Rocks Madeline C, Wu Meagan, Comunale Victoria, Agrawal Nikhil, Nicholas Rebecca S, Azad Ali, Hacquebord Jacques H
George Washington School of Medicine and Health Sciences, Washington, District of Columbia.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Reconstr Microsurg. 2025 Jul;41(6):515-520. doi: 10.1055/a-2434-5798. Epub 2024 Oct 3.
While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction.
A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups.
A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%).
Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.
虽然先前的研究建议在创伤性肢体损伤的软组织重建中，在受伤后72小时内立即进行皮瓣覆盖，但在先进伤口护理技术的背景下，最近的证据不再强调立即覆盖的必要性。负压伤口治疗（NPWT）一直是延长确定性软组织覆盖时间的重要工具。本研究旨在阐明术前使用NPWT对显微外科重建成功的影响。
使用以下数据库从其创建到2023年2月进行文献检索：PubMed、OVID数据库（Embase和Cochrane图书馆）、科学网和Scopus。在801篇已识别的文章中，评估了648篇，纳入了24篇。根据术前是否使用NPWT对病例进行分组。记录确定性覆盖的时间、损伤细节和基本人口统计学信息。比较两组之间的皮瓣失败、感染、骨不连、再次手术和并发症发生率。
共纳入1027例患者和1047个皮瓣，其中894例（85.39%）在皮瓣术前接受了NPWT。NPWT组和非NPWT组的平均确定性覆盖时间分别为16天和18天。除深部感染外，NPWT组在所有报告的并发症中的术后并发症发生率均低于非NPWT组。与非NPWT组相比，NPWT组的任何皮瓣失败率（3.69%对9.80%）和部分皮瓣失败率（2.24%对6.54%）较低。
术前NPWT与术后并发症减少相关，最重要的是皮瓣失败率降低。这值得进一步研究创伤性肢体重建的决策过程。需要未来采用标准化方案并进行更长时间随访的前瞻性研究，以更好地了解术前使用NPWT在软组织重建中的潜在有益作用。
