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Rubber Bands with Negative Pressure Wound Therapy; A Simple Technique for Management of Wound Dehiscence /Partial Necrosis Following Breast Reconstruction with TRAM Flap

Safwat M. Ibrahim*,Ayman Helmi,Khurram Javed,Jamal El Deib and Fatema S. Al Subhi

Objectives: The aim of this study is to introduce the application of the well-known rubber bands technique and negative pressure wound therapy after surgical debridement for gradual direct closure of wound dehiscence/partial necrosis following breast reconstruction with TRAM flap.
Methods: We evaluated 12 patients who had a mastectomy and breast reconstruction using ipsilateral TRAM flap regarding the effectiveness of rubber bands technique and negative pressure wound therapy for direct closure of donor and recipient areas wound dehiscence/partial necrosis. The outcome was evaluated according to wound gap reduction and the success of direct wound closure.
Results: Three of the studied group (two partial TRAM flap necrosis and one donor site abdominal wound necrosis) had a post-operative wound dehiscence/partial necrosis complication. In these cases, the wound edges were approximated gradually after surgical debridement using the described technique. The wounds were closed directly in all cases. The patients were followed up for an average of three months after complete closure without recurrent wound dehiscence/necrosis, skin graft or another flap.
Conclusion: The described protocol proved to be an effective method in managing TRAM flap as well as donor site wound dehiscence/partial necrosis complication with less number of surgeries, shorter time and better aesthetic outcome.