Vacuum-assisted closure for complicated wounds in head and neck region after reconstruction

Abstract

Objective: The aim of this study is to suggest that negative pressure wound therapy (NPWT) is an excellent alternative for managing complicated wounds after head and neck reconstruction.

Summary background data: Management of complicated wounds such as wound infection or persistent saliva leakage from poor wound healing with dead space is challenging in head and neck reconstruction. The NPWT is a useful device widely used in treating many complicated wounds. In this study, we applied this device on complicated wounds after head and neck reconstruction and share our experience and modifications.

Methods: From January 2004 to December 2009, 13 male patients (mean age: 50.0 years) were included. Eleven patients were reconstructed with free flap transfer and the other two patients received a local flap for repair immediately after tumour ablation. Among them, 12 patients (92%) had complicated wounds with infection and one patient (8%) with partial loss of the free flap. Eight of these 13 patients (62%) had saliva leakage and fistula formation. For those who had a free flap transfer, the vacuum-assisted closure (VAC) system was applied with modifications to the complicated wound 2 weeks later, after better neo-vascularisation around the free flap. Watertight suturing on the mucosal side is needed to ensure air sealing and enhance wound healing acquired by the VAC system.

Results: All wounds demonstrated adequate control of wound infection, quick obliteration of dead space and rapid growth of granulation tissue under the NPWT. Eleven patients (85%) had wound healing with secondary intention; one (8%) needed a further skin grafting; and one patient (8%) needed a free flap transfer due to partial flap loss in a severe wound infection even after the NPWT application. The average duration of the NPWT usage was 10.8 days (4-24 days); most of the wounds healed within 1 week after the NPWT application.

Conclusion: The NPWT is an excellent alternative for managing complicated wounds after head and neck reconstruction. It is safe and comfortable for the patient and provides good results in infection control, dead space obliteration and improvement of wound healing.

Keywords: Complicated wound; Fistula formation; Head and neck reconstruction; Negative pressure wound therapy (NPWT); Vacuum-assisted closure (VAC) system.