Incisional Negative Pressure Wound Therapy with Reinforcement of Subcutaneous Drainage (Hybrid-iNPWT)

Abstract

Introduction: Incisional negative pressure wound therapy (iNPWT) is a preventive measure for postoperative wound dehiscence in which negative pressure is applied to the suture wound. Indeed, insufficient drainage in the deep layer is associated with an increased risk of developing subcutaneous hematoma and wound complications. Here, we report two cases of lower limb degloving injury successfully managed by iNPWT, with the reinforcement of subcutaneous drainage (hybrid-iNPWT). Case presentation: Case 1 was that of an 87-year-old man who sustained a deep, dissecting hematoma of the left lower leg associated with the sensation of severe tightness and pain. After emergency incision and removal of the hematoma in the deep fascia, we performed a primary closure of the flap wound. A negative pressure of 80 mmHg was applied to the sutured wound via foam dressing (iNPWT). Concurrently, we connected the negative pressure device with a subcutaneous drainage tube inserted under the flap (hybrid-iNPWT). The flap survived without recurrence of hematoma. Case 2 was that of an 89-year-old woman with a right lower leg degloving injury. The skin and subcutaneous tissues were detached from the underlying fascia. After primary closure of the flap, hybrid-iNPWT was performed at a subatmospheric pressure of 80 mmHg. The patient was discharged without any complications related to wound healing. Discussion: The aim of using hybrid-iNPWT was to apply negative pressure not only to the surface of the sutured wound but also to the posterior portion of the flap. The intensity of the negative pressure provided by the iNPWT device was higher than that of the conventional suction drainage tube system. Hybrid-iNPWT can be an alternative solution for hematoma prevention and may allow early ambulation in the management of lower limb degloving injuries in elderly patients.

Modified Incisional Negative Pressure Wound Therapy Increases Seroma Evacuation: An Ex Vivo Model

“…Until now, relevant large-scale in vivo data is lacking on similarly modified iNPWT dressing as we were the first to consider possible modifications based on clinical expertise. Recently, Kitano et al presented two cases in which they applied a similar iNPWT system with a connected subcutaneous suction drain tube [ 31 ]. They termed the apparatus hybrid-iNPWT and used it for hematoma prevention in degloving injuries of two elderly patients.…”

“…We performed the measurements in linear incisions that are straight, nonwinding cavities. In contrast, degloving injuries represent larger, nonlinear wounds, and the hybrid-iNPWT still seemed to ameliorate wound hematoma formation [ 31 ]. Taking together our ex vivo and the scarce existing clinical data, it suggests an efficacy on linear as well as wider wounds by modified iNPWT.…”

Osteoporotic osseointegration: therapeutic hallmarks and engineering strategies

“…The effect of negative pressure on bone defect repair can be modified by adjusting the working distance and pressure magnitude. As the distance increases, the pressure, shear stress, and fluid velocity of bone trabeculae decrease exponentially, and the magnitude of negative pressure greatly influences fluid dynamics, especially when the pressure is near the pressure source 158 . Moreover, the structural anisotropy of bone trabeculae is associated with the anisotropic hydrodynamic behavior of the marrow, and the stimulation of negative pressure leads to unstable marrow flow during trabecular regeneration.…”

Statistical Study on Negative Pressure Strength during Skin Graft Fixation

“…The therapy has evolved extensively, including some with a cleaning function 2,3) and others intended mainly for outpatient use. It has additional clinical applications, such as drainage of dead spaces using continuous negative pressure 4) and continuous local perfusion of highly concentrated antibiotics 5) . Recent studies have demonstrated that NPWT is useful for skin graft fixation 6,7) because of advantages such as better stability and drainage of exudate than conventional fixation methods (e.g., tie-over method).…”