抄録
Negative pressure wound therapy is widely used to expedite wound healing; however, achieving sufficient contraction in large wounds, refractory ulcers, and fasciotomy wounds following necrotizing fasciitis remains challenging, often requiring skin grafts. This study introduces a three-dimensional negative-pressure wound therapy application method that maximizes wound contraction, aiming to achieve direct closure, even for large ulcers.
We applied this technique in two cases: necrotizing fasciitis of the thigh and diabetic foot gangrene due to chronic limb-threatening ischemia. Our three-step approach adapted negative-pressure wound therapy application based on wound shape—first promoting horizontal contraction while preventing early adhesion between the wound pocket and underlying tissues, then adjusting foam placement to enhance further contraction, and finally inducing vertical contraction. This method achieved effective wound closure in both cases, thereby avoiding the need for skin grafts. Additionally, in comparison to skin grafting, it reduced scarring and hospitalization duration. In the case of transmetatarsal amputation, the thick plantar skin effectively covered the weight-bearing area, lowering the risk of ulcer recurrence. This technique is simple and minimally invasive, and may offer a functionally and aesthetically superior alternative for wound closure.
(A) A 44-year-old man underwent debridement for necrotizing fasciitis of the right thigh, with resection of the fascia of the vastus lateralis, rectus femoris, gluteus medius, and biceps femoris muscles. (B) Eighth day after debridement: Infection control of the wound was achieved, and NPWT was initiated. Horizontal contraction was applied. (C) Tenth day after NPWT initiation: A second debridement was performed. To enhance mobility between the subcutaneous tissue and the underlying bed, additional subcutaneous dissection was carried out, and NPWT was applied to continue horizontal contraction. (D) Twenty-first day after NPWT initiation: As the speed of horizontal contraction slowed, the focus was shifted to vertical contraction. (E) Twenty-eighth day after NPWT initiation: Since both horizontal and vertical contraction were achieved, NPWT was discontinued. (F) Twenty-eighth day after NPWT initiation: Direct closure was performed. (G) One year after operation: The wound healed without dehiscence or infection.
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