From 20 free flaps performed between 2010 and 2020, seven patients who underwent microsurgical intervention to cover skin defects and needed NPWT were included. Six men with an average age of 39.4 years (range 30–59 years) received six flaps to cover skin defects in the lower limb (Table 1) (Figure 1).
Defect on the medial aspect of the heel. A, Immediate postoperative with ALT free flap. B, 24 hours postoperative with venous congestion. C, After exploration, vein thrombectomy and new anastomosis, NPWT. D, final outcome at 6 months follow-up.
All the patients were clinically diagnosed with venous congestion, and the NPWT was applied immediately after the identification. NPWT is applied peripherally in the skin of the free flap, in less than 180 degrees of its circumference away from the pedicle. Just one patient needed re-exploration of the microsurgical anastomosis prior to the application of the NPWT. The indication for the re-exploration was the rapid establishment of venous congestion, less than 24 hours after surgery; in our cases, this was the only venous congestion established rapidly with a high indication for venous exploration, with final result in thrombosis of one vein that needed irrigation and new anastomoses. Two cases with peripheral skin necrosis were identified at postoperative follow-up, and NPWT was initiated at 453 and 826 hours after surgery, respectively. The average time between the diagnosis of venous congestion and the application of the NPWT was 51.5 hours (range 24–125 hours). The use of the NPWT was incisional. Average duration of the NPWT was 7.8 days (1–24); four patients had continuous therapy and two had intermittent. Unfortunately, for one patient, we lacked information about the blood loss associated with the NPWT. Pressure was between 50 and 125 mm Hg. The variability of the pressure, intensity, and days of the therapy is due to the lack of information in the literature, and we followed the manufacture's recommendation (Table 2).
None of the patients had any late complications in the donor area, in the receptor area, or associated with the anticoagulation therapy. None of the patients needed blood transfusion secondary to active bleeding or the use of NPWT during the time in the hospital. At the end of the follow-up, none of the patients had flap necrosis, flap loss, or reimplanted finger loss. Full integration of the flap was seen in all the patients at 3 months postoperative, and final follow-up was 6 months (3–12 months) (Table 3).
Plast Reconstr Surg Glob Open. 2021;9(8):e3725 © 2021 Lippincott Williams & Wilkins