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Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach
Author(s) -
Mir Ahsan,
Guys Nicholas,
Arianpour Khashayar,
Svider Peter F.,
Rayess Hani,
Zuliani Giancarlo,
Raza S. Naweed,
Lin Hosheng
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27262
Subject(s) - medicine , negative pressure wound therapy , head and neck cancer , cochrane library , randomized controlled trial , etiology , surgery , medline , meta analysis , confidence interval , relative risk , systematic review , observational study , head and neck , radiation therapy , pathology , alternative medicine , political science , law
Objective To perform an evidence‐based review with recommendations that evaluates the indications and utility of negative pressure wound therapy (NPWT) in the head and neck. Methods The authors searched the PubMed, Medline, Embase, Web of Science, and Cochrane Library databases for relevant literature. The primary outcome was successful intended use of NPWT, be it for granulation tissue formation, infection control, or complete wound closure. Patient demographics, etiology, and other clinical characteristics were explored. Meta‐analysis of observational studies was used to examine response rates and wound sizes. Results Fifty‐seven articles encompassing 522 patients were included. The most common etiologies reported included: neoplasm (343 patients [65.7%]), oro‐/pharyngocutaneous fistula (9.8%), infection (10.5%), and trauma (9.6%). The majority of wounds treated were in the neck (61.6%). Potential risk factors that may compromise wound healing were noted in 217 of 522 patients (41.6%). Of these 217 patients, 135 had properly documented risk factors, with the most common being prior irradiation (63%). The overall mean response across studies was 85.7% (95% confidence interval: 0.806–0.896, P < 0.001, I 2 = 0 %). Conclusion Negative pressure wound therapy is useful for the management of head and neck wounds and should be considered for patients in whom wound healing is progressing insufficiently, including those with a history of head and neck cancer, oro‐/pharyngocutaenous fistula, and trauma. Randomized controlled trials further comparing NPWT versus other modalities may be invaluable in further delineating its appropriate role. Laryngoscope , 129:671–683, 2019