Abstract: The Use of Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer

Abstract

INTRODUCTION: Initially introduced for wound management, the benefits of negative pressure wound therapy (NPWT) have stimulated the investigation of its use in new clinical scenarios.1 Most recently, incisional NPWT has been shown to be beneficial.2 Incisional NPWT applied to skin containing free tissue transfer has not been well defined.3 This may originate from concerns of dressing material obscuring frequent examination of the newly transferred tissue or risk of pedicle compression and potential for increased risk of tissue loss. Our aim is to describe NPWT in fasciocutaneous free tissue transfer. METHODS: An IRB-approved retrospective review of consecutive free tissue transfer patients was completed over a 3-year period. After fixation of the free flap, one or two drains were inserted in the sub-flap position. The surface of the flap was protected with vaseline gauze followed by a layer of sterile cotton. The V.A.C.® (KCI, Texas, USA) was applied and NPWT was initiated at -125 mm Hg. A window was routinely made over the flap’s distal region to allow for serial flap examination. For extremity procedures, no splints were utilized. NPWT was employed continuously for 7 days and subsequently removed along with operative drains. RESULTS: A total of 24 consecutive patients underwent fasciocutaneous free tissue transfer with a mean follow-up of 8.1 months. The average patient age was 39.8 years with mean BMI of 23. Tobacco use was noted in 58% of patients. The indications for the free tissue transfer included trauma, malignancy, and burn reconstruction. The areas of reconstruction included scalp, lower extremity, and upper extremity. Free flaps employed consisted of latissimus dorsi myocutaneous, anterolateral thigh, thoracodorsal artery perforator, and radial forearm free flap. The average defect size reconstructed was 238.3 cm2 with a mean operative time of 501 minutes. Postoperatively, patients remained in the hospital an average of 15.5 days. No hematomas, seromas, surgical site infections, or DVT/ PE occurred in the series. None of the flaps required return to the OR. There were no documented cases with partial or complete flap loss. CONCLUSION: NPWT may be employed in a fashion similar to standard incisional application. With this technique, serial flap examination remains possible and is not associated with pedicle compression or increased rates of flap loss. Reference Citations: 1. A Anghel EL, Kim PJ. Negative-pressure wound therapy: a comprehensive review of the evidence. Plastic and Reconstructive Surgery. 2016;138(3S):129S-137S. 2. A Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 2012;26:37a€”42. 3. A Yu P, Yu N, Yang X, Jin X, Lu H, Qi Z. Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review. Journal of Reconstructive Microsurgery. 2017;33(05):358–366.