Reduced Anterolateral Thigh Flap Donor-Site Morbidity Using Incisional Negative Pressure Therapy
27 March 2018
09 August 2018
27 September 2018 (eFirst)
Background Primary closure of the donor-site after harvest of a large anterolateral thigh flap (ALT) is associated with significant morbidity. Incisional negative pressure therapy (INPT) may decrease complications in high-risk incisions. This study assessed if the incidence of complications after primary closure of the ALT flap donor-site decreases with INPT.
Methods Retrospective cohort study of a prospectively maintained database including patients who underwent upper and lower limb reconstruction, using an ALT free flap with primary closure of the donor-site. Two groups were defined: primary closure and INPT (study group) and primary closure with traditional dressings (control group). Nonparametric statistics were employed to identify prognostic factors, p < 0,05.
Results Fifty-eight free ALT flaps in 58 patients (study group n = 28; control group n = 30) were included. Median flap width and length were 9 cm (range: 5–14) and 25 cm (range: 10–48), respectively. Median follow-up was 19 months (range: 3–78 months). No significant differences in age or flap size were identified in both groups (p > 0.05). The global complication rate was 7.14% (n = 2) in the INPT group, and 37% (n = 11) in the control group (p = 0.007). The study group had a lower dehiscence and skin necrosis rate (p < 0.05). Multivariate logistic regression analysis showed IPNT was associated with a significant reduction of donor-site complications (p = 0.006), especially in patients with defects > 8 cm (p = 0.003).
Conclusion In this cohort study the use of INPT significantly reduced the donor-site morbidity after ALT flap harvest.
- 1 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (07) 2219-2226 , discussion 2227–2230
- 2 Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg 2012; 20 (01) 17-23
- 3 Webster J, Scuffham P, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev 2014; (10) CD009261
- 4 Kim DY, Park SJ, Bang SI, Mun GH, Pyon JK. Does the use of incisional negative-pressure wound therapy prevent mastectomy flap necrosis in immediate expander-based breast reconstruction?. Plast Reconstr Surg 2016; 138 (03) 558-566
- 5 Peter Suh HS, Hong JP. Effects of incisional negative-pressure wound therapy on primary closed defects after superficial circumflex iliac artery perforator flap harvest: randomized controlled study. Plast Reconstr Surg 2016; 138 (06) 1333-1340
- 6 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
- 7 Ali RS, Bluebond-Langner R, Rodriguez ED, Cheng MH. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009; 124 (6, Suppl): e395-e407
- 8 Townley WA, Royston EC, Karmiris N, Crick A, Dunn RL. Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 2011; 64 (12) 1621-1626
- 9 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010; 125 (01) 209-214
- 10 Purnell CA, Lewis KC, Mioton LM. , et al. Donor-site morbidity of medial and lateral thigh-based flaps: a comparative study. Plast Reconstr Surg Glob Open 2016; 4 (11) e1012
- 11 Lakhiani C, DeFazio MV, Han K, Falola R, Evans K. Donor-Site morbidity following free tissue harvest from the thigh: a systematic review and pooled analysis of complications. J Reconstr Microsurg 2016; 32 (05) 342-357
- 12 Shanmugam VK, Fernandez SJ, Evans KK. , et al. Postoperative wound dehiscence: Predictors and associations. Wound Repair Regen 2015; 23 (02) 184-190
- 13 Seth AK, Iorio ML. Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg 2017; 33 (07) 466-473
- 14 Hong JP, Choi DH, Suh H. , et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30 (07) 491-496
- 15 Horch RE. Incisional negative pressure wound therapy for high-risk wounds. J Wound Care 2015; 24 (4, Suppl) 21-28
- 16 Scalise A, Calamita R, Tartaglione C. , et al. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional negative pressure wound therapy. a systematic review of the literature. Int Wound J 2016; 13 (06) 1260-1281
- 17 Suh H, Lee AY, Park EJ, Hong JP. Negative pressure wound therapy on closed surgical wounds with dead space: animal study using a swine model. Ann Plast Surg 2016; 76 (06) 717-722
- 18 Schmedes GW, Banks CA, Malin BT, Srinivas PB, Skoner JM. Massive flap donor sites and the role of negative pressure wound therapy. Otolaryngol Head Neck Surg 2012; 147 (06) 1049-1053
- 19 Angspatt A, Laopiyasakul T, Pungrasmi P, Suwajo P. The role of negative-pressure wound therapy in latissimus dorsi flap donor site seroma prevention: a cohort study. Arch Plast Surg 2017; 44 (04) 308-312
- 20 Sandy-Hodgetts K, Leslie GD, Lewin G, Hendrie D, Carville K. Surgical wound dehiscence in an Australian community nursing service: time and cost to healing. J Wound Care 2016; 25 (07) 377-383
- 21 Corrêa NF, de Brito MJ, de Carvalho Resende MM. , et al. Impact of surgical wound dehiscence on health-related quality of life and mental health. J Wound Care 2016; 25 (10) 561-570