![]() ![]() As NPWT was an adjuvant procedure before final reconstructive surgery, the duration of NPWT treatment varied considerably according to the status of the wound defect size and location. Six chronic diabetic and one venous ulcer could be reconstructed successfully without microsurgery. Thirteen wide pressure ulcers were reconstructed by full (3 patients) or thick split thickness skin graft (STSG 10 patients) with a flap ( Figure 2). Among them, there were two immunocompromised patients, who had undergone systemic steroid treatment or chemotherapy. NPWT was applied to 30 patients with a wide, deep, irregular wound defect combined with a minor infection ( Figure 1). There was no typical wound complication during the procedures and most patients were satisfied with the final outcomes. The authors used NPWT as an adjuvant or dressing method before reconstructing the soft tissue defect. It was a good adjuvant dressing method for skin grafting, particularly for infants or mobile skin surfaces, such as the neck, penis, dorsum of the hand, joint surface and abdomen (58 patients). The other condition was to improve the result of skin grafting. This treatment was applied under two conditions: one condition is a situation when acute or chronic complicated wounds are presented as wide and deep skin and soft tissue defects but an immediate reconstruction or aggressive or more radical operations are not feasible because the wounds are unsuitable for an early reconstruction, the patients are either too old or too young, have poor general health or are uncooperative (30 patients). Vacuum‐assisted closure (V.A.C.®, Kinetic Concepts, Inc., San Antonio, TX) was used according to the manufacturer's user guides ( ) and the guidelines of the US Food and Drug Administration (FDA) ( ). Since 2006, NPWT was administered to 88 patients as an adjuvant therapy for surgery. NPWT application, if used appropriately, produces successful surgical reconstructions for large, deep skin and soft tissue defects without extensive or radical flap surgery or loss of skin graft. ![]() ![]() There were no typical wound complications. NPWT was used as an alternative dressing method for skin grafting for infants or mobile skin surfaces such as the neck, penis, dorsum of the hand, knee joint, abdomen, etc. NPWT was applied for two different treatment strategies: as an adjuvant therapy to facilitate the formation of a healthy wound bed and to reduce the size and depth of a defect. The authors used NPWT on 88 patients as an adjuvant therapy before reconstructive surgery since 2006. This article introduces refined techniques, indications and the clinical experience of the application of negative pressure wound therapy (NPWT) as an easy ancillary wound dressing method for the reconstruction of large or difficult skin and soft tissue defects. Published by John Wiley & Sons Ltd.Wide and deep wound defects are a challenge to surgeons, particularly when aggressive or more radical operations are unavailable. This provides a molecular basis for understanding NPWT. Matrix metalloproteinase-1, -2, -9 and -13 expression was reduced but there was no effect on their enzymatic inhibitor, tissue inhibitor of metalloproteinase 1.Ĭytokine and growth factor expression profiles under NPWT suggest that promotion of wound healing occurs by modulation of cytokines to an anti-inflammatory profile, and mechanoreceptor and chemoreceptor-mediated cell signalling, culminating in angiogenesis, extracellular matrix remodelling and deposition of granulation tissue. Expression of vascular endothelial growth factor, fibroblast growth factor 2, transforming growth factor β and platelet-derived growth factor was increased, consistent with mechanoreceptor and chemoreceptor transduction in response to stress and hypoxia. Systemic IL-10 and local IL-8 expression were increased by NPWT. Tumour necrosis factor expression was reduced in acute and chronic wounds, whereas expression of interleukin (IL) 1β was reduced in acute wounds only. Sixteen studies met the inclusion criteria. MEDLINE (January 1997 to present), Embase (January 1997 to present), PubMed (no time limit), the Cochrane Database of Systematic Reviews and the Cochrane Controlled Trials Register were searched for articles that evaluated the influence of NPWT on growth factor expression quantitatively. As their expression profiles are being unravelled, it is pertinent to consider the mode of action of NPWT at the molecular level. Negative-pressure wound therapy (NPWT) promotes angiogenesis and granulation, in part by strain-induced production of growth factors and cytokines. ![]()
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