负压伤口疗法在游离皮瓣移植手术中的应用研究进展

邓雅萍; 邓呈亮

doi:10.3760/cma.j.cn501225-20231106-00181

负压伤口疗法在游离皮瓣移植手术中的应用研究进展

doi: 10.3760/cma.j.cn501225-20231106-00181

邓雅萍,
邓呈亮^,

遵义医科大学附属医院烧伤整形外科,遵义　　563003

基金项目:

贵州省科技计划重点项目[黔科合基础-ZK（2021）重点 011] ZK2021-011

省部共建协同创新中心项目 2020-39

详细信息

通讯作者:
邓呈亮,Email：cheliadeng@sina.com

计量
- 文章访问数: 82
- HTML全文浏览量: 9
- PDF下载量: 16
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-06
- 网络出版日期: 2024-09-27

Research advances on the application of negative pressure wound therapy in free flap transplantation surgery

Deng Yaping,
Deng Chengliang^,

Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

Key Project of Guizhou Provincial Science and Technology Plan of China ZK2021-011

Collaborative Innovation Center of Chinese Ministry of Education 2020-39

More Information

Corresponding author: Deng Chengliang, Email: cheliadeng@sina.com

摘要

摘要: 负压伤口疗法（NPWT）是一种利用持续性真空负压管理创面的方法,被广泛用于各种创面的治疗。局部应用NPWT技术可清除创面渗出物,减少细菌感染,刺激血管和肉芽组织形成等,为游离皮瓣移植提供良好的基底。然而,对于游离皮瓣移植术后是否行NPWT存在争议。研究表明,NPWT联合游离皮瓣移植治疗具有促进创面愈合、减少并发症的作用；在皮瓣供区创面使用NPWT可以减小创面张力,促进创面愈合,还能改善色素沉着。该文对NPWT在游离皮瓣移植术中的临床应用相关文献进行总结,为两者的联合应用提供理论依据。
- 负压伤口疗法 /
- 外科皮瓣 /
- 手术后并发症 /
- 创面修复
Abstract: Negative pressure wound therapy (NPWT) is a therapy that utilizes continuous vacuum negative pressure to manage wounds, and it is commonly employed in treating various wounds. The local application of NPWT technology is helpful in removing wound exudate, decreasing bacterial infection, and stimulating the formation of blood vessels and granulation tissue, thus providing a good base for free flap transplantation. However, there is controversy over whether NPWT should be performed after free flap transplantation. Researches showed that NPWT combined with free flap transplantation could promote wound healing and reduce complications. Additionally, applying NPWT in the wounds of flap donor areas can decrease wound tension, promote wound healing, and improve pigmentation. This paper aims to review literature related to the clinical use of NPWT in free flap transplantation, providing a theoretical basis for their combined application.
- Negative-pressure wound therapy /
- Surgical flaps /
- Postoperative complications /
- Wound repair
所有作者均声明不存在利益冲突

HTML全文

参考文献(47)

[1]	ShimboK,KawamotoH,KoshimaI.Muscle/musculocutaneous versus fasciocutaneous free flap reconstruction in the lower extremity: a systematic review and meta-analysis[J].Microsurgery,2022,42(8):835-847.DOI: 10.1002/micr.30961.
[2]	LangdellHC,ShammasRL,AtiaA,et al.Vein grafts in free flap reconstruction: review of indications and institutional pearls[J].Plast Reconstr Surg,2022,149(3):742-749.DOI: 10.1097/PRS.0000000000008856.
[3]	SchiltzD,TaegerCD,BiermannN,et al.Transcutaneous oxygen measurement using ratiometric fluorescence imaging as a valid method for monitoring free flap transplants[J].Clin Hemorheol Microcirc,2019,73(1):113-123.DOI: 10.3233/CH-199225.
[4]	YuP,YuN,YangX,et al.Clinical efficacy and safety of negative-pressure wound therapy on flaps: a systematic review[J].J Reconstr Microsurg,2017,33(5):358-366.DOI: 10.1055/s-0037-1599076.
[5]	OdoricoSK,Reuter MuñozK,Nicksic PJ,et al.Surgical and demographic predictors of free flap salvage after takeback: a systematic review[J].Microsurgery,2023,43(1):78-88.DOI: 10.1002/micr.30921.
[6]	KosterI,BorgdorffMP,JamaludinFS,et al.Strategies following free flap failure in lower extremity trauma: a systematic review[J].JPRAS Open,2023,36:94-104.DOI: 10.1016/j.jpra.2023.03.002.
[7]	YuanK,QuahA,HweeJ,et al.Use of negative pressure wound therapy on locoregional flaps: a case-control study[J].J Wound Care,2023,32(Sup4):S5-13.DOI: 10.12968/jowc.2023.32.Sup4.S5.
[8]	ChenCY,KuoSM,TarngYW,et al.Immediate application of negative pressure wound therapy following lower extremity flap reconstruction in sixteen patients[J].Sci Rep,2021,11(1):21158.DOI: 10.1038/s41598-021-00369-5.
[9]	DornseiferU,PfeilerPP,KarglL,et al.Negative pressure wound therapy in free muscle flaps-risk or benefit?[J].J Reconstr Microsurg,2024,40(3):197-204.DOI: 10.1055/a-2110-0421.
[10]	MunroSP,DeardenA,JosephM,et al.Reducing donor-site complications in DIEP flap breast reconstruction with closed incisional negative pressure therapy: a cost-benefit analysis[J].J Plast Reconstr Aesthet Surg,2023,78:13-18.DOI: 10.1016/j.bjps.2022.08.003.
[11]	LiebmanRM,HanubalKS,DziegielewskiPT.Negative pressure wound therapy in the head and neck: a summary of uses and application techniques[J].Semin Plast Surg,2022,37(1):9-18.DOI: 10.1055/s-0042-1759562.
[12]	MorrowBT.Plastic surgery techniques for wound coverage[J].Surg Clin North Am,2020,100(4):733-740.DOI: 10.1016/j.suc.2020.05.005.
[13]	WangQ,ZhangX,SunW,et al.Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma[J].Pak J Med Sci,2022,38(1):248-253.DOI: 10.12669/pjms.38.1.4631.
[14]	刘勇,张志强,刘大东.负压封闭引流术联合游离皮瓣修复治疗急诊四肢软组织创伤的临床效果[J].临床医学研究与实践,2021,6(24):66-68.DOI: 10.19347/j.cnki.2096-1413.202124022.
[15]	林传东.VSD联合游离皮瓣移植术对创伤性大面积软组织缺损的修复效果研究[J].中国医学创新,2021,18(34):82-85.DOI: 10.3969/j.issn.1674-4985.2021.34.019.
[16]	OshimaJ,SasakiK,AiharaY,et al.Combination of three different negative pressure wound therapy applications and free flap for open elbow joint injury with extensive burns[J].J Burn Care Res,2022,43(2):479-482.DOI: 10.1093/jbcr/irab228.
[17]	BiH,KhanM,LiJ,et al.Use of incisional negative pressure wound therapy in skin-containing free tissue transfer[J].J Reconstr Microsurg,2018,34(3):200-205.DOI: 10.1055/s-0037-1608621.
[18]	SchlattererDR,HirschfeldAG,WebbLX.Negative pressure wound therapy in grade ⅢB tibial fractures: fewer infections and fewer flap procedures?[J].Clin Orthop Relat Res,2015,473(5):1802-1811.DOI: 10.1007/s11999-015-4140-1.
[19]	HomDB,OstranderBT.Reducing risks for local skin flap failure[J].Facial Plast Surg Clin North Am,2023,31(2):275-287.DOI: 10.1016/j.fsc.2023.01.006.
[20]	KurlanderDE,SwansonM,WeeC, et al. Flap plus sub-flap irrigation and negative pressure therapy for infected extremity wounds[J]. Orthoplastic Surgery, 2020, 1/2: 16-20. DOI: 10.1016/j.orthop.2020.10.002.
[21]	EisenhardtSU,SchmidtY,ThieleJR,et al.Negative pressure wound therapy reduces the ischaemia/reperfusion-associated inflammatory response in free muscle flaps[J].J Plast Reconstr Aesthet Surg,2012,65(5):640-649.DOI: 10.1016/j.bjps.2011.11.037.
[22]	EisenhardtSU,MomeniA,IblherN,et al.The use of the vacuum-assisted closure in microsurgical reconstruction revisited: application in the reconstruction of the posttraumatic lower extremity[J].J Reconstr Microsurg,2010,26(9):615-622.DOI: 10.1055/s-0030-1267378.
[23]	ChimH,ZoghbiY,NugentAG,et al.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[J].Arch Plast Surg,2018,45(1):45-50.DOI: 10.5999/aps.2016.01977.
[24]	KuenlenA,WakedK,EisenburgerM,et al.Influence of VAC therapy on perfusion and edema of gracilis flaps: prospective case-control study[J].Plast Reconstr Surg Glob Open,2023,11(4):e4964.DOI: 10.1097/GOX.0000000000004964.
[25]	ShimadaK,OjimaY,IdaY,et al.Negative-pressure wound therapy for donor-site closure in radial forearm free flap: a systematic review and meta-analysis[J].Int Wound J,2022,19(2):316-325.DOI: 10.1111/iwj.13632.
[26]	NaallaR,BhushanS,AbedinMU,et al.Closed incisional negative pressure wound therapy at flap suture line: an innovative approach for improving outcomes in suboptimal wound conditions[J].Indian J Plast Surg,2020,53(1):90-96.DOI: 10.1055/s-0040-1709528.
[27]	余道江,安璐,陆蒋惠文,等.自由穿支血管组合皮瓣修复腹股沟及邻近部位恶性肿瘤扩大切除后皮肤软组织缺损[J].中华整形外科杂志,2022,38(2):169-175.DOI: 10.3760/cma.j.cn114453-20200303-00099.
[28]	VaientiL,GazzolaR,BenantiE,et al.Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma: the role of negative-pressure wound therapy[J].J Orthop Traumatol,2013,14(3):213-217.DOI: 10.1007/s10195-013-0236-0.
[29]	ArdilaMP,Gómez-OrtegaV.Negative pressure wound therapy as an artificial leech to save a congestive flap: case report[J].Plast Reconstr Surg Glob Open,2022,10(3):e4162.DOI: 10.1097/GOX.0000000000004162.
[30]	SeoBF,KimKJ,KimMK,et al.The effects of human keratinocyte coculture on human adipose-derived stem cells[J].Int Wound J,2016,13(5):630-635.DOI: 10.1111/iwj.12335.
[31]	QiuSS,HsuCC,HannaSA,et al.Negative pressure wound therapy for the management of flaps with venous congestion[J].Microsurgery,2016,36(6):467-473.DOI: 10.1002/micr.30027.
[32]	LiZY,XieK,LiM,et al.The role of intermittent negative pressure wound therapy combined with a mesh incision in the salvage of perforator flaps with venous congestion[J].Asian J Surg,2021,44(3):592-593.DOI: 10.1016/j.asjsur.2020.12.033.
[33]	QuinteroJI,CárdenasLL,AchuryAC,et al.Negative pressure wound therapy as a salvage procedure in venous congestion of microsurgical procedures[J].Plast Reconstr Surg Glob Open,2021,9(8):e3725.DOI: 10.1097/GOX.0000000000003725.
[34]	KimTH,ParkJH.A novel negative pressure wound therapy (NPWT) monitoring system for postoperative flap management[J].Medicine (Baltimore),2021,100(44):e27671.DOI: 10.1097/MD.0000000000027671.
[35]	ParkJH,ParkJU.Flap monitoring with incisional negative pressure wound therapy (NPWT) in diabetic foot patients[J].Sci Rep,2022,12(1):15684.DOI: 10.1038/s41598-022-20088-9.
[36]	AgarwalP,KukreleR,SharmaD.Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: a review[J].J Clin Orthop Trauma,2019,10(5):845-848.DOI: 10.1016/j.jcot.2019.06.015.
[37]	SiegwartLC,SieberL,FischerS,et al.Influence of closed incision negative-pressure therapy on abdominal donor-site morbidity in microsurgical breast reconstruction[J].Microsurgery,2022,42(1):32-39.DOI: 10.1002/micr.30683.
[38]	HsiaoHY,HsiehWC,ChangFC,et al.The effect of negative pressure on wound healing and regeneration in closed incisions under high tension: evidence from animal studies and clinical experience[J].J Clin Med,2022,12(1):106.DOI: 10.3390/jcm12010106.
[39]	WuM,LiuQ,YuZ,et al.Negative-pressure wound therapy induces lymphangiogenesis in murine diabetic wound healing[J].Plast Reconstr Surg,2023,151(4):779-790.DOI: 10.1097/PRS.0000000000009997.
[40]	FangCL,ChangchienCH,ChenMS,et al.Closed incision negative pressure therapy following abdominoplasty after breast reconstruction with deep inferior epigastric perforator flaps[J].Int Wound J,2020,17(2):326-331.DOI: 10.1111/iwj.13273.
[41]	MaroufA,MortadaH,KhedrB,et al.Effectiveness and safety of immediate application of negative pressure wound therapy in head and neck free flap reconstruction: a systematic review[J].Br J Oral Maxillofac Surg,2022,60(8):1005-1011.DOI: 10.1016/j.bjoms.2022.04.003.
[42]	LimS,LeeDY,KimB,et al.Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery: a case report[J].World J Clin Cases,2023,11(1):143-149.DOI: 10.12998/wjcc.v11.i1.143.
[43]	LanceS,HarrisonL,OrbayH,et al.Assessing safety of negative-pressure wound therapy over pedicled muscle flaps: a retrospective review of gastrocnemius muscle flap[J].J Plast Reconstr Aesthet Surg,2016,69(4):519-523.DOI: 10.1016/j.bjps.2015.11.010.
[44]	ChienYC,LinYH,ChenCC,et al.Compromised flap salvage with closed incision negative pressure therapy under real-time indocyanine green fluorescence assessment[J].Ann Plast Surg,2021,86(2S Suppl 1):S96-101.DOI: 10.1097/SAP.0000000000002653.
[45]	LenzY,GrossR,PennaV,et al.Evaluation of the implantable Doppler probe for free flap monitoring in lower limb reconstruction[J].J Reconstr Microsurg,2018,34(3):218-226.DOI: 10.1055/s-0037-1608628.
[46]	PoteetSJ,SchulzSA,PovoskiSP,et al.Negative pressure wound therapy: device design, indications, and the evidence supporting its use[J].Expert Rev Med Devices,2021,18(2):151-160.DOI: 10.1080/17434440.2021.1882301.
[47]	BernerJE,WillP,GeogheganL,et al.Safety and effectiveness of negative pressure therapy on free flaps following lower limb reconstruction: a systematic review[J].J Plast Reconstr Aesthet Surg,2021,74(2):407-447.DOI: 10.1016/j.bjps.2020.08.080.