Shin Seung Jun, Han DaeHee, Song Hyunsuk, Jang Yu Jin, Park Dong Ha, Park Myong Chul
From the Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Republic of Korea.
J Craniofac Surg. 2014 Jul;25(4):1427-31. doi: 10.1097/SCS.0000000000000575.
Although various reconstructive flap surgeries have been successfully performed, there still are difficult wound complications, such as seroma formation, wound margin necrosis, delayed wound healing, and even flap failures. The negative-pressure wound therapy has been described in detail in the literature to assist open chronic/complex wound closure in reconstructive surgery. However, the negative-pressure wound therapy was difficult to be applied under the incisional closed wounds.
A total of 23 patients underwent the various reconstructive flap surgeries with continuous high-pressure negative suction drain. Instead of using regular suction units, Barovac (50-90 mm Hg, Sewoon Medical, Seoul, Republic of Korea) drainage tubes were connected to the wall suction unit, providing continuous high-powered negative pressure. In addition, continuous subatmospheric suction pressure (100-300 mm Hg) was applied. Outcome of the measures was obtained from the incidence of seroma, volume of postoperative drainage, hospitalization period, and incidence of other typical wound complications. Dead space was evaluated postoperatively with ultrasonography.
Using continuous high-pressure negative suction drain, successful management of seroma was obtained without any major complication such as wound infection, flap loss, and wound margin necrosis, except for only 1 case of seroma after discharge from the hospital. The indwelling time of the drain in the latissimus dorsi donor site was significantly reduced in comparison with the authors' previous data (P = 0.047). The volume of drainage and hospitalization period were also reduced; however, these were not statistically significant. The dead space with continuous high-pressure negative suction drain was more reduced than in the control group in the immediate postoperative period and confirmed with ultrasonography.
Continuous high-pressure negative suction drain might be the simple and powerful solution in the management of challenging closed wounds.
尽管各种重建皮瓣手术已成功实施，但仍存在一些棘手的伤口并发症，如血清肿形成、伤口边缘坏死、伤口愈合延迟，甚至皮瓣坏死。负压伤口治疗在文献中已有详细描述，可辅助重建手术中开放性慢性/复杂伤口的闭合。然而，负压伤口治疗难以应用于切开闭合的伤口。
共有23例患者接受了各种重建皮瓣手术，并使用持续高压负压引流。未使用常规吸引装置，而是将Barovac（50 - 90毫米汞柱，韩国首尔Sewoon Medical公司）引流管连接到墙壁吸引装置上，提供持续的高功率负压。此外，施加持续的低于大气压的吸引压力（100 - 300毫米汞柱）。通过血清肿发生率、术后引流量、住院时间以及其他典型伤口并发症的发生率来评估这些措施的效果。术后通过超声检查评估死腔情况。
使用持续高压负压引流，成功控制了血清肿，除1例出院后出现血清肿外，未发生任何重大并发症，如伤口感染、皮瓣坏死和伤口边缘坏死。与作者之前的数据相比，背阔肌供区引流管的留置时间显著缩短（P = 0.047）。引流量和住院时间也有所减少；然而，这些差异无统计学意义。术后即刻，持续高压负压引流组的死腔比对照组减少更多，并通过超声检查得到证实。
持续高压负压引流可能是处理具有挑战性的闭合伤口的简单而有效的方法。
