• NPWT
• NPWTi-d
• lower limb trauma wound
• open fracture
• orthopedics

• Rats
• Animals
• Epigastric Arteries/surgery
• Reproducibility of Results
• Free Tissue Flaps
• Ischemic Preconditioning/methods

• R01 AR082825 NIAMS NIH HHS

Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer. However, flap reconstruction for diabetic foot ulcer treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperative monitoring procedure implemented in conjunction with negative pressure wound therapy immediately after flap operations for treating diabetic foot. A retrospective analysis was performed on diabetic foot patients who underwent free flaps and perforator flaps from March 2019 through August 2021. The surgical outcomes of interest were the rates of survival and complications. On the third postoperative day, patients underwent computed tomography angiography to check for pedicle compression or fluid collection in the sub-flap plane. Monitoring time, as well as comparisons between NPWT and conventional methods, were analyzed. Statistical analysis was performed between the two groups. This study included 26 patients. Among patients, the negative pressure wound Therapy treated group included 14 flaps and the conventional monitoring group included 12 flaps. There was no significant intergroup difference in flap survival rate (p = 0.83). In addition, there was no significant intergroup difference in the diameters of perforators or anastomosed vessels before and after negative pressure wound therapy (p = 0.97). Compared with conventional monitoring, flap monitoring with incisional negative pressure wound therapy was associated with a significantly lower mean monitoring time per flap up to postoperative day 5. Although conventional monitoring is widely recommended, especially for diabetic foot ulcer management, the novel incisional negative pressure wound therapy investigated in this study enabled effortless serial flap monitoring without increasing complication risks. The novel flap monitoring technique is efficient and safe for diabetic foot patients and is a promising candidate for future recognition as the gold standard for flap monitoring.

Historically, patients with lower limb defects have represented a challenge for plastic surgeons because of their higher rate of complications. One of the main complications is venous congestion. Recently, various studies have suggested the use of negative pressure wound therapy as a salvage flap therapy, showing promising results. In this case report, we will outline the case of an elderly patient with different comorbidities in whom we used negative pressure wound therapy (as an artificial leech) to reverse venous congestion in the flap, with a satisfactory clinical outcome and without any more surgical procedures.

• free flap
• negative pressure wound therapy
• pedicled flap

• Aged
• Aged, 80 and over
• Female
• Free Tissue Flaps
• Humans
• Male
• Middle Aged
• Negative-Pressure Wound Therapy
• Plastic Surgery Procedures
• Retrospective Studies
• Treatment Outcome
• Wound Healing

Negative pressure wound therapy (NPWT) is usually applied in wound management and soft-tissue salvage after the development of complications. However, immediate postoperative application of NPWT over the flap coverage is seldom reported. We evaluate the effectiveness of immediate postoperative application of NPWT following fasciocutaneous or muscle flap coverage for lower leg reconstruction. A retrospective review of patients who underwent either fasciocutaneous or muscle flap coverage of lower leg soft-tissue defects applied with NPWT immediately after surgery was conducted in a level I trauma center. Sixteen patients, with an average age of 51.2 years, were included in the study. Nine patients had trauma-related soft-tissue loss, six had subsequent soft-tissue defects after debridement, and one had burn injury. Two patients had been treated with free anterolateral thigh flaps, 11 with pedicle flaps, and three with muscle flaps. All flaps survived except for those in two patients with venous congestion on postoperative day 1, which needed further debridement and skin grafting. Therefore, the use of immediate incisional NPWT is an alternative for wound care following flap coverage. The U-shaped design allows easy flap observation and temperature check. Furthermore, this method eliminates any concerns of vascular pedicle compression under negative pressure.

Background Paradoxical respiration is a sinister consequence of bony chest cage defects which can persist even post chest wall reconstruction. It leads to prolonged dependence on mechanical ventilation postoperatively, thereby delaying recovery. Methods Negative pressure wound therapy (NPWT) was applied in early postoperative period to a patient with chest wall defect reconstructed with folded prolene mesh and free anterolateral thigh flap. Arterial blood gas (ABG), fraction of inspired oxygen (FiO ₂ ), peak end expiratory pressure (PEEP), oxygen saturation (SpO ₂ ), and blood pressure (BP) readings pre and post NPWT application were compared. Results There was marked improvement in the breathing mechanics and related parameters post NPWT application over the flap. Conclusions Negative extrathoracic pressure in the form of a temporary splint can enable early weaning off the ventilator and a smoother postoperative recovery in reconstructed chest wall defects.

• chest wall reconstruction
• negative pressure wound therapy
• paradoxical respiration

• Negative pressure wound therapy
• Vacum asisted closure
• axial skin flap
• congested flap
• flaps
• plastic surgery
• venous skin flap

• Female
• Fluorescence
• Humans
• Indocyanine Green
• Male
• Plastic Surgery Procedures
• Surgical Flaps
• Surgical Wound

Wounds from orthopedic limb reconstruction are often difficult to heal due to the surgery, patient comorbidities, or a combination of these factors. The role of negative pressure wound therapy (NPWT) modalities in the perioperative management of patients with complex lower extremity wounds is evolving. Here, we present a case study using adjunctive NPWT with instillation and a dwell time, standard NPWT, and closed-incision negative pressure therapy (ciNPT) to manage a complex lower extremity wound. The patient was a 51-year-old man who presented with severe scarring of the lower extremity and infection following plate osteosynthesis of a tibial shaft fracture. Following lower extremity reconstruction, the patient received 5 days of NPWT with instillation and a dwell time with cycles that consisted of instilling normal saline with a 1-second dwell time, followed by 2 hours of continuous negative pressure at −125 mm Hg. The wound is then covered with an adjacent local tissue flap, which showed signs of vascular complication. ciNPT is applied over the flap incision for 7 days, which resulted in restored normal coloration; ciNPT is continued for another 7 days. A skin substitute is applied over the flap donor site, followed by NPWT using a silver foam dressing. Dressing changes are performed weekly for 4 weeks. At 8 weeks postsurgery, a skin graft is applied over the donor site. In this case, adjunctive use of multiple NPWT modalities resulted in a completely healed wound within 12 months with no complications.

• Ankle reconstruction
• Foot reconstruction
• Free flap
• Kickstand external fixator

Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy (NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms (macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms (including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.

• Negative pressure wound therapy
• Chronic wounds
• Microdeformational wound therapy
• Vacuum assisted closure
• Pressure ulcers

• Achilles region
• Debridement
• Defects
• Flaps
• HBOT
• Management
• Reconstructive ladder
• Soft-tissue
• Wounds

Successful closure is a primary step of treatment in open fracture wounds. Delayed healing or complications can lead to increased treatment duration, costs and disability rates. The aim of this study was to compare Negative Pressure Wound Therapy (NPWT) and conventional wound dressings in patients with open fracture wounds.

In a prospective randomized clinical trial study, 90 patients with open fractures that were referred for treatment were enrolled between February 2013 to March 2015. Patients were divided into two groups. Group I underwent NPWT and group II underwent conventional wound dressing. Then patients were followed up for one month. Within the one month, the number of dressing change varied based on the extent of the wound. Duration of wound healing, presence of infection and the number of hospitalization days in these patients were recorded and compared at the end of the study between the two groups. Questionnaires and check lists were used to collect data. Analysis was done with SPSS 20_, paired sample T-test, and chi-square tests. P<0.05 was considered significant.

There was a significant difference between the rate of wound healing in the group one or NPWT group and group II (conventional wound dressings) P<0.05. There was no significant difference between two groups in incidence of infection (P=0.6).

Using NPWT expedites the healing process of extremity wounds. It is more economical and can be considered as a substitute for the treatment of extremity wounds.

• Conventional Wound Dressings
• Infection
• Negative Pressure Wound Therapy
• Wound healing

• Achilles tendon
• Ankle
• Perforator flap
• Soft-tissue reconstruction

Soft tissue defects over the mid- and distal third tibia, heel, dorsum and plantar aspect of the foot and over the medial, lateral and posterior aspect of the ankle are a common scenario in clinical orthopaedic practice. In this article, we describe the utility of the reverse sural fasciocutaneous flap with a cutaneous pedicle in 109 clinical cases with distal lower limb soft tissue defects.

A total of 109 patients were operated on for moderate (5–15 cm) and large (more than 15 cm) soft tissue defects at various sites along the lower limb including foot, heel and sole with the reverse sural fasciocutaneous flap. The defects were secondary to trauma (61 cases), diabetic ulcers (12 cases), post-traumatic scar contracture (8 cases), venous ulcer (4 cases), wound dehiscence (10 cases), leprotic non-healing ulcer (1 case), post-infective wound (1 case), radiation-induced ulcer following radiotherapy for synovial cell sarcoma (1 case), post-fibromatosis excision (1 case), post-dermatofibrosarcoma excision (1 case), post-heel melanoma excision (1 case) and actinomycosis foot (1 case). Patients were assessed for flap uptake and healing of defects.

Among the 102 cases analysed, 81 were male and 21 female with an average age of 32.7 years. The average size of the flaps was 148.10 ± 59.54 cm². The flap healed uneventfully in 89.21 % of patients. Edge necrosis occurred in 9 cases. Donor site regrafting was required in 7 patients.

The reverse sural fasciocutaneous flap with a cutaneous pedicle is a quick, versatile, easy and safe soft tissue defect coverage technique to cover most of the soft tissue defects of the lower limb in common orthopaedic practice and does not require any microvascular repair, though it may be cosmetically unappealing in a few cases.

IV (Case series)

• Bandages
• Biofilms
• Cell- and Tissue-Based Therapy/trends
• Female
• Humans
• Male
• Negative-Pressure Wound Therapy/methods
• Negative-Pressure Wound Therapy/trends
• Occlusive Dressings
• Suction
• Treatment Outcome
• Wound Healing
• Wounds and Injuries/pathology
• Wounds and Injuries/therapy