Negative Pressure Wound Therapy to Promote Fixation and Remodeling of Omental Flap in Patients with Revascularized Limbs: A Case Series
| Autor: | Mario D'Oria, Nicla Settembre, Charbel Saba, Sergueï Malikov, Zakariyae Bouziane |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Ischemia 030204 cardiovascular system & hematology Omental flap Revascularization Surgical Flaps 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Negative-pressure wound therapy medicine Humans In patient Fixation (histology) Aged Wound Healing business.industry General Medicine Skin Transplantation Middle Aged medicine.disease Limb Salvage Surgery Treatment Outcome Lower Extremity Chronic Disease Skin grafting Cardiology and Cardiovascular Medicine Wound edge business Omentum Vascular Surgical Procedures Negative-Pressure Wound Therapy |
| Zdroj: | Annals of vascular surgery. 52 |
| ISSN: | 1615-5947 |
| Popis: | We present our experience with 5 patients with chronic limb threatening ischemia (CLTI) treated with distal revascularization and omental flap coverage. We decided to investigate the efficacy and safety of negative-pressure wound therapy (NPWT) in promoting the fixation and remodeling of the omental flap as there is some evidence in the literature about the optimization of results for skin graft and dermal substitutes. Surgical revascularization was always the first procedure attempted; wound coverage was realized 3–5 days after the primary procedure (omental free-flap in 3 patients and omental flow-through flap in 2 patients). NPWT with small foam at −75 mm Hg was applied on the second postoperative day after flap coverage. Effective remodeling of the flap was defined as the flap overcoming the wound edge no more than 10 mm. Limb salvage rate was 100%; in all the patients, and we observed satisfactory fixation and remodeling of the omental flap after 10–20 days of NPWT, secondary skin grafting within 3–4 weeks after revascularization, and adequate and complete mobilization within 6 months after hospital discharge. We did not report any relapsing infection nor any recurrent wound up to 2 years of follow-up. Distal revascularization combined with omental free-flap or flow-through flap is highly effective for limb salvage in CLTI patients with complex wounds. NPWT may be an useful adjunct to promote fixation and remodeling of the omental flap before secondary skin grafting. It may reduce secondary issues related to omental flap coverage allowing rapid and satisfactory mobilization of patients. |
| Databáze: | OpenAIRE |
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