Negative pressure wound therapy for the management of flaps with venous congestion

Qiu, Shan Shan; Hsu, Chung-Chen; Hanna, Steven; Chen, Sirena Hsin-Yu; Cheong, Chon-Fok; Lin, Chih‐Hung; Chang, Tommy Nai-Jen

doi:10.1002/micr.30027

Cited by 28 publications

(28 citation statements)

References 26 publications

(51 reference statements)

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“…1). [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] There was only one prospective randomized trial 27 ; the other 15 studies were all retrospective observational studies with low-level evidence according to the Oxford classification of evidence-based medicine (►Table 1). The first article on this topic was published in 2004, 31 and the remaining articles were published within the past 10 years (►Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

Yang

et al. 2017

J reconstr Microsurg

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Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the past decade, negative-pressure wound therapy (NPWT) has been increasingly applied to facilitate flap transfer and salvage flaps threatened by complications. It has achieved some success, but its efficacy and safety remain controversial because of the limited number of reports and lack of systematic reviews. English-language articles describing the application of NPWT on flaps were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the purpose of NPWT application. The complication rate, success rate, and salvage rate were obtained. Among the 3,395 articles searched, 16 articles describing 137 flaps were eligible. NPWT was applied on 105 (76.4%) newly transferred flaps to facilitate flap attachment and on 32 (23.4%) complication-threatened flaps to relieve flap infection and venous congestion. In total, complications developed in six flaps, three of which were lost; thus, the complication rate was 5.7% (6/105) and the success rate was 97.1% (102/105). Only 1 of the 32 threatened flaps was not successfully salvaged; thus, the salvage rate was 96.9% (31/32). NPWT may facilitate flap transfer with few side effects and help to rescue flaps threatened by infection and venous congestion with a high salvage rate. Further studies are needed to test the safety of NPWT application on flaps with arterial compromise.

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Section: Resultsmentioning

confidence: 99%

“…According to the reconstruction maneuver, there were 18 (13.1%) local random flaps, 21,22 21 (15.3%) pedicle flaps, 29,[31][32][33]36 and 98 (71.5%) free flaps. [23][24][25][26][27][28]30,[32][33][34][35] However, the articles were divided into groups based on the purpose of NPWT application. The details are presented in ►Tables 2 to 5.…”

Section: Resultsmentioning

confidence: 99%

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

Yang

et al. 2017

J reconstr Microsurg

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“…They removed the furthest stitches and applied NPWT on a raw surface. As a result, all aps survived (20). Uygur, et al saved an anterolateral thigh fasciocutaneous ap with two cycles of VAC therapy-an early version of NPWT, in which case venous congestion disappeared mostly 72 hours later (22).…”

Section: Discussionmentioning

confidence: 99%

“…Also, precise operation is needed, to reduce damage around the vascular pedicle. When the surgery is nished, doctors and nurses should provide expert intensive care in the early postoperative period: monitor if any oozing of dusky blood occurs, notice any changes in skin color and temperature, check the blood ow by puncture tests, and take photos regularly if possible (20).…”

Section: Discussionmentioning

confidence: 99%

“…However, contraindications of surgical intervention do exist at some point. Examples are, venous compromise after propeller ap reconstruction with sizeable perforators; venous congestion after dividing the skin bridge in pedicle aps; venous congestion after non-physiological ap reconstructions; and other patient conditions for which surgical intervention is contraindicated, such as patient's severe comorbidities, refusal of further surgeries, or tortuous venous anatomy (20). In our cases, we used a mesh incision as an exploration and observation method.…”

Section: Discussionmentioning

confidence: 99%

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The role of intermittent negative pressure wound therapy combined with a mesh incision in the salvage of perforator flap with venous congestion, a case report

Xie

et al. 2020

Preprint

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Background: The application of perforator flap is becoming wide. The most common postoperative complication is venous congestion but traditional treatments’ effect is limited. A new method called negative pressure wound therapy(NPWT) was introduced to improve wound healing. Many scholars have tried this method with continuous mode and achieved good outcomes. In this paper, we tried a different mode(intermittent) of negative pressure wound therapy on congested perforator flaps after a mesh incision, and we expected this paper could provide information for follow-up clinical research.Case presentation: A retrospective research of 6 patients (6 perforator flaps) who had been suffered from venous congestion from June, 2016 to June, 2019 was performed. All flaps were treated by intermittent negative pressure wound therapy after a mesh incision. Among 6 flaps, 4 of them were totally survived while the other 2 of them were mostly survived.Conclusions: Intermittent negative pressure wound therapy combined with a mesh incision can be a safe option to rescue perforator flaps with venous congestion. This technique has a certain success rate and clinical application value.

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History of Negative-Pressure Wound Therapy (NPWT)

Shiffman¹

2017

Pressure Injury, Diabetes and Negative Pressure Wound Therapy

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Negative pressure wound therapy for the management of flaps with venous congestion

Abstract: NPWT may be considered an alternative management strategy for flaps, which has undergone venous congestion not due to a mechanical cause. © 2016 Wiley Periodicals, Inc. Microsurgery 36:467-473, 2016.

Cited by 28 publications

References 26 publications

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

The role of intermittent negative pressure wound therapy combined with a mesh incision in the salvage of perforator flap with venous congestion, a case report

History of Negative-Pressure Wound Therapy (NPWT)

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