title: 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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Yi-Hsun
authors.initials: YH
authors.lastname: Yang
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Guan-Ming
authors.initials: GM
authors.lastname: Feng
authors.forename: Chien Chung
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D044964:Cervicoplasty / Q000009:adverse effects*; D017577:Cutaneous Fistula / Q000209:etiology / Q000628:therapy*; D016154:Digestive System Fistula / Q000209:etiology / Q000628:therapy*; D058752:Free Tissue Flaps / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D016155:Oral Fistula / Q000209:etiology / Q000628:therapy*; D010608:Pharyngeal Diseases / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012463:Saliva; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D013997:Time Factors
keywords: Complicated wound; Fistula formation; Head and neck reconstruction; Negative pressure wound therapy (NPWT); Vacuum-assisted closure (VAC) system