Negative pressure wound therapy in the early period after hand and forearm replantation, is it safe?
OBJECTIVE
In this study, effectiveness and reliability of negative pressure wound therapy (NPWT) in the early period after replantation will be examined retrospectively in a series of patients.


METHODS
Patients who underwent replantation between 2007 and 2014, and had tissue defect or partial necrosis in the absence of a major circulation problem were included in this retrospective study. Following debridement of necrotic tissues on the postoperative 7-10 days, NPWT was applied to all patients one day later and adjusted as intermittent 75 mmHg pressure. Intermittent phase adjustment was arranged as 5 minutes suction and 2 minutes resting, and resting pressure was adjusted as 35 mmHg. NPWT was applied for six days and dressings were changed in every three days in the first six day period. Open wounds was debrided again and grafted with split-thickness skin graft and NPWT was continued over the graft for 4 days more.


RESULTS
There were 11 patients included of which nine amputations were complete and two were nearly total amputations of forearm. Granulation tissue was observed following 6 days of NPWT application in all patients. Graft survival was observed to be almost complete. Wound infection did not occur and tissue cultures obtained in the course of debridement were all negative. Partial oxygen saturations were between 96-99% during the NPWT.


CONCLUSIONS
NPWT (75 mmHg) can be used in the intermittent mode in order to improve wound healing and shorten the period to start physical therapy in the early period after replantation and revascularisation.
Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey.
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M
Dadaci
Acıbadem Healty Group Private Aile Hospital, Clinic of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey.
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ET
Isci
Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey.
B
B
Ince
Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey.
Z
Z
Altuntas
Celal Bayar University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa, Turkey.
M K
MK
Evrenos
Hacettepe University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey.
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H
Uzun
Katip Celebi University, Ataturk State Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir, Turkey.
E
E
Sönmez
Hacettepe University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey.
O
O
Bitik
D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001458:Bandages; D003646:Debridement; D005543:Forearm Injuries / Q000601:surgery*; D006085:Graft Survival; D006097:Granulation Tissue; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D012092:Replantation; D012189:Retrospective Studies; D016038:Skin Transplantation; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
forearm replantation; hand replantation; negative pressure wound therapy; topical negative pressure treatment; vacuum assisted closure therapy