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

Abstract

Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: “negative pressure wound therapy,” “head and neck,” and “fistula.” We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow‐up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of −125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high‐quality trials are warranted to corroborate the findings of this systematic review.

The efficacy of negative‐pressure wound therapy for head and neck wounds: A systematic review and update

“…This is particularly crucial for patients with coagulopathies or those on anticoagulant therapy 26 . Another concern is patients with high‐output fistulae, who must be closely monitored to ensure fluid loss does not lead to hemodynamic instability 3 . An absolute contraindication is the presence of residual malignancy in the wound, as NPWT might stimulate the proliferation of malignant tissue and thus these patients should be excluded 7,35 .…”

A Novel Technique of Negative Pressure Wound Therapy for Pharyngeal Cutaneous Fistulas Around Tracheostomas

“…In recent years, many reports have suggested using NPWT for head and neck wounds with fistulas 2,3 However, to perform NPWT on the fistula, the following 2 conditions have to be met:…”

“…Furthermore, if a fistula forms in the anastomotic part of the esophagus and jejunum, it is difficult to treat. Negative pressure wound therapy (NPWT) is an effective treatment for skin wounds, but in recent years, its usefulness in cases of pharyngeal cutaneous fistulas after head and neck reconstruction has been reported 2,3 …”

Unterdrucktherapie, Negative Pressure Wound Therapy (NPWT)

“…Die Verwendung von NPWT zielt auf die Optimierung mehrerer Faktoren der Wundheilung ab, indem subatmosphärische Drücke die Entzündungsreaktionen reduzieren und die Bildung von Granulationsgewebe fördern [1]. Die Unterdrucktherapie stellt nicht nur eine temporäre Weichteilbedeckung bei offenen, komplexen Wunden dar, sondern ist vielmehr als eigenständiger Bestandteil des rekonstruktiven Armamentariums zu betrachten [5]. Zu den Fachrichtungen, die NPWT-Verbände regelhaft im klinischen Alltag anwenden, zählen u. a. die Unfallchirurgie, Orthopädie, Gefäßchirurgie, Plastische Chirurgie, Gynäkologie, Viszeralchirurgie und Neurochirurgie.…”