Clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap

Abstract

Objective: To observe the clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap. Methods: The retrospective observational study was conducted. From April 2018 to October 2020, ninety-five patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 55 males and 40 females, aged 5-78 years, with a defect wound area of 82 (9, 216) cm2. All patients underwent abdominal flap repair for soft tissue defects of hand and forearm. According to the different fixation methods adopted in the operation area, the patients were divided into negative pressure group (n=48) and plaster group (n=47). Wounds of the injury sites of patients in the 2 groups were repaired by flap transplantation after debridement. The negative pressure suction device was placed after dry gauze dressing to form a "bridge" to fix the affected upper limb and chest and abdomen in negative pressure group. Patients in plaster group were treated with conventional dry gauze matting and plaster fixation. On post surgery day (PSD) 1, 3, 5, 7, and 14, flap blood circulation and pain intensity of patients in the 2 groups were calculated by self-made blood flow scoring scale and Changhai Pain Ruler, respectively. On PSD 5, the common complications in operative area and surrounding skin were observed and their incidences were calculated. On PSD 7, satisfaction degree of patients was scored. During follow-up of one month after pedicle division, the appearance and functional recovery of the affected limb were observed. Data were statistically analyzed with analysis of variance for repeated measurement, independent samples t est, Cochran & Cox approximate t test, chi-square test, and Wilcoxon rank-sum test. Results: On PSD 1, 3, 5, 7, and 14, the flap blood circulation scores of patients in negative pressure group did not change significantly, while that of patients in plaster group showed a time-dependent decrease, and the flap blood circulation scores of patients in negative pressure group were significantly higher than those in plaster group (t=2.259, 2.552, 2.784, 2.821, 3.003, P<0.05 or P<0.01). There were no significant changes in the pain intensity scores of patients in negative pressure group, while those of patients in plaster group increased in a time-dependent manner, and the pain intensity scores of patients in negative pressure group were significantly lower than those in plaster group (t=-4.818, -4.944, -5.011, -5.976, -6.721, P<0.05). On PSD 5, the incidences of common complications in operative area and surrounding skin of patients in negative pressure group were significantly lower than those in plaster group (χ2=6.773, 5.269, P<0.05 or P<0.01). On PSD 7, the satisfaction score of patients in negative pressure group was 14.7±1.1, which was significantly higher than 7.4±1.8 in plaster group (t=23.934, P<0.01). During follow-up of one month after pedicle division, the appearance and function of the affected limb of patients in the 2 groups recovered well. Conclusions: After repairing the upper limb soft tissue defect wound with pedicled abdominal flap, the bridge-type continuous negative-pressure suction fixation can effectively immobilize the affected limbs, chest and abdomen, reduce the incidence of common complications in the operative area and surrounding skin, relieve the pain of immobilization of patients, improve the blood circulation of flap and patient's satisfaction. Thus, it is an effective, portable, comfortable, and easy-to-operate method.