Use of Incisional Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer

Bi, Hong‐Yan; Khan, Mohammad Sharif; Li, Junhui; Pestana, Ivo A.

doi:10.1055/s-0037-1608621

Cited by 27 publications

(37 citation statements)

References 35 publications

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“…Korber et al conducted a study on the postoperative use of VAC on a mesh graft in patients with chronic ulcers and found that the healing rate was significantly higher in the VAC treatment group compared with the conventional dressing group [9]. Similarly, studies have also reported that a VAC dressing without a splint can effectively produce a uniform compressive force and firmly fix the graft in place compared with the conventional bolster dressing [16,17]. Waltzman et al carried out a large sample study to reveal that split-thickness skin grafts (SFSGs) can be well-secured with VAC, especially in patients with burn injuries.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Chou

Hsieh

et al. 2019

Medicina

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Background and Objectives: The tie-over bolster technique has been conventionally used for skin graft fixation; however, long operative times and postoperative pain are the main disadvantages of this method. In this study, we introduce a new method using vacuum-assisted closure (VAC) with a silicon-based dressing as an alternative for skin graft fixation. This retrospective study aimed to evaluate the clinical effect of the VAC plus silicon-based dressing method and the conventional tie-over bolster technique for skin graft fixation in terms of pain, operative time, and skin graft take rate. Materials and Methods: Sixty patients who underwent skin graft surgery performed by a single surgeon from January 2017 to October 2018 were included in this clinical study. They were divided into two groups based on the type of treatment: tie-over bolster technique and vacuum-assisted closure (VAC), or silicon-based dressing groups. The operative times were recorded twice (during suturing or stapling of the graft and during removal of the dressing) in the two groups; similarly, pain was assessed using a numeric rating scale (NRS) after surgery and during dressing removal. Skin graft take rate was evaluated two weeks after dressing removal. Results: Twenty-six patients who met the eligibility criteria were enrolled into the study and assigned to one of the two groups (n = 13 each). No significant differences in age, gender, and graft area were noted between the two groups of patients. The VAC plus silicon-based dressing group demonstrated higher skin graft take rates (p < 0.05), shorter operation times (p < 0.05), and lower levels of pain (postoperative pain and pain during dressing removal) compared with the tie-over bolster technique group (p < 0.05). Conclusions: These findings indicate that VAC with silicon-based dressing can be used for skin graft fixation due to its superior properties when compared with the conventional method, and can improve the quality of life of patients undergoing skin graft fixation.

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Section: Discussionmentioning

confidence: 99%

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Chou

Hsieh

et al. 2019

Medicina

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“…Characteristics of included studies are included in ►Table 1. [11][12][13][14][15][16][17][18][19][20] These studies fulfilled our inclusion and exclusion criteria after analysis of the full content of the articles. Results of quality analysis of each study are illustrated in ►Table 2.…”

Section: Resultsmentioning

confidence: 99%

Flap Viability after Direct Immediate Application of Negative Pressure Wound Therapy on Free Flaps: A Systematic Review and Pooled Analysis of Reported Outcomes

Opoku-Agyeman

Matera

Simone

et al. 2019

J Reconstr Microsurg Open

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Background The use of negative pressure wound therapy (NPWT) devices has gained wide acceptance in the management of wounds. There have been a few reported cases of its use immediately after free tissue transfer. This is the first systematic review and pooled analysis on the immediate use of NPWT for free flaps with emphasis on the rate of free flap loss. Methods The authors performed a systematic review that focused on the rate of total free flap loss after immediate application of NPWT. EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, and PubMed databases were searched from 1997 to April of 2019. Peer-reviewed articles published in the English language were included. Results Ten articles were included in the review, yielding 211 free flap procedures. All studies were retrospective cohort studies except for two that were prospective studies and one that was a case series. The overall complete flap failure rate was n = 7 (3.3%). The most commonly reconstructed area was the lower extremity (n = 158 [74.9%]) followed by head and neck (n = 42 [19.9%]) and upper extremity (n = 11 [5.2%]). The vacuum pressure ranged from 75 to 125 mm/Hg. The time of application of the NPWT ranged from 5 to 7 days. The etiologies of wound defects were from trauma (n = 82 [63.6%]), tumor extirpation (n = 43 [33.3%]), and infection and burn (n = 4 [3.1%]). Conclusion The immediate application of NPWT on free flaps does not seem to be associated with an increased risk of flap failure.

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“…Chim et al and Bi et al have also demonstrated that negative pressure therapy can be used reliably in free tissue transfer. 4,5 Indeed, we have additionally utilized NPWT around fasciocutaneous flaps in situations where trauma has precluded primary closure due to swelling. However, the limitations to the above mentioned studies were their small sample sizes.…”

Section: Discussionmentioning

confidence: 99%

“…There were no complications related to the use of negative pressure therapy and no flap losses, which once again demonstrates that use of negative pressure immediately postoperatively does not increase flap loss or compromise the pedicle supplying the flap. 5 Eisenhardt and associates examined 26 patients with NPWT lower extremity soft tissue defects observing just two flap failures both occurring in patients with comorbid peripheral vascular disease. 6 In our retrospective, multi-institutional study performed over 9 years, we were able to review 97 cases of negative pressure therapy utilized immediately over split-thickness skin grafted free muscle flaps.…”

mentioning

confidence: 99%

Negative Pressure Dressings over Free Muscle Flaps with Immediate Split-Thickness Skin Grafting: A 9-Year Experience

Kumbla¹,

Henry²,

Boyd

et al. 2020

Journal of Reconstructive Microsurgery Open

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Background Negative pressure wound therapy has allowed for significant advances in the treatment of wounds. This occurs through a process of angiogenesis, microdeformation, macrodeformation, and decrease in exudate and bacterial load. It is routinely used as a bolster in the management of skin grafts. However, its role as a dressing over free muscle flaps has not gained widespread acceptance due to the fear of flap compromise. Methods A retrospective review of 97 patients over 9 years was performed. All patients underwent free muscle flap coverage of various wounds with immediate split-thickness skin grafting. A negative pressure dressing was applied, with windows made in the foam sponge to enable Doppler monitoring as well as visual inspection of the flap. Complications including flap failure, skin graft loss, hematoma, distal flap necrosis, negative pressure dressing failure, partial muscle necrosis, and mild flap congestion were assessed. Results Flap loss occurred at a rate of 8.2% (eight flaps). Four of these flaps were lost due to patient factors not attributable to the dressing. In the remaining four flaps (4.1% of the series), it is conceivable that the negative pressure dressing was a contributing factor. However, this failure rate is comparable to flap loss rates in studies where negative pressure dressings were not used. The rates of skin graft failure, hematoma, distal flap necrosis, inability to maintain seal, partial muscle necrosis, and mild flap congestion were also acceptable and similar to studies where negative pressure dressings were not used. Conclusion Negative pressure dressings over free muscle flaps with immediate split-thickness skin grafts are effective and safe to use while allowing for postoperative flap monitoring and skin graft protection.

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Use of Incisional Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer

Cited by 27 publications

References 35 publications

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Flap Viability after Direct Immediate Application of Negative Pressure Wound Therapy on Free Flaps: A Systematic Review and Pooled Analysis of Reported Outcomes

Negative Pressure Dressings over Free Muscle Flaps with Immediate Split-Thickness Skin Grafting: A 9-Year Experience

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