Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions

Abstract

Background Persistent dead space following flap cover is a frequently encountered challenge following the reconstruction of complex wounds. It may lead to a hematoma, seroma, wound infection, and wound dehiscence. Wound dehiscence could be a devastating complication. Closed incisional negative pressure wound therapy (ciNPWT) over the surgical incisions was found to reduce surgical site infection (SSI) and wound dehiscence. We applied this principle at the closed flap suture line and through this article, we share the indications, technique, and outcomes. Methods A retrospective analysis (January 2018–June 2019), in which selected high-risk patients who underwent ciNPWT at the flap suture following complex reconstruction (pedicled or free flap) were included in the study. The indications include deep incisional/organ SSI after debridement and flap coverage, persistent dead space following flap coverage, chronic osteomyelitis. Patients were analyzed in the follow-up period in terms of complications, wound healing. Results Nine patients underwent ciNPWT over the flap suture line. The mean age was 32.2 years (range: 10–48 years). The mean duration of the NPWT application was 7.3 days (range: 3–21 days). Three of the nine patients had flap-related minor complications. One patient had marginal flap necrosis and required skin grafting, one patient had minor wound dehiscence (1 cm) which required secondary skin suturing and one patient had chronic discharging sinus related to osteomyelitis of ischium, which subsequently healed with antibiotics and local wound care. None of the patients had NPWT-related complications. Conclusion Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.

Intraoperative Near-infrared Spectroscopy Can Predict Skin Flap Necrosis

“…The midway point of this zone at StO 2 values of 72.5% has a sensitivity of 86% and specificity of 86% for predicting SFN. This would suggest that for skin flaps with StO 2 measurements below 72.5% and above 60%, perfusion has been compromised but may still be salvageable with adjuncts such as hyperbaric oxygen, 15 topical vasodilators, 16,17 negative pressure dressings, 18 and avoidance of additional insults such as compressive dressings, smoking, pressure, hypoxia, and hypotension. 19,20 This study has limitations.…”

Outcome of Prophylactic Postoperative Negative Pressure Wound Treatment in Colorectal Cancer Patients

“…6,7 Although some recent published articles report that prophylactic use of NPWT following surgery may be associated with fewer SSI, there is controversy surrounding this topic. [8][9][10][11][12][13] Using a nationwide database, this study aims to investigate the outcome of prophylactic negative pressure wound treatment (NPWT) in colorectal cancer operations. We speculated that a prophylactic NPWT would be associated with less postoperative wound infection following colorectal cancer surgery.…”

A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study

“…The first indications for these devices included open fractures and chronic, high-risk, lower extremity wounds [9,2]. As techniques and technology have advanced, NPWT has become a safe and established method for improving surgical site related outcomes in select patients [1,14,15]. The cost effectiveness of NPWT remains controversial, though many studies have found it to be cost-neutral, if not cost saving, in a majority of applications [12,16,28].…”