Satteson Ellen S, Crantford John Clayton, Wood Jeyhan, David Lisa R
*Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem †Division of Plastic and Reconstructive Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
J Craniofac Surg. 2015 Oct;26(7):e599-602. doi: 10.1097/SCS.0000000000002047.
Head and neck wounds can present a reconstructive challenge for the plastic surgeon. Whether from skin cancer, trauma, or burns, there are many different treatment modalities used to dress and manage complex head and neck wounds. Vacuum-assisted closure (VAC) therapy has been used on wounds of nearly every aspect of the body but not routinely in the head and neck area. This study was conducted to demonstrate our results using the VAC in the treatment of complex head and neck wounds.
This is an IRB-approved, retrospective review of 69 patients with 73 head and neck wounds that were managed using the VAC between 1999 and 2008. The wound mechanism, location, and size, length of VAC therapy, patient comorbidities, use of radiation, complications, and ultimate outcome were assessed. In this patient population, the VAC was utilized because the standard reconstructive ladder was not a good option or had previously failed.
Sixty-nine patients with complex head and neck wounds were treated with the wound VAC. The mean age of the patients was 66 years, with a range of 5-96 years. Males outnumbered females in this study nearly 2:1. Eighty-six percent of patients had wounds secondary to cancer, 8% secondary to trauma, 3% secondary to infection, and 3% secondary to burns. The VAC was used as a dressing over skin grafts in 50%, over Integra in 21%, and over open debrided wounds in 29%. Wounds healed without complication in 44% of the skin grafts, 67% of Integra-covered wounds, and 71% of debrided wounds. Minor complications included failure of complete graft take, failure of granulation tissue formation in open debrided wounds, infection, and hematoma formation under skin grafts. Major complications included positive cancer margins requiring reexcision and death secondary to pulmonary embolism, sepsis, and metastatic cancer. Most complications resolved with dressing changes, repeat grafting, or the administration of antibiotics.
Our results demonstrate that the wound VAC provides a reliable, effective, and durable dressing for a multitude of complex head and neck wounds. Additionally, it is a valuable tool when traditional surgical procedures are not a viable option.
头颈部伤口对整形外科医生而言可能是一项重建挑战。无论是因皮肤癌、创伤还是烧伤导致的伤口，都有许多不同的治疗方式用于处理复杂的头颈部伤口。负压封闭引流（VAC）疗法已应用于身体几乎各个部位的伤口，但在头颈部区域尚未常规使用。本研究旨在展示我们使用VAC治疗复杂头颈部伤口的结果。
这是一项经机构审查委员会（IRB）批准的回顾性研究，对1999年至2008年间使用VAC治疗的69例患者的73处头颈部伤口进行分析。评估了伤口的致伤机制、位置、大小、VAC治疗时长、患者合并症、放疗使用情况、并发症及最终结果。在该患者群体中，使用VAC是因为标准的重建阶梯治疗并非理想选择或先前已失败。
69例复杂头颈部伤口患者接受了伤口VAC治疗。患者的平均年龄为66岁，年龄范围为5至96岁。本研究中男性患者数量几乎是女性的两倍。86%的患者伤口继发于癌症，8%继发于创伤，3%继发于感染，3%继发于烧伤。50%的患者将VAC用作皮肤移植后的敷料，21%用于人工真皮（Integra）覆盖后，29%用于开放性清创伤口。44%的皮肤移植伤口、67%的人工真皮覆盖伤口以及71%的清创伤口愈合且无并发症。轻微并发症包括移植皮片完全成活失败、开放性清创伤口肉芽组织形成失败、感染以及皮肤移植下血肿形成。主要并发症包括癌症切缘阳性需再次切除以及因肺栓塞、脓毒症和转移性癌症导致的死亡。大多数并发症通过更换敷料、再次移植或使用抗生素得以解决。
我们的结果表明，伤口VAC为多种复杂头颈部伤口提供了一种可靠、有效且持久的敷料。此外，当传统手术方法不可行时，它是一种有价值的工具。
