Arch Plast Surg.  2018 Jan;45(1):45-50. 10.5999/aps.2016.01977.

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

• Chim H
• Zoghbi Y
• Nugent AG
• Kassira W
• Askari M
• Salgado CJ

• KMID: 2403539
• DOI: http://doi.org/10.5999/aps.2016.01977

Abstract

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.

Keyword

Free tissue flaps; Negative pressure wound therapy; Reconstructive surgery; Tibial fractures; Gustilo classification; Surgical flaps

MeSH Terms

Bandages*
Cohort Studies
Free Tissue Flaps
Humans
Leg
Lower Extremity*
Negative-Pressure Wound Therapy*
Prospective Studies
Surgical Flaps
Tibial Fractures
Trauma Centers
Vacuum*
Wounds and Injuries