Closed Incision Negative Pressure Therapy for Lower Limb Donor Sites in Head and Neck Reconstruction: Literature Review and Institutional Experience

Closed incision negative pressure therapy (ciNPT) has gained attention for its potential to reduce postoperative complications, particularly in high-tension donor sites such as the lower extremities. Though its benefits are well documented in abdominal donor sites used for breast reconstruction, evidence remains limited for lower limb flaps like the anterolateral thigh (ALT) and medial sural artery perforator (MSAP), which are increasingly employed in head and neck reconstruction. We conducted a narrative review of the current literature on ciNPT use in free flap donor sites, with emphasis on lower extremity applications. Additionally, we retrospectively analyzed 56 patients who underwent ALT or MSAP flap harvest at our institution between 2020 and 2024. Of these, 23 received ciNPT, and 33 received conventional dressings. The literature suggests that ciNPT may lower the risk of wound dehiscence and infection in high-tension closures, although concerns remain regarding skin irritation and allergic reactions associated with adhesive dressings. In our series, the ciNPT group showed a lower rate of wound edge necrosis and full-thickness dehiscence, with no increase in hematoma or seroma formation. These findings support the potential role of ciNPT in improving outcomes at mobile or high-risk donor sites. Although adverse skin events were observed in some ciNPT cases, all were mild and resolved with conservative management. Selective use of ciNPT in appropriate patients may enhance wound healing and reduce complications in lower limb reconstruction. Further prospective studies are needed to define optimal indications and evaluate long-term cost-effectiveness.