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

Mir, Ahsan; Guys, Nicholas; Arianpour, Khashayar; Svider, Peter F.; Rayess, Hani; Zuliani, Giancarlo; Raza, Syed Mohsin; Lin, Ho‐Sheng

doi:10.1002/lary.27262

Cited by 23 publications

(30 citation statements)

References 67 publications

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“…In the era of evidence based medicine, Mir et al, [11] yielded in a review 522 cases of NPWT use in head and neck in 57 studies. The total number of trauma cases in all studies (13) was astonishingly only 50 cases in all studies.…”

Section: Discussionmentioning

confidence: 99%

Negative Pressure Wound Therapy (NPWT) in Head and Face Trauma, Can it Change the Reconstruction Ladder?

Kadry

2022

The Egyptian Journal of Plastic and Reconstructive Surgery

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Introduction: Trauma to the head and neck region especially the face is becoming more and more common due to the speed of our life style. Exposed bone in this region presents a daily challenge to the reconstruction surgeon as each of the options available for reconstruction (grafts, flaps, free flaps over even secondary intentions) comes at a price. Negative Pressure Wound therapy evolved over the last few decades offering a way to cover almost all kinds of raw areas. The effectiveness of NPWT over exposed bones have been studied and proven. The use of NPWT in the head and neck trauma setting is still understudied today due to the specific topographic nature of the head and neck making its fixation challenging.Patients and Methods: This randomized prospective control study was conducted on the first 40 patients presenting to the author in the period from April 2017 to April 2021. Patients were randomized into 2 groups. Group A patients treated with NPWT and Group B patients treated with conventional dressing. NPWT was applied on a continuous mode between 100-125mm Hg. The size of the defect as well as the time needed for healing were one of the main parameters recorded.Results: Out of the 40 patients recruited for this study only 35 patients ( 18 in group A & 17 in group B) fulfilled the inclusion and exclusion criteria The time needed for the raw area to be ready for definitive management was statistically significant with a p-value of <0.001 in favor of the NPWT group. This shows a superiority of the NPWT in reducing the time for healing as well as decreasing the frequency of dressing thus decreasing the psychological burden on the patient. Conclusion:Negative Pressure Wound Therapy is a useful tool in covering head and faces exposed bones with shorter recovery time and more ease and comfort for the patient. This study suggests it as modality for treatment in certain conditions as an alternative and not as replacement for other well established techniques such as local and free flaps.

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Section: Discussionmentioning

confidence: 99%

Negative Pressure Wound Therapy (NPWT) in Head and Face Trauma, Can it Change the Reconstruction Ladder?

Kadry

2022

The Egyptian Journal of Plastic and Reconstructive Surgery

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“…The efficacy of NPWT/VAC therapy for all kinds of head and neck wounds has been recently reviewed in an excellent paper [ 32 ]. One problem is the definition of the outcome.…”

Section: Discussionmentioning

confidence: 99%

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

Locatello

Licci

Maggiore

et al. 2021

JCM

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Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.

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“…The intended use was to facilitate granulation tissue formation until subsequent reconstruction using skin graft or local flaps. Mir et al labelled the response to be 100% when there was either complete closure or granulation tissue formation and otherwise a failed or 0 response [36]. The studies in cumulative series showed a mean response rate of 88.2% (82.2 ± 10.4).…”

Section: Discussionmentioning

confidence: 99%

Impact of Previous Irradiation on Wound Healing after Negative Pressure Wound Therapy in Head and Neck Cancer Patients—A Systematic Review

Faisal

Berend

Seemann³

et al. 2021

Cancers

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(1) Background: Negative pressure wound therapy (NPWT) has been effectively used for wound management in comparison to traditional dressings. The purpose of this study was to provide an evidence-based review of NPWT in head and neck cancer patients, as well as the impact of previous irradiation and other risk factors on wound healing. (2) Material and Methods: We conducted a comprehensive search in PubMed, Medline, Embase, Web of Science, and Cochrane Library databases for relevant literature. (3) Results: 15 studies fulfilled the inclusion criteria. The most common etiologies requiring NPWT were defects post tumor resection and flap reconstruction and oro/pharyngo-cutaneous fistulas. The neck was found to be the most common site of involvement (47.3%). The overall wound healing response rate was 87.5%. The median negative pressure recorded was 125 mm of Hg, with a median dressing change time of three days. Previous irradiation (p = 0.01; OR = 4.07) and diabetes mellitus (DM) (p = 0.001; OR = 5.62) were found to be significantly associated with delayed wound healing after NPWT. (4) Conclusion: NPWT treats complex wounds in head and neck cancer patients and should represent a significant armamentarium in head and neck cancers. Previous irradiation and DM have detrimental effects on wound healing after NPWT.

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

Cited by 23 publications

References 67 publications

Negative Pressure Wound Therapy (NPWT) in Head and Face Trauma, Can it Change the Reconstruction Ladder?

Negative Pressure Wound Therapy (NPWT) in Head and Face Trauma, Can it Change the Reconstruction Ladder?

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

Impact of Previous Irradiation on Wound Healing after Negative Pressure Wound Therapy in Head and Neck Cancer Patients—A Systematic Review

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