Continuous high-pressure negative suction drain: new powerful tool for closed wound management: clinical experience.

Abstract

BACKGROUND: Although various reconstructive flap surgeries have been successfully

performed, there still are difficult wound complications, such as seroma

formation, wound margin necrosis, delayed wound healing, and even flap failures.

The negative-pressure wound therapy has been described in detail in the

literature to assist open chronic/complex wound closure in reconstructive

surgery. However, the negative-pressure wound therapy was difficult to be applied

under the incisional closed wounds. METHODS: A total of 23 patients underwent the

various reconstructive flap surgeries with continuous high-pressure negative

suction drain. Instead of using regular suction units, Barovac (50-90 mm Hg,

Sewoon Medical, Seoul, Republic of Korea) drainage tubes were connected to the

wall suction unit, providing continuous high-powered negative pressure. In

addition, continuous subatmospheric suction pressure (100-300 mm Hg) was applied.

Outcome of the measures was obtained from the incidence of seroma, volume of

postoperative drainage, hospitalization period, and incidence of other typical

wound complications. Dead space was evaluated postoperatively with

ultrasonography. RESULTS: Using continuous high-pressure negative suction drain,

successful management of seroma was obtained without any major complication such

as wound infection, flap loss, and wound margin necrosis, except for only 1 case

of seroma after discharge from the hospital. The indwelling time of the drain in

the latissimus dorsi donor site was significantly reduced in comparison with the

authors' previous data (P = 0.047). The volume of drainage and hospitalization

period were also reduced; however, these were not statistically significant. The

dead space with continuous high-pressure negative suction drain was more reduced

than in the control group in the immediate postoperative period and confirmed

with ultrasonography. CONCLUSIONS: Continuous high-pressure negative suction

drain might be the simple and powerful solution in the management of challenging

closed wounds.