Successful Salvage of a Lower Extremity Local Flap Using Multiple Negative Pressure Modalities

Autor: Allen Gabriel, MD, FACS, Maci Pfaffenberger, PA-C, Elizabeth Eldenburg, PA-C
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Plastic and Reconstructive Surgery, Global Open, Vol 8, Iss 6, p e2801 (2020)
Druh dokumentu: article
ISSN: 2169-7574
00000000
DOI: 10.1097/GOX.0000000000002801
Popis: Summary:. 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.
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