Negative pressure wound therapy: an adjuvant to surgical reconstruction of large or difficult skin and soft tissue defects

Abstract

Wide and deep wound defects are a challenge to surgeons, particularly when aggressive or more radical operations are unavailable. This article introduces refined techniques, indications and the clinical experience of the application of negative pressure wound therapy (NPWT) as an easy ancillary wound dressing method for the reconstruction of large or difficult skin and soft tissue defects. The authors used NPWT on 88 patients as an adjuvant therapy before reconstructive surgery since 2006. NPWT was applied for two different treatment strategies: as an adjuvant therapy to facilitate the formation of a healthy wound bed and to reduce the size and depth of a defect. NPWT was used as an alternative dressing method for skin grafting for infants or mobile skin surfaces such as the neck, penis, dorsum of the hand, knee joint, abdomen, etc. There were no typical wound complications. NPWT application, if used appropriately, produces successful surgical reconstructions for large, deep skin and soft tissue defects without extensive or radical flap surgery or loss of skin graft.

Comparison of negative pressure wound therapy and secondary intention healing after excision of acral lentiginous melanoma on the foot

“…24,25 Moreover, significantly decreased wound discharge compared with SIH reduces the number of bacterial colonies and development of infection. [26][27][28] In this comparison of SIH and NPWT after excision of acral lentiginous melanoma on the foot, the patient group treated with negative pressure showed significantly lower VBSAS scores. In particular, a significant difference was also found in the levels of vascularity and depression, showing the positive effects of NPWT on minimizing the size of the final scar, which is relatively hard, by contracting tissues of the skin defect.…”

“…In addition, microperfusion and angiogenesis increase, and the amount of healthy granulation tissue also increases by virtue of cell proliferation, contributing to enhancement of wound healing 24,25 . Moreover, significantly decreased wound discharge compared with SIH reduces the number of bacterial colonies and development of infection 26–28 …”

Topical negative pressure coupled with split‐thickness skin grafting for the treatment of hidradenitis suppurativa: a case report

“…Vacuum sealing drainage can be maintained for 7-10 days without the need of changing dressings, which minimises any patient discomfort and reduces medical staff workload. Thus, TNP is an effective treatment for complex chronic wounds (12).…”

Reconstruction of massive full‐thickness abdominal wall defect: successful treatment with nonabsorbable mesh, negative pressure wound therapy, and split‐skin grafting

“…The first priority is to get closure of the abdominal contents, whereas skin closure is secondary. The use of abdominal negative pressure wound therapy (NWPT) with plastic draping over the abdominal content has become standard of care in most centers 2, 3 as a temporary mean to get the abdominal walls retracted toward the midline, handling swollen soft tissue as well as edematic inner organs due to heavy infection, trauma, etc. 4, 5, 6.…”