Management of Flap Harvest Sites with Negative Pressure Wound Therapy

Head and neck cancers account for 3% of cancers in the United States and $3.6 billion in annual spending. At an academic magnet medical center in the Southeastern United States, scapular and latissimus free flaps are often used to reconstruct resected head and neck cancers.  Current practice in managing these flap donor sites for our ENT oncology and WOC nursing teams is to apply negative pressure wound therapy (NPWT) to the flap donor site to prevent wound complications such as seroma, dehiscence, and surgical site infection. Within 72 hours of surgery, transparent film is fenestrated and applied over the flap harvest site and surrounding tissue. Open cell polyurethane foam is applied over the entire flap donor area to address the underlying defect with the intent of bolstering the tissue layers. After securing the foam with additional transparent film, negative pressure is applied continuously at 175 mmHg. The dressing is left in place with weekly changes until patient’s discharge, or discontinued at physician’s discretion. NPWT has been utilized since the 1980s on a routine basis to better manage both acute and chronic wounds.  While numerous studies have been performed and found throughout the literature, little research exists on utilizing NPWT for the management of flap donor sites closed by primary intention. A retrospective review of 94 patients treated at our facility demonstrated a 12% rate of complication in patients not treated with NPWT versus 6% in patients treated with NPWT (Schmedes, Malin, Srinivas & Skoner, 2012). This innovative methodology has yielded positive patient outcomes thus far, with no negative outcomes related to the NPWT. This novel protocol shows promise in promoting optimal patient outcomes as well as reducing expenses related to wound complications.