PDF(Pubmed)
Abstract：
BACKGROUND: Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence. They require immediate and appropriate management before they progress to an irreversible condition. Although negative pressure wound therapy (NPWT) can prevent wound progression by increasing microcirculation, the inappropriate application of NPWT on complication-threatened transferred and replanted tissues can induce an adverse effect.
METHODS: A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap. While applying a heating pad directly to the flap site, she sustained a deep second to third-degree contact burn over 30% of the transferred flap on postoperative 7 d. As the necrotic changes had progressed, we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d. After 4 d of NPWT application, the exposed fatty tissues of the flap changed to dry and brown-colored necrotic tissues. Upon further debridement, we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.
CONCLUSIONS: Although NPWT has been shown to be successful for treating various wound types, the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
METHODS: A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap. While applying a heating pad directly to the flap site, she sustained a deep second to third-degree contact burn over 30% of the transferred flap on postoperative 7 d. As the necrotic changes had progressed, we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d. After 4 d of NPWT application, the exposed fatty tissues of the flap changed to dry and brown-colored necrotic tissues. Upon further debridement, we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.
CONCLUSIONS: Although NPWT has been shown to be successful for treating various wound types, the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
摘要：
背景：由于失去敏感性而导致的自由转移或重新种植组织的热损伤很少发生。在发展到不可逆转的状况之前，它们需要立即和适当的管理。尽管负压伤口治疗（NPWT）可以通过增加微循环来预防伤口进展，NPWT在有并发症威胁的转移和移植组织上的不当应用可能会产生不利影响。
方法：一名48岁女性患者，采用深腹壁下动脉穿支游离皮瓣立即进行乳房再造。当将加热垫直接应用于皮瓣部位时，术后7d，她在转移的皮瓣中持续了30％以上的深二至三度接触烧伤。随着坏死的进展，我们在术后21d对转移的组织进行整块清创后，在烧伤区域应用了NPWT敷料。NPWT应用4d后，皮瓣暴露的脂肪组织变为干燥和棕色坏死组织。在进一步清创后，我们注意到伤口逐渐达到完全坏死，腹壁下动脉深血管蒂塌陷。
结论：尽管NPWT已被证明可成功治疗各种伤口类型，应提醒在热损伤后短期重建皮瓣伤口中应用NPWT的重大风险.
方法：一名48岁女性患者，采用深腹壁下动脉穿支游离皮瓣立即进行乳房再造。当将加热垫直接应用于皮瓣部位时，术后7d，她在转移的皮瓣中持续了30％以上的深二至三度接触烧伤。随着坏死的进展，我们在术后21d对转移的组织进行整块清创后，在烧伤区域应用了NPWT敷料。NPWT应用4d后，皮瓣暴露的脂肪组织变为干燥和棕色坏死组织。在进一步清创后，我们注意到伤口逐渐达到完全坏死，腹壁下动脉深血管蒂塌陷。
结论：尽管NPWT已被证明可成功治疗各种伤口类型，应提醒在热损伤后短期重建皮瓣伤口中应用NPWT的重大风险.
