Abstract
Local random flaps are seldom used for reconstruction of complex ankle wounds because
of concern for flap failure attributable to vascular compromise and tissue edema.
Negative pressure wound therapy has been shown to improve perfusion and limit tissue
edema. The objective of this study was to demonstrate the utility of negative pressure
wound therapy in improving outcomes for local flaps of the ankle. Ten consecutive
patients presenting with complex ankle wounds and reconstructed using local flaps
were treated with negative pressure wound therapy postoperatively. Type of flap, immediate
and long-term outcomes, and complications were assessed. Seventeen local flaps were
performed on 10 patients to reconstruct their ankle wounds. Mean follow up was 88
days. All flaps healed without tissue compromise or necrosis. Only one partial dehiscence
and no infections were observed. This study demonstrates that negative pressure therapy
may contribute to the viability of random local flaps by decreasing venous congestion.
Our experience using negative pressure wound therapy on local flaps suggests that
it may serve as a useful adjunct to ensure successful closure of high-risk wounds.
Level of Clinical Evidence
Keywords
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References
- Pedicled flaps for lower extremity reconstruction in the elderly: a retrospective study of 16 cases.Ann Plast Surg. 2004; 53: 368-372
- Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.J Plast Reconstr Aesthet Surg. 2006; 59: 912-917
- Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.Ann Plast Surg. 1997; 38: 563-576
- Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.Ann Plast Surg. 1997; 38: 553-562
- Efficacy of negative pressure therapy to enhance take of 1-stage allodermis and a split-thickness graft.Ann Plast Surg. 2007; 58: 536-540
- Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients.Dermatology. 2008; 216: 250-256
- The mechanism of action of the vacuum-assisted closure device.Plast Reconstr Surg. 2008; 122: 786-797
- [Vacuum assisted closure. Wound healing by negative pressure].Ann Chir Plast Esthet. 1996; 41 (French): 583-589
- [Vacuum assisted closure—a new method for wound control and treatment].Harefuah. 2003; 142 (Hebrew): 837-840
- Effects of vacuum-assisted closure on wound microcirculation: an experimental study.Asian J Surg. 2005; 28: 211-217
- Negative-pressure wound therapy I: the paradox of negative-pressure wound therapy.Plast Reconstr Surg. 2009; 123: 589-598
- External fixators as an adjunct to wound healing.Foot Ankle Clin. 2008; 13: 145-156
- Utility of both muscle and fascia flaps in severe lower extremity trauma.J Trauma. 2000; 48: 913-917
- The relative roles of aggressive wound care versus revascularization in salvage of the threatened lower extremity in the renal failure diabetic patient.Plast Reconstr Surg. 2002; 109: 1281-1290
- Perforator-plus flaps: a new concept in traditional flap design.Plast Reconstr Surg. 2007; 119: 590-598
- Negative pressure wound therapy achieved by vacuum-assisted closure: evaluating the assumptions.Ostomy Wound Manage. 2007; 53: 52-57
- Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound-healing adjuvants.Plast Reconstr Surg. 2006; 117: 72S-109S
- Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device.Ann Plast Surg. 2007; 58: 573-576
- Outcomes of skin graft reconstructions with the use of Vacuum Assisted Closure (VAC(R)) dressing for irradiated extremity sarcoma defects.World J Surg Oncol. 2007; 5: 138
- The role of the vacuum-assisted closure therapy in the salvage of venous congestion of the free flap: case report.Int Wound J. 2008; 5: 50-53
Article info
Publication history
Published online: September 01, 2010
Footnotes
Financial Disclosure: Dr. Attinger is a consultant for LifeCell.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
