Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review

Abstract

Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the literature was performed. The following keywords and their combinations were used: "upper extremity," "arm," "forearm," "wrist," "hand," "finger" AND "negative-pressure wound therapy," "VAC therapy," "vacuum assisted closure." A total of 45 articles were included, regrouping 404 cases of NPWT in the upper extremity. The forearm was involved in 53% of cases, followed by hand (36%), fingers (10%), and arm (1%). Seventeen different indications were cited, the most common of which were radial forearm flap reconstruction (23%), burn wounds (18%), and compartment syndromes (17%). Of the cases, 90% did not require any subsequent surgical procedure, as opposed to 6% considered partial failures requiring minor revisions and 4% total failures requiring major revisions. Closure of radial forearm flap donor site required the most revision procedures when treated with NPWT. NPWT can be used for several indications pertaining to the reconstruction of the upper extremity. Positive outcomes as a definitive treatment are demonstrated in this systematic review, which reaffirms NPWT as a potent tool for reconstructive endeavours. K E Y W O R D S hand, NPWT, upper extremity, VAC

Review of History of Basic Principles of Burn Wound Management

“…NPWT has been applied to various surgical wounds since 1997 [ 135 ]. It can accelerate wound healing on both acute and chronic wounds, and it has been widely used on wounds with soft tissue defects [ 136 , 137 ]. Although the mechanism of NPWT promoting wound healing is not fully understood, some researchers suggest that it may contribute to maintaining a moist environment for wounds, removing inflammatory exudate from the wound, and reducing exposure to pathogens [ 138 , 139 ].…”

Soft and tissue repair of the hand and digital reconstruction

“…Negative pressure wound therapy (NPWT) has become a valuable aid to the management of complex wounds of the upper extremity (Shine et al, 2019). The mechanism of action of NPWT is attributed to an increase of local blood flow, the promotion of angiogenesis, removing excessive fluid and bacterial load, the induction of cellular proliferation accelerating tissue regeneration and approximating the wound edges, so reducing the wound surface area (Moue ¨s et al, 2011).…”

Sequelae of distal humeral fractures

“…In the last decade, negative pressure wound therapy (NPWT) efficacy emerged, simplifying management of wound complications and avoiding more complex surgical procedures. A recent review 42 including 404 upper extremities cases, reported good results in 90% of cases, highlighting that NPWT could be considered not only a temporary management tool but even a definitive treatment in selected patients. Minor and some major wound complications are nowadays best treated with oral antibiotics associated with NPWT: this treatment can resolve the majority of cases, often avoiding premature hardware removal.…”