Authors : Ahmed Salah El-Din Mohamed; Amr Magdy Sayed Mahmoud; Ahmed Abd El-Rahim Kenway; Osama Hassan El-Banna

Volume/Issue : Volume 9 - 2024, Issue 9 - September

Google Scholar : https://tinyurl.com/4buttpmt

Scribd : https://tinyurl.com/54558efe

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP1518

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Abstract : Negative Pressure Wound Therapy (NPWT) effectively manages complex wounds by promoting fluid drainage, stabilizing the wound environment, and reducing bacterial load. It aids in granulation tissue formation and modulation of inflammatory reactions. NPWT is increasingly used in reconstructive surgery, particularly in flap procedures, enhancing wound healing and cosmetic outcomes while reducing flap complications. Despite concerns about flap compromise, clinical trials demonstrate low flap loss rates with NPWT. Strategies like observation windows and implantable Doppler devices help overcome monitoring challenges. However, conclusive evidence regarding NPWT's safety and impact on flap vascularity is limited due to scarce studies. The study involved 40 healthy adult patients, mostly male, with soft tissue defects primarily caused by road traffic accidents. They were split into two groups: NPWT (25 patients) and conventional dressing (15 patients). The NPWT group was further categorized into high pressure (8 patients) and low pressure (17 patients) subgroups. Results showed lower flap edema in NPWT groups compared to controls, but high pressure NPWT led to higher flap ischemia and infection rates. Overall, low pressure NPWT yielded the best clinical and aesthetic outcomes with fewer complications. The study suggests a delayed NPWT approach and low-pressure settings for optimal vascular perfusion in Fasciocutaneous flaps, emphasizing the need for further trials to establish its efficacy and determine ideal pressure settings for different flap types.

Keywords : NPWT- Negative Pressure wound Therapy VAC- Vacuum Assisted Closure RFF- Radial Forearm Flap LAF- Lateral Arm Flap ALT- Anterolateral Thigh Flap

References :

1. Yu, P., Chang, D. W., Miller, M. J., Reece, G., & Robb, G. L. (2009). Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck, 31(1), 45–51.
2. Daigle, P., Despatis, M., & Grenier, G. (2013). How mechanical deformations contribute to the effectiveness of negative‐pressure wound therapy. Wound Repair and Regeneration, 21(4), 498–502.
3. Opoku-Agyeman, J. L., Matera, D. V, Simone, J. E., & Behnam, A. B. (2019). Flap viability after direct immediate application of negative pressure wound therapy on free flaps: a systematic review and pooled analysis of reported outcomes. Journal of Reconstructive Microsurgery Open, 4(02), e77–e82.
4. Yu, P., Yu, N., Yang, X., Jin, X., Lu, H., & Qi, Z. (2017). Clinical efficacy and safety of negative-pressure wound therapy on flaps: a systematic review. Journal of Reconstructive Microsurgery, 33(05), 358–366.
5. Bi, H. (2017). Use of Incisional Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer. 1(212).
6. Chim, H., Zoghbi, Y., Nugent, A. G., Kassira, W., Askari, M., & Salgado, C. J. (2022). Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness. 45–50.
7. Lenz, Y., Gross, R., Penna, V., Stark, G. B., & Eisenhardt, S. U. (2017). Evaluation of the Implantable Doppler Probe for Free Flap Monitoring in Lower Limb Reconstruction. 1(212).
8. Bui, D. T., Cordeiro, P. G., Hu, Q.-Y., Disa, J. J., Pusic, A., & Mehrara, B. J. (2007). Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plastic and Reconstructive Surgery, 119(7), 2092–2100.
9. Malsiner, C. C. M., Schmitz, M., Horch, R. E., Keller, A. K., & Leffler, M. (2015). Vessel transformation in chronic wounds under topical negative pressure therapy: an immunohistochemical analysis. International Wound Journal, 12(5), 501–509.
10. Mouës, C. M., Heule, F., & Hovius, S. E. R. (2011). A review of topical negative pressure therapy in wound healing: sufficient evidence? The American Journal of Surgery, 201(4), 544–556.
11. Marouf, A., Mortada, H., Khedr, B., Halawani, L., Alarki, S. M. K. Z., & Alghamdi, H. (2022). Effectiveness and safety of immediate application of negative pressure wound therapy in head and neck free flap reconstruction: a systematic review. British Journal of Oral and Maxillofacial Surgery, 60(8), 1005–1011.