Negative Pressure Wound Therapy in Head and Neck Surgery

Abstract

IMPORTANCE Negative pressure wound therapy has been shown to accelerate healing. There is a paucity of literature reporting its use as a tool to promote wound healing in head and neck reconstruction. OBJECTIVE To review 1 institution's experience with negative pressure dressings to further describe the indications, safety, and efficacy of this technique in the head and neck. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at a tertiary care academic hospital. One hundred fifteen patients had negative pressure dressings applied between April 2005 and December 2011. Data were gathered, including indications, details of negative pressure dressing use, adverse events, wound healing results, potential risk factors for compromised wound healing (defined as previous radiation therapy, hypothyroidism, or diabetes mellitus), and wound characteristics (complex wounds included those with salivary contamination, bone exposure, great vessel exposure, in the field of previous microvascular free tissue transfer, or in the case of peristomal application in laryngectomy). EXPOSURE Negative pressure wound therapy utilized after head and neck reconstruction. MAIN OUTCOMES AND MEASURES Indications for therapy, length and number of dressing applications, identification of wound healing risk factors, classification of wound complexity, wound healing results, and adverse events related to the use of the device. RESULTS Negative pressure wound therapy was used primarily for wounds of the neck (94 of 115 patients [81.7%]) in addition to other head and neck locations (14 of 115 patients [12.2%]), and free tissue transfer donor sites (7 of 115 patients [6.1%]). The mean (SD) wound size was 5.6 (5.0) cm. The mean number of negative pressure dressing applications was 1.7 (1.2), with an application length of 3.7 (1.4) days. Potential risk factors for compromised wound healing were present in 82 of 115 patients (71.3%). Ninety-one of 115 patients (79.1%) had complex wounds. Negative pressure dressings were used in wounds with salivary contamination (n = 64), bone exposure (n = 40), great vessel exposure (n = 25), previous free tissue transfer (n = 55), and peristomal application after laryngectomy (n = 32). Adverse events occurred in 4 of 115 patients (3.5%). CONCLUSIONS AND RELEVANCE Negative pressure wound therapy in head and neck surgery is safe and has potential to be a useful tool for complex wounds in patients with a compromised ability to heal. LEVEL OF EVIDENCE 4

Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

“…The miscellaneous category (Table E) had a treatment length ranging from 6.5 to 42 days, with a follow‐up between 5 to 9 months. In this subgroup, the two largest case series reported 100% successful response rates among a total of 15 patients . Within this subset of patients, there were five with prior radiation exposure.…”

“…There were five patients with DM in this category. There were at least 15 cases of necrotizing fasciitis, and one study did not specify the number of cases of necrotizing fasciitis . Nine of these cases had documented successful responses, whereas six cases from one study had incomplete response data .…”

“…NPWT remains a useful tool in the arsenal of a wound‐care team, with many randomized control trials (RCTs) demonstrating its efficacy as being equivalent to or better than traditional wound therapy . Although there are over 3 thousand scientific articles on NPWT, there remains a paucity of research on its use in the head and neck region . The purpose of this evidence‐based review is to describe the use of NPWT in the head and neck and to provide further evidence for its usefulness.…”

Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications

“…Asher et al analysed 115 patients with head and neck wounds. Of these patients, 64 had salivary contamination.…”

Negative Pressure Wound Therapy in the Treatment of Chylousfistula after Neck Dissection

“…Publications (rather case reports) confirm the positive effects of the therapy, but high-quality, reliable studies are still missing [8]. Experience with a set of 115 patients (2005 to 2011) was published by Asher [9]. In almost 80%, wounds were risky and complicated (saliva contamination, exposure bones, exposed major vessels, the previous free flap transfer, peritracheostomy application after total laryngectomy), and two-thirds of patients had pre-existing risk factors (previous radiotherapy, diabetes mellitus, hypothyroidism).…”