The use of negative pressure wound therapy in severe open lower extremity XXXX : identifying the association between length of therapy and surgical outcomes.

@entity1 @entity174 @entity130
BACKGROUND: Negative pressure wound therapy (NPWT) is a widely accepted method of temporary coverage for complex lower extremity wounds before definitive reconstruction. However, the precise role of NPWT in the perioperative management of @entity1 with complicated lower @entity130 remains unclear. In this study, we examine the effect of NPWT on flap complications and overall outcomes based on timing of soft-tissue reconstruction relative to @entity130 . METHODS: We retrospectively reviewed the medical records of 32 consecutive @entity1 presenting to a single institution receiving lower extremity reconstruction after Gustilo class IIIB or IIIC open @entity174 over a 5-y period. Length of hospitalization, number of surgical procedures, flap failure, infection, and nonunion were parameters of interest in this study. RESULTS: The incidence of complications in @entity1 treated with NPWT was lower compared with @entity1 who underwent wet-to-dry dressing changes, regardless of when surgery was performed. The highest rate of complications was observed in @entity1 operated on >6  wk after injury and who received wet-to-dry dressing changes wound care. By comparison, those who underwent surgery within 1  wk of injury and who were bridged with NPWT had the lowest rate of complications. CONCLUSIONS: The use of NPWT therapy in the perioperative management of @entity1 with open lower extremity @entity174 reduces complication rates associated with limb salvage surgery. Our results suggest that NPWT can be used as a temporizing measure to optimize @entity1 before flap surgery, effectively lengthening the window of opportunity for definitive reconstruction.
