woundhealing(Chaetal.2012;Taghizadehetal.2008;Alietal,2010;Nahas etal.,2007).
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hematomaand promotion ofwound healing wasrefined toapply through the drainage tubes withoutthe polyurethane foam.The usualnegative drainage system providesonly 50to 90ofmmHg negativepressure.Authorstried to apply highernegative pressure continuously using wallsuction units,which provideamaximum of300mmHg.Thelargertheareaoftheflap was,the higherthe pressure was applied.Largerareas such as abdominoplasty area,
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-In the resultofour study,a large flap wound or donor site that needscontinuouscompression toreducedead spacecan beagood indication ofhigh-pressurenegativesuction drain.Latissimusdorsiflap and transverse abdominis flap donor site,flap area after the pressure sore reconstruction, abdominoplasty area, and defect after huge mass excision were good examples. As the disadvantage of this method, it is presumed that high-pressure negative suction can induce ischemia of fat tissue and fat necrosis.However,wethink thatoursuction drain istoo smallto inducea large area offatnecrosis,so dead space willnotbe formed by a small amountoffatnecrosis.
Fig.5.On applying high pressurenegativesuction therapy underthe skin flapat150~160mmHg,theflapsweremorestabilizedtofix the underlying tissues(bluearrows)than othermethodssuchasquilting sutures.
Before using high-pressure negative suction drain,there are a few things to be aware of. If there is a bleeding vessel in the wound, high-pressure negative suction can cause massive bleeding.Thus,before applying high-pressure negative suction drain,meticulous hemostasis ofthe flap and recipientwound is mandatory.In addition,negative suction drain with the highestpressure (300 mmHg)can induce painfulsensation forthe patient.Therefore,ifthe patientcomplains ofpain,gradually increasing the negativepressurewillbehelpful.Becauselocalhigh pressure(>200 mmHg) can inducedrain tubecollapsenearthewallsuction bottle,regularchecking ofthetubeisneeded,andithastobechangedtoathickertubewhenthere isrepetitivecollapse.Inaddition,forthefreeflaporthepedicledflapwound, negativesuctiondrainneartheanastomosissiteortheflappediclecancause vascularcollapsebecauseofhighpressure.Therefore,suctiondrainshouldbe keptawayfrom theanastomosissiteortheflappedicle.
In ourexperience,the application ofnegative-pressure therapy under the clean closed wound is a new powerfultechnique in the postoperative management of various flap surgeries, which may decrease wound complications.Thisisthefirststudy toreportsuch anoveluseofnegative suction drain therapy.A largergroup ofpatientsand prospectiverandomized studiesforappropriatepressurelevelareneededforourrefinedtechnique.
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-REFERENCES
1.AliSN,GillP,OikonomouD,etal.Thecombinationoffibringlueand quiltingreducesdrainageintheextendedlatissimusdorsiflapdonorsite. PlastReconstrSurg125:1615-1619,2010
2.AgrawalA,AyantundeAA,CheungKL.Conceptsofseromaformation andpreventioninbreastcancersurgery.ANZ JSurg76:1088-1095,2006
3.AndradesP,PradoA,DanillaS,etal.Progressivetensionsuturesinthe stateofclinicart.PlastReconstrSurg117:127S-142S,2006
6.ChaHG,KangSG,ShinHS,etal.Doesfibrinsealantreduceseroma afterimmediatebreastreconstructionutilizingalatissimusdorsi myocutaneousflap?ArchPlastSurg39:504-508,2012
7.KilpadiDV,Cunningham MR.Evaluationofclosedincision
managementwithnegativepressurewoundtherapy(CIM):hematoma/
seromaandinvolvementofthelymphaticsystem.WoundRepairRegen 19:588-596,2011
8.LeeDL,RyuAY,RheeSC.Negativepressurewoundtherapy:an adjuvanttosurgicalreconstructionoflargeordifficultskinandsoft
tissuedefects.IntWoundJ8:406-411,2011
9.MendoncaDA,PapiniR,PricePE.Negative-pressurewoundtherapy:a snapshotoftheevidence.IntWoundJ3:261-271,2006
10.NahasFX,FerreiraLM,GhelfondC.Doesquiltingsutureprevent
seroma in abdominoplasty? PlastReconstrSurg 119:1060-1064;discussion 1065-1066,2007
11.SaxenaV,HwangCW,HuangS,etal.Vacuum-assistedclosure: microdeformationsofwoundsandcellproliferation.PlastReconstrSurg
14.SchmedesGW,BanksCA,MalinBT,etal.Massiveflapdonorsitesand theroleofnegativepressurewound therapy.OtolaryngolHead Neck Surg 147:1049-1053,2012
15.ShinIS,LeeDW,Lew DH.Efficacyofquiltingsuturesandfibrinsealant togetherforpreventionofseromainextendedlatissimusdorsiflapdonor sites.ArchPlastSurg39:509-513,2012
16.StebbinsWG,HankeCW,PetersenJ.Ultrasound-guideddrainageof aseromafollowingtumescentliposuction.DermatolTher24:121-124,2011
17.TaghizadehR,ShoaibT,HartAM,etal.Triamcinolonereducesseroma re-accumulationintheextendedlatissimusdorsidonorsite.JPlast ReconstrAesthetSurg61:636-642,2008
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-18.TimmersMS,LeCessieS,BanwellP,etal.Theeffectsofvarying
degreesofpressuredelivered by negative-pressurewound therapy on skin perfusion.AnnPlastSurg55:665-671,2005
19.UbbinkDT,WesterbosSJ,NelsonEA,etal.A systematicreview of topicalnegativepressuretherapy foracuteandchronicwounds.BrJSurg 95:685-692,2008
국문요약
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-저자들의 과거 자료와 비교 시 의미 있게 감소함을 알 수 있었다 (P = 0.047). 배액량과 재원기간 역시 감소함을 나타내었으나 통계적인 유의함은 없었다.초음 파를 통해 평가한 술후 발생한 사강의 경우 대조군과 비교 시 크게 감소하였다.
결론:고압력 연속 음압 흡입치료는 간단하지만 패쇄적 창상의 치료에 있어 서 강력한 치료 방법이다.
핵심어:장액종,wallsuction,고압력 연속음압 흡입기