Educational Objective: The authors propose an infrequently described technique for managing wound dehiscence following free tissue transfer in the head and neck. At the conclusion of this presentation, the participants should be able to understand the utility and limitations of negative pressure dressings in the management of complicated head and neck wounds.

Background: Negative-pressure dressings have received attention for the management of complex wounds of the torso and extremities. In this method, a vacuum-assisted closure system (V.A.C.) is applied to the wound. Subatmospheric pressure at the wound site fosters improved vascular perfusion and decreases bacterial counts and local edema. Additionally, it has been demonstrated to stimulate granulation tissue formation and promote wound debridement. While the emergence of V.A.C. has been embraced avidly for complex wounds throughout the body, it has not been widely implemented for use in the management of complicated head and neck wounds.

Design: By reviewing a clinical case from a series of patients within our practice, the authors highlight the management of wound dehiscence with vacuum-assisted closure.

Method: Case report, review of the literature, and discussion.

Results: A 67-year-old male presented with T4N0M0 squamous cell carcinoma of the left floor of mouth with invasion of the alveolar ridge of the mandible. He underwent surgical resection with segmental mandibulectomy and modified radical neck dissection. Reconstruction was performed with fibular free tissue transfer. By postoperative day eight, the patient developed incisional erythema. Frank dehiscence occurred by day ten, resulting in exposed bone (both native and free flap tissue). Wet-to-dry dressing changes were performed for the following seven days. As minimal granulation tissue was appreciated, a V.A.C system was applied to the area of dehiscence. With three days of negative pressure dressings a dramatic increase in granulation tissue was noted.

Conclusion: While widely employed in many parts of the body, use of the V.A.C. system in the head and neck has been limited. The V.A.C. system has been advocated for use in scalping injuries, pharyngocutaneous fistulas, donor site defects, and as a bolster dressing to cover skin grafts. Its scope of utility should be expanded to include wound dehiscence following free tissue transfer. With continued research and development, negative pressure dressings will find an increasing role in the management of complex wounds of the head and neck.