Antiseptic negative pressure instillation therapy for the treatment of septic wound healing deficits in oral and maxillofacial surgery.

Fabian Matthias Eckstein, Valesca Pinsel, Matthias Christian Wurm, André Wilkerling, Eva-Maria Dietrich, Sebastian Kreißel, Cornelius von WIlmowsky, Tilo Schlittenbauer

Journal: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2019;47(3):389-393

PMID: 30638743

Full Text on Elsevier Science View on PubMed

Abstract

INTRODUCTION

Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option.

MATERIAL AND METHODS

In this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction.

RESULTS

The use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases.

CONCLUSION

The negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.

Address: Department of Oral and Maxillofacial Surgery (Head of the institution: Prof. Dr. med. Dr. med. Dent. Marco Rainer Kesting), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstraße 11, 91054, Erlangen, Germany. Electronic address: [email protected].; Department of Oral and Maxillofacial Surgery (Head of the institution: Prof. Dr. med. Dr. med. Dent. Marco Rainer Kesting), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstraße 11, 91054, Erlangen, Germany.; Department of Oral and Maxillofacial Surgery (Head of the institution: Prof. Dr. med. Dr. med. Dent. Marco Rainer Kesting), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstraße 11, 91054, Erlangen, Germany; Section of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology, Klinikum Augsburg Süd, 86156, Augsburg, Germany.

DOI: 10.1016/j.jcms.2018.12.006

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MeSH Terms: Aged, Bacterial Infections, Bacterial Load, Female, Humans, Jaw, Male, Middle Aged, Negative-Pressure Wound Therapy, Orthognathic Surgical Procedures, Retrospective Studies, Surgical Wound Infection, Wound Healing