{"title":"The efficacy and safety of different negative-pressure wound therapy gradients on flaps outcomes.","authors":"O H Elbanna, A Salah Eldine, A M Sayed, A K Mousa","doi":"10.1007/s13304-025-02156-7","DOIUrl":null,"url":null,"abstract":"<p><p>Negative pressure wound therapy (NPWT) has been shown to be beneficial for improving the wound healing process and reducing flap complications. However, the ideal NPWT settings, especially the pressure levels and application modes, are still debatable. This study examines the efficacy and safety of NPWT at different pressure gradients, namely, high (HNPWT) and low (LNPWT), to determine the optimal conditions for improving flap outcomes and minimizing complications. Over a 30-month period, 65 patients who underwent flap reconstruction were randomly assigned to three groups: HNPWT (75-125 mmHg, continuous mode), LNPWT (50-75 mmHg, intermittent mode), and conventional wound dressing (CWD). Patients were evaluated prospectively for post-operative complications, flap viability, infection, edema, and wound dehiscence. Complications were more common in the CWD group than in the HNPWT group, while the HNPWT group had the highest incidence of flap ischemia (41%). NPWT significantly reduced post-operative edema (P = 0.003) and lower infection and dehiscence rates than the CWD group (P = 0.015 and P = 0.029, respectively). Compared with HNPWT, LNPWT showed superior safety and efficacy, with fewer ischemic events, lower pain scores, faster wound healing times, and better esthetic and function outcomes. Although NPWT offers benefits over conventional wound dressing in flap reconstructions, pressure settings should be carefully adjusted. LNPWT is safer and has more satisfactory outcomes than HNPWT, with reduced ischemia and better overall healing. These findings suggest that LNPWT in the intermittent mode is most favorable for improving flap viability and minimizing adverse effects.Registration identification number NCT06080958- July 22, 2024. \"Retrospectively registered\" URL for the registry: http://www.clinicaltrials.gov/.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Updates in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13304-025-02156-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Negative pressure wound therapy (NPWT) has been shown to be beneficial for improving the wound healing process and reducing flap complications. However, the ideal NPWT settings, especially the pressure levels and application modes, are still debatable. This study examines the efficacy and safety of NPWT at different pressure gradients, namely, high (HNPWT) and low (LNPWT), to determine the optimal conditions for improving flap outcomes and minimizing complications. Over a 30-month period, 65 patients who underwent flap reconstruction were randomly assigned to three groups: HNPWT (75-125 mmHg, continuous mode), LNPWT (50-75 mmHg, intermittent mode), and conventional wound dressing (CWD). Patients were evaluated prospectively for post-operative complications, flap viability, infection, edema, and wound dehiscence. Complications were more common in the CWD group than in the HNPWT group, while the HNPWT group had the highest incidence of flap ischemia (41%). NPWT significantly reduced post-operative edema (P = 0.003) and lower infection and dehiscence rates than the CWD group (P = 0.015 and P = 0.029, respectively). Compared with HNPWT, LNPWT showed superior safety and efficacy, with fewer ischemic events, lower pain scores, faster wound healing times, and better esthetic and function outcomes. Although NPWT offers benefits over conventional wound dressing in flap reconstructions, pressure settings should be carefully adjusted. LNPWT is safer and has more satisfactory outcomes than HNPWT, with reduced ischemia and better overall healing. These findings suggest that LNPWT in the intermittent mode is most favorable for improving flap viability and minimizing adverse effects.Registration identification number NCT06080958- July 22, 2024. "Retrospectively registered" URL for the registry: http://www.clinicaltrials.gov/.
期刊介绍:
Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future.
Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts.
Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.