Long-term follow-up of negative pressure wound therapy with instillation: a limb salvage procedure?

Negative pressure wound therapy (NPWT) is a treatment to reduce oedema, stimulate granulation tissue formation, remove wound exudate and diminish wound area, thus preparing it for secondary healing, skin grafting or coverage with flaps. The association of instillation to NPWT (NPWTi) is a new method for treating severe wounds, in particular, limb lesions at high risk for amputation. This therapy helps to deliver instillation fluid automatically into the contaminated wound, before application of negative pressure. These steps, repeated cyclically, help to remove infectious material, leading to a better moist environment, a necessary condition for wound healing. We report our experience of treating three patients with complex wounds and associated noble structure exposition conservatively with NPWTi and flap coverage. In a long-term follow-up (5 years), we were able to achieve a stable surgery reconstruction on preserved limbs, without evidence of chronic infection and other sequelae or complications. Despite the fact that our experience is limited , as it is based on only a few cases, it suggests how NPWTi could be considered useful in a conservative approach to the treatment of acute complex wounds of the lower extremities. In these patients with high risk of amputation, a long-term follow-up becomes fundamental in order to evaluate wound bed status after NPTWi.

Combination of two long-pedicled myocutaneous flaps for closure of a complex contralateral dorsal defect.

A large and deep oncological defect has been filled up using a very long-pedicled latissimus dorsi myocutaneous flap, together with a trapezius myocutaneous flap, both harvested contralaterally to the lesion. Despite the distance of the defect from the area from which the flaps have been harvested, use of long-pedicled flaps warranted a better flap rotation with less tension and greater availability of bulky tissues. Both flaps were viable, and the recipient site healed uneventfully. The two donor sites were closed directly and healed rapidly. Therefore, a challenging complex thoracic defect was covered immediately after oncological resection through a combination of two myocutaneous flaps contralaterally harvested, which seemed safe and reliable.