Kuenlen Anian, Waked Karl, Eisenburger Michael, Oramary Alan, Alsherawi Abeer, Ninkovic Milomir
Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany.
Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Plast Reconstr Surg Glob Open. 2023 Apr 28;11(4):e4964. doi: 10.1097/GOX.0000000000004964. eCollection 2023 Apr.
The gracilis muscle flap is a popular choice in reconstructive surgery to repair soft tissue defects or for functional restoration. Little is known on the influence of postoperative application of VAC (vacuum-assisted closure; Kinetic Concepts Inc., San Antonio, Tex.) therapy on perfusion and postoperative flap edema of free gracilis muscle flaps.
In total, 26 patients with soft tissue defects of lower extremity underwent gracilis muscle flap reconstruction. The study group (VAC, n = 13) was supplied with postoperative negative pressure therapy as a dressing; the control group (NVAC, n = 13) was supplied with conventional fat gauze dressing. Postoperative measurements of micro- and macroperfusion were performed intraoperatively, on postoperative day (POD) 3 and POD 5. Flap edema measurement was performed intraoperatively, on POD 5 and 2 weeks after operation.
The VAC group showed significantly better macroflow during intraoperative VAC treatment, as well on POD 3 and POD 5. Venous outflow was also better with lower hemoglobin levels. Microflow was better in the NVAC group with higher measured oxygen levels. All gracilis muscle flaps of the VAC group showed significantly less flap edema compared with the control group.
VAC application on free gracilis muscle flaps leads to significantly less postoperative flap edema, improved arterial macroflow, and improved venous outflow. VAC therapy can be used without any danger for patient's safety, as flap survival is not endangered, and presents an easy to handle and pleasant dressing regimen for nursing staff and patients.
股薄肌皮瓣是重建手术中修复软组织缺损或进行功能重建的常用选择。关于术后应用VAC（真空辅助闭合；动力概念公司，得克萨斯州圣安东尼奥）疗法对游离股薄肌皮瓣灌注及术后皮瓣水肿的影响，目前知之甚少。
共有26例下肢软组织缺损患者接受股薄肌皮瓣重建。研究组（VAC组，n = 13）术后使用负压疗法作为敷料；对照组（非VAC组，n = 13）使用传统脂肪纱布敷料。术中、术后第3天（POD 3）和第5天（POD 5）进行微血管和大血管灌注的术后测量。术中、POD 5及术后2周进行皮瓣水肿测量。
VAC组在术中VAC治疗期间以及POD 3和POD 5时大血流明显更好。静脉流出也更好，血红蛋白水平更低。非VAC组微血管血流更好，测量的氧水平更高。与对照组相比，VAC组所有股薄肌皮瓣的皮瓣水肿明显更少。
对游离股薄肌皮瓣应用VAC可显著减少术后皮瓣水肿，改善动脉大血流和静脉流出。VAC疗法对患者安全无任何危险，因为皮瓣存活不受威胁，并且为护理人员和患者提供了一种易于操作且舒适的敷料方案。
