Title
NPWTi allows safe delayed free flap repair of Gustilo IIIb injuries: A prospective case series
UMMS Affiliation
Department of Surgery, Division of Plastic Surgery
Publication Date
2021-04-23
Document Type
Article
Disciplines
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Plastic Surgery | Surgery
Abstract
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.
Keywords
Free flap, GIIIb, 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
Rights and Permissions
© 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/
DOI of Published Version
10.1016/j.reth.2021.04.001
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
Journal/Book/Conference Title
Regenerative therapy
Related Resources
PubMed ID
33997186
Repository Citation
Matsumine H, Giatsidis G, Fujimaki H, Yoshimoto N, Makino Y, Hosoi S, Takagi M, Shimizu M, Takeuchi M. (2021). NPWTi allows safe delayed free flap repair of Gustilo IIIb injuries: A prospective case series. Open Access Publications by UMass Chan Authors. https://doi.org/10.1016/j.reth.2021.04.001. Retrieved from https://escholarship.umassmed.edu/oapubs/4710
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Included in
Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Plastic Surgery Commons, Surgery Commons