Impact of Previous Irradiation on Wound Healing after Negative Pressure Wound Therapy in Head and Neck Cancer Patients—A Systematic Review

Abstract

(1) Background: Negative pressure wound therapy (NPWT) has been effectively used for wound management in comparison to traditional dressings. The purpose of this study was to provide an evidence-based review of NPWT in head and neck cancer patients, as well as the impact of previous irradiation and other risk factors on wound healing. (2) Material and Methods: We conducted a comprehensive search in PubMed, Medline, Embase, Web of Science, and Cochrane Library databases for relevant literature. (3) Results: 15 studies fulfilled the inclusion criteria. The most common etiologies requiring NPWT were defects post tumor resection and flap reconstruction and oro/pharyngo-cutaneous fistulas. The neck was found to be the most common site of involvement (47.3%). The overall wound healing response rate was 87.5%. The median negative pressure recorded was 125 mm of Hg, with a median dressing change time of three days. Previous irradiation (p = 0.01; OR = 4.07) and diabetes mellitus (DM) (p = 0.001; OR = 5.62) were found to be significantly associated with delayed wound healing after NPWT. (4) Conclusion: NPWT treats complex wounds in head and neck cancer patients and should represent a significant armamentarium in head and neck cancers. Previous irradiation and DM have detrimental effects on wound healing after NPWT.

Cutaneous Radiation Injuries: REAC/TS Clinical Experience

“…15 Pre-operative and post-operative use of negative pressure wound therapy, hyperbaric oxygen therapy, and platelet antiaggregating agents have shown promise in reducing time to healing and wound complications. [21][22][23] It should be mentioned that in the United States insurance environment, approval for non-traditional therapies can be very difficult to obtain in a timely fashion and often requires the engagement of the treating physician and outside experts in these cases, in the experiences of the REAC/TS staff. For example, hyperbaric oxygen treatments, which is a therapeutic treatment frequently employed in dealing with chronic ulcers, have shown efficacy with soft tissue radiation injuries but in the REAC/TS experience require more treatments than usual for chronic wound or ulcer treatment.…”

Considerations of Medical Preparedness to Assess and Treat Various Populations During a Radiation Public Health Emergency

“…In addition to exacerbating radiation-induced injury to the cardiovascular system, GI, and lungs, the combination of DM and radiation-induced microvascular damage may slow wound healing; a major concern given the likelihood of combined injuries in a radiological or nuclear incident (167,168). The exacerbation of all of these radiation injuries by diabetic complications is further concerning given that diabetic patients are at higher risk of infection due to hyperglycemia-related suppression of neutrophil function, depression of the antioxidant system, and more (157).…”

Negative Pressure Wound Therapy in the Head and Neck: A Summary of Uses and Application Techniques

“…Their analysis was able to identify history of radiation and diabetes mellitus as significant risk factors for an unfavorable response to NPWT when success of therapy was defined as granulation tissue covering at least 80% of the wound surface area. 18 Additionally, across 380 patients included they were able to report mean length of use of NPWT (10 days) as well as mean number of dressing changes (3.2). Their overall success rate of 88.2% was comparable to that of Mir et al…”