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      Temporary Extrathoracic Vacuum Therapy Splint in Chest Wall Reconstruction

      case-report

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          Abstract

          Background Paradoxical respiration is a sinister consequence of bony chest cage defects which can persist even post chest wall reconstruction. It leads to prolonged dependence on mechanical ventilation postoperatively, thereby delaying recovery. Methods Negative pressure wound therapy (NPWT) was applied in early postoperative period to a patient with chest wall defect reconstructed with folded prolene mesh and free anterolateral thigh flap. Arterial blood gas (ABG), fraction of inspired oxygen (FiO 2 ), peak end expiratory pressure (PEEP), oxygen saturation (SpO 2 ), and blood pressure (BP) readings pre and post NPWT application were compared. Results There was marked improvement in the breathing mechanics and related parameters post NPWT application over the flap. Conclusions Negative extrathoracic pressure in the form of a temporary splint can enable early weaning off the ventilator and a smoother postoperative recovery in reconstructed chest wall defects.

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          Materials and techniques in chest wall reconstruction: a review

          Stefano Sanna, Jury Brandolini, Alessandro Pardolesi … (2017)
          Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.
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            Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus.

            E. Krug, L. Berg, C. Lee … (2011)
            Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma: the role of negative-pressure wound therapy

              L. Vaienti, R. Gazzola, E. Benanti … (2013)
              Lower limb reconstruction with pedicled or free flaps can be commonly compromised by venous insufficiency. This complication often leads to partial/complete flap necrosis and increases the risk of superinfection. Negative-pressure wound therapy (NPWT) is known to increase local blood flow, decrease edema, promote tissue granulation, and reduce the likelihood of soft tissue infection. This study aims to evaluate the effectiveness of NPWT in the treatment of congested pedicled and free flaps of the lower limb after reconstructions in lower limb traumas. A retrospective analysis was performed on four congested (pedicled and free) flaps on the lower limbs. NPWT was applied in all cases after partial flap debridement. NPWT was able to improve and resolve tissue edema and venous insufficiency, avoid further flap necrosis, and promote granulation. On NPWT removal, a split-thickness skin graft was applied on the wound, achieving complete and uneventful healing. NPWT is a useful instrument in managing flaps affected by venous insufficiency in lower limb reconstruction, although larger studies are necessary to better define the effectiveness and indications of NPWT in this setting.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Plast Surg
                Journal ID (iso-abbrev): Indian J Plast Surg
                Journal ID (doi): 10.1055/s-00042863
                Title: Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
                Publisher: Thieme Medical and Scientific Publishers Pvt. Ltd. (A-12, 2nd Floor, Sector 2, Noida-201301 UP, India )
                ISSN (Print): 0970-0358
                ISSN (Electronic): 1998-376X
                Publication date (Print): April 2021
                Publication date (Electronic): 15 June 2021
                Volume: 54
                Issue: 2
                Pages: 211-214
                Affiliations
                [1 ]Department of Plastic and Reconstructive Surgery, Manipal Hospital, Bangalore, India
                [2 ]Department of Critical Care Medicine, Manipal Hospital, Bangalore, India
                Author notes
                Address for correspondence Ritu Baath S, MBBS, DrNB (Plastic Surgery) Department of Plastic and Reconstructive Surgery Manipal Hospital, Bangalore 560017India dr.ritubatth@ 123456gmail.com
                Article
                Publisher ID: IJPS2010362
                DOI: 10.1055/s-0041-1729502
                PMC ID: 8257296
                PubMed ID: 34239247
                SO-VID: 3ed35793-8f20-48d5-bb67-b52de5fbbc42
                Copyright © Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: chest wall reconstruction,negative pressure wound therapy,paradoxical respiration
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: chest wall reconstruction, negative pressure wound therapy, paradoxical respiration

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