The use of Negative Pressure Wound Therapy in Vulvar Wounds

This study intended to evaluate wound-healing outcomes following the application of negative pressure wound therapy to vulvar wounds resulting from surgical debridement of hidradenitis suppurativa (HS) or necrotizing fasciitis (NF). The study design was a retrospective chart review. Four patients who were treated at Thomas Jefferson University Hospital that under went radical vulvectomies for Hidradenitis Suppurativa (HS) or necrotizing fasciitis with subsequent application of negative pressure wound therapy were identified. The chart review was conducted and data was collected related to their postoperative course. These patients required extensive surgical debridement of the vulvar, perirectal, and buttock area. Following debridement, negative pressure wound therapy was placed intra-operatively. The patients were taken back to the operating room for wound washout; further debridement and negative pressure wound therapy reapplication. Once the wounds were free of necrotic tissue, the patients continued to have negative pressure wound therapy-dressing changes three times a week at bedside for a variable amount of time. Details of wound healing progression were documented in the patient’s charts along with details of patient’s tolerance to the dressing changes. Most cases reported in the literature use negative pressure wound therapy initially to aid in wound healing. However, complete wound closure was typically achieved using split-thickness skin grafts. Very few cases reports have used the negative pressure wound therapy alone to achieve complete closure. Three of the four patients in our case series achieved complete wound closure with negative pressure wound therapy alone. One patient required closure with a split-thickness skin graft after the negative pressure wound therapy was removed.

Patients with severe hidradenitis suppurativa (HS) or necrotizing fasciitis (NF) often require extensive surgical debridement. Data conflict over the optimal methods of management of post-surgical vulvar wounds. Our experience supports good outcomes for complete closure of vulvar wounds with negative pressure wound therapy.