Salvage of Venous Congested Muscle Flaps Using Negative Pressure Wound Therapy
Ryan Rebowe, MD, Nicholas Walker, MD, Malcolm W. Marks, MD, Louis Argenta, MD, Michael Morykwas, MD, Ivo A. Pestana, MD.
Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
PURPOSE: The technique of flap salvage using negative pressure wound therapy (NPWT) is only recently described in the literature. We provide an update of our ongoing study of utilizing NPWT for salvage of venous congested flaps to discern optimum timing of NPWT application in relation to venous compromise and possible mechanism for salvage.
METHODS: The latissimus muscle of twenty-one Yorkshire pigs was islandized on a dominant intercostal perforating vessel. Venous return was then isolated, ligated, and transected. Continuous NPWT was then applied to the wound at differing time points between one and eight hours post-transection. Muscle was assessed at one, three, and seven days for clinical viability. Following euthanization at one week, tissue samples were taken from the isolated muscle and tissue deep to the muscle along with contralateral controls.
RESULTS: When NPWT was applied at three hours or less, 6/6 (100%) muscle flaps showed clinical and histologic evidence of viability. Only 7/15 (46.6%) muscle flaps survived when NPWT was applied at four hours or greater (p<0.05). After western blot analysis, Vascular Endothelial Growth Factor (VEGF) was shown to be elevated in both the isolated muscle and tissue deep to the muscle while being absent from control tissue.
CONCLUSION: NPWT is a promising intervention for venous congested pedicled flaps. Possible mechanisms include diversion of venous backflow, an increase in angiogenetic factors, and rapid vascular ingrowth.
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