Effectiveness of Negative Pressure Wound Therapy on Closed Incision of Flap Coverage for Pressure Ulcer

Objective: Flap coverage for pressure ulcers has high risk of wound complications. Negative pressure wound therapy (NPWT) has recently been used over closed incisions to decrease surgical site complications including seroma, dehiscence and also infection. This study aimed to investigate the role of NPWT in close incision after flap coverage for pressure ulcers. Material and Method: Comparative study was designed to compare effectiveness of NPWT on closed incision of flap coverage for pressure ulcers. In a control group, we performed a retrospective chart review of 20 patients between 2013 and 2014 who underwent flap coverage for pressure ulcers and had conventional gauze-based postoperative wound dressing. In an experiment group, NPWT was placed on close incisions after flap coverage for pressure ulcers and the data were collected prospectively from 10 patients between 2014 and 2015. Drain content, which represented seroma in this study, was monitored daily for 7 days. The result of wound dehiscence and infection was monitored until postoperative day (POD) 30. Results: In the first group (control), median drain content on POD 1, 2, 3, 4, 5, 6, 7 were 87.5, 100, 70, 45, 35, 25, 30 mL while in second group (NPWT), median drain content were 100, 42.5, 22.5, 15, 10, 5, 2.5 mL, respectively. The result showed statistical significant difference on POD 2 to 7 (p-value = 0.03, 0.02, 0.04, 0.05, 0.02, respectively). Wound dehiscence occurred 60% in control group and 20% in experiment group (p = 0.06). Wound infection occurred 20% in control group while 0% in experiment group (p = 0.27). Conclusion: NPWT can reduce drain content in patients who had flap coverage for pressure ulcer. NPWT showed a trend to reduce wound dehiscence and wound infection.