Flap Viability after Direct Immediate Application of Negative Pressure Wound Therapy on Free Flaps: A Systematic Review and Pooled Analysis of Reported Outcomes

Abstract

Background The use of negative pressure wound therapy (NPWT) devices has gained wide acceptance in the management of wounds. There have been a few reported cases of its use immediately after free tissue transfer. This is the first systematic review and pooled analysis on the immediate use of NPWT for free flaps with emphasis on the rate of free flap loss.

Methods The authors performed a systematic review that focused on the rate of total free flap loss after immediate application of NPWT. EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, and PubMed databases were searched from 1997 to April of 2019. Peer-reviewed articles published in the English language were included.

Results Ten articles were included in the review, yielding 211 free flap procedures. All studies were retrospective cohort studies except for two that were prospective studies and one that was a case series. The overall complete flap failure rate was n = 7 (3.3%). The most commonly reconstructed area was the lower extremity (n = 158 [74.9%]) followed by head and neck (n = 42 [19.9%]) and upper extremity (n = 11 [5.2%]). The vacuum pressure ranged from 75 to 125 mm/Hg. The time of application of the NPWT ranged from 5 to 7 days. The etiologies of wound defects were from trauma (n = 82 [63.6%]), tumor extirpation (n = 43 [33.3%]), and infection and burn (n = 4 [3.1%]).

Conclusion The immediate application of NPWT on free flaps does not seem to be associated with an increased risk of flap failure.

Keywords

NPWT - free flap - microvascular free flap

• References

• 1 Orgill DP, Bayer LR. Negative pressure wound therapy: past, present and future. Int Wound J 2013; 10 (Suppl. 01) 15-19
• 2 Webb LX, Pape HC. Current thought regarding the mechanism of action of negative pressure wound therapy with reticulated open cell foam. J Orthop Trauma 2008; 22 (10, Suppl): S135-S137
• 3 Malmsjö M, Ingemansson R, Martin R, Huddleston E. Wound edge microvascular blood flow: effects of negative pressure wound therapy using gauze or polyurethane foam. Ann Plast Surg 2009; 63 (06) 676-681
• 4 Malmsjö M, Ingemansson R, Martin R, Huddleston E. Negative-pressure wound therapy using gauze or open-cell polyurethane foam: similar early effects on pressure transduction and tissue contraction in an experimental porcine wound model. Wound Repair Regen 2009; 17 (02) 200-205
• 5 Ge D. The safety of negative-pressure wound therapy on surgical wounds: an updated meta-analysis of 17 randomized controlled trials. Adv Skin Wound Care 2018; 31 (09) 421-428
• 6 Yu P, Yu N, Yang X, Jin X, Lu H, Qi Z. Clinical efficacy and safety of negative-pressure wound therapy on flaps: a systematic review. J Reconstr Microsurg 2017; 33 (05) 358-366
• 7 Blackburn II JH, Boemi L, Hall WW. , et al. Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 1998; 40 (05) 453-457
• 8 Centre for Reviews and Dissemination. Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care 2009. York, United Kingdom: Centre for Reviews and Dissemination, University of York; 2009 . Available at: www.york.ac.uk/media/crd/Systematic_Reviews.pdf . Accessed March 1, 2019
• 9 Higgins JPT, Green S. , eds. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 (updated March 2011). Available at: https://training.cochrane.org/handbook . Accessed March 1, 2016
• 10 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
• 11 Hanasono MM, Skoracki RJ. Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device. Ann Plast Surg 2007; 58 (05) 573-576
• 12 Bannasch H, Iblher N, Penna V. , et al. A critical evaluation of the concomitant use of the implantable Doppler probe and the vacuum assisted closure system in free tissue transfer. Microsurgery 2008; 28 (06) 412-416
• 13 Eisenhardt SU, Momeni A, Iblher N. , et al. The use of the vacuum-assisted closure in microsurgical reconstruction revisited: application in the reconstruction of the posttraumatic lower extremity. J Reconstr Microsurg 2010; 26 (09) 615-622
• 14 Nelson JA, Kim EM, Serletti JM, Wu LC. A novel technique for lower extremity limb salvage: the vastus lateralis muscle flap with concurrent use of the vacuum-assisted closure device. J Reconstr Microsurg 2010; 26 (07) 427-431
• 15 Eisenhardt SU, Schmidt Y, Thiele JR. , et al. Negative pressure wound therapy reduces the ischaemia/reperfusion-associated inflammatory response in free muscle flaps. J Plast Reconstr Aesthet Surg 2012; 65 (05) 640-649
• 16 Henry SL, Weinfeld AB, Sharma SK, Kelley PK. External Doppler monitoring of free flaps through negative pressure dressings. J Reconstr Microsurg 2011; 27 (04) 215-218
• 17 Bi H, Khan M, Li J, Pestana IA. Use of incisional negative pressure wound therapy in skin containing free tissue transfer. J Reconstr Microsurg 2018; 34 (03) 200-205
• 18 Chim H, Zoghbi Y, Nugent AG, Kassira W, Askari M, Salgado CJ. Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness. Arch Plast Surg 2018; 45 (01) 45-50
• 19 Lin PY, Liou TL, Lin KC, Hsieh MH, Chien CY, Hsieh CH. Immediate negative pressure wound therapy after free flap transfer for head and neck cancer surgery. Laryngoscope 2018; 128 (11) 2478-2482
• 20 Lenz Y, Gross R, Penna V, Bannasch H, Stark GB, Eisenhardt SU. Evaluation of the implantable Doppler probe for free flap monitoring in lower limb reconstruction. J Reconstr Microsurg 2018; 34 (03) 218-226
• 21 Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 2006; 117 (7, Suppl): 121S-126S
• 22 Llanos S, Danilla S, Barraza C. , et al. Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double-masked, controlled trial. Ann Surg 2006; 244 (05) 700-705
• 23 Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007; 119 (07) 2092-2100
• 24 Kind GM, Buntic RF, Buncke GM, Cooper TM, Siko PP, Buncke Jr HJ. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg 1998; 101 (05) 1268-1273 , discussion 1274–1275
• 25 Rosenberg JJ, Fornage BD, Chevray PM. Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test. Plast Reconstr Surg 2006; 118 (01) 109-113 , discussion 114–115