2021 年 2 巻 1 号 p. 20-26
Introduction: Incisional negative pressure wound therapy (iNPWT) is a preventive measure for postoperative wound dehiscence in which negative pressure is applied to the suture wound. Indeed, insufficient drainage in the deep layer is associated with an increased risk of developing subcutaneous hematoma and wound complications. Here, we report two cases of lower limb degloving injury successfully managed by iNPWT, with the reinforcement of subcutaneous drainage (hybrid-iNPWT).
Case presentation: Case 1 was that of an 87-year-old man who sustained a deep, dissecting hematoma of the left lower leg associated with the sensation of severe tightness and pain. After emergency incision and removal of the hematoma in the deep fascia, we performed a primary closure of the flap wound. A negative pressure of 80 mmHg was applied to the sutured wound via foam dressing (iNPWT). Concurrently, we connected the negative pressure device with a subcutaneous drainage tube inserted under the flap (hybrid-iNPWT). The flap survived without recurrence of hematoma. Case 2 was that of an 89-year-old woman with a right lower leg degloving injury. The skin and subcutaneous tissues were detached from the underlying fascia. After primary closure of the flap, hybrid-iNPWT was performed at a subatmospheric pressure of 80 mmHg. The patient was discharged without any complications related to wound healing.
Discussion: The aim of using hybrid-iNPWT was to apply negative pressure not only to the surface of the sutured wound but also to the posterior portion of the flap. The intensity of the negative pressure provided by the iNPWT device was higher than that of the conventional suction drainage tube system. Hybrid-iNPWT can be an alternative solution for hematoma prevention and may allow early ambulation in the management of lower limb degloving injuries in elderly patients.