Immediate Negative Pressure Wound Therapy After Free Flap Transfer for Head and Neck Cancer Surgery

Abstract

Objective: This study aimed to assess the outcomes of administering negative-pressure wound therapy (NPWT) in patients immediately following free flap reconstruction after head and neck cancer surgery and radical neck lymph node dissection. The outcomes were compared with those of patients who received conventional wound care (CWC).Methods: A retrospective analysis was performed for 58 patients with head and neck cancer who underwent free flap reconstruction after tumor ablation and radical neck dissection between February 1, 2016, and October 31, 2016. All reconstructions were performed by the same plastic surgeon. Charts were reviewed for patient demographics, comorbidities, cancer type, operation time, flap type, postoperative drainage volume, complication rates, length of hospital stay, and wound outcomes.Results: No significant difference was observed between patients receiving NPWT and CWC regarding operation time and drainage volume from the vacuum ball. After the application of NPWT, no patients experienced flap failure or developed a wound infection. Significantly fewer patients receiving NPWT developed complications (9.7% vs. 37.0%; P = 0.025) and developed infections (0.0% vs. 14.8%; P = 0.041) compared with those receiving CWC.Conclusion: On the basis of fewer associated complications and infections, this study supports the immediate use of NPWT after free flap reconstruction in patients who have undergone head and neck cancer ablation and radical neck lymph node dissection.

Surgical Site Infection Affects Length of Stay After Complex Head and Neck Procedures

“…However, several potential confounders of our analysis could not be controlled for due to lack of availability or robust reporting with the NSQIP database; particularly, data on perioperative antibiotic prophylaxis, previous radiation therapy, postoperative wound therapy, and patient alcohol use were not available. These variables are recognized in the literature as influencing SSI occurrence 3,9–10,27 . This limitation is inherent in the use of the ACS‐NSQIP database to answer this clinical question.…”

“…These variables are recognized in the literature as influencing SSI occurrence. 3,9,10,27 This limitation is inherent in the use of the ACS-NSQIP database to answer this clinical question. A broad definition of SSI was used in an effort to capture all possible SSIs, which included cases recorded as wound breakdown in the ACS-NSQIP database.…”

“…3 Studied risk factors for SSI in HNS include length of surgery, contamination of the neck via communication with the oral cavity, and more complex surgery, among others. [7][8][9][10][11][12] The recent increased complexity of HNS cases is largely due to the implementation of free tissue transfer for reconstruction of surgical defects. This has led to an increase not only in operative times, but also in the number of exposed body sites during surgery.…”

“…Rates vary widely due to heterogeneous definitions of SSI and depending on the particular subset of patients studied 3 . Studied risk factors for SSI in HNS include length of surgery, contamination of the neck via communication with the oral cavity, and more complex surgery, among others 7–12 . The recent increased complexity of HNS cases is largely due to the implementation of free tissue transfer for reconstruction of surgical defects.…”

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

“…Characteristics of included studies are included in ►Table 1. [11][12][13][14][15][16][17][18][19][20] These studies fulfilled our inclusion and exclusion criteria after analysis of the full content of the articles. Results of quality analysis of each study are illustrated in ►Table 2.…”