Background: To report a case series utilizing negative pressure wound therapy for the treatment of venous congestion in pedicled flaps and to provide a literature review regarding the efficacy of this method.
Methods: Case series report.
Results: 5 patients (3 males, 2 females; mean age 37, range 22-60 years old) presenting with lower limb defects caused by trauma (60%), burns (20%), or chronic diabetic ulcers (20%) were included. Reconstruction was performed using reverse sural flaps (60%), tibial artery perforator flaps (20%), or propeller perforator flaps (20%). All patients developed venous congestion within 36-72 hours postoperatively (mean: 50 hours) and were treated with negative pressure wound therapy at negative pressures of -100 to -125 mmHg, maintained for 5-7 days (mean: 6.2 days). Results 4 out of 5 flaps (80%) survived completely, 1 flap (20%) sustained minor marginal necrosis (< 5% of surface area), which was managed with supplemental skin grafting; there were no cases of total flap loss. Venous congestion significantly improved after 48-72 hours of negative pressure wound therapy application in 100% of patients.
Conclusion: Negative pressure wound therapy is an effective, minimally invasive flap salvage method that is feasible in hospitals lacking microsurgical capabilities. Further randomized controlled trials are required to establish optimal indications, timing, and parameters.