In Japan, negative pressure wound therapy (NPWT) has become an important wound management technique since a NPWT device was approved for use under the Japanese national health insurance system. On the other hand, its utility for treating infected sites is limited because it results in the formation of a semi-enclosed environment and can even exacerbate infections in some cases. Recently, a device with combined NPWT and irrigation functions has been introduced in other countries, although it has not yet been approved for use under the Japanese national health insurance system. We produced a custom NPWT device that allows continuous irrigation and used a preexisting NPWT instrument as a motor source. The system enables patients to retain their ability to perform activities of daily living. The system is able to create stable negative pressure environments while providing continuous focal irrigation, which are associated with good wound bed preparation. Here, we describe the construction of the system.

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It is difficult to apply skin grafts to hypovascular tissue, such as that found on the skull. Exposing the bone marrow is a commonly used technique during the application of skin grafts to the skull. However, during extensive surgery for skull-exposing wounds removing the calvarial bone can increase blood loss and even weaken the skull.
We compared the skin graft methods employed in 3 patients who were left with wide skull-exposing wounds after tumor excision. In case 1, we removed the whole calvarial bone, and performed a skin graft operation directly on the bone marrow. In case 2, we partially removed the calvarial bone and covered the whole wound with artificial dermis. At 28 days after the first operation, we performed a skin graft operation. In case 3, we drilled the calvarial bone in a reticular pattern and covered the whole wound with artificial dermis. At 21 days after the first operation, we performed a skin graft operation. In these 3 cases, we found that retaining the calvarial bone had certain advantages. In addition to increasing the strength of the bone, the skin grafts placed on calvarial bone were more stable than the skin graft that was placed directly on the bone marrow. Therefore, we consider that as much as possible of the calvarial bone should be kept intact when reconstructing full-thickness scalp defects.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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