Vacuum-assisted closure aids complex wound healing in head and neck
medwireNews: Vacuum-assisted closure (VAC) is an effective treatment in the management of wound-healing disorders of the head and neck, say researchers.
"We suggest that VAC therapy should become a routine for selected patients with complex wounds in the head and neck area," say Maximilian Reiter and Ulrich Harréus, from Ludwig Maximilians University in Munich, Germany.
VAC has advantages over conventional dressings in that negative pressure decreases the wound area and, if the procedure is combined with the use of custom-made polyurethane foams, granulation tissue formation can be enhanced. Reiter and Harréus say that theirs is the largest case series to date dealing with VAC in the management of complex head and neck wounds.
The researchers conducted a retrospective study of 23 patients, aged a mean of 58 years, who underwent VAC therapy for complex wounds and defective healing. All patients had wounds of at least 20 cm3 in area.
As reported in the American Journal of Otolaryngology - Head and Neck Surgery, after a mean VAC treatment period of 10.3 days, closure of the wound was achieved in 18 (78%) patients, with no further surgical procedure required.
In 13 of the patients, wound healing disorders occurred after extensive resection and reconstruction for head and neck squamous cell carcinoma, all of which were stage III or IV cancer. Of these patients, 11 had previously been treated with radiation therapy (58-90 Gy in the area of the wound) and five of those individuals needed further surgery to close the remaining defect after VAC therapy.
"Often patients have been treated with radiotherapy or radiochemotherapy before [undergoing VAC therapy],"say Reiter et al. "In these cases there is limited tissue available for local reconstruction and microvascular procedures are necessary to close remaining defects."
VAC therapy may not produce the desired results in patients who have previously been irradiated, says the team, but otherwise the system is a useful modality to manage complex wounds in the head and neck.
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By Sally Robertson, medwireNews Reporter