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Original Investigation |

Negative Pressure Wound Therapy in Head and Neck Surgery

Scott A. Asher, MD1; Hilliary N. White, MD1; Joseph B. Golden, MD1; J. Scott Magnuson, MD1; William R. Carroll, MD1; Eben L. Rosenthal, MD1
[+] Author Affiliations
1Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham
JAMA Facial Plast Surg. 2014;16(2):120-126. doi:10.1001/jamafacial.2013.2163.
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Importance  Negative pressure wound therapy has been shown to accelerate healing. There is a paucity of literature reporting its use as a tool to promote wound healing in head and neck reconstruction.

Objective  To review 1 institution’s experience with negative pressure dressings to further describe the indications, safety, and efficacy of this technique in the head and neck.

Design, Setting, and Participants  Retrospective case series at a tertiary care academic hospital. One hundred fifteen patients had negative pressure dressings applied between April 2005 and December 2011. Data were gathered, including indications, details of negative pressure dressing use, adverse events, wound healing results, potential risk factors for compromised wound healing (defined as previous radiation therapy, hypothyroidism, or diabetes mellitus), and wound characteristics (complex wounds included those with salivary contamination, bone exposure, great vessel exposure, in the field of previous microvascular free tissue transfer, or in the case of peristomal application in laryngectomy).

Exposure  Negative pressure wound therapy utilized after head and neck reconstruction.

Main Outcomes and Measures  Indications for therapy, length and number of dressing applications, identification of wound healing risk factors, classification of wound complexity, wound healing results, and adverse events related to the use of the device.

Results  Negative pressure wound therapy was used primarily for wounds of the neck (94 of 115 patients [81.7%]) in addition to other head and neck locations (14 of 115 patients [12.2%]), and free tissue transfer donor sites (7 of 115 patients [6.1%]). The mean (SD) wound size was 5.6 (5.0) cm. The mean number of negative pressure dressing applications was 1.7 (1.2), with an application length of 3.7 (1.4) days. Potential risk factors for compromised wound healing were present in 82 of 115 patients (71.3%). Ninety-one of 115 patients (79.1%) had complex wounds. Negative pressure dressings were used in wounds with salivary contamination (n = 64), bone exposure (n = 40), great vessel exposure (n = 25), previous free tissue transfer (n = 55), and peristomal application after laryngectomy (n = 32). Adverse events occurred in 4 of 115 patients (3.5%).

Conclusions and Relevance  Negative pressure wound therapy in head and neck surgery is safe and has potential to be a useful tool for complex wounds in patients with a compromised ability to heal.

Level of Evidence  4

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Figure 1.
Peristomal Application of Negative Pressure Wound Therapy in Wounds After Laryngectomy

A, Necrotic wound in a laryngectomy patient before debridement. B, Endotracheal tube modified to decrease dead space via skeletonizing pilot balloon tract. C, Example of incorporation of artificial airway into negative pressure dressing.

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Figure 2.
Negative Pressure Dressing Used for Complex Neck Wound Infection

A, Six days after free flap reconstruction, the patient demonstrated signs of infection with exudate in the drain, erythema, and edema of the overlying skin. B, The wound is explored and irrigated, demonstrating osseocutaneous free flap with intraoral dehiscence (salivary contamination), exposed bone and hardware, as well as microvascular anastamosis in the contaminated field. C, Sizing microporous sponge inserted into the defect. D, Final appearance of negative pressure dressing once it has been applied.

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