Application of Mechanical Negative Pressure Drainage (Cupping Method) for Venous Compromise in Flap Surgery

ABSTRACT
Background: Venous insufficiency after flap surgery is an unpredictable complication that can lead to flap loss. Several approaches have been described to eliminate the venous problems after flap surgery, but it still remains unsolved. In this study, we aimed to demonstrate the application of the cupping method to treat the venous compromise in the flaps.
Patients and Methods: Patients with flaps undergoing mechanical negative pressure drainage due to venous compromise were included in the study. Only procedures with pedicled island flaps were included to exclude cases of venous insufficiency due to thrombosis or anastomotic problems. Patients with free flaps, perforator flaps and skin-connected flaps were also excluded. Demographic data (age, sex), mean duration and frequency of application, complications were recorded.
Results: Eight patients were included in the study with a mean age of 40.3 years. A parascapular flap was performed in four patients, a transverse rectus abdominis flap in three patients and a medial gastrocnemius musculocutaneous flap in one patient. The mean duration of mechanical negative pressure drainage was 2.8 days and the mean frequency of application was 4.6 times per day. The mean duration of the procedure was 2.25 minutes. Two patients underwent revision surgery on postoperative day 5 under local anaesthesia due to marginal necrosis of the flap. There were no complications in the other patients.
Conclusion: Compared to other approaches described in the literature, the cupping method may provide a more practical and faster solution for venous congestion. Although the limited number of patients seems to be a limitation of the study, the main priority of the study was to demonstrate the applicability of the method. A large population study with a controlled randomised methodology will make a positive contribution to the literature.
Keywords: Cupping method, venous compromise, flap surgery, mechanical negative pressure drainage method