Chim Harvey, Zoghbi Yasmina, Nugent Ajani George, Kassira Wrood, Askari Morad, Salgado Christopher John
Division of Plastic Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
Arch Plast Surg. 2018 Jan;45(1):45-50. doi: 10.5999/aps.2016.01977. Epub 2018 Jan 10.
Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity.
Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients.
There was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was 6.4±6.4 mm, while flap thickness for the exposed flap group was 29.6±13.5 mm. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group.
Immediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.
游离肌皮瓣是修复小腿远端伤口和伴有骨外露的下肢大面积伤口的主要手段。然而，一个主要问题是术后皮瓣明显肿胀，肿胀可能需要数月才能消退。我们研究了游离肌皮瓣移植至下肢后立即应用负压封闭引流（VAC）敷料的有效性和安全性。
在19个月的时间里，对一家一级创伤中心所有连续进行下肢重建的游离肌皮瓣进行前瞻性评估，观察术后皮瓣厚度、并发症及皮瓣存活情况。9例患者在皮瓣移植后立即应用VAC敷料，8例患者则让皮瓣暴露以进行监测。
两组患者皮瓣存活率无统计学显著差异。VAC组术后第5天皮瓣平均厚度为6.4±6.4毫米，而暴露皮瓣组皮瓣厚度为29.6±13.5毫米。VAC敷料组术后第5天皮瓣厚度显著降低。
游离肌皮瓣移植至下肢后立即应用VAC敷料不会影响皮瓣存活或预后，且能降低皮瓣厚度，获得更好的美学效果。
