Wednesday, November 6, 2002
674

Defining the Role for Negative Pressure Therapy in the Treatment Algorithm of Extremity Wounds

Liza C. Wu, MD, Loren S. Schechter, MD, Robert F. Lohman, MD, Robin Wall, PA, and Mieczyslawa Franczyk, PT, PhD.

Introduction: Negative pressure therapy has been promoted as a method of simplifying care and reducing the extent of soft tissue reconstruction in complex extremity wounds. The role of this new therapy has yet to be defined. A cohort of patients receiving negative pressure therapy and free tissue transfer was evaluated. Methods: All patients undergoing soft tissue reconstruction of the extremities are entered into a prospective database. A subset of patients treated with both negative pressure wound therapy and free tissue transfer was analyzed. Results: From 6/99 to 2/02, 16 patients with extremity wounds were treated with negative pressure wound therapy and free tissue transfer: 14 males and 2 females, 14 lower extremity and 2 upper extremity wounds. Wounds occurred as a result of trauma (13), vascular insufficiency (1), a brown recluse spider bite (1), and therapy for soft tissue sarcoma (1). Major complications requiring reoperation occurred in 7 (44%) patients: total flap loss (2), persistent osteomyelitis (1), abscess (1), tibial non-union (1), hematoma (1), and loss of skin graft (1). Complications did not appear to be related to age, co-morbidities, method of injury, or MESS. The mean number of days between injury and soft tissue reconstruction for the patients without complications was 48 (4 – 165) compared to the patients with complications, 101 (17-224). The mean number of days of negative pressure therapy for patients without complications was 14 (2 – 90), compared to 49 (8 – 100) for patients with complications (p < 0.05). Conclusion: Although negative pressure therapy has a role in the management of complex extremity wounds, delayed soft tissue reconstruction continues to have a high complication rate. Negative pressure wound therapy will probably reduce the need for emergency free flaps, but does not change the basic principles of extremity reconstruction: adequate debridement and early soft tissue reconstruction.


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