1
|
Razii N, Hrycaiczuk A, Kennedy JW, Shields DW, Meek RMD, Jamal B. Proceedings of the United Kingdom Periprosthetic Joint Infection Meeting 2022: Fracture-Related Infection Session. Injury 2024; 55:111905. [PMID: 39368344 DOI: 10.1016/j.injury.2024.111905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/02/2024] [Accepted: 09/15/2024] [Indexed: 10/07/2024]
Abstract
Implant-related infections represent a relatively common and significant challenge in the surgical management of musculoskeletal trauma patients. The third United Kingdom Periprosthetic Joint Infection (UK PJI) Meeting convened in Glasgow on 1 April 2022, and brought together over 180 delegates, representing orthopaedics, infectious diseases, microbiology, plastic surgery, anaesthetics, and allied health professions, including pharmacy and specialist nurses. The meeting comprised a plenary session for all delegates, and separate breakout sessions for fracture-related infection (FRI) and arthroplasty. The UK PJI working group prepared consensus statements in advance of each session, based upon topics that were discussed at previous meetings, and delegates engaged in an anonymous electronic voting process. This article presents the findings of the FRI session, and examines each consensus topic within the context of the contemporary literature.
Collapse
Affiliation(s)
- Nima Razii
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
| | - Alex Hrycaiczuk
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - John W Kennedy
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - David W Shields
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - R M Dominic Meek
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Bilal Jamal
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| |
Collapse
|
2
|
Parry JA, Salimi M, Stacey SC, Mauffrey C. There is no correlation between differences in adverse events and differences in patient-reported outcome measures in orthopaedic trauma randomized controlled trials: A systematic review. Injury 2024; 55:111909. [PMID: 39332228 DOI: 10.1016/j.injury.2024.111909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/21/2024] [Accepted: 09/15/2024] [Indexed: 09/29/2024]
Abstract
INTRODUCTION A recovery without adverse events is a top priority of orthopaedic trauma patients, however many randomized controlled trials (RCTs) are only powered to detect a difference in patient-reported outcome measures (PROMs). While it may be assumed that differences in major adverse event rates between treatment groups will result in differences in PROMs, this has not been established. The purpose of this study was to perform a systematic review of RCTs to evaluate if differences in these outcomes were correlated. METHODS A systematic search was conducted of online databases to identify RCTs in orthopaedic trauma fracture management that reported both major adverse events and PROMs. Adverse events included secondary surgeries or complications that could negatively affect long-term outcomes (nonunion, chronic regional pain syndrome, etc.). The correlation between a difference (p < 0.05) in adverse events and a difference in PROMs was assessed. RESULTS The systematic review yielded 30 RCTs involving 6,769 patients. The primary outcome was a continuous PROM in 70.0 % (21/30). A difference in major adverse events was reported in 23.3 % (7/30) and a difference in PROMs was reported in 6.7 % (2/30). Studies reporting a difference in adverse events, compared to those that did not, were not more likely to report a difference in PROMs (14.3 % (1/7) vs. 4.3 % (1/23); p = 0.42). CONCLUSIONS There was no correlation between differences in adverse event rates and differences in PROMs in orthopaedic trauma RCTs. Investigators should consider powering studies to detect differences in the major adverse events that both patients and surgeons wish to avoid. LEVEL OF EVIDENCE Level I.
Collapse
Affiliation(s)
- Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States.
| | - Maryam Salimi
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
| | - Stephen C Stacey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
| |
Collapse
|
3
|
Maher M, Ward A, Ward K, Robinson K, Mills E. Minimizing the Risk of Surgical Site Infection Following Hip Fracture Operation. Surg Infect (Larchmt) 2024; 25:574-579. [PMID: 38958043 DOI: 10.1089/sur.2024.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Introduction: Hip fractures are the most common serious injury in the elderly, associated with disability, morbidity, and mortality. Surgical site infection (SSI) is a serious post-operative complication. This prospective cohort study outlines how our center made cumulative improvements in SSI incidence rates, reaching a 12-month average of 0.5%. Methods: All patients undergoing hip fracture operation between 2016 and 2021 were included. The primary outcome measure was confirmed SSI, according to the Public Health England definition. Results were compared with the baseline recordings by an independent SSI team in 2013. Demographic data were compared with National Hip Fracture Database records. Peri-operative infection control and wound management tactics introduced between 2014 and 2021 were collated to gain an overview care bundle. Results: Baseline recordings identified a 9.0% SSI rate in a three-month observation period. In our study, 3,138 hip fracture operative cases were completed between October 2016 and December 2021. There were 9 superficial and 32 deep infections identified, yielding an overall infection rate of 1.3%. However, when analyzing the 12-month average, there was consistent decline in SSI from the baseline 9.0% in 2013 to 0.5% in 2021 (p < 0.05). A peri-operative care bundle included pre-operative bleeding risk assessment. Intra-operatively, double preparation and draping is used for arthroplasty. Broad-spectrum antibiotic agents and tranexamic acid are administered. Meticulous hemostasis and watertight wound closure are observed. Anti-coagulated patients received negative pressure dressings. Post-operatively, a dedicated senior lead team provided daily inpatient review of patients, with urgent consultant review of all wound healing concerns. Conclusion: Patients with a hip fracture have numerous risk factors for SSI. A dedicated multi-focal tactic, adopted by a multi-disciplinary department, can yield substantial risk reduction. Each intervention is evidence based and contributes to cumulative improvement. By prioritizing infection prevention, we have minimized the need for complex infection management interventions and achieved an annual saving of £860,000 for our trust.
Collapse
Affiliation(s)
- Mark Maher
- Department of Trauma and Orthopaedic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alex Ward
- Department of Trauma and Orthopaedic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Karen Ward
- Department of Trauma and Orthopaedic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Karen Robinson
- Department of Trauma and Orthopaedic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Edward Mills
- Department of Trauma and Orthopaedic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| |
Collapse
|
4
|
Li W, Zheng J. Negative Pressure Wound Therapy for Chronic Wounds. Ann Plast Surg 2024; 93:S19-S26. [PMID: 38896874 DOI: 10.1097/sap.0000000000003891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT Chronic wounds, including those caused by venous and arterial insufficiency, diabetic complications, and pressure-induced ulcers, pose significant treatment challenges. Negative pressure wound therapy has been increasingly used for managing these wounds. This treatment aims to promote wound healing, prepare the wound bed for further surgical intervention, minimize the risk of infection, and potentially shorten the time to wound healing. Considering variances in techniques applied in different regions globally, there is an emerging need to comprehensively evaluate the effectiveness of negative pressure wound therapy on chronic wounds. Unfortunately, detailed descriptions of the techniques applied to achieve negative pressure are often lacking in existing literature abstracts, posing challenges for direct comparisons. This review aims to analyze the application of negative pressure wound therapy in the treatment of chronic wounds, summarize its advantages and disadvantages, and further explore the potential value and future research direction of negative pressure wound therapy in the repair of chronic wounds.
Collapse
Affiliation(s)
- Wenbo Li
- From the Plastic Surgery Department, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | |
Collapse
|
5
|
Costa ML, Achten J, Knight R, Campolier M, Massa MS. Five-year outcomes for patients sustaining severe fractures of the lower limb from the Wound Healing in Surgery for Trauma (WHIST) trial. Bone Joint J 2024; 106-B:858-864. [PMID: 39084646 DOI: 10.1302/0301-620x.106b8.bjj-2024-0169.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims The aims of this study were to report the outcomes of patients with a complex fracture of the lower limb in the five years after they took part in the Wound Healing in Surgery for Trauma (WHIST) trial. Methods The WHIST trial compared negative pressure wound therapy (NPWT) dressings with standard dressings applied at the end of the first operation for patients undergoing internal fixation of a complex fracture of the lower limb. Complex fractures included periarticular fractures and open fractures when the wound could be closed primarily at the end of the first debridement. A total of 1,548 patients aged ≥ 16 years completed the initial follow-up, six months after injury. In this study we report the pre-planned analysis of outcome data up to five years. Patients reported their Disability Rating Index (DRI) (0 to 100, in which 100 = total disability), and health-related quality of life, chronic pain scores and neuropathic pain scores annually, using a self-reported questionnaire. Complications, including further surgery related to the fracture, were also recorded. Results A total of 1,015 of the original patients (66%) provided at least one set of outcome data during the five years of follow-up. There was no evidence of a difference in patient-reported disability between the two groups at five years (NPWT group mean DRI 30.0 (SD 26.5), standard dressing group mean DRI 31.5 (SD 28.8), adjusted difference -0.86 (95% CI -4.14 to 2.40; p = 0.609). There was also no evidence of a difference in the complication rates at this time. Conclusion We found no evidence of a difference in disability ratings between NPWT compared with standard wound dressings in the five years following the surgical treatment of a complex fracture of the lower limb. Patients in both groups reported high levels of persistent disability and reduced quality of life, with little evidence of improvement during this time.
Collapse
Affiliation(s)
- Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Juul Achten
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Ruth Knight
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool, UK
| | - Marta Campolier
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - M S Massa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| |
Collapse
|
6
|
Impieri L, Pezzi A, Hadad H, Peretti GM, Mangiavini L, Rossi N. Orthobiologics in delayed union and non-union of adult long bones fractures: A systematic review. Bone Rep 2024; 21:101760. [PMID: 38618008 PMCID: PMC11010966 DOI: 10.1016/j.bonr.2024.101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
Background Fracture healing poses a significant challenge in orthopedics. Successful regeneration of bone is provided by mechanical stability and a favorable biological microenvironment. This systematic review aims to explore the clinical application of orthobiologics in treating aseptic delayed union and non-union of long bones in adults. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were explored, with no date restrictions, using keywords related to orthobiologics and delayed union and non-union. Eligible studies included human clinical studies in English, with available full texts, examining orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone morphogenetic protein (BMPs) for treating aseptic delayed unions and non-unions in adults. Animal studies, in vitro research, and studies on non-unions due to congenital defects, tumors or infections were excluded. Results The initial search identified 9417 studies, with 20 ultimately included in the review. These studies involved 493 patients affected by non-union and 256 patients affected by delayed union, with an average age respectively of 40.62 years and 41.7 years. The mean follow-up period was 15.55 months for non-unions and 8.07 months for delayed unions. PRP was the most used orthobiologic, and outcomes were evaluated through time to union, functional scores, and clinical examinations. The results indicated that orthobiologics, especially PRP, tended to yield better outcomes compared to surgical procedures without biological factors. Conclusion This systematic review suggests that orthobiologics, such as PRP, BMPs, and MSCs, can be effective and safe in the management of delayed union and non-union fractures. These biological treatments have the potential to improve union rates, reduce healing times, and enhance functional outcomes in patients with non-union fractures. Further research is essential to refine treatment protocols and determine the most suitable orthobiologic for specific patient populations and fracture types.
Collapse
Affiliation(s)
- Lorenzo Impieri
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andrea Pezzi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Henrique Hadad
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), Araçatuba School of Dentistry, São Paulo, Brazil
| | - Giuseppe M. Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Nicolò Rossi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| |
Collapse
|
7
|
Vaddavalli VV, Girdhani B, Savlania A, Behera A, Rastogi A, Kaman L, Abuji K. Effectiveness of incisional negative pressure wound therapy after major lower extremity amputation: a randomised controlled trial. Ann R Coll Surg Engl 2024; 106:418-424. [PMID: 37435705 PMCID: PMC11060853 DOI: 10.1308/rcsann.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD). METHODS This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement. RESULTS It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group (p = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant (p > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, p = 0.002). CONCLUSIONS iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.
Collapse
Affiliation(s)
- VV Vaddavalli
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Girdhani
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Savlania
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Behera
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Rastogi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - L Kaman
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Abuji
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Gross CE, Rivas G, George K, Reid K, Hartsock L. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Case Report: Prevention of Surgical Site Infection After Major Extremity Trauma. J Am Acad Orthop Surg 2024; 32:e214-e218. [PMID: 38175999 DOI: 10.5435/jaaos-d-23-01073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 01/06/2024] Open
Abstract
Major extremity fractures are serious limb injuries often including notable soft-tissue injury with possible injuries to the head, chest, or abdomen. High-energy traumatic fractures carry a high risk of surgical site infections even with use of systemic antibiotics and techniques in risk reduction. The American Academy of Orthopaedic Surgeons released a clinical practice guideline in 2023 based on current literature on the prevention of surgical site infections after major extremity trauma. The case presented in this article is an example to demonstrate the clinical application of these guidelines.
Collapse
Affiliation(s)
- Christopher E Gross
- From the Department of Orthopaedics and Physical Medicine, University of South Carolina, Charleston, SC
| | | | | | | | | |
Collapse
|
9
|
Murray-Ramcharan M, Feltes Escurra M, Engdahl R, Gattorno FL. Negative-Pressure Wound Therapy for the Management of Complex Surgical Wounds in a Minority Population. Cureus 2024; 16:e56726. [PMID: 38646389 PMCID: PMC11032736 DOI: 10.7759/cureus.56726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Negative-pressure wound therapy (NPWT) has been used for decades as an established treatment modality for complex wounds, now commonplace in hospitals and various clinical and outpatient settings. Several studies have noted improved healing outcomes with this device, but the current state of literature is in debate on both clinical and economic effectiveness. The use of NPWT can become expensive, largely because of the complexity of wounds and the need for outpatient management, from which a majority of the benefit is derived. This creates a disparity in access to this therapy. A lack of insurance and limited access to healthcare that is present in minority populations contribute to this inequality. Methods We reviewed the clinical courses of eight patients who were treated with NPWT at a single acute care facility in an underserved area caring for a minority population. Results We describe several different anatomic wounds along with details including the size of wounds, number of debridements, length of hospital stay, duration of treatment, and ensuing courses of the minority patients who received NPWT for the entire duration of their wound care course. Conclusions This case series demonstrates desirable wound healing outcomes with the use of NPWT in the minority population. The authors draw attention to the outpatient benefit of this device that may be lost in those with limited insurance in minority populations and seek to encourage further studies in this population in resource-limited settings to determine its true clinical effectiveness.
Collapse
Affiliation(s)
| | | | - Ryan Engdahl
- Plastic Surgery, Harlem Hospital Center, Harlem, USA
| | | |
Collapse
|
10
|
Habibi S, Mohammadi T, Asadi AA. Tailoring polyethylene oxide-modified cross-linked chitosan/PVA nanofibrous membranes: Burn dressing scaffold developed for mupirocin release. Int J Biol Macromol 2024; 258:128983. [PMID: 38159709 DOI: 10.1016/j.ijbiomac.2023.128983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
In emergency treatment research, the focus on chitosan-based products for wound healing has been consistent. This study specifically explores a dressing made by mixing chitosan (CS) and poly (vinyl alcohol) PVA. Using electrospinning technology, nanofiber membranes of CS and PVA are created with the assistance of non-toxic and hydrophilic polyethylene oxide (PEO). The outcome is a new nanofibrous membrane loaded with mupirocin, designed for healing burn wounds. The study delves into the influence of PVA, CS, and PEO concentrations on the structural and chemical characteristics of the mats. This comprehensive exploration involves techniques such as Scanning Electron Microscope (SEM), Atomic Force Microscopy (AFM) imaging, Fourier Transform Infrared Spectrometry (FTIR analysis), and Contact angle measurements. Additionally, the research evaluates the antibacterial performance and biomedical behavior of the developed scaffolds. PEO proves beneficial in the electrospinning process, contributing to smoother fibers. Meanwhile, the addition of CS and mupirocin leads to formation of the thinner nanofibers (251 ± 5 μm and 263 ± 4 μm, respectively) and scaffolds with higher swelling (up to ∼3.5 times at 90 min). Notably, the (MTT) assay confirms the non-cytotoxicity of the fabricated nanofibers, with proliferations exceeding ∼85% for all samples. The crosslinked samples released the drug more slowly than the non-crosslinked dressings, with 80% of the scaffolds releasing the drug within 24 h. The in-vivo investigations suggested that the drug-containing scaffolds performed reliably and showed promise as a medical dressing for treating burn wounds.
Collapse
Affiliation(s)
- Soha Habibi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran
| | - Toraj Mohammadi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran.
| | - Amir Atabak Asadi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Petroleum Refining Technology Development Division, Research Institute of Petroleum Industry (RIPI), Tehran, 14857-33111, Iran
| |
Collapse
|
11
|
James K, Glasswell A, Costa B. Single-use negative pressure wound therapy versus conventional dressings for the reduction of surgical site infections in closed surgical incisions: Systematic literature review and meta-analysis. Am J Surg 2024; 228:70-77. [PMID: 37903665 DOI: 10.1016/j.amjsurg.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND To evaluate whether a single-use negative pressure wound therapy (sNPWT) device can reduce the incidence of surgical site infection (SSI) in at-risk patients with closed surgical incisions across a range of surgical specialties, compared with standard care. METHODS PubMed, Embase, Cochrane Library and ClinicalTrials.gov were searched from the period January 2011 to April 2021. RESULTS Out of 15,283 articles identified, 19 were included. A statistically significant improvement (p < 0.05) in the composite SSI (odds ratio [OR]: 0.36; 95 % confidence interval [CI]: 0.27-0.49), superficial SSI (OR: 0.30; 95 % CI: 0.17-0.53), and deep SSI (OR: 0.67; 95 % CI: 0.46-0.96) outcomes was observed with the sNPWT device compared with standard care in a pooled analysis of all surgical specialties. CONCLUSION A -80 mmHg sNPWT device reduces the incidence of composite, superficial, and deep SSIs when compared with standard care across a heterogenous at-risk surgical population containing a variety of surgical specialties.
Collapse
Affiliation(s)
- Kelly James
- General Surgery, United Surgical Associates of Kansas City, Missouri, USA.
| | - Amy Glasswell
- Global Clinical and Medical Affairs, Smith and Nephew, Hull, UK.
| | - Ben Costa
- Global Clinical and Medical Affairs, Smith and Nephew, Hull, UK.
| |
Collapse
|
12
|
Johnson TR, Oquendo YA, Seltzer R, Van Rysselberghe NL, Bishop JA, Gardner MJ. Incisional negative pressure wound therapy may not protect against post-operative surgical site complications in bicondylar tibial plateau fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1173-1181. [PMID: 37989870 DOI: 10.1007/s00590-023-03782-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To determine if incisional negative pressure wound therapy is protective against post-operative surgical site complications following definitive fixation of bicondylar tibial plateau fractures. METHODS A retrospective analysis of patients diagnosed with an acute bicondylar tibial plateau fracture (AO/OTA 41-C) undergoing ORIF from 2010 to 2020 was performed. Patients received either a standard sterile dressing (SD) or incisional negative pressure wound therapy (iNPWT). Primary outcomes included surgical site infection, osteomyelitis, and wound dehiscence. Secondary outcomes included non-union and return to the operating room. Multivariate logistic regression analyses were performed. RESULTS 180 patients were included and 22% received iNPWT (n = 40) and 78% received standard dressings (n = 140). iNPWT was more common in active smokers (24.7% vs. 19.3%, p = 0.002) and the SD group was more likely to be lost to follow up (3.6% vs. 0%, p = 0.025). iNPWT was not protective against infection or surgical site complications, and in fact, was associated with higher odds of post-operative infection (OR: 8.96, p = 0.005) and surgical site complications (OR:4.874, p = 0.009) overall. Alcohol abuse (OR: 19, p = 0.005), tobacco use (OR: 4.67, p = 0.009), and time to definitive surgery (OR = 1.21, p = 0.033) were all independent risk factors for post-operative infection. CONCLUSION In this series of operatively treated bicondylar tibial plateau fractures, iNPWT did not protect against post-operative surgical site complications compared to conventional dressings. Tobacco use, alcohol abuse, and time to definitive surgery, were independent risk factors for post-operative infection. Further studies are needed to determine if iNPWT offers a protective benefit in exclusively high-risk patients with relevant medical and social history.
Collapse
Affiliation(s)
- Taylor R Johnson
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA.
| | - Yousi A Oquendo
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
| | - Ryan Seltzer
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
| | | | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
| |
Collapse
|
13
|
Lai R, Yan S, Wang S, Yang S, Yan Z, Lan P, Wang Y, Li Q, Wang J, Wang W, Ma Y, Liang Z, Zhang J, Zhou N, Han X, Zhang X, Zhang M, Zhao X, Zhang G, Zhu H, Yu X, Lyu C. The Chinese guideline for management of snakebites. World J Emerg Med 2024; 15:333-355. [PMID: 39290598 PMCID: PMC11402871 DOI: 10.5847/wjem.j.1920-8642.2024.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/08/2024] [Indexed: 09/19/2024] Open
Abstract
In 2009, the World Health Organization included snakebite on the list of neglected tropical diseases, acknowledging it as a common occupational hazard for farmers, plantation workers, and others, causing tens of thousands of deaths and chronic physical disabilities every year. This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims. These recommendations are based on clinical experience and clinical research evidence. This guideline focuses on the following topics: snake venom, clinical manifestations, auxiliary examination, diagnosis, treatments, and prevention.
Collapse
Affiliation(s)
- Rongde Lai
- Emergency Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou 571199, China
| | - Shijun Wang
- Surgery Department of Traditional Chinese Medicine, the Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China
| | - Shuqing Yang
- Emergency Department, Chongqing University Central Hospital/Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Zhangren Yan
- Department of Surgery of Traditional Chinese Medicine, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang 330006, China
| | - Pin Lan
- Department of Emergency Medicine, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Central Hospital, Lishui Hospital of Zhejiang University, Lishui 323000, China
| | - Yonggao Wang
- General Surgery Department, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Qi Li
- Emergency Department, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Jinlong Wang
- Emergency Department, Chongqing University Fuling Hospital, Chongqing University, Chongqing 408000, China
| | - Wei Wang
- Emergency Department, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yuefeng Ma
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zijing Liang
- Emergency Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianfeng Zhang
- Emergency Department , Wuming Hospital of Guangxi Medical University, Nanning 530021, China
| | - Ning Zhou
- Emergency Department, Central People's Hospital of Zhanjiang, Zhanjiang 524037, China
| | - Xiaotong Han
- Emergency Department, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Xinchao Zhang
- Emergency Department, National Geriatrics Center of Beijing Hospital, Beijing 100020, China
| | - Mao Zhang
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiaodong Zhao
- Emergency Department, the Fourth Medical Center of the PLA General Hospital, Beijing 100048, China
| | - Guoqiang Zhang
- Emergency Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, BeiJing 100730, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, BeiJing 100730, China
| | - Chuanzhu Lyu
- Emergency Department, Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital, Chengdu 610072, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou 571199, China
| |
Collapse
|
14
|
An Y, Jiang J, Peng T, Zhao J, Xu H, Zhang X, Sun M, Zhao X. A New Predictive Nomogram for the Risk of Delayed Incision Healing After Open Posterior Lumbar Surgery: A Retrospective Study. Clin Spine Surg 2023; 36:E402-E409. [PMID: 37363826 DOI: 10.1097/bsd.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
STUDY DESIGN This was a primary research study. OBJECTIVE A risk nomogram was established and externally validated by exploring the related risk factors for delayed incision healing in patients undergoing open posterior lumbar surgery. SUMMARY OF BACKGROUND DATA The use of a nomogram model to predict prognosis in patients with delayed incision healing is an evolving field given the complex presentation of patients with this condition. PATIENTS AND METHODS This study reviewed 954 patients with data collected from January 2017 to December 2021 who were randomized into a training set and a validation set (7:3). We built a prediction model based on a training set of 616 patients. The "least absolute shrinkage and selection operator" regression model was applied to screen out the optimal prediction features, and binary logistic regression was used to develop a prediction model. The discrimination, calibration, and clinical applicability of the prediction model were assessed by using the area under the curve, C -index, calibration curve, and decision curve analysis. RESULTS Postoperative delayed incision healing occurred in 214 (24.4%) patients. The least absolute shrinkage and selection operator regression model showed that smoking, white blood cell count, infection, diabetes, and obesity were involved in delayed incision healing ( P ≠ 0). A binary logistic regression model confirmed that smoking [odds ratio (OR) = 3.854, 95% CI: 1.578~9.674, P = 0.003], infection (OR = 119.524, 95% CI: 59.430~263.921, P < 0.001), diabetes (OR = 3.935, 95% CI: 1.628~9.703, P = 0.003), and obesity (OR = 9.906, 95% CI: 4.435~23.266, P < 0.001) were predictors of delayed incision healing, and a nomogram model was established. The area under the curve was 0.917 (95% CI: 0.876-0.959). The calibration curve showed good consistency. Decision curve analysis showed that when the risk threshold of delayed incision healing was >5%, the use of this nomogram was more clinically valuable. CONCLUSIONS Smoking, infection, diabetes, and obesity are risk factors for delayed incision healing. The nomogram model could be used to predict the risk of delayed incision healing and could provide a reference for early clinical intervention.
Collapse
Affiliation(s)
- Yan An
- Department of Anesthesia, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Jun Jiang
- Department of Anesthesia, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
| | - Tianliang Peng
- Weifang Medical University, School of Anesthesiology, Weifang, Shandong Province, China
| | - Junhui Zhao
- Department of Anesthesiology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong Province, China
| | - Huiying Xu
- Weifang Medical University, School of Anesthesiology, Weifang, Shandong Province, China
| | - Xinyuan Zhang
- Weifang Medical University, School of Anesthesiology, Weifang, Shandong Province, China
| | - Meiyan Sun
- Department of Anesthesia, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
- Weifang Medical University, School of Anesthesiology, Weifang, Shandong Province, China
| | - Xiaoyong Zhao
- Department of Anesthesia, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China
- Weifang Medical University, School of Anesthesiology, Weifang, Shandong Province, China
| |
Collapse
|
15
|
Sallade E, Grimes D, Jeng L, MacEwan MR. Antimicrobial Effectiveness Testing of Resorbable Electrospun Fiber Matrix per United States Pharmacopeia (USP) <51>. Cureus 2023; 15:e50055. [PMID: 38186476 PMCID: PMC10768939 DOI: 10.7759/cureus.50055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Contamination of surgical, traumatic, and chronic wounds with microorganisms presents a challenge to successful wound healing. In the present in vitro study, a synthetic electrospun fiber matrix (SEFM) cleared for use in the management of chronic, surgical, and traumatic wounds underwent USP (United States Pharmacopeia) <51> Antimicrobial Effectiveness Testing to determine its in vitro effectiveness against various microorganisms commonly found in non-healing wounds. The SEFM was tested in both sheet (s-SEFM) and micronized form (m-SEFM) against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Aspergillus brasiliensis, Candida albicans, Proteus mirabilis, and Enterococcus faecalis. Testing was performed per the USP <51> standard on days 7, 14, and 28. Both the s-SEFM and m-SEFM met the USP <51> acceptance criteria for all microorganisms. The results obtained for s-SEFM demonstrated >1-log10 reduction against E. coli, S. aureus, P. aeruginosa, P. mirabilis, E. faecalis, and C. albicans at day 7; >3-log10 reduction with no detection of these microbes at days 14 and 28, and no increase from initial inoculum at days 7, 14, and 28 against A. brasiliensis. The results obtained for m-SEFM demonstrated >3-log10 reduction with no detectable microorganisms at day 7. The results observed in this study indicate that the SEFM is effective in vitro at inhibiting bacterial and fungal growth and colonization per USP <51> testing.
Collapse
Affiliation(s)
- Emily Sallade
- Clinical Research, Acera Surgical, Inc., St. Louis, USA
| | | | - Lily Jeng
- Research and Development, Acera Surgical, Inc., St. Louis, USA
| | | |
Collapse
|
16
|
Png ME, Costa ML, Petrou S, Achten J, Knight R, Bruce J, Keene DJ. Pain with neuropathic characteristics after surgically treated lower limb fractures: Cost analysis and pain medication use. Br J Pain 2023; 17:428-437. [PMID: 38107761 PMCID: PMC10722105 DOI: 10.1177/20494637231179809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Introduction Neuropathic pain is prevalent among people after lower limb fracture surgery and is associated with lower health-related quality of life and greater disability. This study estimates the financial cost and pain medication use associated with neuropathic pain in this group. Methods A secondary analysis using pain data collected over six postoperative months from participants randomised in the Wound Healing in Surgery for Trauma (WHiST) trial. Pain states were classified as pain-free, chronic non-neuropathic pain (NNP) or chronic neuropathic pain (NP). Cost associated with each pain state from a UK National Health Service (NHS) and personal social services (PSS) perspective were estimated by multivariate models based on multiple imputed data. Pain medication usage was analysed by pain state. Results A total of 934 participants who provided either 3- or 6-months pain data were included. Compared to participants with NP, those with NNP (adjusted mean difference -£730, p = 0.38, 95% CI -2368 to 908) or were pain-free (adjusted mean difference -£716, p = 0.53, 95% CI -2929 to 1497) had lower costs from the NHS and PSS perspective in the first three postoperative months. Over the first three postoperative months, almost a third of participants with NP were prescribed opioids and 8% were prescribed NP medications. Similar trends were observed by 6 months postoperatively. Conclusion This study found healthcare costs were higher amongst those with chronic NP compared to those who were pain-free or had chronic NNP. Opioids, rather than neuropathic pain medications, were commonly prescribed for NP over the first six postoperative months, contrary to clinical guidelines.
Collapse
Affiliation(s)
- May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew L Costa
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - David J Keene
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
17
|
Jeanmougin T, Cole E, Duceau B, Raux M, James A. Heterogeneity in defining multiple trauma: a systematic review of randomized controlled trials. Crit Care 2023; 27:363. [PMID: 37736733 PMCID: PMC10515068 DOI: 10.1186/s13054-023-04637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION While numerous randomized controlled trials (RCTs) have been conducted in the field of trauma, a substantial portion of them are yielding negative results. One potential contributing factor to this trend could be the lack of agreement regarding the chosen definitions across different trials. The primary objective was to identify the terminology and definitions utilized for the characterization of multiple trauma patients within randomized controlled trials (RCTs). METHODS A systematic review of the literature was performed in MEDLINE, EMBASE and clinicaltrials.gov between January 1, 2002, and July 31, 2022. RCTs or RTCs protocols were eligible if they included multiple trauma patients. The terms employed to characterize patient populations were identified, and the corresponding definitions for these terms were extracted. The subsequent impact on the population recruited was then documented to expose clinical heterogeneity. RESULTS Fifty RCTs were included, and 12 different terms identified. Among these terms, the most frequently used were "multiple trauma" (n = 21, 42%), "severe trauma" (n = 8, 16%), "major trauma" (n = 4, 8%), and trauma with hemorrhagic shock" (n = 4, 8%). Only 62% of RCTs (n = 31) provided a definition for the terms used, resulting a total of 21 different definitions. These definitions primarily relied on the injury severity score (ISS) (n = 15, 30%), displaying an important underlying heterogeneity. The choice of the terms had an impact on the study population, affecting both the ISS and in-hospital mortality. Eleven protocols were included, featuring five different terms, with "severe trauma" being the most frequent, occurring six times (55%). CONCLUSION This systematic review uncovers an important heterogeneity both in the terms and in the definitions employed to recruit trauma patients within RCTs. These findings underscore the imperative of promoting the use of a unique and consistent definition.
Collapse
Affiliation(s)
- Thomas Jeanmougin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Elaine Cole
- Centre of Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Baptiste Duceau
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013, Paris, France
| | - Arthur James
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France.
- Centre of Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
| |
Collapse
|
18
|
Wu H, Chen J, Zhao P, Liu M, Xie F, Ma X. Development and Prospective Applications of 3D Membranes as a Sensor for Monitoring and Inducing Tissue Regeneration. MEMBRANES 2023; 13:802. [PMID: 37755224 PMCID: PMC10535523 DOI: 10.3390/membranes13090802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
For decades, tissue regeneration has been a challenging issue in scientific modeling and human practices. Although many conventional therapies are already used to treat burns, muscle injuries, bone defects, and hair follicle injuries, there remains an urgent need for better healing effects in skin, bone, and other unique tissues. Recent advances in three-dimensional (3D) printing and real-time monitoring technologies have enabled the creation of tissue-like membranes and the provision of an appropriate microenvironment. Using tissue engineering methods incorporating 3D printing technologies and biomaterials for the extracellular matrix (ECM) containing scaffolds can be used to construct a precisely distributed artificial membrane. Moreover, advances in smart sensors have facilitated the development of tissue regeneration. Various smart sensors may monitor the recovery of the wound process in different aspects, and some may spontaneously give feedback to the wound sites by releasing biological factors. The combination of the detection of smart sensors and individualized membrane design in the healing process shows enormous potential for wound dressings. Here, we provide an overview of the advantages of 3D printing and conventional therapies in tissue engineering. We also shed light on different types of 3D printing technology, biomaterials, and sensors to describe effective methods for use in skin and other tissue regeneration, highlighting their strengths and limitations. Finally, we highlight the value of 3D bioengineered membranes in various fields, including the modeling of disease, organ-on-a-chip, and drug development.
Collapse
Affiliation(s)
| | | | - Pengxiang Zhao
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China (F.X.); (X.M.)
| | | | | | | |
Collapse
|
19
|
Li M, Xia W, Khoong YM, Huang L, Huang X, Liang H, Zhao Y, Mao J, Yu H, Zan T. Smart and versatile biomaterials for cutaneous wound healing. Biomater Res 2023; 27:87. [PMID: 37717028 PMCID: PMC10504797 DOI: 10.1186/s40824-023-00426-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023] Open
Abstract
The global increase of cutaneous wounds imposes huge health and financial burdens on patients and society. Despite improved wound healing outcomes, conventional wound dressings are far from ideal, owing to the complex healing process. Smart wound dressings, which are sensitive to or interact with changes in wound condition or environment, have been proposed as appealing therapeutic platforms to effectively facilitate wound healing. In this review, the wound healing processes and features of existing biomaterials are firstly introduced, followed by summarizing the mechanisms of smart responsive materials. Afterwards, recent advances and designs in smart and versatile materials of extensive applications for cutaneous wound healing were submarined. Finally, clinical progresses, challenges and future perspectives of the smart wound dressing are discussed. Overall, by mapping the composition and intrinsic structure of smart responsive materials to their individual needs of cutaneous wounds, with particular attention to the responsive mechanisms, this review is promising to advance further progress in designing smart responsive materials for wounds and drive clinical translation.
Collapse
Affiliation(s)
- Minxiong Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Wenzheng Xia
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi Min Khoong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lujia Huang
- Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Xin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Hsin Liang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yun Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jiayi Mao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Haijun Yu
- Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
| | - Tao Zan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| |
Collapse
|
20
|
Groenen H, Jalalzadeh H, Buis DR, Dreissen YE, Goosen JH, Griekspoor M, Harmsen WJ, IJpma FF, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, de Jonge SW, Orsini RG, Eskes AM, Wolfhagen N, Boermeester MA. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine 2023; 62:102105. [PMID: 37538540 PMCID: PMC10393772 DOI: 10.1016/j.eclinm.2023.102105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Background The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA). Methods PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995. Findings We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. Interpretation In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence. Funding Dutch Association for Quality Funds Medical Specialists.
Collapse
Affiliation(s)
- Hannah Groenen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Hasti Jalalzadeh
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Dennis R. Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Yasmine E.M. Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jon H.M. Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Wouter J. Harmsen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Frank F.A. IJpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Division of Trauma Surgery, Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Maarten J. van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Roald R. Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, Netherlands
- Dutch Association of Anesthesiology (NVA), Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wil C. van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, Maastricht, Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Ricardo G. Orsini
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| |
Collapse
|
21
|
Yuan S, Zhang T, Zhang D, He Q, Du M, Zeng F. Impact of negative pressure wound treatment on incidence of surgical site infection in varied orthopedic surgeries: A systematic review and meta-analysis. Int Wound J 2023; 20:2334-2345. [PMID: 36524330 PMCID: PMC10333009 DOI: 10.1111/iwj.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 07/20/2023] Open
Abstract
Negative pressure wound therapy (NPWT) is a popular treatment to heal infected wounds. This meta-analysis aimed to determine if NPWT was more effective than conventional wound dressings for surgical site infections (SSI) in varied orthopaedic surgeries. Literature was retrieved from seven electronic databases (Medline, Web of Science, PubMed, Embase, Google Scholar, Cochrane Library, and CNKI). Randomised control trials (RCT) and retrospective cohort studies (RS) involving arthroplasty, fracture, and spinal surgery were extracted. SSI was our primary outcome, while total complications and length of hospital stay were secondary outcomes. We carried out the risk of bias assessment and meta-analysis using the Cochrane Risk of Bias 2.0 tool and Stata 17.0. Among the 798 studies retrieved, 18 of them met our inclusion criteria. We identified 13 RCTs and 5 RSs. The results of meta-analysis showed that the incidence of SSI in the NPWT group was significantly lower relative to the control group (OR = 0.60, 95% CI 0.47 to 0.77, P < 0.001). Subgroup analyses revealed that the incidences of SSI involving arthroplasty, fracture, and spinal surgery in the NPWT group accounted for 46%, 69%, and 37% relative to the control group, respectively. The incidence of SSI in RS (OR = 0.27, 95% CI 0.13 to 0.56) was significantly lower than that in RCT (OR = 0.69, 95% CI 0.54 to 0.90) (P = 0.02). Moreover, patients in the NPWT group had a lower total complication rate (OR = 0.51, 95% CI 0.34 to 0.76) and shorter hospital stays (SMD = -0.42, 95% CI -0.83 to -0.02), although high heterogeneity existed. NPWT may be an efficient alternative to help prevent the incidence of SSI and total complications as well as achieved shorten hospital stay in varied orthopaedic surgeries. The rational use of NPWT should be based on the presence of patients' clinical conditions and relevant risk factors.
Collapse
Affiliation(s)
- Song Yuan
- Department of OrthopaedicsDazhou Central HospitalDazhouChina
| | - Tingjiu Zhang
- Department of OrthopaedicsDazhou Central HospitalDazhouChina
| | - Dong Zhang
- Department of OrthopaedicsDazhou Central HospitalDazhouChina
| | - Qin He
- Department of OrthopaedicsDazhou Central HospitalDazhouChina
| | - Meiting Du
- Department of OrthopaedicsDazhou Central HospitalDazhouChina
| | - Fanwei Zeng
- Department of SpineSichuan Provincial Orthopedics HospitalChengduChina
| |
Collapse
|
22
|
Kendal JK, Slawaska-Eng D, Gazendam A, Schneider P, Wessel LE, Ghert M, Bernthal NM. Risk Factors for All-Cause Early Reoperation Following Tumor Resection and Endoprosthetic Reconstruction: A Secondary Analysis from the PARITY Trial. J Bone Joint Surg Am 2023; 105:4-9. [PMID: 37466573 DOI: 10.2106/jbjs.22.00815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Oncologic resection and endoprosthetic reconstruction of lower-extremity musculoskeletal tumors are complex procedures fraught with multiple modes of failure. A robust assessment of factors contributing to early reoperation in this population has not been performed in a large prospective cohort. The aim of the present study was to assess risk factors for early reoperation in patients who underwent tumor excision and endoprosthetic reconstruction, with use of data from the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. METHODS Baseline characteristics were assessed, including age, sex, tumor type, tumor location, presence of a soft-tissue mass, diabetes, smoking status, chemotherapy use, and neutropenia. Operative factors were recorded, including operative time, topical antibiotics, silver-coated prosthetics, endoprosthetic fixation, extra-articular resection, length of bone resected, margins, tranexamic acid, postoperative antibiotics, negative-pressure wound therapy, and length of stay. Univariate analysis was utilized to explore the differences between patients who did and did not undergo reoperation within 1 year postoperatively, and a multivariate Cox proportional hazards regression model was utilized to explore the predictors of reoperation within 1 year. RESULTS A total of 155 (25.7%) of 604 patients underwent ≥1 reoperation. In univariate analysis, tumor type (p < 0.001), presence of a soft-tissue mass (p = 0.045), operative time (p < 0.001), use of negative-pressure wound therapy (p = 0.010), and hospital length of stay (p < 0.001) were all significantly associated with reoperation. On multivariate assessment, tumor type (benign aggressive bone tumor versus primary bone malignancy; hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.63; p = 0.01), operative time (HR per hour, 1.15; 95% CI, 1.10 to 1.23; p < 0.001), and use of negative-pressure wound therapy (HR, 1.93; 95% CI, 1.30 to 2.90; p = 0.002) remained significant predictors of reoperation within 1 year. CONCLUSIONS Independent variables associated with reoperation within 1 year in patients who underwent tumor resection and endoprosthetic reconstruction included tumor type (benign aggressive bone tumor versus primary bone malignancy), operative time, and use of negative-pressure wound therapy. These results will help to inform patients and surgeons regarding the risk of reoperation by diagnosis and reinforce operative time as a factor influencing reoperation. These results also support further investigation into the use of negative-pressure wound therapy at the time of surgery in this patient population. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Joseph K Kendal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Schneider
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Wessel
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| |
Collapse
|
23
|
Sang S, Wang S, Wu J, Zhang X. Sprayable Berberine-Silk Fibroin Microspheres with Extracellular Matrix Anchoring Function Accelerate Infected Wound Healing through Antibacterial and Anti-inflammatory Effects. ACS Biomater Sci Eng 2023. [PMID: 37142304 DOI: 10.1021/acsbiomaterials.3c00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The conventional method of applying local medications for treating wound infections is often ineffective because of the dilution of drugs by the excess wound exudate. In addition, there have been insufficient studies investigating the adhesion between drug-loaded nanomaterials and cells or tissue. To address this intractable problem, berberine-silk fibroin microspheres (Ber@MPs) with an extracellular matrix-anchoring function were developed in this study. The microspheres were prepared from silk fibroin using the polyethylene glycol emulsion precipitation method. Subsequently, berberine was loaded onto the microspheres. Our results revealed that Ber@MPs firmly anchored to cells, continuously releasing berberine in the microenvironment. Moreover, both Ber@MPs and Ber@MPs-cell complexes exerted a strong and long-lasting antibacterial effect against Staphylococcus aureus and Staphylococcus epidermidis in the microenvironment, despite the large amount of wound exudate. In addition, Ber@MPs effectively resisted the inflammatory response induced by lipopolysaccharides and accelerated the migration of fibroblasts and neovascularization of endothelial cells cultured in inflammation-induced media. Finally, the in vivo experiments confirmed that the Ber@MP spray accelerated the healing of infected wounds via its antibacterial and anti-inflammatory effects. Therefore, this study provides a novel strategy for treating infected wounds in the presence of excess exudate.
Collapse
Affiliation(s)
- Shang Sang
- Department of Orthopaedics, Shanghai Sixth People' Hospital, Shanghai 200233, China
| | - Shengjie Wang
- Department of Orthopaedics, Shanghai Sixth People' Hospital, Shanghai 200233, China
| | - Jianbing Wu
- College of Textile, Garment and Design, Changshu Institute of Technology, Suzhou 215500, China
| | - Xianlong Zhang
- Department of Orthopaedics, Shanghai Sixth People' Hospital, Shanghai 200233, China
| |
Collapse
|
24
|
Habibi S, Mohammadi T, HMTShirazi R, Atyabi F, Kiani M, Asadi AA. A bilayer mupirocin/bupivacaine-loaded wound dressing based on chitosan/poly (vinyl alcohol) nanofibrous mat: Preparation, characterization, and controlled drug release. Int J Biol Macromol 2023; 240:124399. [PMID: 37059279 DOI: 10.1016/j.ijbiomac.2023.124399] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
An infected skin wound caused by external injury remains a serious challenge. Electrospun drug-loaded nanofibers with antibacterial properties based on biopolymers have been widely explored for wound healing. In this study, the double-layer CS/PVA/mupirocin (CPM) + CS/PVA/bupivacaine (CPB) mats were prepared by electrospinning method (20 % polymer weight) and then crosslinked with glutaraldehyde (GA) to optimize the water-resistant and biodegradation properties for wound dressing applications. The morphology of mats was characterized as defect-free and interconnected nanofibers by Scanning Electron Microscope (SEM) and Atomic Force Microscopy (AFM). Fourier Transform Infrared Spectrometry (FTIR) analysis also assessed the chemical structural properties. The porosity, surface wettability, and swelling degree of the dual-drug loaded mats were improved by about 20 %, 12°, and 200 % of the CS/PVA sample to provide a moist environment for efficient wound breathing and repairing. This highly porous mat facilitated the wound exudates absorption and air permeability excellently, reducing the chance of bacterial infections by inhibiting the growth of S. aureus bacterial colonies with a zone of 71.3 mm diameter. In vitro drug release results showed a high-burst release of 80 % and a continuous release profile for bupivacaine and mupirocin, respectively. MTT assay and in vivo tests indicated >90 % of cell viability and improvement in cell proliferation. It triply accelerated wound closure compared to the control group, reaching nearly full closure after 21 days as a potential clinical wound treatment.
Collapse
Affiliation(s)
- Soha Habibi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran
| | - Toraj Mohammadi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran.
| | - Romina HMTShirazi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran
| | - Fatemeh Atyabi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Kiani
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Atabak Asadi
- Center of Excellence for Membrane Science and Technology, Department of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Research and Technology Centre of Membrane Separation Processes, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran; Petroleum Refining Technology Development Division, Research Institute of Petroleum Industry (RIPI), Tehran 14857-33111, Iran
| |
Collapse
|
25
|
Yakkanti RR, Mohile NV, Cohen-Levy WB, Haziza S, Lavelle MJ, Bellam KG, Quinnan SM. Perioperative management of acetabular and pelvic fractures: evidence-based recommendations. Arch Orthop Trauma Surg 2023; 143:1311-1321. [PMID: 34854977 DOI: 10.1007/s00402-021-04278-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. METHODS A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. RESULTS A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. CONCLUSION The literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.
Collapse
Affiliation(s)
- Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Neil V Mohile
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | | | - Sagie Haziza
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA.
| | - Matthew J Lavelle
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Krishna G Bellam
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | | |
Collapse
|
26
|
Lin FY, Kempny T, Knoz M, Cheng HT. Meta-analysis of randomized controlled studies of closed incisional negative pressure wound therapy versus standard wound dressing in the prevention of surgical site infections for patients undergoing surgeries for lower extremity fractures. J Plast Reconstr Aesthet Surg 2023; 79:68-73. [PMID: 36870102 DOI: 10.1016/j.bjps.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Fu-Yu Lin
- Department of Neurology, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Tomas Kempny
- Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic; MEDICent Clinic, Na Ctvrti 22, 70300 Ostrava, Hrabuvka, Czech Republic; Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Martin Knoz
- Department of Burns and Plastic Surgery, Institution shared with University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic; Clinic of Plastic and Aesthetic surgery, St. Anne's University Hospital, Faculty of Medicine, Pekarska 664/53, 602 00 Brno, Czech Republic
| | - Hsu-Tang Cheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan; Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan; Big Data Center, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
27
|
Zhang L, Yang Y, Xiong YH, Zhao YQ, Xiu Z, Ren HM, Zhang K, Duan S, Chen Y, Xu FJ. Infection-responsive long-term antibacterial bone plates for open fracture therapy. Bioact Mater 2023; 25:1-12. [PMID: 36713134 PMCID: PMC9860072 DOI: 10.1016/j.bioactmat.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
The infections in open fracture induce high morbidity worldwide. Thus, developing efficient anti-infective orthopedic devices is of great significance. In this work, we designed a kind of infection-responsive long-term antibacterial bone plates. Through a facile and flexible volatilization method, a multi-aldehyde polysaccharide derivative, oxidized sodium alginate, was crosslinked with multi-amino compounds, gentamycin and gelatin, to fabricate a uniform coating on Ti bone plates via Schiff base reaction, which was followed by a secondary crosslinking process by glutaraldehyde. The double-crosslinked coating was stable under normal condition, and could responsively release gentamycin by the triggering of the acidic microenvironment caused by bacterial metabolism, owning to the pH-responsiveness of imine structure. The thickness of the coating was ranging from 22.0 μm to 63.6 μm. The coated bone plates (Ti-GOGs) showed infection-triggered antibacterial properties (>99%) and high biocompatibility. After being soaked for five months, it still possessed efficient antibacterial ability, showing its sustainable antibacterial performance. The in vivo anti-infection ability was demonstrated by an animal model of infection after fracture fixation (IAFF). At the early stage of IAFF, Ti-GOGs could inhibit the bacterial infection (>99%). Subsequently, Ti-GOGs could promote recovery of fracture of IAFF. This work provides a convenient and universal strategy for fabrication of various antibacterial orthopedic devices, which is promising to prevent and treat IAFF.
Collapse
Affiliation(s)
- Lujiao Zhang
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Yurun Yang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yan-Hua Xiong
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Yu-Qing Zhao
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Zongpeng Xiu
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Hui-Min Ren
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Kai Zhang
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Shun Duan
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Corresponding author.
| | - Ying Chen
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
- Corresponding author.
| | - Fu-Jian Xu
- State Key Laboratory of Chemical Resource Engineering, Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Corresponding author.
| |
Collapse
|
28
|
He SY, Yu B, Jiang N. Current Concepts of Fracture-Related Infection. Int J Clin Pract 2023; 2023:4839701. [PMID: 37153693 PMCID: PMC10154639 DOI: 10.1155/2023/4839701] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/24/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023] Open
Abstract
Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.
Collapse
Affiliation(s)
- Si-ying He
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| |
Collapse
|
29
|
Huang XH, Zheng LQ, Dai YX, Hu SN, Ning WC, Li SM, Fan YG, Lin ZL, Huang SH. Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy. Front Bioeng Biotechnol 2023; 11:1056707. [PMID: 36873351 PMCID: PMC9978480 DOI: 10.3389/fbioe.2023.1056707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
Background: The treatment of bone defects remains a clinical challenge. The effect of negative pressure wound therapy (NPWT) on osteogenesis in bone defects has been recognized; however, bone marrow fluid dynamics under negative pressure (NP) remain unknown. In this study, we aimed to examine the marrow fluid mechanics within trabeculae by computational fluid dynamics (CFD), and to verify osteogenic gene expression, osteogenic differentiation to investigate the osteogenic depth under NP. Methods: The human femoral head is scanned using micro-CT to segment the volume of interest (VOI) trabeculae. The VOI trabeculae CFD model simulating the bone marrow cavity is developed by combining the Hypermesh and ANSYS software. The effect of trabecular anisotropy is investigated, and bone regeneration effects are simulated under NP scales of -80, -120, -160, and -200 mmHg. The working distance (WD) is proposed to describe the suction depth of the NP. Finally, gene sequence analysis, cytological experiments including bone mesenchymal stem cells (BMSCs) proliferation and osteogenic differentiation are conducted after the BMSCs are cultured under the same NP scale. Results: The pressure, shear stress on trabeculae, and marrow fluid velocity decrease exponentially with an increase in WD. The hydromechanics of fluid at any WD inside the marrow cavity can be theoretically quantified. The NP scale significantly affects the fluid properties, especially those fluid close to the NP source; however, the effect of the NP scale become marginal as WD deepens. Anisotropy of trabecular structure coupled with the anisotropic hydrodynamic behavior of bone marrow; An NP of -120 mmHg demonstrates the majority of bone formation-related genes, as well as the most effective proliferation and osteogenic differentiation of BMSCs compared to the other NP scales. Conclusion: An NP of -120 mmHg may have the optimal activated ability to promote osteogenesis, but the effective WD may be limited to a certain depth. These findings help improve the understanding of fluid mechanisms behind NPWT in treating bone defects.
Collapse
Affiliation(s)
- Xiu-Hong Huang
- School of Stomatology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Li-Qin Zheng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue-Xing Dai
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shao-Nan Hu
- School of Stomatology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Wan-Chen Ning
- School of Stomatology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Si-Min Li
- School of Stomatology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Yue-Guang Fan
- Department of Joint Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zi-Ling Lin
- Department of Orthopedic Trauma, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shao-Hong Huang
- School of Stomatology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
30
|
McMillan H, Vo UG, Moss JL, Barry IP, Bosanquet DC, Richards T. Controlling the controls: what is negative pressure wound therapy compared to in clinical trials? Colorectal Dis 2022; 25:794-805. [PMID: 36579358 DOI: 10.1111/codi.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
AIM Surgical site infections (SSIs) are common following colorectal operations. Clinical trials suggest that closed incision negative pressure wound therapy (ciNPWT) may reduce SSIs compared to a 'standard of care' group. However, wound management in the standard of care group may vary. The aim of this review was to assess the control arms in trials of ciNPWT for potential confounding variables that could influence the rates of SSI and therefore the trial outcomes. METHODS A mapping review of the PubMed database was undertaken in the English language for randomized controlled trials that assessed, in closed surgical wounds, the use of ciNPWT compared to standard of care with SSI as an outcome. Data regarding wound care to assess potential confounding factors that may influence SSI rates were compared between the ciNPWT and standard of care groups. Included were the method of wound closure, control dressing type, frequency of dressing changes and postoperative wound care (washing). RESULTS Twenty-seven trials were included in the mapping review. There was heterogeneity in ciNPWT duration. There was little control in the comparator standard of care groups with a variety of wound closure techniques and different control dressings used. Overall standard of care dressings were changed more frequently than the ciNPWT dressing and there was no control over wound care or washing. No standard for 'standard of care' was apparent. CONCLUSION In randomized trials assessing the intervention of ciNPWT compared to standard of care there was considerable heterogeneity in the comparator groups and no standard of care was apparent. Heterogeneity in dressing protocols for standard of care groups could introduce potential confounders impacting SSI rates. There is a need to standardize care in ciNPWT trials to assess potential meaningful differences in SSI prevention.
Collapse
Affiliation(s)
- Hayley McMillan
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Uyen G Vo
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.,Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jana-Lee Moss
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.,Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ian P Barry
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - David C Bosanquet
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK
| | - Toby Richards
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| |
Collapse
|
31
|
Burhan A, Khusein NBA, Sebayang SM. Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis. BELITUNG NURSING JOURNAL 2022; 8:470-480. [PMID: 37554236 PMCID: PMC10405659 DOI: 10.33546/bnj.2220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 11/13/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Negative Pressure Wound Therapy (NPWT) is considered an effective treatment in facilitating the healing of chronic wounds. However, its effect remains inconsistent, which allows for further investigation. OBJECTIVE This study aimed to assess the effectiveness of the NPWT program in improving the management of chronic wound healing. DESIGN Systematic review and meta-analysis was used. DATA SOURCES The search strategy ranged from 2016 to 2021 in PubMed, CINAHL, ProQuest, and ScienceDirect. REVIEW METHODS Risk of bias was done based on the Risk of Bias 2.0 guideline using RevMan 5.4.1, and meta-analysis was done using Jeffreys's Amazing Statistics Program (JASP) software version 0.16.3. Critical appraisal of the included articles was done according to Joanna Briggs Institute's (JBI) appraisal checklist. RESULTS A total of 15 articles were included, with 3,599 patients with chronic wounds. There was no publication bias in this study seen from the results of the Egger's test value of 0.447 (p >0.05), symmetrical funnel plot, and fail-safe N of 137. However, heterogeneity among studies was present, with I2 value of 66.7%, Q = 41.663 (p <0.001); thus, Random Effect (RE) model was used. The RE model showed a significant positive effect of the NPWT on chronic wound healing, with z = 3.014, p = 0.003, 95% CI 0.085 to 0.400. The observed effects include decreased rate of surgical site infection, controlled inflammation, edema, and exudate, as well as increased tissue with varying forest plot size, as demonstrated by the small effect size (ES = 0.24, 95% CI -0.26 to 0.79, p <0.05). CONCLUSION The analysis results show that the standard low pressure of 80-125 mmHg could improve microcirculation and accelerate the healing process of chronic wounds. Therefore, applying the NPWT program could be an alternative to nursing interventions. However, it should be carried out by competent wound nurses who carry out procedure steps, implement general patient care, and give tips on overcoming device problems and evaluation. PROSPERO REGISTRATION NUMBER CRD42022348457.
Collapse
Affiliation(s)
- Asmat Burhan
- School of Nursing, Health Faculty, Universitas Harapan Bangsa, Indonesia
| | | | | |
Collapse
|
32
|
Prada C, Bengoa F, Bhandari M. The management of fracture related infections: What practices can be supported by high-level evidence? J Orthop Surg (Hong Kong) 2022; 30:10225536221119580. [PMID: 36545907 DOI: 10.1177/10225536221119580] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Fracture related infections (FRIs) are a disabling condition causing significant concern within the orthopaedic community. FRIs have a huge societal and economic burden leading to prolonged recovery times and the potential for becoming chronic conditions or being life-threatening. Despite its importance in our field, the surgical community has just recently agreed on a definition which, added to the lack of surgical trials assessing preventive and treatment interventions have limited our understanding and precipitated wide variations in surgeons' practice. This article aims to review the current practices that can be supported with high-quality evidence. Currently, we have a limited body of high-quality evidence on FRI prevention and treatment. A handful of measures have proven effective, such as the use of prophylactic antibiotics, the use of saline and low pressure as the preferred irrigation solution and the safety of delaying initial surgical débridement more than 6 hours without impacting infection rates for open fracture wounds débridement. Future multicentre trials, properly powered, will shed light on current areas of controversy regarding the benefit of different preoperative and perioperative factors for the prevention and treatment of FRIs. Higher quality evidence is needed to guide surgeons to offer an evidence-based approach to prevent FRI occurrence and to treat patients suffering from them.
Collapse
Affiliation(s)
- Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
| | - Francisco Bengoa
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
33
|
Closed-Incision Negative Pressure Therapy Prevents Major Abdominal Donor-Site Complications in Autologous Breast Reconstruction. Ann Plast Surg 2022; 89:529-531. [PMID: 36279578 DOI: 10.1097/sap.0000000000003285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Outcomes in autologous breast reconstruction continue to improve with refinements in microsurgical techniques; however, donor-site morbidity remains a concern. Closed-incision negative pressure therapy (ciNPT) has been shown to reduce wound complications. Limited evaluation in abdominal donor sites has shown promising results. We hypothesize that ciNPT will reduce abdominal donor-site complications. METHODS A retrospective chart review was performed of patients who underwent abdominally based autologous free tissue transfer for breast reconstruction by 4 microsurgeons at an academic institution from 2015 to 2020. The application of a commercial ciNPT for donor-site management was at the discretion of the operating surgeon. Demographics, operative details, and management of donor-site complications were analyzed. RESULTS Four hundred thirty-three patients underwent autologous breast reconstruction; 212 abdominal donor sites were managed with ciNPT and 219 with standard dressings. Demographics were statistically similar between groups. Abdominal wound healing complications were noted in 30.2% of ciNPT patients (64/212) and 22.8% of control patients (50/219, P = 0.08); however, overall wound complications were attributed to obesity on multivariable analysis. Closed-incision negative pressure therapy significantly decreased complications requiring reoperation (ciNPT 6.2%, 4/64; control 26.5%, 13/51; P = 0.004). There were no significant differences in surgical site infection rates (P = 0.73) and rates of abdominal scar revisions (ciNPT 11.8%, 25/212; control 9.1%, 20/219; P = 0.37). CONCLUSIONS Use of ciNPT in abdominal donor-site management significantly decreases the incidence of delayed wound healing requiring surgical intervention, with one major wound healing complication prevented for every 6 donor sites managed with ciNPT.
Collapse
|
34
|
Xie W, Dai L, Qi Y, Jiang X. Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta-analysis. Int Wound J 2022; 19:1319-1328. [PMID: 34854236 PMCID: PMC9493229 DOI: 10.1111/iwj.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of negative pressure wound therapy compared with conventional wound dressings on closed incisions in orthopaedic trauma surgery. A systematic literature search up to October 2021 was done and 12 studies included 3555 subjects with closed incisions in orthopaedic trauma surgery at the start of the study: 1833 of them were provided with negative pressure wound therapy and 1722 were conventional wound dressings. They were reporting relationships about the effect of negative pressure wound therapy compared with conventional wound dressings on closed incisions in orthopaedic trauma surgery. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of negative pressure wound therapy compared with conventional wound dressings on closed incisions in orthopaedic trauma surgery using the dichotomous and continuous methods with a random or fixed-effect model. Negative pressure wound therapy had significantly lower deep surgical site infection (OR, 0.65; 95% CI, 0.48-0.88, P = .005), superficial surgical site infection (OR, 0.23; 95% CI, 0.11-0.49, P = .31), and wound dehiscence (OR, 0.41; 95% CI, 0.21-0.80, P = .009) compared with conventional wound dressings in subjects with closed incisions in orthopaedic trauma surgery. However, negative pressure wound therapy had no significant effect on the length of hospital stay (MD, 0.29; 95% CI, -2.00- 2.58, P = .80) compared with conventional wound dressings in subjects with closed incisions in orthopaedic trauma surgery. Negative pressure wound therapy had significantly lower deep surgical site infection, superficial surgical site infection, and wound dehiscence; however, negative pressure wound therapy had no beneficial effect on the length of hospital stay compared with conventional wound dressings in subjects with closed incisions in orthopaedic trauma surgery. Further studies are required to validate these findings.
Collapse
Affiliation(s)
- Weiwei Xie
- Department of Operation RoomThe First People's Hospital of WenlingWenlingChina
| | - Lingyan Dai
- Ambulatory Surgery CenterWuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, (Wuhan Maternal and Children's Healthcare Center)WuhanChina
| | - Yameng Qi
- Department of DermatologySecond Hospital Affiliated to Tianjin Medical UniversityTianjinChina
| | - Xixi Jiang
- Department of Operation RoomThe First People's Hospital of WenlingWenlingChina
| |
Collapse
|
35
|
Qian H, Lei T, Hu Y. Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials. Foot Ankle Surg 2022; 28:1120-1128. [PMID: 35450789 DOI: 10.1016/j.fas.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/11/2022] [Accepted: 03/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The superiority of negative pressure wound therapy (NPWT) to standard gauze dressings for managing open fractures of the lower limbs remains controversial. This study aimed to comprehensively compare their clinical efficacy through a meta-analysis using randomized controlled trials (RCTs) alone. We hypothesized that NPWT would be more superior against infections. METHODS A literature search was implemented in various databases, including PubMed, Web of Science, Medline, Clinicaltrial.gov, and Cochrane Library, etc, to screen eligible RCTs. All included RCTs were evaluated for risk of bias using the Cochrane Collaboration tool. In accordance with the heterogeneity assessment, a fixed-effect or random-effect model was chosen for the data analysis. RESULTS Ten RCTs, including 2780 patients, were eligible for the meta-analysis. We found that patients in the NPWT group showed a lower overall infection rate (MD=0.70, 95% CI: 0.54-0.90, P = 0.005), acute wound infection rate (MD = 0.35, 95% CI: 0.16-0.77, P = 0.009), and shorter hospital stay (MD = 24.00, 95% CI: 6.82-84.46, P < 0.00001) compared with the control group. The NPWT group showed a higher proportion of patients with wound coverage than the control group. No significant difference was found between the two groups in terms of function score and other complications, including deep infection rate, amputation, and bone nonunion. CONCLUSIONS From the pooled results, we suggest that NPWT may be superior than traditional gauze dressings for managing open fractures of the lower limbs.
Collapse
Affiliation(s)
- Hu Qian
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, China
| | - Ting Lei
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, China.
| | - Yihe Hu
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, China; Department of Orthopedic Surgery, The First Affliated Hospital, College of Medicine, Zhejiang University, China; Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, China.
| |
Collapse
|
36
|
Lathan R, Sidapra M, Yiasemidou M, Long J, Totty J, Smith G, Chetter I. Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:108. [PMID: 35922663 PMCID: PMC9349203 DOI: 10.1038/s41746-022-00655-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022] Open
Abstract
The Sars-CoV-2 pandemic catalysed integration of telemedicine worldwide. This systematic review assesses it's accuracy for diagnosis of Surgical Site Infection (SSI). Databases were searched for telemedicine and wound infection studies. All types of studies were included, only paired designs were taken to meta-analysis. QUADAS-2 assessed methodological quality. 1400 titles and abstracts were screened, 61 full text reports were assessed for eligibility and 17 studies were included in meta-analysis, mean age was 47.1 ± 13.3 years. Summary sensitivity and specificity was 87.8% (95% CI, 68.4-96.1) and 96.8% (95% CI 93.5-98.4) respectively. The overall SSI rate was 5.6%. Photograph methods had lower sensitivity and specificity at 63.9% (95% CI 30.4-87.8) and 92.6% (95% CI, 89.9-94.5). Telemedicine is highly specific for SSI diagnosis is highly specific, giving rise to great potential for utilisation excluding SSI. Further work is needed to investigate feasibility telemedicine in the elderly population group.
Collapse
Affiliation(s)
- Ross Lathan
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK.
| | - Misha Sidapra
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK
| | - Marina Yiasemidou
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK
- Bradford Teaching Hospitals, Bradford, UK
| | - Judith Long
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK
| | - Joshua Totty
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - George Smith
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK
| | - Ian Chetter
- Centre for Clinical Sciences, Hull York Medical School, Hull, UK
| |
Collapse
|
37
|
Halvachizadeh S, Klingebiel FKL, Pfeifer R, Gosteli M, Schuerle S, Cinelli P, Zelle BA, Pape HC. The local soft tissue status and the prediction of local complications following fractures of the ankle region. Injury 2022; 53:1789-1795. [PMID: 35382943 DOI: 10.1016/j.injury.2022.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. METHODS This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region. INCLUSION CRITERIA Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF. RESULTS Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an OR of 1.01 (95%CI 0.97 to 1.05, p = 0.595). Additional injuries did not predict complications (OR 1.23, 95%CI 0.44 to 3.45, p = 0.516). The most predictive RF were open fracture (OR 3.47, 95%CI 1.64 to 7.34, p < 0.001), followed by local tissue damage (OR 3.05, 95%CI 1.23 to 40.92, p = 0.04), and diabetes (OR 2.3, 95%CI 1.1 to 4.79, p = 0.26). CONCLUSION Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes.
Collapse
Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland.
| | - Felix Karl Ludwig Klingebiel
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Martina Gosteli
- Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Simone Schuerle
- Institute for translational medicine, Department of Health Science & Technology, ETH Zurich, Rämistrasse 101, Zürich 8092, Switzerland
| | - Paolo Cinelli
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas TX 78229, United States
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| |
Collapse
|
38
|
Ding X, Tang Q, Xu Z, Xu Y, Zhang H, Zheng D, Wang S, Tan Q, Maitz J, Maitz PK, Yin S, Wang Y, Chen J. Challenges and innovations in treating chronic and acute wound infections: from basic science to clinical practice. BURNS & TRAUMA 2022; 10:tkac014. [PMID: 35611318 PMCID: PMC9123597 DOI: 10.1093/burnst/tkac014] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/06/2022] [Indexed: 12/30/2022]
Abstract
Acute and chronic wound infection has become a major worldwide healthcare burden leading to significantly high morbidity and mortality. The underlying mechanism of infections has been widely investigated by scientist, while standard wound management is routinely been used in general practice. However, strategies for the diagnosis and treatment of wound infections remain a great challenge due to the occurrence of biofilm colonization, delayed healing and drug resistance. In the present review, we summarize the common microorganisms found in acute and chronic wound infections and discuss the challenges from the aspects of clinical diagnosis, non-surgical methods and surgical methods. Moreover, we highlight emerging innovations in the development of antimicrobial peptides, phages, controlled drug delivery, wound dressing materials and herbal medicine, and find that sensitive diagnostics, combined treatment and skin microbiome regulation could be future directions in the treatment of wound infection.
Collapse
Affiliation(s)
- Xiaotong Ding
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Qinghan Tang
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Zeyu Xu
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Ye Xu
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Hao Zhang
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Dongfeng Zheng
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Shuqin Wang
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Qian Tan
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Joanneke Maitz
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Sydney, Australia, 2137
| | - Peter K Maitz
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Sydney, Australia, 2137
| | - Shaoping Yin
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Yiwei Wang
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Jun Chen
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| |
Collapse
|
39
|
Zhang D, He L. A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings. Int Wound J 2022; 20:46-54. [PMID: 35535660 PMCID: PMC9797922 DOI: 10.1111/iwj.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 01/07/2023] Open
Abstract
We performed a meta-analysis to evaluate the influences of closed incisions in orthopaedic trauma surgery (OTS) by negative pressure wound treatment (NPWT) compared with conventional dressings. A systematic literature search up to March 2022 was done and 14 studies included 3935 subjects with OTS at the start of the study; 2023 of them used NPWT and 1912 were conventional dressings. They were reporting relationships between the influences of closed incisions in OTS by NPWT compared with conventional dressings. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influences of closed incisions in OTS by NPWT compared with conventional dressings using the dichotomous methods with a random or fixed-effect model. NPWT had significantly lower deep surgical site infections (SSIs) (OR, 0.65; 95% CI, 0.48-0.87, P = .004), superficial SSIs (OR, 0.34; 95% CI, 0.19-0.61, P < .001), and wound dehiscence (OR, 0.41; 95% CI, 0.21-0.80, P = .009) compared with conventional dressings in subjects with closed incisions in OTS. NPWT showed a beneficial effect on deep SSIs, superficial SSIs, and wound dehiscence compared with conventional dressings in subjects with closed incisions in OTS. Further studies are required to validate these findings.
Collapse
Affiliation(s)
- Dahua Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Xi'an Medical UniversityXi'anShaanxiChina
| | - Liang He
- Department of OrthopedicsThe First Affiliated Hospital of Xi'an Medical UniversityXi'anShaanxiChina
| |
Collapse
|
40
|
Png ME, Petrou S, Knight R, Masters J, Achten J, Costa ML. Economic outcomes associated with deep surgical site infection from lower limb fractures following major trauma. Bone Jt Open 2022; 3:398-403. [PMID: 35535505 PMCID: PMC9134829 DOI: 10.1302/2633-1462.35.bjo-2022-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma. METHODS Data from the Wound Healing in Surgery for Trauma (WHiST) trial, which collected outcomes from 1,547 adult participants using self-completed questionnaires over a six-month period following major trauma, was used as the basis of this empirical investigation. Associations between deep SSI and NHS and personal social services (PSS) costs (£, 2017 to 2018 prices), and between deep SSI and quality-adjusted life years (QALYs), were estimated using descriptive and multivariable analyses. Sensitivity analyses assessed the impact of uncertainty surrounding components of the economic analyses. RESULTS Compared to participants without deep SSI, those with deep SSI had higher mean adjusted total NHS and PSS costs (adjusted mean difference £1,577 (95% confidence interval (CI) -951 to 4,105); p = 0.222), and lower mean adjusted QALYs (adjusted mean difference -0.015 (95% CI -0.032 to 0.002); p = 0.092) over six months post-injury, but this difference was not statistically significant. The results were robust to the sensitivity analyses performed. CONCLUSION This study found worse economic outcomes during the first six months post-injury in participants who experience deep SSI following orthopaedic surgery for major trauma to the lower limb. However, the increase in cost associated with deep SSI was less than previously reported in the orthopaedic trauma literature. Cite this article: Bone Jt Open 2022;3(5):398-403.
Collapse
Affiliation(s)
- May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - James Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford, UK
| | - Matthew L. Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford, UK
| |
Collapse
|
41
|
Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, Stankiewicz M, Dumville JC. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2022; 4:CD009261. [PMID: 35471497 PMCID: PMC9040710 DOI: 10.1002/14651858.cd009261.pub7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS In January 2021, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane risk of bias tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Our primary outcomes were SSI, mortality, and wound dehiscence. MAIN RESULTS In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Eleven studies (6384 participants) which reported mortality were pooled. There is low-certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm; risk ratio (RR) 0.78 (95% CI 0.47 to 1.30; I2 = 0%). Fifty-four studies reported SSI; 44 studies (11,403 participants) were pooled. There is moderate-certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery; RR 0.73 (95% CI 0.63 to 0.85; I2 = 29%). Thirty studies reported wound dehiscence; 23 studies (8724 participants) were pooled. There is moderate-certainty evidence that there is probably little or no difference in dehiscence between people treated with NPWT (6.62%) and those treated with standard dressing (6.97%), although there is imprecision around the estimate that includes risk of benefit and harms; RR 0.97 (95% CI 0.82 to 1.16; I2 = 4%). Evidence was downgraded for imprecision, risk of bias, or a combination of these. Secondary outcomes There is low-certainty evidence for the outcomes of reoperation and seroma; in each case, confidence intervals included both benefit and harm. There may be a reduced risk of reoperation favouring the standard dressing arm, but this was imprecise: RR 1.13 (95% CI 0.91 to 1.41; I2 = 2%; 18 trials; 6272 participants). There may be a reduced risk of seroma for people treated with NPWT but this is imprecise: the RR was 0.82 (95% CI 0.65 to 1.05; I2 = 0%; 15 trials; 5436 participants). For skin blisters, there is low-certainty evidence that people treated with NPWT may be more likely to develop skin blisters compared with those treated with standard dressing (RR 3.55; 95% CI 1.43 to 8.77; I2 = 74%; 11 trials; 5015 participants). The effect of NPWT on haematoma is uncertain (RR 0.79; 95 % CI 0.48 to 1.30; I2 = 0%; 17 trials; 5909 participants; very low-certainty evidence). There is low-certainty evidence of little to no difference in reported pain between groups. Pain was measured in different ways and most studies could not be pooled; this GRADE assessment is based on all fourteen trials reporting pain; the pooled RR for the proportion of participants who experienced pain was 1.52 (95% CI 0.20, 11.31; I2 = 34%; two studies; 632 participants). Cost-effectiveness Six economic studies, based wholly or partially on trials in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in five indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty; coronary artery bypass grafts; and vascular surgery with inguinal incisions. They calculated quality-adjusted life-years or an equivalent, and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the evidence certainty varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS People with primary closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSIs than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate-certainty evidence). There may be a reduced risk of death after surgery for people treated with NPWT compared with standard dressings but there is uncertainty around this as confidence intervals include risk of benefit and harm (low-certainty evidence). People treated with NPWT may experience more instances of skin blistering compared with standard dressing treatment (low-certainty evidence). There are no clear differences in other secondary outcomes where most evidence is low or very low-certainty. Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.
Collapse
Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Elizabeth Ma Murphy
- Ward 64, St. Mary's Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
| | - Laura Chiverton
- NIHR Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Monica Stankiewicz
- Chermside Community Health Centre, Community and Oral Health Directorate, Brisbane, Australia
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
42
|
Kumaar A, Shanthappa AH, Ethiraj P. A Comparative Study on Efficacy of Negative Pressure Wound Therapy Versus Standard Wound Therapy for Patients With Compound Fractures in a Tertiary Care Hospital. Cureus 2022; 14:e23727. [PMID: 35509767 PMCID: PMC9060726 DOI: 10.7759/cureus.23727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Orthopedic surgeons face a difficult task in treating serious open fractures, which usually result in complications, morbidity, and even amputation. Compound fracture wounds were traditionally treated with a standard saline dressing. To avoid infection and problems during therapy, several studies found that open fractures require early skeletal stability as well as soft tissue repair. In favoring the above fact vacuum-assisted closure (VAC) is now undergoing a paradigm shift. With this background, this study aimed to compare the effects of VAC dressing versus standard wound dressing on compound fracture wounds. Methodology: This study has been conducted as a single-blind randomized control trial among 128 patients who got admitted to the Department of Orthopedics, R L Jalappa Hospital attached to Sri Devaraj Urs Medical College, Karnataka, India from August 2019 to November 2021. The study participants were randomly allotted into two groups negative pressure wound therapy (NPWT) and standard wound therapy (SWT) consisting of 64 participants in each group. VAC dressing was used on group NPWT, while normal saline wound dressing was used on group SWT. Both groups were followed up for a month after their discharge from the hospital. Frequency in dressing changes wound healing time, infection presence, and hospitalization days were all recorded and compared over one month. The data collection was done using questionnaires and the statistical analysis was done with SPSS version 21 (Chicago, IL: IBM Corp.). Results: There was a statically significant difference favoring group NPWT compared to group SWT with a hospital stay, number of dressings required, wound size reduction, wound healing time, and deep infection rate (p<0.05). Conclusions: The use of NPWT speeds up the healing of compound fracture wounds significantly. It is affordable and can be used as a substitute in resource-constrained areas to reduce infection and manage open fracture wounds quickly.
Collapse
|
43
|
Png ME, Petrou S, Bourget-Murray J, Knight R, Trompeter AJ, Costa ML. Association between the Orthopaedic Trauma Society classification of open fractures and economic costs. Bone Joint J 2022; 104-B:408-412. [PMID: 35227087 DOI: 10.1302/0301-620x.104b3.bjj-2021-1237.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate the relationship between the Orthopaedic Trauma Society (OTS) classification of open fractures and economic costs. METHODS Resource use was measured during the six months that followed open fractures of the lower limb in 748 adults recruited as part of two large clinical trials within the UK Major Trauma Research Network. Resource inputs were valued using unit costs drawn from primary and secondary sources. Economic costs (GBP sterling, 2017 to 2018 prices), estimated from both a NHS and Personal Social Services (PSS) perspective, were related to the degree of complexity of the open fracture based on the OTS classification. RESULTS Adjusted mean total NHS and PSS costs were £13,785 following treatment of complex fractures and £3,550 following treatment of simple fractures, where the open fracture wound is closed at the end of the first wound debridement, generating a mean difference of £10,235 (95% confidence interval £8,074 to £12,396). CONCLUSION Following previous work correlating clinical outcomes with the OTS classification of open fractures, this study suggests that the new OTS classification also correlates with economic costs estimated from alternative study perspectives. Cite this article: Bone Joint J 2022;104-B(3):408-412.
Collapse
Affiliation(s)
- May E Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alex J Trompeter
- Orthopaedic Trauma and Limb Reconstruction Unit, St George's University Hospital, London, UK
| | - Matt L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford, UK
| |
Collapse
|
44
|
Duwelius PJ. CORR Insights®: Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2022; 480:560-561. [PMID: 34554967 PMCID: PMC8846347 DOI: 10.1097/corr.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 01/31/2023]
|
45
|
Popa M, Cursaru A, Popa V, Munteanu A, Șerban B, Crețu B, Iordache S, Smarandache C, Orban C, Cîrstoiu C. Understanding orthopedic infections through a different perspective: Microcalorimetry growth curves. Exp Ther Med 2022; 23:263. [DOI: 10.3892/etm.2022.11189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mihnea Popa
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Cursaru
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Vlad Popa
- ‘Ilie Murgulescu’ Institute of Physical Chemistry, 060021 Bucharest, Romania
| | - Alexandru Munteanu
- Department of Medical Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Șerban
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Crețu
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sergiu Iordache
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Smarandache
- Department of General Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Carmen Orban
- Department of Anaesthesia and Intensive Care, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin Cîrstoiu
- Department of Orthopedics and Traumatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
46
|
Wound Closure Following Intervention for Closed Orthopedic Trauma. Injury 2022; 53:313-322. [PMID: 34865820 DOI: 10.1016/j.injury.2021.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
The method of skin closure and post-operative wound management has always been important in orthopedic surgery and plays an even larger role now that surgical site infection (SSI) is a national healthcare metric for both surgeons and hospitals. Wound related issues remain some of the most feared complications following orthopedic trauma procedures and are associated with significant morbidity. In order to minimize the risk of surgical site complications, surgeons must be familiar with the physiology of wound healing as well as the patient and surgical factors affecting healing potential. The goal of all skin closure techniques is to promote rapid healing with acceptable cosmesis, all while minimizing risk of infection and dehiscence. Knowledge of the types of closure material, techniques of wound closure, surgical dressings, negative pressure wound therapy, and other local modalities is important to optimize wound healing. There is no consensus in the literature as to which closure method is superior but the available data can be used to make informed choices. Although often left to less experienced members of the surgical team, the process of wound closure and dressing the wound should not be an afterthought, and instead must be part of the surgical plan. Wounds that are in direct communication with bony fractures are particularly at risk due to local tissue trauma, resultant swelling, hematoma formation, and injured vasculature.
Collapse
|
47
|
Bruce J, Knight R, Parsons N, Betteridge R, Verdon A, Brown J, Campolier M, Achten J, Costa ML. Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma. Bone Joint J 2021; 103-B:1802-1808. [PMID: 34847717 DOI: 10.1302/0301-620x.103b12.bjj-2021-0447.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. METHODS Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. RESULTS Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). CONCLUSION Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J 2021;103-B(12):1802-1808.
Collapse
Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ruth Knight
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ria Betteridge
- Tissue Viability Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amy Verdon
- Tissue Viability Service, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Julie Brown
- Tissue Viability Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Marta Campolier
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matt L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
48
|
Modified Incisional Negative Pressure Wound Therapy Increases Seroma Evacuation: An Ex Vivo Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5846724. [PMID: 34722767 PMCID: PMC8553466 DOI: 10.1155/2021/5846724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/18/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Background Incisional negative wound pressure therapy (iNPWT) is a relatively novel dressing technique with the aim of reducing postoperative wound infections and dehiscence in high-risk wounds after all kinds of surgical procedures. There is a lack of theoretical knowledge about the way those dressing would ameliorate wound healing. One aspect is the reduction of superficial tension, but significant remaining seroma might still cause deep wound infections. The aim of this study was the evaluation of technical modifications of the standard iNPWT dressing to increase seroma evacuation. Methods iNPWT dressings were applied on the porcine abdominal wall, and an incremental pressure ramp from 50 to 200 mmHg was performed. The resulting wound pressures were measured using (i) balloon manometry and (ii) esophageal manometry catheter. Seroma evacuation was analyzed with a seroma model. All measurements were performed with (i) standard iNPWT dressing, (ii) wound gauze diverted through the incision, and (iii) placement of suction drain tube into iNPWT. Results Due to the modifications of the iNPWT dressing, the vacuum applied by the iNPWT dressing could be transferred into the wound and was not only restricted to superficial layers. More importantly, placement of wound gauzes or suction drain tubes led to complete extraction of wound seroma. The placement of the suction drain tube showed the best combination of increased intrawound pressure as well as seroma evacuation. Conclusion Addition of a suction drain tube to the iNPWT dressing leads to an improved function of the iNPWT dressing in our ex vivo model.
Collapse
|
49
|
Farrow L, Gardner WT, Ablett AD, Kutuzov V, Johnstone A. A review of trauma and orthopaedic randomised clinical trials published in high-impact general medical journals. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1469-1479. [PMID: 34613468 PMCID: PMC9587938 DOI: 10.1007/s00590-021-03137-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022]
Abstract
Introduction The recent past has seen a significant increase in the number of trauma and orthopaedic randomised clinical trials published in “the big five” general medical journals. The quality of this research has, however, not yet been established. Methods We therefore set out to critically appraise the quality of available literature over a 10-year period (April 2010–April 2020) through a systematic search of these 5 high-impact general medical journals (JAMA, NEJM, BMJ, Lancet and Annals). A standardised data extraction proforma was utilised to gather information regarding: trial design, sample size calculation, results, study quality and pragmatism. Quality assessment was performed using the Cochrane Risk of Bias 2 tool and the modified Delphi list. Study pragmatism was assessed using the PRECIS-2 tool. Results A total of 25 studies were eligible for inclusion. Over half of the included trials did not meet their sample size calculation for the primary outcome, with a similar proportion of these studies at risk of type II error for their non-significant results. There was a high degree of pragmatism according to PRECIS-2. Non-significant studies had greater pragmatism that those with statistically significant results (p < 0.001). Only 56% studies provided adequate justification for the minimum clinically important difference (MCID) in the population assessed. Overall, very few studies were deemed high quality/low risk of bias. Conclusions These findings highlight that there are some important methodological concerns present within the current evidence base of RCTs published in high-impact medical journals. Potential strategies that may improve future trial design are highlighted. Level of evidence Level 1. Supplementary Information The online version contains supplementary material available at 10.1007/s00590-021-03137-3.
Collapse
Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
- Aberdeen Royal Infirmary, Aberdeen, UK.
| | | | | | | | | |
Collapse
|
50
|
What is the diagnostic value of the Centers for Disease Control and Prevention criteria for surgical site infection in fracture-related infection? Injury 2021; 52:2879-2885. [PMID: 34412852 DOI: 10.1016/j.injury.2021.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fracture-related infection (FRI) remains one of the most challenging complications in orthopaedic trauma surgery. An early diagnosis is of paramount importance to guide treatment. The primary aim of this study was to compare the Centers for Disease Control and Prevention (CDC) criteria for the diagnosis of organ/space surgical site infection (SSI) to the recently developed diagnostic criteria of the FRI consensus definition in operatively treated fracture patients. METHODS This international multicenter retrospective cohort study evaluated 257 patients with 261 infections after operative fracture treatment. All patients included in this study were considered to have an FRI and treated accordingly ('intention to treat'). The minimum follow-up was one year. Infections were scored according to the CDC criteria for organ/space SSI and the diagnostic criteria of the FRI consensus definition. RESULTS Overall, 130 (49.8%) FRIs were captured when applying the CDC criteria for organ/space SSI, whereas 258 (98.9%) FRIs were captured when applying the FRI consensus criteria. Patients could not be classified as having an infection according to the CDC criteria mainly due to a lack of symptoms within 90 days after the surgical procedure (n = 96; 36.8%) and due to the fact that the surgery was performed at an anatomical localization not listed in the National Healthcare Safety Network (NHSN) operative procedure code mapping (n = 37; 14.2%). CONCLUSION This study confirms the importance of standardization with respect to the diagnosis of FRI. The results endorse the recently developed FRI consensus definition. When applying these diagnostic criteria, 98.9% of the infections that occured after operative fracture treatment could be captured. The CDC criteria for organ/space SSI captured less than half of the patients with an FRI requiring treatment, and seemed to have less diagnostic value in this patient population.
Collapse
|