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Table 3: Wound etiology in patients (n = 66) separate wounds, requiring two separate wound VACs.
Wound etiology Number of patients In total, NPWT was used 74 times in 66 patients.
Trauma 2
Wound dehiscence 2 Wound etiology is presented in Table 3. Fifty-six patients
Post-surgical 56 had surgically-created wounds. Two patients had
Skin infection 1 traumatic wounds. Two patients had wound dehiscence
Pressure sore 1 requiring NPWT. One patient had pressure ulcer. There
Sickle-cell/vascular disease 1
Cutaneous acute lymphoblastic leukemia 1 was one case of sickle-cell induced avascular skin
Purpura fulminans 1 necrosis. One case of cutaneous acute lymphoblastic
Extravasation injury 1 leukemia resulted in full thickness skin loss. One patient
with osteosarcoma who was treated with methotrexate
Table 4: Indication for negative pressure wound developed a case of purpura fulminans that required
therapy (n = 66) debridement and NPWT. One wound resulted after
Indication Number of patients debridement of a cutaneous infection. There was one
Local wound care 44 wound that resulted after an extravasation injury. Three
Skin graft/Integra fixation 11 patients had amputations that required NPWT; 2 of them
Brachytherapy 1 for open wounds and 1 for an incisional wound. NPWT
Support of primarily-closed incision 10 was applied immediately in the event of surgically-
created wounds, and it was delayed for a range of 1 to
Table 5： Anatomic location of wounds, and exposed 21 days in the remaining patients.
structures at wound base (wounds = 74)
Number of wounds NPWT indication is shown on Table 4. NPWT was used
Wound location for local wound care in 44 patients, skin graft and/or
Head and neck 4 integra fixation in 10 patients, local wound care in the
Trunk 13 setting of brachytherapy in one patient, and incisional
Upper extremity 10 support in 11 patients. With respect to incisional
Lower extremity 47 NPWT, 4 patients had previous external beam radiation
Exposed structures therapy, and 2 patients had previous brachytherapy.
Bone 11 There were 10 extremity wounds and 1 scalp wound
Fascia 4
Tendon 7 that utilized incisional NPWT. All wounds were healed
Nerve 3 without complications at the time incisional NPWT was
Endoprosthesis 2 discontinued (5-7 days postoperatively).
Skin (incisional wound VAC) 11
Muscle or fat 36 Table 5 shows the anatomic distribution of wound NPWT
VAC: vacuum-assisted closure usage. NPWT was used in the head and head/neck in
three patients, trunk in 13 patients, upper extremity in
Table 6: Outcomes of negative pressure wound 10 patients, and lower extremity in 40 patients. Eleven
therapy utilization (n = 66) wounds had bone exposure in the wound bed; four had
Number of patients exposure of fascia; seven had tendon exposure; three
Mechanism of closure in healed (n = 60) had nerve exposure; and two patients had exposure of
wounds
Secondary intention 47 their endoprostheses. The remaining had either skin,
Skin graft/Integra 6 fat, or muscle exposed.
Local flap/tissue closure 4
Delayed primary closure 3 The respective wounds ultimately healed in 60 patients
Characteristics of non-healing (n = 6) [Table 6]. Wounds healed by secondary intention in 47
wounds patients, skin grafting in four patients, adjacent tissue
Wound recurrence 2 transfer in three patients, split-thickness skin graft (STSG)
Died of primary disease before 1 and Integra in two patients, local flap in one patient, and
wound closure delayed primary closure in three patients. Wounds failed
Died of necrotizing fasciitis 1 to heal in 2 patients who had recurrence of their wound
Amputation 2
at last follow up, in 1 patient who died of necrotizing
had NPWT therapy twice: once before reconstruction fasciitis, in 1 patient who died of primary disease, and
and again for skin graft fixation. One patient had NPWT in 2 of the 3 patients who required amputation. No
patients required free flap to reconstruct their wound.
applied three times: first, for local wound care; second,
for fixation of integra dermal regeneration template At the time of their last follow-ups, 2 patients had died
(Integra Life Sciences, Plainsborough, New Jersey, USA); of their primary disease. One patient died secondary
and third, for skin graft fixation. Three patients had two to necrotizing fasciitis. One patient had a below-knee
250 Plast Aesthet Res || Volume 3 || July 14, 2016