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The Use of Instillation Negative Pressure Wound Therapy in the Management of Complex Tissue Loss; a New Paradigm in Reconstruction

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The Use of instillation Negative Pressure Wound Therapy in the Management of Complex Tissue Loss; a New Paradigm in Reconstruction

 

Antoine Duong, Edouard Coeugniet, MD, MSc, Alain Danino, MD, PhD, FRCSC, Laurence Paek, MD, MSc, FRCSC, Ali Izadpanah, MD, MSc, FRCSC, FACS,

 

 

Abstract

 

Introduction

Complex wounds present a challenge to both the surgeon and patient in operative management, long-term care, cosmetic outcome, and effects on lifestyle, self-image, and general health. Each patient with complex wounds usually manifests multiple risk factors for their development. We present a review of some of select cases managed with instillation Negative Pressure Wound Therapy (iNPWT) and iNPWT-Cleanse Choice. 

 

Materials and Methods

After obtaining an institutional Review Board approval, we performed a retrospective review of our select cases requiring potential flap for obtaining a definitive closure that were treated only with iNWPT and iNWPT-Cleanse Choice ™. 

 

Results

Between May 2016 and June 2018, a total of fourteen cases potentially requiring flap closure for exposed bones and tendons, or for filling large dead space cavities were treated with surgical debridement, application of iNWPT-Cleanse Choice ™. Many of these cases had previously failed to lead to a successful reconstruction using IntegraÔDermal Regeneration Template even after a three week or more period of integration. 

In addition, this allowed many cases to be treated by dressing changes using the iNPWT after the initial surgical debridement where operating room was not accessible or where the wound was not progressing adequately using regular NPWT. 

Cost-effective comparison to conventional free tissue transfers and the use of dermal substitutes is performed.

 

Conclusion

Instillation Negative Pressure Wound Therapy is an effective measure in the management of exposed bones and tendons, and closure of large dead-spaces where surgical soft tissue transfers are not ideal or feasible. All reconstructive surgeons should make themselves aware of the potentials for the use of iNPWT in the management of complex wounds. This is an effective addition to our reconstructive ladder with similar or lower costs compared to more conventional methods. In addition, it could be used as a salvage in these failed cases.          

 

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