title: Negative pressure wound therapy in head and neck surgery.
abstract: IMPORTANCE Negative pressure wound therapy has been shown to accelerate healing. There is a paucity of literature reporting its use as a tool to promote wound healing in head and neck reconstruction. OBJECTIVE To review 1 institution's experience with negative pressure dressings to further describe the indications, safety, and efficacy of this technique in the head and neck. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at a tertiary care academic hospital. One hundred fifteen patients had negative pressure dressings applied between April 2005 and December 2011. Data were gathered, including indications, details of negative pressure dressing use, adverse events, wound healing results, potential risk factors for compromised wound healing (defined as previous radiation therapy, hypothyroidism, or diabetes mellitus), and wound characteristics (complex wounds included those with salivary contamination, bone exposure, great vessel exposure, in the field of previous microvascular free tissue transfer, or in the case of peristomal application in laryngectomy). EXPOSURE Negative pressure wound therapy utilized after head and neck reconstruction. MAIN OUTCOMES AND MEASURES Indications for therapy, length and number of dressing applications, identification of wound healing risk factors, classification of wound complexity, wound healing results, and adverse events related to the use of the device. RESULTS Negative pressure wound therapy was used primarily for wounds of the neck (94 of 115 patients [81.7%]) in addition to other head and neck locations (14 of 115 patients [12.2%]), and free tissue transfer donor sites (7 of 115 patients [6.1%]). The mean (SD) wound size was 5.6 (5.0) cm. The mean number of negative pressure dressing applications was 1.7 (1.2), with an application length of 3.7 (1.4) days. Potential risk factors for compromised wound healing were present in 82 of 115 patients (71.3%). Ninety-one of 115 patients (79.1%) had complex wounds. Negative pressure dressings were used in wounds with salivary contamination (n = 64), bone exposure (n = 40), great vessel exposure (n = 25), previous free tissue transfer (n = 55), and peristomal application after laryngectomy (n = 32). Adverse events occurred in 4 of 115 patients (3.5%). CONCLUSIONS AND RELEVANCE Negative pressure wound therapy in head and neck surgery is safe and has potential to be a useful tool for complex wounds in patients with a compromised ability to heal. LEVEL OF EVIDENCE 4.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Asher
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Hilliary N
authors.initials: HN
authors.lastname: White
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Golden
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine at the University of Alabama at Birmingham, Birmingham.
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D061214:Patient Safety; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*