Negative Pressure Dressings Over Free Muscle Flaps: A 6 Year Experience
Ashley Q. Thorburn, MD1, Rene P. Myers, MD1, Patrick K. Kelley, MD2, Steven L. Henry, MD2.
1University of Alabama, Birmingham, Birmingham, AL, USA, 2University of Texas at Austin, Dell Medical School, Austin, TX, USA.
Negative pressure dressings (NPDs) make excellent skin graft bolsters that improve graft healing and ease of care. However, some microsurgeons are reluctant to use them over free flaps for fear of impairing flap perfusion and/or assessment. In 2011 we described the use of NPDs over skin grafted free muscle flaps in 13 cases, showing favorable results. METHODS:
We performed a retrospective review of these cases performed at 2 institutions over a 6 year period. RESULTS:
The majority of flaps were for lower extremity trauma wounds (74), followed by upper extremity trauma wounds (8), scalp tumor defects (4), and one torso wound. There were 7 flap losses, but of these, 4 were due to noncompliance with postoperative immobilization/elevation orders; excluding these 4 failures for which the NPD was clearly not a factor, the flap success rate was 96.4%. Skin graft healing was uniformly excellent, with the exception of the above 7 cases, as well as 2 graft losses due to disruption during flap takeback, 2 partial graft losses due to infection, and 1 partial graft loss due to hematoma. In only one case (a scalp flap), the NPD was discontinued early, on postoperative day 1, due to inability to maintain a seal. CONCLUSION:
This series strongly suggests that NPDs do not contribute to free flap failure. While we do believe there are important technical caveats to NPD placement over free flaps, we feel that NPDs are safe, effective, and in many ways advantageous in this setting.
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