Comorbidities May Delay Healing After Negative Pressure Wound Therapy in Head and Neck Cancer

Although negative pressure wound therapy (NPWT) was observed to benefit patients recovering from surgery for head or neck cancer, patient comorbidities, including previous irradiation and type 2 diabetes (T2D), prolonged the time needed for wounds to heal, according to a recent literature review.

The review, published in Cancers, provided new insight into NPWT performance in wound management for head and neck sites, an area of research that has not been extensively explored in the past, possibly because the complexity of anatomical subsites of the head and neck can make dressing a wound more difficult to do and observe.

“NPWT must be considered an excellent alternative to traditional dressings for the management of compromised head and neck wounds. The anatomical complexity of these areas along with risk factors such as previous radiation and DM has posed challenges to the treating physicians in terms of complete wound healing,” wrote the investigators.

For over half a decade, NPWT has been a staple wound management tactic for general, orthopedic, and plastic surgeons. The process incorporates the use of an adhesive film to apply negative pressure over a foam padding, which removes wound exudate and reduces the risk of interstitial edema and bacterial load at the surgical site. NPWT can also increase tissue perfusion and allow for the formation of a well-granulating wound bed.

Patients with head and neck cancers often present at an advanced stage that may require major surgical removal of tissue and reconstruction of large defects. Several factors, including malnutrition and previously irradiated tissue, can delay wound healing, which can lead to increased financial burden, longer hospital stays, and worse clinical outcomes.

The investigators searched 5 literature databases for studies with 3 or more cases focusing on the use of NPWT for head and neck wounds published from 2000 to 2020. Out of the 151 identified studies, 16 studies containing data on 380 patients were included in the analysis. The patients had a mean age of 63 years (range, 50-67 years) and a majority were male (n = 287).

NPWT was applied for mostly neck wounds (n = 170; 47.3%), followed by face (n = 66; 18.3%) and head wounds (n = 20; 5.5%). The mean (SD) response for wound healing was 88.2%.

About half of the studies reported the time needed for the wound to heal with a varied range and the average healing time was 14.4 days (range, 6-53 days). Also, the mean time needed for dressing changes was 3 days (range, 2-5).

Among the comorbidities that are suspected to delay wound healing, previous irradiation was the most reported (39.80%), followed by T2D (22.00%), hypothyroidism (11.97%), malnutrition (4.17%), and coronary artery disease (3.8%).

The mean hospital stay was 10 days (range, 2-35 days). Patients with a high output chyle or multiple comorbidities were more likely to have longer hospital stays.

During a univariate analysis, the investigators found that previous irradiation had a detrimental effect on wound healing, with an OR of 4.34 (P = .005). Additionally, wound healing was impacted by T2D, with an OR of 5.65 (P = .01). A multivariate analysis showed that previous radiation and DM were the only factors to significantly alter wound healing.

When assessing the studies’ assessment criteria quality, the investigators said that 12 were rated as having good quality and 3 were considered fair quality.

The selected studies posed some limitations, including that most studies did not contain information on the duration of NPWT and the types of conventional methods used prior to NPWT application. In addition, there was missing data on the sub-class analyses of patients’ fistula types and the differences in healing times and responses.

“This further warrants future prospective studies comparing fistulous versus closed wounds in the background of other factors such as types of fistula, previous irradiation, and the impact of comorbidities on wound healing,” wrote the investigators.

Reference

Faisal M, Berend PD, Seemann R, et al. Impact of previous irradiation on wound healing after negative pressure wound therapy in head and neck cancer patients—A systematic review. Cancers. May 19, 2021;13(10):2482. doi: 10.3390/ cancers13102482