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American Association for Hand Surgery

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The Effects of Negative-Pressure Wound Therapy on Complex Extremity Wounds Requiring Coverage with a Meshed Bilayer Wound Matrix: A Retrospective Analysis
Christopher Castagno, BS, Texas Tech University Health Sciences Center El Paso, El Paso, TX, Jordan Carter, BS, Texas Tech University Health Sciences Center, El Paso, TX, Michael M Polmear, MD, MS, Texas Tech University Health Sciences Center, EL Paso, TX, Fernando Herrera, MD, Division of Plastic Surgery, Medical University of South Carolina, Division of Plastic Surgery, Charleston, SC and Gilberto Gonzalez, MD, Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Pasop, TX

Introduction: The treatment of complex extremity wounds is a technically challenging problem facing all reconstructive surgeons. The use of the Integra® Meshed Bilayer Wound Matrix (IMBWM) and negative-pressure wound therapy (NPWT) has shown promise in the treatment of these wounds in case reports and small case series. In this cohort study, we compare the use of IMBWM combined with NPWT versus IMBWM alone. We hypothesized that patients treated with a combination of IMBWM and NPWT would have fewer postoperative complications, shorter recovery times, and fewer additional grafts.

Methods: The records of all patients undergoing extremity wound coverage with IMBWM at a single academic institution were queried from the electronic medical record (EMR) using data obtained from the operating surgeon. Data collected included standard demographic information, etiology of the wound, the number of grafts required, and post-operative complications.

Results: Preliminary data revealed a total of 109 patients undergoing treatment with IMBWM for a complex extremity wound coverage. Among them, 62 patients were treated with IMBWM and NPWT, and 47 patients treated with IMBWM alone. The most common etiology of these injuries was trauma. At 3 weeks postoperatively, 2 patients from the IMBWM + NPWT group and 7 patients in the IBWM alone group required reapplication of the matrix before definitive coverage with a split-thickness skin graft (STSG).

Conclusions: The combination of IMBWM and NPWT can reduce postoperative complications, the number of reapplications, and lead to shorter recovery times in the setting of complex extremity wounds. Traditionally, these injuries have been treated with delayed closure, with STSGs or technically challenging flap procedures. Treatment with IMBWM and NPWT decreases the time from initial injury to definitive closure as well as requires less technical skill than traditional methods, thus increasing the availability of complex wound treatment to more than just specialty surgery centers. Thus, the use of IMBWM in combination with NPWT has the potential to improve both surgical procedures and patient outcomes in the setting of complex extremity wounds.

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