Plastic, Reconstructive and Aesthetic Surgery Service, Department of Surgery, Khoo Teck Puat Hospital.
Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Tan Tock Seng Hosiptal, Singapore.
J Wound Care. 2023 Apr 1;32(Sup4):S5-S13. doi: 10.12968/jowc.2023.32.Sup4.S5.
The use of negative pressure wound therapy (NPWT) is ubiquitous in the management of complex wounds. Extending beyond the traditional utility of NPWT, it has been used after reconstructive flap surgery in a few case series. The authors sought to investigate the outcomes of NPWT use on flap reconstruction in a case-control study.
Patients who underwent flap reconstruction between November 2017 and January 2020 were reviewed for inclusion in the study, and divided into an NPWT group and a control group. For patients in the NPWT group, NPWT was used directly over the locoregional flap immediately post-surgery for 4-7 days, before switching to conventional dressings. The control group used conventional dressing materials immediately post-surgery. Outcome measures such as flap necrosis, surgical site infections (SSIs), wound dehiscence as well as time to full functional recovery and hospitalisation duration were evaluated.
Of the 138 patients who underwent flap reconstruction, 37 who had free flap reconstructions were excluded, and 101 patients were included and divided into two groups: 51 patients in the NPWT group and 50 patients in the control group. Both groups had similar patient demographics, and patient and wound risk factors for impaired wound healing. Results showed that there was no statistically significant difference between flap necrosis, SSIs, wound dehiscence, hospitalisation duration as well as functional recovery rates. Cost analysis showed that the use of NPWT over flaps for the first seven postoperative days may potentially be more cost effective in our setting.
In this study, the appropriate use of NPWT over flaps was safe and efficacious in the immediate postoperative setting, and was not inferior to the conventional dressings used for reconstructive flap surgery. The main benefits of NPWT over flaps include better exudate management, oedema reduction and potential cost savings. Further studies would be required to ascertain any further benefit.
负压伤口治疗（NPWT）在复杂伤口的处理中被广泛应用。除了 NPWT 的传统用途外，在少数病例系列中，它也被用于重建皮瓣手术后。作者试图通过病例对照研究调查 NPWT 在皮瓣重建中的应用效果。
回顾 2017 年 11 月至 2020 年 1 月期间接受皮瓣重建的患者，纳入研究，并分为 NPWT 组和对照组。对于 NPWT 组的患者，术后立即在局部皮瓣上直接使用 NPWT 4-7 天，然后改为常规敷料。对照组术后立即使用常规敷料。评估皮瓣坏死、手术部位感染（SSI）、伤口裂开以及完全功能恢复和住院时间等结果。
在 138 例接受皮瓣重建的患者中，有 37 例接受游离皮瓣重建的患者被排除，101 例患者被纳入并分为两组：NPWT 组 51 例，对照组 50 例。两组患者的人口统计学特征和伤口愈合受损的患者和伤口危险因素相似。结果表明，皮瓣坏死、SSI、伤口裂开、住院时间以及功能恢复率之间无统计学显著差异。成本分析表明，在我们的环境中，NPWT 覆盖皮瓣在术后头 7 天使用可能更具成本效益。
在这项研究中，NPWT 在重建皮瓣的即刻术后使用是安全有效的，并不逊于用于重建皮瓣手术的常规敷料。NPWT 覆盖皮瓣的主要优势包括更好的渗出物管理、减轻水肿和潜在的成本节约。需要进一步的研究来确定是否有进一步的获益。
