NPWTi allows safe delayed free flap repair of Gustilo IIIb injuries: A prospective case series
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Matsumine, HajimeGiatsidis, Giorgio
Fujimaki, Hiroshi
Yoshimoto, Nobuyuki
Makino, Yuma
Hosoi, Satoshi
Takagi, Mika
Shimizu, Mari
Takeuchi, Masaki
UMass Chan Affiliations
Department of Surgery, Division of Plastic SurgeryDocument Type
Journal ArticlePublication Date
2021-04-23Keywords
Free flapGIIIb
Gustilo IIIb injuries
Lower extremity
Microsurgery
NPWT
Negative-pressure Wound Therapy
NPWTi
Negative-pressure Wound Therapy with instillation for wound irrigation
Negative Pressure Wound Therapy
Analytical, Diagnostic and Therapeutic Techniques and Equipment
Plastic Surgery
Surgery
Metadata
Show full item recordAbstract
Introduction: Free flap lower extremity repair is associated with a high complication rate ( > 31%); higher rates are observed in more severe patients. In cases requiring prior systemic/local stabilization, delayed repair increases complication rate (+10% at 7 days): Negative-pressure Wound Therapy (NPWT) decreases complications but only when applied for less than 7 days. Recent limited evidence suggests that augmentation of NPWT with instillation for wound irrigation (NPWTi) might safely extend such window. This study hypothesizes that, through the combined cleansing effect of NPWT and instillation, NPWTi allows safe (low complication rate) delayed free flap repair in severe patients with Gustilo IIIb injuries (GIIIb). Methods: A prospective case series was designed (inclusion criteria: GIIIb requiring microsurgical repair, severe patient/injury condition preventing immediate/early repair; exclusion criteria: allergy to NPWTi dressing). Patients received NPWTi (suction: 125 mmHg continuous; irrigation: NaCl 0.9%) until considered clinically ready for repair. Preoperative/postoperative complications (dehiscence, wound infection, bone non-union, osteomyelitis, flap failure) were monitored with clinical signs, imaging, and serum markers (CRP, WBC). Results: Four patients (male: N = 4, female N = 1; Age: 59 [44-75] years-old) were treated. NPWTi was applied for 15.2 [9-28] days. No complication (0%) was observed preoperatively or postoperatively. Delayed repair occurred by latissimus dorsi musculocutaneous flap (N = 3), and anterolateral thigh flap (N = 2). All patients walked weight-bearing 12 [6-20] weeks after injury. Conclusions: NPWTi seems to allow safe delayed free flap repair in patients with severe lower extremity injuries unable to undergo immediate/early repair.Source
Matsumine H, Giatsidis G, Fujimaki H, Yoshimoto N, Makino Y, Hosoi S, Takagi M, Shimizu M, Takeuchi M. NPWTi allows safe delayed free flap repair of Gustilo IIIb injuries: A prospective case series. Regen Ther. 2021 Apr 23;18:82-87. doi: 10.1016/j.reth.2021.04.001. PMID: 33997186; PMCID: PMC8094577. Link to article on publisher's site
DOI
10.1016/j.reth.2021.04.001Permanent Link to this Item
http://hdl.handle.net/20.500.14038/41903PubMed ID
33997186Related Resources
Rights
© 2021, The Japanese Society for Regenerative Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/Distribution License
http://creativecommons.org/licenses/by-nc-nd/4.0/ae974a485f413a2113503eed53cd6c53
10.1016/j.reth.2021.04.001
Scopus Count
Collections
Except where otherwise noted, this item's license is described as © 2021, The Japanese Society for Regenerative Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/