Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2019; 52(01): 073-080
DOI: 10.1055/s-0039-1687922
Review Article
Association of Plastic Surgeons of India

The Role of Negative-Pressure Wound Therapy in Lower-Limb Reconstruction

Renita Sirisena
1   Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
,
Gregory Lucien Bellot
1   Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
,
Mark Edward Puhaindran
1   Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
› Author Affiliations
Further Information

Publication History

Publication Date:
16 April 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Negative-pressure wound therapy (NPWT) has gained increasing popularity among clinicians since its introduction in 1997 as a potential aid to wound healing. Multiple benefits of NPWT have since been proven in studies, including increase in granulation tissue formation, decrease in bacterial load, and the improved survival of flaps. With our increasing use and greater understanding of the tissue and cellular changes that occur in a wound treated with NPWT, our lower-limb reconstructive practice has also evolved. Although controversial, the definite timing for lower-limb reconstruction has stretched from 72 hours to longer than 2 weeks as NPWT contains the wound within a sterile, closed system. It has also shown to decrease the rate of infection in open tibia fractures. Previously, a large number of critical defects of the lower limb would require free tissue transfer for definitive reconstruction. NPWT has reduced this rate by more than 50% and has allowed for less complicated resurfacing procedures to be performed instead.

Keywords

lower-limb reconstruction - lower-limb trauma - negative-pressure wound therapy - tissue resurfacing
 

  • References

  • 1 Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38 (06) 553-562
    CrossrefPubMedGoogle Scholar
  • 2 Kanakaris NK, Thanasas C, Keramaris N, Kontakis G, Granick MS, Giannoudis PV. The efficacy of negative pressure wound therapy in the management of lower extremity trauma: review of clinical evidence. Injury 2007; 38 (Suppl. 05) S9-S18
    PubMedGoogle Scholar
  • 3 Andros G, Armstrong DG, Attinger CE. et al; Tucson Expert Consensus Conference. Consensus statement on negative pressure wound therapy (V.A.C. therapy) for the management of diabetic foot wounds. Ostomy Wound Manage. 2006 (Suppl) 1-32
    Google Scholar
  • 4 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78 (03) 285-292
    CrossrefPubMedGoogle Scholar
  • 5 Yaremchuk MJ, Brumback RJ, Manson PN, Burgess AR, Poka A, Weiland AJ. Acute and definitive management of traumatic osteocutaneous defects of the lower extremity. Plast Reconstr Surg 1987; 80 (01) 1-14
    CrossrefPubMedGoogle Scholar
  • 6 Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma 1989; 29 (08) 1086-1094
    CrossrefPubMedGoogle Scholar
  • 7 Liu DS, Sofiadellis F, Ashton M, MacGill K, Webb A. Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma. Injury 2012; 43 (06) 772-778
    CrossrefPubMedGoogle Scholar
  • 8 Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38 (06) 563-576 discussion 577
    CrossrefPubMedGoogle Scholar
  • 9 Weed T, Ratliff C, Drake DB. Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance?. Ann Plast Surg 2004; 52 (03) 276-279 discussion 279–280
    CrossrefPubMedGoogle Scholar
  • 10 Mouës CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 2004; 12 (01) 11-17
    CrossrefPubMedGoogle Scholar
  • 11 Joethy J, Sebastin SJ, Chong AK, Peng YP, Puhaindran ME. Effect of negative-pressure wound therapy on open fractures of the lower limb. Singapore Med J 2013; 54 (11) 620-623
    PubMedGoogle Scholar
  • 12 Stannard JP, Volgas DA, Stewart R, McGwin Jr G, Alonso JE. Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma 2009; 23 (08) 552-557
    CrossrefPubMedGoogle Scholar
  • 13 Blum ML, Esser M, Richardson M, Paul E, Rosenfeldt FL. Negative pressure wound therapy reduces deep infection rate in open tibial fractures. J Orthop Trauma 2012; 26 (09) 499-505
    CrossrefPubMedGoogle Scholar
  • 14 DeFranzo AJ, Argenta LC, Marks MW. et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 2001; 108 (05) 1184-1191
    CrossrefPubMedGoogle Scholar
  • 15 Herscovici Jr D, Sanders RW, Scaduto JM, Infante A, DiPasquale T. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma 2003; 17 (10) 683-688
    CrossrefPubMedGoogle Scholar
  • 16 Lalezari S, Lee CJ, Borovikova AA. et al. Deconstructing negative pressure wound therapy. Int Wound J 2017; 14 (04) 649-657
    CrossrefPubMedGoogle Scholar
  • 17 Orgill DP, Manders EK, Sumpio BE. et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery 2009; 146 (01) 40-51
    CrossrefPubMedGoogle Scholar
  • 18 Peinemann F, Sauerland S. Negative-pressure wound therapy: systematic review of randomized controlled trials. Dtsch Arztebl Int 2011; 108 (22) 381-389
    PubMedGoogle Scholar
  • 19 Kairinos N, Solomons M, Hudson DA. Negative-pressure wound therapy I: the paradox of negative-pressure wound therapy. Plast Reconstr Surg 2009; 123 (02) 589-598 discussion 599–600
    CrossrefPubMedGoogle Scholar
  • 20 Anesäter E, Borgquist O, Hedström E, Waga J, Ingemansson R, Malmsjö M. The influence of different sizes and types of wound fillers on wound contraction and tissue pressure during negative pressure wound therapy. Int Wound J 2011; 8 (04) 336-342
    CrossrefPubMedGoogle Scholar
  • 21 Lancerotto L, Bayer LR, Orgill DP. Mechanisms of action of microdeformational wound therapy. Semin Cell Dev Biol 2012; 23 (09) 987-992
    CrossrefPubMedGoogle Scholar
  • 22 Erba P, Ogawa R, Ackermann M. et al. Angiogenesis in wounds treated by microdeformational wound therapy. Ann Surg 2011; 253 (02) 402-409
    CrossrefPubMedGoogle Scholar
  • 23 Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 2004; 114 (05) 1086-1096 discussion 1097–1098
    PubMedGoogle Scholar
  • 24 Yang SL, Han R, Liu Y, Hu LY, Li XL, Zhu LY. Negative pressure wound therapy is associated with up-regulation of bFGF and ERK1/2 in human diabetic foot wounds. Wound Repair Regen 2014; 22 (04) 548-554
    CrossrefPubMedGoogle Scholar
  • 25 Wiegand C, White R. Microdeformation in wound healing. Wound Repair Regen 2013; 21 (06) 793-799
    CrossrefPubMedGoogle Scholar
  • 26 Lu F, Ogawa R, Nguyen DT. et al. Microdeformation of three-dimensional cultured fibroblasts induces gene expression and morphological changes. Ann Plast Surg 2011; 66 (03) 296-300
    CrossrefPubMedGoogle Scholar
  • 27 Johnson KE, Wilgus TA. Vascular endothelial growth factor and angiogenesis in the regulation of cutaneous wound repair. Adv Wound Care (New Rochelle) 2014; 3 (10) 647-661
    CrossrefPubMedGoogle Scholar
  • 28 Wang W, Pan Z, Hu X, Li Z, Zhao Y, Yu AX. Vacuum-assisted closure increases ICAM-1, MIF, VEGF and collagen I expression in wound therapy. Exp Ther Med 2014; 7 (05) 1221-1226
    CrossrefPubMedGoogle Scholar
  • 29 Kim BS, Pallua N, Bernhagen J, Bucala R. The macrophage migration inhibitory factor protein superfamily in obesity and wound repair. Exp Mol Med 2015; 47: e161
    CrossrefPubMedGoogle Scholar
  • 30 Yukitake H, Takizawa M, Kimura H. Macrophage migration inhibitory factor as an emerging drug target to regulate antioxidant response element system. Oxid Med Cell Longev 2017; 2017: 8584930
    PubMedGoogle Scholar
  • 31 Grimm A, Dimmler A, Stange S. et al. Expression of HIF-1 alpha in irradiated tissue is altered by topical negative-pressure therapy. Strahlenther Onkol 2007; 183 (03) 144-149
    CrossrefPubMedGoogle Scholar
  • 32 Ma Z, Shou K, Li Z, Jian C, Qi B, Yu A. Negative pressure wound therapy promotes vessel destabilization and maturation at various stages of wound healing and thus influences wound prognosis. Exp Ther Med 2016; 11 (04) 1307-1317
    CrossrefPubMedGoogle Scholar
  • 33 Xia CY, Yu AX, Qi B, Zhou M, Li ZH, Wang WY. Analysis of blood flow and local expression of angiogenesis-associated growth factors in infected wounds treated with negative pressure wound therapy. Mol Med Rep 2014; 9 (05) 1749-1754
    CrossrefPubMedGoogle Scholar
  • 34 Britland S, Ross-Smith O, Jamil H, Smith AG, Vowden K, Vowden P. The lactate conundrum in wound healing: clinical and experimental findings indicate the requirement for a rapid point-of-care diagnostic. Biotechnol Prog 2012; 28 (04) 917-924
    CrossrefPubMedGoogle Scholar
  • 35 Hunt TK, Aslam RS, Beckert S. et al. Aerobically derived lactate stimulates revascularization and tissue repair via redox mechanisms. Antioxid Redox Signal 2007; 9 (08) 1115-1124
    CrossrefPubMedGoogle Scholar
  • 36 Zabel DD, Feng JJ, Scheuenstuhl H, Hunt TK, Hussain MZ. Lactate stimulation of macrophage-derived angiogenic activity is associated with inhibition of Poly(ADP-ribose) synthesis. Lab Invest 1996; 74 (03) 644-649
    Google Scholar
  • 37 Trabold O, Wagner S, Wicke C. et al. Lactate and oxygen constitute a fundamental regulatory mechanism in wound healing. Wound Repair Regen 2003; 11 (06) 504-509
    CrossrefPubMedGoogle Scholar