Negative Pressure Wound Therapy as a Salvage Procedure in Venous Congestion of Microsurgical Procedures

Quintero, Jorge I.; Cárdenas, Laura; Achury, Adriana C; Vega-Hoyos, Daniela; Bermudez, J. Cañete; Hand, Fsfb

doi:10.1097/gox.0000000000003725

Cited by 5 publications

(7 citation statements)

References 18 publications

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“…All patients were started on anticoagulation treatment. 5 No complications, other than venous congestion, were identified during the hospitalization or follow-up period. At the time of the last follow-up, none of the patients needed a blood transfusion, no complications were seen secondary to the anticoagulation therapy‚ and all three fingers healed with normal function.…”

Section: Resultsmentioning

confidence: 99%

“…We followed our prior setting. 5 NPWT was applied around the injured finger and the next one. NPWT foam was used in the volar and dorsal aspects of the finger, leaving the fingertip uncovered to allow the surgeon to evaluate the graft.…”

Section: Resultsmentioning

confidence: 99%

“…All patients followed the same anticoagulation protocol previously described. 5 Settings and duration of NPWT of all three digits were recorded.…”

Section: Methodsmentioning

confidence: 99%

“… 4 Recently, negative pressure wound therapy (NPWT) has been identified as a novel method to treat venous congestion in free flaps. 5 These favorable results have allowed for exploration of the use of NPWT in venous congestion following finger replantation. We report three cases of finger replantation that developed venous congestion and were treated with NPWT as a salvage procedure.…”

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confidence: 99%

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Microsurgical Complications after Finger Reimplantation Treated with Negative Pressure Wound Therapy: A Case Report

Quintero

Moreno-Serrano

Bermudez

2022

Plastic and Reconstructive Surgery - Global Open

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Venous congestion is the most critical complication following microsurgical finger replantation and can present within the first postoperative days or even in the immediate postoperative period. 1 Several treatment options for this complication have been described, including leech therapy, 2 active bleeding of the fingertip or nail bed, 3 and systemic anticoagulation with a high risk of anemia and blood transfusion requirements. 4 Recently, negative pressure wound therapy (NPWT) has been identified as a novel method to treat venous congestion in free flaps. 5 These favorable results have allowed for exploration of the use of NPWT in venous congestion following finger replantation. We report three cases of finger replantation that developed venous congestion and were treated with NPWT as a salvage procedure. MATERIALS AND METHODSThis is a case series of three patients who underwent digit replantation. The postoperative course was complicated by venous congestion. NPWT was applied after the diagnosis of venous congestion since venous reconstruction was very challenging due to the amputation zone. All patients followed the same anticoagulation protocol previously described. 5 Settings and duration of NPWT of all three digits were recorded. RESULTSThe first patient is a 33-year-old woman with an amputation of the index finger at the level of the distal interphalangeal joint secondary to a table saw injury. Microsurgical anastomosis of one artery and one vein was performed 33 hours after her admission. Venous congestion and probable arterial insufficiency were identified 44 hours after the finger reimplantation and NPWT was initiated. Five days after continuous NPWT the finger was no longer congested and viable.The second patient is a 46-year-old man with an amputation of the left thumb at interphalangeal joint secondary to a table saw injury. Microsurgical anastomosis of one artery and one vein was performed after 8 hours of cold ischemia. Venous congestion was identified 96 hours later, and NPWT was applied. Three days after continuous NPWT, the thumb was less congested and was viable.The third patient is a 28-year-old man with an avulsion amputation of the right ring finger at mid-third of the proximal phalanx. Microsurgical anastomosis of one artery and two veins was performed after 2 hours of cold ischemia. Fracture of the head of the middle phalanx with avulsion of the flexor digitorium profundus and complete laceration of the extensor mechanism was the initial injury. The radial and ulnar nerves were sutured, and the

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…All patients followed the same anticoagulation protocol previously described. 5 Settings and duration of NPWT of all three digits were recorded.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Microsurgical Complications after Finger Reimplantation Treated with Negative Pressure Wound Therapy: A Case Report

Quintero

Moreno-Serrano

Bermudez

2022

Plastic and Reconstructive Surgery - Global Open

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“…(1) NPWT is now being used in the treatment of venous congestion after microsurgical procedures. (2) This case series aims to demonstrate the applicability of NPWT for pedicled flap reconstruction using our institutional protocol.…”

Section: Introductionmentioning

confidence: 99%

Use of Negative Pressure Wound Therapy in Pedicled Flaps can Improve Graft Integration and Minimize Complications

Suarez,

Latorre,

Quintero

2024

J Reconstr Microsurg Open

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Negative pressure wound therapy (NPWT) has been used in the treatment of open fractures to improve local wound treatment, to allow skin integration when skin grafting is needed. During the last decade, the use of this device contributes to decreasing the venous congestion in microsurgical procedures in free flaps and finger replantation. The negative pressure increases the vascularization and decreases the edema, allowing the integration of tissue. Nine patients were included in this protocol. These patients had an open wound, and primary healing was not an option. Therefore, reconstructive surgery was needed. One female and eight male patients were included. Five reconstructive surgeries were performed in the lower limb and four in the upper limb due to an open fracture, skin defect secondary to infection, avulsion injury of the upper limb, and electric burn. Following the reconstructive procedure, NPWT was applied immediately peripheral to the pedicled flap. Our protocol indicates that the suction was placed for 5 days, set at continuous pressure of −100 mm Hg. At the end of the treatment, no complications were observed, and full integration of the flap was achieved. NPWT avoids local complications such as hematoma, shearing forces, and infection.

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Distal ligation with proximal catheterization of short saphenous vein to decrease venous congestion in the distally based sural artery flap

Abd-Almoktader

Youssif²,

Sholkamy³

et al. 2023

Eur J Plast Surg

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Negative Pressure Wound Therapy as a Salvage Procedure in Venous Congestion of Microsurgical Procedures

Cited by 5 publications

References 18 publications

Microsurgical Complications after Finger Reimplantation Treated with Negative Pressure Wound Therapy: A Case Report

Microsurgical Complications after Finger Reimplantation Treated with Negative Pressure Wound Therapy: A Case Report

Use of Negative Pressure Wound Therapy in Pedicled Flaps can Improve Graft Integration and Minimize Complications

Distal ligation with proximal catheterization of short saphenous vein to decrease venous congestion in the distally based sural artery flap

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