Management of complicated head and neck wounds with vacuum-assisted closure system

Background. The vacuum-assisted closure system (V.A.C.), or negative pressure dressings, has been successfully used to manage complex wounds of the torso and extremities, but its role in the head and neck region has not been frequently described. Methods. A retrospective study was performed. The V.A.C. system (Kinetic Concepts Inc., San Antonio, TX) was used at the University of Iowa Hospitals and Clinics for management of complicated head and neck wounds. Results. The V.A.C. system was utilized at 13 sites for 12 patients. Nine subjects had exposed calvarium (4 had failed pedicled reconstructive flaps, 3 had ablative or Moh's defects, and 2 had traumatic scalping injuries) necessitating bony coverage. Three subjects had the V.A.C. system used as a bolster dressing placed over split-thickness skin grafts (STSGs) used to reconstruct large defects of the face and skull, and 1 patient had a large soft tissue neck defect after radical surgical resection for necrotizing fascitis. One subject used the V.A.C. system for the management of 2 distinct wounds. All patients had successful healing of their wounds with the V.A.C. system without complication. All STSGs had 100% viability after 5 to 7 days of the V.A.C. system use as a bolster dressing. Conclusion. This study demonstrates the V.A.C. system is a valuable tool in the management of complicated head and neck wounds.