Use of negative pressure wound therapy on locoregional flaps: a case-control study

Objective: The use of negative pressure wound therapy (NPWT) is ubiquitous in the management of complex wounds. Extending beyond the traditional utility of NPWT, it has been used after reconstructive flap surgery in a few case series. The authors sought to investigate the outcomes of NPWT use on flap reconstruction in a case-control study. Method: Patients who underwent flap reconstruction between November 2017 and January 2020 were reviewed for inclusion in the study, and divided into an NPWT group and a control group. For patients in the NPWT group, NPWT was used directly over the locoregional flap immediately post-surgery for 4-7 days, before switching to conventional dressings. The control group used conventional dressing materials immediately post-surgery. Outcome measures such as flap necrosis, surgical site infections (SSIs), wound dehiscence as well as time to full functional recovery and hospitalisation duration were evaluated. Results: Of the 138 patients who underwent flap reconstruction, 37 who had free flap reconstructions were excluded, and 101 patients were included and divided into two groups: 51 patients in the NPWT group and 50 patients in the control group. Both groups had similar patient demographics, and patient and wound risk factors for impaired wound healing. Results showed that there was no statistically significant difference between flap necrosis, SSIs, wound dehiscence, hospitalisation duration as well as functional recovery rates. Cost analysis showed that the use of NPWT over flaps for the first seven postoperative days may potentially be more cost effective in our setting. Conclusion: In this study, the appropriate use of NPWT over flaps was safe and efficacious in the immediate postoperative setting, and was not inferior to the conventional dressings used for reconstructive flap surgery. The main benefits of NPWT over flaps include better exudate management, oedema reduction and potential cost savings. Further studies would be required to ascertain any further benefit.