Negative pressure wound therapy on a musculocutaneous free flap in no skin edge wound bed: A case report

Necrotising soft tissue infection (NSTI) is an exceptionally dangerous infectious disease targeting soft tissues with high mortality as well as morbidity. The aim of reconstructive surgery after initial debridement is to maintain function as well as to achieve a satisfactory cosmetic result.

A 50-year-old male presented with necrotising soft tissue infection on the thorax and left upper arm following mastectomy for breast cancer. He underwent aggressive debridement and was left with a large complicated soft tissue defect on the thorax, abdomen and left axilla with a wound bed consisting of exposed bone, nerves and vessels. There were close to no adjacent skin edges to fixate the flap, due to the size of the defect. Reconstruction with a free musculocutaneous latissimus dorsi (LD) and split skin grafting was performed. Vacuum therapy was applied immediately over the free flap and the vascular pedicle, as well as the skin graft.

Application of NPWT to the entire reconstructed area, including the free flap, in terms of achieving better and faster healing, is somewhat novel. Applying negative pressure wound therapy (NPWT) on free flaps is not a new practice but it has mostly been used as incisional therapy or when complications have occurred.

Our case shows a successful microsurgical reconstruction in a challenging area, with the direct application of NPWT perioperatively, without compromising flap survival, and with good patient outcome.