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Original Investigation
October 2013

Prospective Evaluation of a Negative Pressure Dressing System in the Management of the Fibula Free Flap Donor Site: A Comparative Analysis

Author Affiliations
  • 1Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, England
  • 2Evidence-Based Practice Research Centre, Faculty of Health, Edge Hill University, Ormskirk, England
  • 3Molecular and Clinical Cancer Medicine, School of Cancer Studies, University of Liverpool, England
JAMA Otolaryngol Head Neck Surg. 2013;139(10):1048-1053. doi:10.1001/jamaoto.2013.4544

Importance  The fibula free flap donor site has been associated with short-term donor site morbidity, most commonly delayed healing.

Objective  To evaluate the effectiveness of a negative pressure dressing (NPD) system in the management of fibula free flap donor sites that required skin graft closure.

Design  Cohort study comparing a prospective cohort whose donor sites were managed with the NPD system from June 2009 through March 2012 with a retrospective cohort whose donor sites were managed with a conventional pressure (bolster) dressing (CPD) from August 2006 through May 2009.

Setting  Tertiary regional head and neck reconstructive and maxillofacial surgery unit.

Participants  All patients who had a composite fibula free flap for maxillofacial reconstructive surgery and required donor site closure with split-thickness skin grafts from August 2006 through March 2012.

Intervention  Negative pressure dressing used to manage the skin-grafted fibula donor site.

Main Outcomes and Measures  Primary: time until complete healing of the fibula donor site. Secondary: skin graft take rate, infection rate, returns to operating theater for donor site problems, delayed hospital discharge due to donor site problems, and community intervention required for donor site dressing.

Results  All healing outcome measures were similar for the 21 patients in the NPD group and the 19 patients in the CPD group, with no statistically significant difference. Two patients in the CPD group required surgical debridement of the fibula donor site, compared with none in the NPD group (P =.22). The NPD group had a higher skin graft take success rate (15 [71%] vs 11 [58%]; P =.51) and required less nursing intervention for donor site dressings (8 [38%] vs 9 [47%]; P =.75) but had a higher wound infection rate (6 [29%] vs 2 [11%]; P =.24).

Conclusions and Relevance  Our findings would, at best, suggest that NPD may decrease the rate of return to the operating theater for donor site problems. The fibula donor site healing remains problematic, and our results suggest that routine use of the NPD system in the management of the fibula free flap donor site is not justified from a health economic perspective.