Negative Pressure Wound Therapy

We report our experience with three patients who received NPWT over complex incisions following combined fleur-de-lis panniculectomy with ventral hernia repair. All patients received perioperative antibiotics. Panniculectomy was performed prior to components separation and underlay of biologic graft. Closure followed with drain placement to all undermined areas, with 3 French fry portals left open in areas at risk for wound breakdown. Three-layer closure was achieved with epidermal approximation using interrupted-nonabsorbable sutures placed 1cm apart along the incision, excluding the 3 portals (2-3cm each). White foam strips (1-2cm, French fries) were placed into each portal followed by silver-impregnated hydrofiber dressing strips over the incision. NPWT was applied to the incision line for 7-10 days, followed by NPWT (mean: 21.3 days) to only portal sites. One patient’s incision had a small partial thickness necrosis at the T-junction, which resolved with local wound care alone. The other 2 patients’ incisions healed without consequence. In these patients, using NPWT with the French fry technique allowed for superficial control of the incision line and deep control for internal compression of deep dead spaces, which assisted with complete incisional healing. Use of NPWT helped to address and minimize serious complications in these high-risk surgical patients.