Summary
Background
We recently established negative pressure wound therapy (NPWT) as a safe postoperative
care concept for free muscle flaps; however, the molecular effects of NPWT on free
muscle flaps remain elusive. Here we investigated the effects of NPWT on pathological
changes associated with ischaemia/reperfusion injury in free flap tissue.
Methods
From July 2008 to September 2010, 30 patients receiving skin-grafted free muscle transfer
for defect coverage were randomly assigned to two treatment groups: In one group the
skin-grafted free flap was covered by a vacuum dressing (NPWT); in the second group,
flaps were covered by conventional petroleum gauze dressings (conv). Biopsies were
taken intra-operatively prior to clipping of the pedicle and on postoperative day
5. Samples were analysed by immunohistochemistry for infiltration of inflammatory
cells, real-time polymerase chain reaction (RT-PCR) for the analysis of expression
levels of interleukin-1β (IL-1β) and tumour necrosis factor (TNF)-alpha as markers
of inflammation. Histological samples were also examined for interstitial oedema formation,
and apoptosis was detected by a terminal deoxynucleotidyl transferase dUTP nick end
labelling (TUNEL) assay.
Results
NPWT leads to a significantly reduced tissue infiltration of CD68 + macrophages and
reduced expression of the inflammatory cytokines IL-1β and TNFα. None of these parameters
was significantly elevated in the pre-ischaemic biopsies. Furthermore, NPWT reduced
the interstitial oedema formation and the number of apoptotic cells in free flap tissue.
Conclusion
NPWT of skin-grafted free muscle flaps leads to a reduced inflammatory response following
ischaemia/reperfusion, resulting in reduced oedema formation improving the microcirculation
and ultimately reduced tissue damage. We thereby deliver new insight into the effects
of NPWT.
Keywords
Abbreviations:
NPWT (negative pressure wound therapy), PMH (past medical history), HTN (hypertension), DM (diabetes mellitus), CHD (coronary heart disease), PAOD (peripheral artery occlusive disease), RA (rheumatoid arthritis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 05, 2011
Accepted:
November 10,
2011
Received:
June 17,
2011
Footnotes
☆Parts of this work have been presented at the Meeting of the International Confederation for Plastic Reconstructive & Aesthetic Surgery (IPRAS), Vancouver, Canada 2011 and at the Plastic Surgery Research Council (PSRC) Meeting, San Francisco, USA 2010.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
