Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions
08 April 2020 (online)
Background Persistent dead space following flap cover is a frequently encountered challenge following the reconstruction of complex wounds. It may lead to a hematoma, seroma, wound infection, and wound dehiscence. Wound dehiscence could be a devastating complication. Closed incisional negative pressure wound therapy (ciNPWT) over the surgical incisions was found to reduce surgical site infection (SSI) and wound dehiscence. We applied this principle at the closed flap suture line and through this article, we share the indications, technique, and outcomes.
Methods A retrospective analysis (January 2018–June 2019), in which selected high-risk patients who underwent ciNPWT at the flap suture following complex reconstruction (pedicled or free flap) were included in the study. The indications include deep incisional/organ SSI after debridement and flap coverage, persistent dead space following flap coverage, chronic osteomyelitis. Patients were analyzed in the follow-up period in terms of complications, wound healing.
Results Nine patients underwent ciNPWT over the flap suture line. The mean age was 32.2 years (range: 10–48 years). The mean duration of the NPWT application was 7.3 days (range: 3–21 days). Three of the nine patients had flap-related minor complications. One patient had marginal flap necrosis and required skin grafting, one patient had minor wound dehiscence (1 cm) which required secondary skin suturing and one patient had chronic discharging sinus related to osteomyelitis of ischium, which subsequently healed with antibiotics and local wound care. None of the patients had NPWT-related complications.
Conclusion Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.
- 1 Shanmugam VK, Fernandez SJ, Evans KK. et al. Postoperative wound dehiscence: predictors and associations. Wound Repair Regen 2015; 23 (02) 184-190
- 2 van Ramshorst GH, Nieuwenhuizen J, Hop WC. et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 2010; 34 (01) 20-27
- 3 Hasselmann J, Björk J, Svensson-Björk R, Acosta S. Inguinal vascular surgical wound protection by incisional negative pressure wound therapy: a randomized controlled Trial-INVIPS Trial. Ann Surg 2020; 27 (01) 48-53
- 4 Nam D, Sershon RA, Levine BR. Della Valle CJ. The use of closed incision negative-pressure wound therapy in orthopaedic surgery. J Am Acad Orthop Surg 2018; 26 (09) 295-302
- 5 Abesamis GM, Chopra S, Vickery K, Deva AK. A comparative trial of incisional negative-pressure wound therapy in abdominoplasty. Plast Reconstr Surg Glob Open 2019; 7 (05) e2141
- 6 Matusiak D, Wichtowski M, Pieszko K, Kobylarek D, Murawa D. Is negative-pressure wound therapy beneficial in modern-day breast surgery?. Contemp Oncol (Pozn) 2019; 23 (02) 69-73
- 7 Tran BNN, Johnson AR, Shen C, Lee BT, Lee ES. Closed-incision negative-pressure therapy efficacy in abdominal wall reconstruction in high-risk patients: a meta-analysis. J Surg Res 2019; 241: 63-71
- 8 Hussamy DJ, Wortman AC, McIntire DD, Leveno KJ, Casey BM, Roberts SW. Closed incision negative pressure therapy in morbidly obese women undergoing cesarean delivery: a randomized controlled trial. Obstet Gynecol 2019; 134 (04) 781-789
- 9 Berger P, de Bie D, Moll FL, de Borst GJ. Negative pressure wound therapy on exposed prosthetic vascular grafts in the groin. J Vasc Surg 2012; 56 (03) 714-720
- 10 Capobianco CM, Zgonis T. An overview of negative pressure wound therapy for the lower extremity. Clin Podiatr Med Surg 2009; 26 (04) 619-631
- 11 Wilkes RP, Kilpad DV, Zhao Y, Kazala R, McNulty A. Closed incision management with negative pressure wound therapy (CIM): biomechanics. Surg Innov 2012; 19 (01) 67-75
- 12 Nishimura K, Blume P, Ohgi S, Sumpio BE. Effect of different frequencies of tensile strain on human dermal fibroblast proliferation and survival. Wound Repair Regen 2007; 15 (05) 646-656
- 13 Mouës CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 2004; 12 (01) 11-17
- 14 Webster J, Liu Z, Norman G. et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2019; 3: CD009261
- 15 Gombert A, Babilon M, Barbati ME. et al. Closed incision negative pressure therapy reduces surgical site infections in vascular surgery: a prospective randomised trial (AIMS Trial). Eur J Vasc Endovasc Surg 2018; 56 (03) 442-448
- 16 Giannini S, Mazzotti A, Luciani D. et al. Postoperative wound management with negative pressure wound therapy in knee and hip surgery: a randomised control trial. J Wound Care 2018; 27 (08) 520-525
- 17 Sahebally SM, McKevitt K, Stephens I. et al. Negative pressure wound therapy for closed laparotomy incisions in general and colorectal surgery: a systematic review and meta-analysis. JAMA Surg 2018; 153 (11) e183467
- 18 Abai B, Zickler RW, Pappas PJ. Lal BK, Padberg FT Jr. Lymphorrhea responds to negative pressure wound therapy. J Vasc Surg 2007; 45 (03) 610-613
- 19 Peter HS Suh, Hong JP. Effects of incisional negative-pressure wound therapy on primary closed defects after superficial Circumflex Iliac artery perforator flap harvest: randomized controlled study. Plast Reconstr Surg 2016; 138 (06) 1333-1340
- 20 Grauhan O, Navasardyan A, Hofmann M, Müller P, Stein J, Hetzer R. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg 2013; 145 (05) 1387-1392
- 21 Malmsjö M, Ingemansson R. Effects of green foam, black foam and gauze on contraction, blood flow and pressure delivery to the wound bed in negative pressure wound therapy. J Plast Reconstr Aesthet Surg 2011; 64 (12) e289-e296