Negative pressure wound therapy for management of Achilles region defects: a systematic review of the literature

Background: Despite the efforts of plastic and orthopedic surgeons to elaborate the most appropriate treatment for lesions of the Achilles region and their reconstruction, no universal guideline exists. Regenerative treatments such as negative pressure wound therapy (NPWT) are increasingly being used in the management of these defects. Objective: To research the different usage protocols, roles, and outcomes of NPWT in the management and reconstruction of Achilles region defects. Methods: A scientific literature search was performed by querying Medline and Scopus using the terms "(Achilles tendon) AND ((vac) OR (vacuum assisted closure) OR (negative pressure) OR (NPWT))." The authors used an online screening software. The investigation followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic review. Results: Of the initial 153 studies identified, only 14 fulfilled the eligibility criteria and were included in this review. Analyzed protocols mainly included surgical debridement combined with the use of NPWT as a primary dressing directly on the tendon or as a secondary dressing covering a split-thickness skin graft (STSG) or a flap. Additionally, the combination of negative pressure with matrices was found to provide optimal results even after STSG failure. Most of the reported complications described in the included studies involved partial loss of graft or flap. Conclusion: NPWT can be used either as a primary dressing (directly on the lesion) or as a secondary dressing (over a flap or a skin graft) for management of Achilles region defects. The combined use of negative pressure with matrices can also aid in wound reduction.