K. A. Rezzadeh1, L. A. SEGOVIA1, A. HOKUGO1, R. Jarrahy1 1University Of California, Los Angeles,Surgery- Plastic,Los Angeles, CA, USA
Introduction: Negative pressure wound therapy (NPWT) is a widely accepted method of temporary wound coverage prior to soft tissue flap reconstruction of severe lower extremity injuries. However, an examination of the effects of NPWT on complications related to limb salvage surgery has yet to be performed. The precise role of NPWT in the perioperative management of patients with complicated lower extremity injuries remains unclear. In this study we examine the impact of NPWT on the outcomes of traumatic lower extremity wounds treated with flap coverage for the purpose of limb salvage. Specifically, we elucidate the effect of NPWT on flap complications and overall outcomes based upon the timing of soft tissue reconstruction relative to initial injury.
Methods: : An institutional case series was performed consisting of thirty-two consecutive patients receiving lower extremity reconstruction following Gustilo Class IIIB and IIIC open tibial fractures from 1996 to 2001. Demographic, operative, and clinical data were collected retrospectively. Outcomes of interest included length of hospitalization, number of surgical procedures, extremity amputation, and non-union.
Results:Among patients reconstructed within all study time periods (i.e., acute, subacute, and chronic), the incidence of overall complications was lower for the group treated with NPWT than for those patients who underwent conventional wet-to-dry dressing changes. Patients operated on in the chronic period and who received conventional dressing changes had the highest rate (83.3%) of complications while those who were reconstructed in the acute period with perioperative NPWT had the lowest incidence (0%).
Conclusion:We have shown that the use of NPWT therapy in the perioperative management of patients with open distal lower extremity fractures reduces complication rates associated with limb salvage surgery. Based on our results, we conclude that NPWT can be used as a temporizing measure to optimize patients prior to flap surgery, effectively lengthening the window of opportunity for reconstructive surgeons to manage these challenging patients.
