519 The Application of Negative Pressure Wound Therapy to Promote Integration of Facial Grafts and Dermal Substitutes

Abstract

Negative pressure is an important modality in our burn center’s treatment algorithm of acute burns and reconstructive patients. Many studies have cited the potential benefits of NPWT but few look at the feasibility of application in locations such as the face and the care that is required to provide a successful outcome while maintaining important underlying structures. Here, we present our techniques for successful application and outcomes in the application of NPWT to the face. Patients requiring dermal substitute placement or autografting to the face were evaluated by the staff surgeon in the OR for potential placement of NPWT. When the burn surgeon determined the wound bed was deemed appropriate, the physical therapist was called to place the NPWT dressing with assistance from the OR staff and surgeons. Due to the often complex nature of intricate grafting, specialty products were used to assist with the placement and maintenance of a seal. In areas of intact skin, skin glues and/or hydrocolloids were used. When the graft was bordered with continued burn or open wounds, products such as ostomy paste and strip adhesives were used. Vital structures such as the eyes, ear canal, nares, and mouth require more attention. Silicone sheeting coupled with bolsters or other forms of compression were used to decrease the chance of residue from the ostomy products migrating into these areas. Low pressure settings were used (<75mmHg). The dressings were changed per the manufactures’ time frames. There were no areas of unplanned graft or dermal substitute loss as a direct result of the NPWT dressing being placed and no adverse events. In our burn center, we have utilized NPWT to the face since 2007 without sequelae. With appropriate wound bed preparation, practitioners proficient with placement of a NPWT dressing to the face and close monitoring, NPWT is a safe and beneficial dressing to assist with the vascularization, immobilization, and splinting of skin grafts and dermal substitutes placed on the face. Discussion of practices that work on difficult placement of NPWT will benefit less experienced practitioners.