Logistic regression analysis was performed. Results Study sample was 50 patients. PFPFs showed higher rates of success, while STSG showed increased complications and adverse events. Pain and ADLs significantly affected in STSG group. Cosmesis was better in the PFPF group, and overall cost was significantly higher in STSG group. Conclusion PFPFs show greater success rates, fewer complications, improved cosmesis, less pain, reduced cost compared to STSG for wound coverage after fibula flap harvest.

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Comparison of negative pressure wound therapy and conventional dressing methods for fibula free flap donor site management in patients with head and neck cancer

Abstract: The use of negative pressure wound therapy for fibula free flap donor site management facilitates early patient mobilization, ensures better graft acceptance, and significantly decreases the healing time.

Cited by 14 publications

References 16 publications

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning

Comparison of propeller flaps versus skin grafts for coverage of osteocutaneous fibula free flap donor site defects

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