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Clinical Note |

Vacuum-Assisted Closure in Revision Free Flap Reconstruction

Kiran Kakarala, MD; Jeremy D. Richmon, MD; Derrick T. Lin, MD; Daniel G. Deschler, MD
Arch Otolaryngol Head Neck Surg. 2011;137(6):622-624. doi:10.1001/archoto.2011.74.
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Since their introduction in 1997, vacuum-assisted closure (VAC) dressings have found widespread use in the treatment of complicated surgical and traumatic wounds.1 The VAC system consists of a porous foam and overlying occlusive dressing to which subatmospheric pressure is applied. The VAC dressing has many beneficial effects on wound healing, including increased tissue perfusion, decreased wound edema and bacterial counts, and microdebridement of nonviable tissue. Healthy vascularized granulation tissue forms in the wound bed, allowing for more rapid healing than with conventional dressings.1,2

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Figure 1.

Case 1. A, Postoperative day 10 following vacuum-assisted closure (VAC) dressing removal revealing healthy granulation tissue. B, Split-thickness skin graft applied over granulation tissue. C, VAC dressing applied as bolster over split-thickness skin graft. D, Postoperative day 23.

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Figure 2.

Case 2. A, Composite oromandibular defect. B, Cutaneous defect following fibular free flap reconstruction with exposed free flap muscle (arrow). C, Postoperative day 1: vacuum-assisted closure dressing applied to cutaneous defect directly over free flap muscle. D, Postoperative day 22: defect epithelialized with small remaining area of healthy granulation tissue (arrow).

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