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

Abstract

Negative pressure wound therapy (NPWT) has had an expanded role in the management of complex wounds including its increasing use for complex wounds in the head and neck region. Challenges for use in the head and neck region include variations in surface topography and the proximity of sensitive mouth, nose, ear, eye, and tracheal openings. Despite these challenges, NPWT has been used in the head and neck immediately following free flap surgery, to prepare wounds for skin grafting or local flaps, to treat orocutaneous and pharyngocutaneous fistulas, to treat necrotizing and deep neck space infections, to temporize and palliate, and to treat chronic wounds with exposed bone and hardware among others. This review demonstrates the proven track record of successful uses of NPWT in the aforementioned scenarios, provides suggestions to improve efficacy, as well as an algorithm for use in certain clinical situations.

Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula

“…Our results show that TNPT can significantly decrease the frequency of dressing changes and shorten the healing time without serious adverse events. Mechanistically, NPWT could accelerate wound healing by increasing dermal and subdermal perfusion, continuously removing interstitial fluid, enhancing formation of granulation tissue, increasing vascularity, and decreasing bacterial counts 14,42,43 …”

“…44,45 However, most of the relevant research has focused on the external fistula orifice, with only a limited number of studies having investigated treatment of the internal fistula orifice. 42,46 Loeck et al found that endoscopic vacuum therapy could promote closure of a PCF by treating the internal fistula orifice. 47 However, this was an isolated case report, and more studies are needed to validate the effectiveness of endoscopic vacuum therapy.…”

“…Mechanistically, NPWT could accelerate wound healing by increasing dermal and subdermal perfusion, continuously removing interstitial fluid, enhancing formation of granulation tissue, increasing vascularity, and decreasing bacterial counts. 14,42,43 At present, owing to variations in surface topography and the existence of five sense organs, use of NPWT for PCF has not been studied extensively despite having been used in complicated wound healing for decades. Teixeira et al investigated NPWT as a topical negative pressure dressing and Zhang et al evaluated the availability of continuous negative pressure flush through a dual tube.…”

“…Teixeira et al investigated NPWT as a topical negative pressure dressing and Zhang et al evaluated the availability of continuous negative pressure flush through a dual tube 44,45 . However, most of the relevant research has focused on the external fistula orifice, with only a limited number of studies having investigated treatment of the internal fistula orifice 42,46 . Loeck et al found that endoscopic vacuum therapy could promote closure of a PCF by treating the internal fistula orifice 47 .…”

More than skin deep: cyclic peptides as wound healing and cytoprotective compounds

“…These challenges are compounded by the increasing use of non-pharmacological interventions in the wound healing space, which may not pose the same degree of risk and are an attractive alternative ( Ongarora, 2022 ). An example of such a technology is Negative Pressure Wound Therapy, which has been shown to improve wound healing times in surgical and traumatic injuries ( De Pellegrin et al, 2023 ; Liebman et al, 2023 ). Additionally, although studies claim that the cost of these wound healing peptides would be low, currently approved peptide drugs such as man-made insulin often come with significant price tags that are a cause of noncompliance amongst patients ( Chiang et al, 2023 ; Li et al, 2023 ).…”