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KMID : 1038220180450010045
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Archives of Plastic Surgery
2018 Volume.45 No. 1 p.45 ~ p.50
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Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness
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Chim Harvey
Zoghbi Yasmina
Nugent Ajani George
Kassira Wrood
Askari Morad
Salgado Christopher John
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Abstract
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Background: Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity.
Methods: Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients.
Results: There was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was 6.4±6.4 mm, while flap thickness for the exposed flap group was 29.6±13.5 mm. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group.
Conclusions: Immediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.
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KEYWORD
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Free tissue flaps , Negative pressure wound therapy , Reconstructive surgery , Tibial fractures , Gustilo classification , Surgical flaps
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