Negative Pressure Wound Therapy in Free Muscle Flaps-Risk or Benefit?

Area of Science:

• Microsurgery
• Wound Healing
• Biomedical Engineering

Background:

• Negative pressure wound therapy (NPWT) offers potential benefits for free flaps by reducing edema and applying external pressure.
• The combined effects of NPWT on flap perfusion (macro- and microcirculation) and edema require further investigation for clinical application.
• This study assesses NPWT's impact on free flap circulation and edema in microsurgical reconstructions.

Purpose of the Study:

• To evaluate the influence of NPWT on macro- and microcirculation in free flaps.
• To assess the efficacy of NPWT in reducing flap edema.
• To determine the clinical value of NPWT in microsurgical reconstructions.

Main Methods:

• A prospective cohort study involving 26 patients with free gracilis muscle flaps for lower extremity reconstruction.
• Patients were treated with either NPWT (13) or conventional gauze dressing (13) for 5 postoperative days.
• Flap perfusion was monitored using laser Doppler flowmetry, remission spectroscopy, and an implanted Doppler probe; flap edema was assessed via 3D scans.

Main Results:

• No flap exhibited circulatory disturbances in either group.
• NPWT significantly increased macrocirculatory blood flow velocity compared to the control group.
• NPWT effectively reduced flap edema, with sustained volume decrease post-therapy, unlike the control group where edema increased.

Conclusions:

• NPWT is a safe and effective dressing for free muscle flaps.
• NPWT enhances blood flow and achieves significant, sustainable edema reduction.
• NPWT should be considered a supportive therapy for free tissue transfer, not just a wound covering.