Negative Pressure Dressings
Negative Pressure Dressings
Free tissue transfer is a well established tool for the reconstruction of large, complicated wounds of the extremities. However, when free flap reconstruction is contraindicated or in cases where it has failed, the management of this type of wound presents a formidable task. Although negative pressure wound therapy (NPWT) plays an increasing role in the treatment of complex open wounds, there are only a few reports of successful management of wounds with areas of exposed tendon or bone. The authors present their experience with the use of NPWT in the treatment of open wounds of the extremities with relatively large areas of exposed bone.
Free flap reconstruction is a well established technique for the closure of large, complex wounds of the extremities with exposed functional structures. The management of wounds in which there are large areas of exposed bone or tendons or in wounds that are located in functionally active areas can become a formidable task when free flap coverage is contraindicated. Such circumstances include extensive crush or burn injuries in which the condition of the recipient vessels eliminates free tissue transfer as an option. Other situations that may necessitate an alternative to free flap transfer include patients with significant comorbidities, patients who are unable to tolerate extended periods of general anesthesia, and patients who have had free flap failure at the wound site.
The only viable alternatives to free tissue transfer for the management of large, complex wounds of the extremities with exposed bone and other functional structures are pedicled flaps (eg, cross-legged flaps). However, these methods have a wide range of complications and are not always feasible. Skin grafting is not a treatment of choice for coverage of wounds with exposed bone or hardware, especially over disrupted periosteum.
In 1995, a new method utilizing negative pressure was used by Argenta et al. at the Bowman School of Medicine in Winston-Salem, NC, and approved by the US Food and Drug Administration (FDA) for the management of wounds in a wide variety of clinical settings. Negative pressure wound therapy (NPWT, V.A.C.® Therapy System, KCI, San Antonio, Tex) has been reported to serve dependably and superiorly to conventional dressings in the management of large complex wounds. Myers et al. concluded that NPWT may serve as an effective adjunct to definitive treatment to delay free tissue transfer when it is appropriate but should not be used in place of free tissue transfer. Recently, DeFranzo et al. and Heugel et al. have reported successful management of wounds with small areas of exposed bone, tendon, and orthopedic hardware using NPWT. The authors' experience supports these previous reports and further suggests that NPWT might have a significant role in the management of wounds with large areas of exposed bone and tendon in cases where free tissue transfer is contraindicated.
Free tissue transfer is a well established tool for the reconstruction of large, complicated wounds of the extremities. However, when free flap reconstruction is contraindicated or in cases where it has failed, the management of this type of wound presents a formidable task. Although negative pressure wound therapy (NPWT) plays an increasing role in the treatment of complex open wounds, there are only a few reports of successful management of wounds with areas of exposed tendon or bone. The authors present their experience with the use of NPWT in the treatment of open wounds of the extremities with relatively large areas of exposed bone.
Free flap reconstruction is a well established technique for the closure of large, complex wounds of the extremities with exposed functional structures. The management of wounds in which there are large areas of exposed bone or tendons or in wounds that are located in functionally active areas can become a formidable task when free flap coverage is contraindicated. Such circumstances include extensive crush or burn injuries in which the condition of the recipient vessels eliminates free tissue transfer as an option. Other situations that may necessitate an alternative to free flap transfer include patients with significant comorbidities, patients who are unable to tolerate extended periods of general anesthesia, and patients who have had free flap failure at the wound site.
The only viable alternatives to free tissue transfer for the management of large, complex wounds of the extremities with exposed bone and other functional structures are pedicled flaps (eg, cross-legged flaps). However, these methods have a wide range of complications and are not always feasible. Skin grafting is not a treatment of choice for coverage of wounds with exposed bone or hardware, especially over disrupted periosteum.
In 1995, a new method utilizing negative pressure was used by Argenta et al. at the Bowman School of Medicine in Winston-Salem, NC, and approved by the US Food and Drug Administration (FDA) for the management of wounds in a wide variety of clinical settings. Negative pressure wound therapy (NPWT, V.A.C.® Therapy System, KCI, San Antonio, Tex) has been reported to serve dependably and superiorly to conventional dressings in the management of large complex wounds. Myers et al. concluded that NPWT may serve as an effective adjunct to definitive treatment to delay free tissue transfer when it is appropriate but should not be used in place of free tissue transfer. Recently, DeFranzo et al. and Heugel et al. have reported successful management of wounds with small areas of exposed bone, tendon, and orthopedic hardware using NPWT. The authors' experience supports these previous reports and further suggests that NPWT might have a significant role in the management of wounds with large areas of exposed bone and tendon in cases where free tissue transfer is contraindicated.
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