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Mahjoor M, Fakouri A, Farokhi S, Nazari H, Afkhami H, Heidari F. Regenerative potential of mesenchymal stromal cells in wound healing: unveiling the influence of normoxic and hypoxic environments. Front Cell Dev Biol 2023; 11:1245872. [PMID: 37900276 PMCID: PMC10603205 DOI: 10.3389/fcell.2023.1245872] [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: 06/23/2023] [Accepted: 08/11/2023] [Indexed: 10/31/2023] Open
Abstract
The innate and adaptive immune systems rely on the skin for various purposes, serving as the primary defense against harmful environmental elements. However, skin lesions may lead to undesirable consequences such as scarring, accelerated skin aging, functional impairment, and psychological effects over time. The rising popularity of mesenchymal stromal cells (MSCs) for skin wound treatment is due to their potential as a promising therapeutic option. MSCs offer advantages in terms of differentiation capacity, accessibility, low immunogenicity, and their central role in natural wound-healing processes. To accelerate the healing process, MSCs promote cell migration, angiogenesis, epithelialization, and granulation tissue development. Oxygen plays a critical role in the formation and expansion of mammalian cells. The term "normoxia" refers to the usual oxygen levels, defined at 20.21 percent oxygen (160 mm of mercury), while "hypoxia" denotes oxygen levels of 2.91 percent or less. Notably, the ambient O2 content (20%) in the lab significantly differs from the 2%-9% O2 concentration in their natural habitat. Oxygen regulation of hypoxia-inducible factor-1 (HIF-1) mediated expression of multiple genes plays a crucial role in sustaining stem cell destiny concerning proliferation and differentiation. This study aims to elucidate the impact of normoxia and hypoxia on MSC biology and draw comparisons between the two. The findings suggest that expanding MSC-based regenerative treatments in a hypoxic environment can enhance their growth kinetics, genetic stability, and expression of chemokine receptors, ultimately increasing their effectiveness.
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Affiliation(s)
- Mohamad Mahjoor
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
- Department of Immunology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arshia Fakouri
- Student Research Committee, USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Simin Farokhi
- Student Research Committee, USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hojjatollah Nazari
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Hamed Afkhami
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Medical Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Fatemeh Heidari
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
- Department of Anatomy, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
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Huang GS, Xu KC. Application of negative pressure wound therapy after skin grafting in the treatment of skin cancer: A case report. World J Clin Cases 2023; 11:6812-6816. [PMID: 37901026 PMCID: PMC10600851 DOI: 10.12998/wjcc.v11.i28.6812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Skin cancer is a common malignant tumor in dermatology. A large area must be excised to ensure a negative incisal margin on huge frontotemporal skin cancer, and it is difficult to treat the wound. In the past, treatment with skin grafting and pressure dressing was easy to cause complications such as wound infections, subcutaneous effusion, skin necrosis, and contracture. Negative pressure wound therapy (NPWT) has been applied to treat huge frontotemporal skin cancer. CASE SUMMARY Herein, we report the case of a 92-year-old woman with huge frontotemporal skin cancer. The patient presented to the surgery department complaining of ruptured bleeding and pain in a right frontal mass. The tumor was pathologically diagnosed as highly differentiated squamous cell carcinoma. The patient underwent skin cancer surgery and skin grafting, after which NPWT was used. She did not experience a relapse during the three-year follow-up period. CONCLUSION NPWT is of great clinical value in the postoperative treatment of skin cancer. It is not only inexpensive but also can effectively reduce the risk of surgical effusion, infection, and flap necrosis.
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Affiliation(s)
- Gao-Shi Huang
- Department of Surgery, Wuyi First People's Hospital, Wuyi 321200, Zhejiang Province, China
| | - Ke-Chen Xu
- Clinical Laboratory, Wuyi First People's Hospital, Wuyi 321200, Zhejiang Province, China
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Al-Ishaq Z, Rahman E, Salem F, Taj S, Mula-Hussain L, Mylvaganam S, Vidya R, Matey P, Sircar T. Is Using Closed Incision Negative Pressure Therapy in Reconstructive and Oncoplastic Breast Surgery Helpful in Reducing Skin Necrosis? Cureus 2023; 15:e38167. [PMID: 37122978 PMCID: PMC10146378 DOI: 10.7759/cureus.38167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Skin necrosis is a major concern of morbidity in patients undergoing reconstructive and oncoplastic breast surgery (ROBS) as it may lead to a poor aesthetic outcome, necessitate further surgery, and delay adjuvant chemotherapy and radiotherapy if required postoperatively. Some studies have reported that closed incision negative pressure therapy (ciNPT) immediately after surgery can reduce the incidence of wound complications. Our study aimed to investigate the effect of ciNPT on skin necrosis rate after ROBS. Methods Our study included 82 patients in a single center who underwent 121 ROBS procedures. We used conventional dressing in 42 patients (62 procedures, group A), while we used ciNPT in 40 patients (59 procedures, group B). When ciNPT dressing was introduced in our breast unit, 40 patients with 59 ROBS procedures who had ciNPT dressing were studied prospectively. The risk factors recorded were age, body mass index (BMI), history of previous radiotherapy, history of smoking, type of incision, type of operation, breast tissue specimen weight, use of neoadjuvant chemotherapy, and implant size. Skin necrosis was classified as "minor" if it was managed conservatively with regular dressings and "major" if surgical debridement in theater and/or exchange or implant removal was necessary. Results The incidence of overall skin necrosis in the conventional dressing group was 17.7% (11/62), while in the ciNPT group, it was higher at 25.4% (15/59), although this was not statistically significant (p = 0.51). ciNPT also did not show a statistically significant difference from the conventional dressing in the rate of minor necrosis (18.6% versus 11.2%, respectively; p = 0.44) and major necrosis (6.7% versus 6.4%, respectively; p = 1.00) Conclusion Our data has shown no superiority of ciNPT in reducing skin necrosis rate in a patient undergoing reconstructive and oncoplastic breast surgery, contrary to many other published reports. However, it may have reduced rates of other wound complications such as wound dehiscence, wound infection, and hypertrophic scar formation, which were not studied in our cohort. Further studies are needed to confirm its benefits, especially in high-risk patients.
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Affiliation(s)
- Zaid Al-Ishaq
- Breast Surgery, Sultan Qaboos Comprehensive Cancer Center, Muscat, OMN
| | - Ehsanur Rahman
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Fathi Salem
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Saima Taj
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Layth Mula-Hussain
- Radiation Oncology, Sultan Qaboos Comprehensive Cancer Center, Muscat, OMN
| | - Senthurun Mylvaganam
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Raghavan Vidya
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Pilar Matey
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Tapan Sircar
- Breast Surgery, The Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
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Bi AS, Fisher ND, Konda SR, Egol KA, Ganta A. Delayed Versus Primary Closure of Diaphyseal Forearm Fractures in Adults: Short-Term Soft Tissue Outcomes. Indian J Orthop 2022; 56:1594-1600. [PMID: 36052385 PMCID: PMC9385914 DOI: 10.1007/s43465-022-00688-3] [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: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the effect of delayed closures, whether delayed primary closure (DPC) or split-thickness skin grafting (STSG), of operatively treated forearm fractures on short-term soft tissue outcomes. METHODS In this retrospective cohort comparative study of two academic-level one trauma centers from 2010 to 2020, adult patients with diaphyseal forearm fractures who underwent open reduction and internal fixation (ORIF) were either closed primarily at index surgery, or underwent delayed closure, either with DPC or with a STSG. Primary outcome measures were soft-tissue outcomes as measured by wound healing (delayed healing, dehiscence, or skin breakdown) and fracture-related infection (FRI) at time of final follow-up. RESULTS Eighty-one patients with 81 diaphyseal forearm fractures underwent ORIF with a mean follow-up of 14.3 months. Forty-one fractures (50.6%) were open injuries. Thirteen patients (16.0%) were unable to be closed primarily and underwent an average of 2.46 ± 0.7 surgeries including final coverage, with an average of 4.31 ± 2.8 days to final coverage. Four patients (30.8%) underwent DPC and 9 (69.2%) underwent STSG. Five (6.6%) patients in the delayed closure group had pre-operative compartment syndrome and underwent formal two-incision fasciotomies. There were no significant differences between delayed versus primary closure in wound healing complication rates, FRI, or radiographic union. CONCLUSIONS Diaphyseal forearm fractures that undergo ORIF have equivalent short-term soft tissue outcomes when closed primarily at index surgery or when closed in a delayed fashion.
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Affiliation(s)
- Andrew S. Bi
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA
| | - Nina D. Fisher
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA
| | - Sanjit R. Konda
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA ,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Espy, Richmond Hill, NY 11418 USA
| | | | - Abhishek Ganta
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003 USA ,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Espy, Richmond Hill, NY 11418 USA
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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.
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Costa ML, Achten J, Knight R, Png ME, Bruce J, Dutton S, Madan J, Vadher K, Dritsaki M, Masters J, Spoors L, Campolier M, Parsons N, Fernandez M, Jones S, Grant R, Nanchahal J. Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT. Health Technol Assess 2020; 24:1-86. [PMID: 32821038 DOI: 10.3310/hta24380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. OBJECTIVES To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. DESIGN A pragmatic, multicentre, randomised controlled trial. SETTING Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. PARTICIPANTS A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. INTERVENTIONS Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. MAIN OUTCOME MEASURES Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. RESULTS A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. LIMITATIONS Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. CONCLUSIONS The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. FUTURE WORK Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. TRIAL REGISTRATION Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.
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Affiliation(s)
- Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ruth Knight
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julie Bruce
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susan Dutton
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jason Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karan Vadher
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- 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, University of Oxford, Oxford, UK
| | - Louise Spoors
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Marta Campolier
- Oxford Trauma, 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
| | - Miguel Fernandez
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Jagdeep Nanchahal
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Norman G, Goh EL, Dumville JC, Shi C, Liu Z, Chiverton L, Stankiewicz M, Reid A. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2020; 5:CD009261. [PMID: 32356396 PMCID: PMC7192856 DOI: 10.1002/14651858.cd009261.pub5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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 June 2019, 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 type of NPWT. 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. MAIN RESULTS In this third update, we added 15 new randomised controlled trials (RCTs) and three new economic studies, resulting in a total of 44 RCTs (7447 included participants) and five economic studies. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Four studies (2107 participants) reported mortality. There is low-certainty evidence (downgraded twice for imprecision) showing no clear difference in the risk of death after surgery for people treated with NPWT (2.3%) compared with standard dressings (2.7%) (risk ratio (RR) 0.86; 95% confidence interval (CI) 0.50 to 1.47; I2 = 0%). Thirty-nine studies reported SSI; 31 of these (6204 participants), were included in meta-analysis. There is moderate-certainty evidence (downgraded once for risk of bias) that NPWT probably results in fewer SSI (8.8% of participants) than treatment with standard dressings (13.0% of participants) after surgery; RR 0.66 (95% CI 0.55 to 0.80 ; I2 = 23%). Eighteen studies reported dehiscence; 14 of these (3809 participants) were included in meta-analysis. There is low-certainty evidence (downgraded once for risk of bias and once for imprecision) showing no clear difference in the risk of dehiscence after surgery for NPWT (5.3% of participants) compared with standard dressings (6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13; I2 = 0%). Secondary outcomes There is low-certainty evidence showing no clear difference between NPWT and standard treatment for the outcomes of reoperation and incidence of seroma. For reoperation, the RR was 1.04 (95% CI 0.78 to 1.41; I2 = 13%; 12 trials; 3523 participants); for seroma, the RR was 0.72 (95% CI 0.50 to 1.05; I2 = 0%; seven trials; 729 participants). The effect of NPWT on occurrence of haematoma or skin blisters is uncertain (very low-certainty evidence); for haematoma, the RR was 0.67 (95% CI 0.28 to 1.59; I2 = 0%; nine trials; 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65 to 10.68; I2 = 69%; seven trials; 796 participants). The overall effect of NPWT on pain is uncertain (very low-certainty evidence from seven trials (2218 participants) which reported disparate measures of pain); but moderate-certainty evidence suggests there is probably little difference between the groups in pain after three or six months following surgery for lower limb fracture (one trial, 1549 participants). There is also moderate-certainty evidence for women undergoing caesarean sections (one trial, 876 participants) and people having surgery for lower limb fractures (one trial, 1549 participants) that there is probably little difference in quality of life scores at 30 days or 3 or 6 months, respectively. Cost-effectiveness Five economic studies, based wholly or partially on trials included in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in four indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty and coronary artery bypass graft surgery. They calculated quality-adjusted life-years for treatment groups and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the grade of the evidence 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 experiencing primary wound closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSI than people treated with standard dressings (moderate-certainty evidence). There is no clear difference in number of deaths or wound dehiscence between people treated with NPWT and standard dressings (low-certainty evidence). There are also no clear differences in secondary outcomes where all evidence was low or very low-certainty. In caesarean section in obese women and surgery for lower limb fracture, there is probably little difference in quality of life scores (moderate-certainty evidence). Most evidence on pain is very low-certainty, but there is probably no difference in pain between NPWT and standard dressings after surgery for lower limb fracture (moderate-certainty evidence). 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.
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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
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - 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
| | - 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
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - 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
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
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Costa ML, Achten J, Knight R, Bruce J, Dutton SJ, Madan J, Dritsaki M, Parsons N, Fernandez M, Grant R, Nanchahal J. Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial. JAMA 2020; 323:519-526. [PMID: 32044942 PMCID: PMC7042841 DOI: 10.1001/jama.2020.0059] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting. OBJECTIVE To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018. INTERVENTIONS Incisional negative pressure wound therapy (n = 785), which involved a specialized dressing used to create negative pressure over the wound, vs standard wound dressing not involving negative pressure (n = 763). MAIN OUTCOMES AND MEASURES The primary outcome measure was deep surgical site infection at 30 days diagnosed according to the criteria from the US Centers for Disease Control and Prevention. A preplanned secondary analysis of the primary outcome was performed at 90 days. The secondary outcomes were patient-reported disability (Disability Rating Index), health-related quality of life (EuroQol 5-level EQ-5D), surgical scar assessment (Patient and Observer Scar Assessment Scale), and chronic pain (Douleur Neuropathique Questionnaire) at 3 and 6 months, as well as other local wound healing complications at 30 days. RESULTS Among 1548 participants who were randomized (mean [SD] age, 49.8 [20.3] years; 561 [36%] were aged ≤40 years; 583 [38%] women; and 881 [57%] had multiple injuries), 1519 (98%) had data available for the primary outcome. At 30 days, deep surgical site infection occurred in 5.84% (45 of 770 patients) of the incisional negative pressure wound therapy group and in 6.68% (50 of 749 patients) of the standard wound dressing group (odds ratio, 0.87 [95% CI, 0.57 to 1.33]; absolute risk difference, -0.77% [95% CI, -3.19% to 1.66%]; P = .52). There was no significant difference in the deep surgical site infection rate at 90 days (11.4% [72 of 629 patients] in the incisional negative pressure wound therapy group vs 13.2% [78 of 590 patients] in the standard wound dressing group; odds ratio, 0.84 [95% CI, 0.59 to 1.19]; absolute risk difference, -1.76% [95% CI, -5.41% to 1.90%]; P = .32). For the 5 prespecified secondary outcomes reported, there were no significant differences at any time point. CONCLUSIONS AND RELEVANCE Among patients who underwent surgery for major trauma-related lower limb fractures, use of incisional negative pressure wound therapy, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection. The findings do not support the use of incisional negative pressure wound therapy in this setting, although the event rate at 30 days was lower than expected. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN12702354.
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Affiliation(s)
- Matthew L. Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Ruth Knight
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Julie Bruce
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, England
| | - Susan J. Dutton
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Jason Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, England
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, England
| | - Miguel Fernandez
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | | | - Jagdeep Nanchahal
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
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9
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De Simone B, Sartelli M, Coccolini F, Ball CG, Brambillasca P, Chiarugi M, Campanile FC, Nita G, Corbella D, Leppaniemi A, Boschini E, Moore EE, Biffl W, Peitzmann A, Kluger Y, Sugrue M, Fraga G, Di Saverio S, Weber D, Sakakushev B, Chiara O, Abu-Zidan FM, ten Broek R, Kirkpatrick AW, Wani I, Coimbra R, Baiocchi GL, Kelly MD, Ansaloni L, Catena F. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 2020; 15:10. [PMID: 32041636 PMCID: PMC7158095 DOI: 10.1186/s13017-020-0288-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/01/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
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Affiliation(s)
- Belinda De Simone
- Department of General Surgery, Azienda USL-IRCSS di Reggio Emilia, Guastalla Hospital, Via Donatori di sangue 1, 42016 Guastalla, RE Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, 62100 Macerata, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56124 Pisa, Italy
| | - Chad G. Ball
- Department of Surgery and Oncology, Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care Surgery, University of Calgary Foothills Medical Center, Calgary, Alberta T2N 2T9 Canada
| | - Pietro Brambillasca
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit and Trauma Center, Cisanello Hospital, Pisa, Italy
| | | | - Gabriela Nita
- Unit of General Surgery, Castelnuovo ne’Monti Hospital, AUSL, Reggio Emilia, Italy
| | - Davide Corbella
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Elena Boschini
- Medical Library, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health and University of Colorado, Denver, USA
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Andrew Peitzmann
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Gustavo Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Boris Sakakushev
- University Hospital St George First, Clinic of General Surgery, Plovdiv, Bulgaria
| | - Osvaldo Chiara
- State University of Milan, Acute Care Surgery Niguarda Hospital, Milan, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Micheal D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, 47521 Cesena, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100 Parma, Italy
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10
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Gao X, Yin H, Sun J. Preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid of foot and ankle wounds improves outcome of reconstructive skin flap surgery. J Orthop Surg Res 2019; 14:374. [PMID: 31747959 PMCID: PMC6869274 DOI: 10.1186/s13018-019-1418-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/15/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives By observing the infection and soft tissue defect on the wound surface of the foot and ankle, this paper attempts to explore the effect of preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid (abPI-VSD) on the bacterial quantity and the local inflammatory response at the flap, and further to provide a basis for applying this technique before a reconstructive skin flap surgery of foot and ankle wounds. Methods Seventy-five patients were randomly divided into two groups, and all surgeries were done by one physician. The flap reconstructions were done to 31 cases with the abPI-VSD being used (group A); the flap reconstructions were done to the rest 44 cases after wound cleaning using antibiotic irrigation solution without the use of the abPI-VSD (group B). Quantitative bacteriology was made to group A before and after the use of abPI-VSD; quantitative bacteriology was made to group B before and after wound cleaning. Then, the reconstructive skin flap surgery was done. After the surgeries, the time of local inflammatory response at the flap in both groups were recorded. The measured bacterial quantity was evaluated in logarithm and by t test. Results The bacterial quantity was 3.2 ± 1.9 × 107 cfu/g in group A before the use of abPI-VSD and 2.3 ± 2.0 × 107 in group B (P > 0.05) before debridement. The bacterial quantity was 1.2 ± 2.0 × 104 cfu/g in group A after abPI-VSD and was 2.9 ± 4.0 × 106 in group B after wound cleaning (P < 0.05). The time of postoperative inflammatory response in the flap was 8 ± 2.5 days in group A and 13 ± 3.4 days in group B (P < 0.05). Conclusions abPI-VSD can distinctly reduce the bacterial quantity on the surface of the wound, provide a good condition of tissue bed for the flap reconstruction, and effectively control the local inflammatory response at the flap and hence improve the survival quality of the flap.
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Affiliation(s)
- Xu Gao
- Department of Orthopedics, Qingdao University, Qingdao City, 266071, People's Republic of China
| | - Hailei Yin
- Department of Orthopedics, No.971 Hospital of the People Liberation Army, 22 Min-Jiang Rd, Qingdao, 266071, People's Republic of China.
| | - Jixia Sun
- Department of foot and hand trauma surgery, Qingdao Central Hospital, Qingdao, City, 266071, People's Republic of China
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11
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Jeffery S, Leaper D, Armstrong D, Lantis J. Using negative pressure wound therapy to prevent surgical site infection. J Wound Care 2019; 27:S5-S13. [PMID: 29509094 DOI: 10.12968/jowc.2018.27.sup3.s5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is estimated that, at the very least, 5% of patients who undergo surgery develop a surgical site infection (SSI). There has been much interest in the use of negative pressure wound therapy (NPWT) as a prophylactic treatment to reduce the risk of SSI. Evidence suggests it can accelerate healing times, reduce both the length of hospital stay and the frequency of dressing changes, and improve patients' quality of life. The efficacy of traditional and portable NPWT systems is similar. However, the latter has an advantage in that it increases patient mobility and does not hinder individuals from carrying out activities of daily living. There are also economic data suggesting that portable NPWT devices are associated with long-term cost savings.
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Affiliation(s)
- Steven Jeffery
- Consultant Burns and Plastic Surgeon, Professor of Wound Study, Birmingham City University, UK
| | - David Leaper
- Emeritus Professor of Surgery, University of Newcastle upon Tyne, Emeritus Professor of Clinical Sciences, University of Huddersfield and Visiting Professor, Imperial College, London, UK
| | - David Armstrong
- Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine, University of Southern California, US
| | - John Lantis
- Vice Chairman, Department of Surgery, Chief of Vascular and Endovascular Surgery, Mount Sinai St Luke's and West Hospitals, Professor of Surgery, Icahn School of Medicine, USA
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12
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Clark JM, Rychlik S, Harris J, Seikaly H, Biron VL, O'Connell DA. Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy. J Otolaryngol Head Neck Surg 2019; 48:21. [PMID: 31113481 PMCID: PMC6528371 DOI: 10.1186/s40463-019-0344-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD. Methods Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications. Results Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively (P = 0.016). Flexion at seven days was improved in NPD group (P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation. Conclusions In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.
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Affiliation(s)
- Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada
| | - Shannon Rychlik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada. .,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada.
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13
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Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2019; 3:CD009261. [PMID: 30912582 PMCID: PMC6434581 DOI: 10.1002/14651858.cd009261.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). While existing evidence for the effectiveness of NPWT remains uncertain, new trials necessitated an updated review of the evidence for the effects of NPWT on postoperative wounds healing by primary closure. OBJECTIVES To assess the effects of negative pressure wound therapy for preventing surgical site infection in wounds healing through primary closure. SEARCH METHODS We searched the Cochrane Wounds Specialised Register, CENTRAL, Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus in February 2018. We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions on language, publication date, or 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 type of NPWT. DATA COLLECTION AND ANALYSIS Four review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to GRADE methodology. MAIN RESULTS In this second update we added 25 intervention trials, resulting in a total of 30 intervention trials (2957 participants), and two economic studies nested in trials. Surgeries included abdominal and colorectal (n = 5); caesarean section (n = 5); knee or hip arthroplasties (n = 5); groin surgery (n = 5); fractures (n = 5); laparotomy (n = 1); vascular surgery (n = 1); sternotomy (n = 1); breast reduction mammoplasty (n = 1); and mixed (n = 1). In three key domains four studies were at low risk of bias; six studies were at high risk of bias; and 20 studies were at unclear risk of bias. We judged the evidence to be of low or very low certainty for all outcomes, downgrading the level of the evidence on the basis of risk of bias and imprecision.Primary outcomesThree studies reported mortality (416 participants; follow-up 30 to 90 days or unspecified). It is uncertain whether NPWT has an impact on risk of death compared with standard dressings (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.25 to 1.56; very low-certainty evidence, downgraded once for serious risk of bias and twice for very serious imprecision).Twenty-five studies reported on SSI. The evidence from 23 studies (2533 participants; 2547 wounds; follow-up 30 days to 12 months or unspecified) showed that NPWT may reduce the rate of SSIs (RR 0.67, 95% CI 0.53 to 0.85; low-certainty evidence, downgraded twice for very serious risk of bias).Fourteen studies reported dehiscence. We combined results from 12 studies (1507 wounds; 1475 participants; follow-up 30 days to an average of 113 days or unspecified) that compared NPWT with standard dressings. It is uncertain whether NPWT reduces the risk of wound dehiscence compared with standard dressings (RR 0.80, 95% CI 0.55 to 1.18; very low-certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision).Secondary outcomesWe are uncertain whether NPWT increases or decreases reoperation rates when compared with a standard dressing (RR 1.09, 95% CI 0.73 to 1.63; 6 trials; 1021 participants; very low-certainty evidence, downgraded for very serious risk of bias and serious imprecision) or if there is any clinical benefit associated with NPWT for reducing wound-related readmission to hospital within 30 days (RR 0.86, 95% CI 0.47 to 1.57; 7 studies; 1271 participants; very low-certainty evidence, downgraded for very serious risk of bias and serious imprecision). It is also uncertain whether NPWT reduces incidence of seroma compared with standard dressings (RR 0.67, 95% CI 0.45 to 1.00; 6 studies; 568 participants; very low-certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision). It is uncertain if NPWT reduces or increases the risk of haematoma when compared with a standard dressing (RR 1.05, 95% CI 0.32 to 3.42; 6 trials; 831 participants; very low-certainty evidence, downgraded twice for very serious risk of bias and twice for very serious imprecision. It is uncertain if there is a higher risk of developing blisters when NPWT is compared with a standard dressing (RR 6.64, 95% CI 3.16 to 13.95; 6 studies; 597 participants; very low-certainty evidence, downgraded twice for very serious risk of bias and twice for very serious imprecision).Quality of life was not reported separately by group but was used in two economic evaluations to calculate quality-adjusted life years (QALYs). There was no clear difference in incremental QALYs for NPWT relative to standard dressing when results from the two trials were combined (mean difference 0.00, 95% CI -0.00 to 0.00; moderate-certainty evidence).One trial concluded that NPWT may be more cost-effective than standard care, estimating an incremental cost-effectiveness ratio (ICER) value of GBP 20.65 per QALY gained. A second cost-effectiveness study estimated that when compared with standard dressings NPWT was cost saving and improved QALYs. We rated the overall quality of the reports as very good; we did not grade the evidence beyond this as it was based on modelling assumptions. AUTHORS' CONCLUSIONS Despite the addition of 25 trials, results are consistent with our earlier review, with the evidence judged to be of low or very low certainty for all outcomes. Consequently, uncertainty remains about whether NPWT compared with a standard dressing reduces or increases the incidence of important outcomes such as mortality, dehiscence, seroma, or if it increases costs. Given the cost and widespread use of NPWT for SSI prophylaxis, there is an urgent need for larger, well-designed and well-conducted trials to evaluate the effects of newer NPWT products designed for use on clean, closed surgical incisions. Such trials should initially focus on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.
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Affiliation(s)
- Joan Webster
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
- The University of QueenslandSchool of Nursing and MidwiferyBrisbaneQueenslandAustralia
- Royal Brisbane and Women's HospitalNursing and Midwifery Research CentreButterfield StreetHerstonQueenslandAustralia4029
| | - Zhenmi Liu
- West China Hospital, Sichuan UniversityWest China School of Public HealthChengduSichuanChina610041
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Laura Chiverton
- St Mary's Hospital, Manchester University NHS Foundation TrustNeonatal Intensive Care UnitManchesterUK
| | | | - Monica Stankiewicz
- Haut Dermatology201 Wickham Terrace BrisbaneSpring HillBrisbaneQueenslandAustralia4000
| | - Wendy P Chaboyer
- Griffith UniversitySchool of Nursing and MidwiferyBrisbaneQueenslandAustralia
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14
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Tanaydin V, Beugels J, Andriessen A, Sawor JH, van der Hulst RRWJ. Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality. Aesthetic Plast Surg 2018; 42:927-935. [PMID: 29442143 PMCID: PMC6097780 DOI: 10.1007/s00266-018-1095-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast. METHODS The primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips. The secondary outcome was aesthetic appearance and quality of scarring using questionnaires [visual analogue scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS)] scored at day 42-, 90-, 180- and 365-day follow-up using additional scar measurement modalities, such as viscoelasticity. RESULTS For the 32 included patients, the number of wound complications was significantly lower (p < 0.004) for the NPWT treated sites compared to fixation strips. POSAS and VAS scores at 42 and 90 days revealed a significantly better quality of scarring in the NPWT treatment breasts than in fixation strips. At 180-day follow-up, there was a significant improvement in total VAS scores, as well as a comparable improvement in POSAS scores. No consistent significant improvement in scar quality was demonstrated with the assays that were used. CONCLUSIONS Our study showed less complications and a significant improvement in quality of scarring in favor of the NPWT-treated sites. The results indicate NPWT to be an attractive option for these patients. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- V Tanaydin
- Maastricht University Medical Center, Maastricht, The Netherlands.
| | - J Beugels
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Andriessen
- Andriessen Consultants, Malden, The Netherlands
- UMC St Radboud Nijmegen, Nijmegen, The Netherlands
| | - J H Sawor
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
| | - R R W J van der Hulst
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
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15
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Sarandy MM, Miranda LL, Altoé LS, Novaes RD, Zanuncio VV, Leite JPV, Gonçalves RV. Strychnos pseudoquina modulates the morphological reorganization of the scar tissue of second intention cutaneous wounds in rats. PLoS One 2018; 13:e0195786. [PMID: 29649320 PMCID: PMC5896999 DOI: 10.1371/journal.pone.0195786] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/29/2018] [Indexed: 12/12/2022] Open
Abstract
Natural substances are used in folk medicines to treat injuries. Strychnos pseudoquina has scarring, antipyretic, and antimalarial actions. The present study aimed to analyze the effect of S. pseudoquina on cutaneous wound healing in rats. The S. pseudoquina extract was submitted to phytochemical prospection. The levels of flavonoids and total phenolic compounds in the extract were 50.7 mg/g and 2.59 mg/g, respectively. Thirty Wistar rats were individualized in cages with food and water ad libitum (registration no. 730/2014). After anesthesia, three circular wounds (12mm diameter) were made in the animals, which were randomly separated into five treatments: Sal, saline; VO, ointment vehicles (lanolin and Vaseline); SS, positive control (silver sulfadiazine 1%); LE 5, freeze-dried extract 5%; and LE 10, lyophilized extract 10%. The animals were treated with the ointment daily for 21 days. Every seven days, the area and the rate of wound contraction were evaluated. Tissue samples were removed for histopathological analysis of the number of mast cells, elastic and collagen fibers, and biochemical analyses, quantification of malondialdehyde (MDA), carbonylated proteins (PCN), superoxide dismutase (SOD), catalase (CAT), transforming growth factor β (TGF-β), Interleukin 10 (IL-10) and tumor necrosis factor (TNF). The number of mast cells, collagen and elastic fibers in the rat wounds were higher in the treatments with the plant. The extract also stimulated the activity of antioxidant enzymes, particularly SOD, presenting high levels, and maintained low levels of PCN. The TGF-β and IL-10 concentration was higher in the LE5 and LE10 treatment of the extract than in the Sal, OV and SS treatments on day 7. The ointment based on S. pseudoquina closed the wound faster and accelerated wound healing in animals.
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Affiliation(s)
| | - Lyvia Lopes Miranda
- Institute of Biomedical Sciences, Department General Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Luciana Schulthais Altoé
- Institute of Biomedical Sciences, Department General Biology, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Rômulo Dias Novaes
- Department of Structural Biology, Universidade Federal de Alfenas, Alfenas, Minas Gerais, Brazil
| | - Virgínia Vinha Zanuncio
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - João Paulo Viana Leite
- Department of Agricultural Biochemistry, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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16
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Managing Complications in Abdominoplasty: A Literature Review. Arch Plast Surg 2017; 44:457-468. [PMID: 28946731 PMCID: PMC5621815 DOI: 10.5999/aps.2017.44.5.457] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 11/08/2022] Open
Abstract
Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
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Young CN, Ng KYB, Webb V, Vidow S, Parasuraman R, Umranikar S. Negative pressure wound therapy aids recovery following surgical debridement due to severe bacterial cellulitis with abdominal abscess post-cesarean: A case report (CARE-Compliant). Medicine (Baltimore) 2016; 95:e5397. [PMID: 27977577 PMCID: PMC5268023 DOI: 10.1097/md.0000000000005397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Bacterial cellulitis post-Cesarean section is rare. Negative pressure wound therapy (NPWT) is widely used in various medical specialities; its effectiveness in obstetrics however remains the topic of debate-used predominantly as an adjunct to secondary intention specific to high-risk patient groups. Its application in the treatment of actively infected wounds post-Cesarean is not well documented. Here, we document NPWT in the treatment of an unusually severe case of bacterial cellulitis with abdominal abscess postpartum. We provide a unique photographic timeline of wound progression following major surgical debridement, documenting the effectiveness of 2 different NPWT systems (RENASYS GO and PICO, Smith & Nephew). We report problems encountered using these NPWT systems and "ad-hoc" solutions to improve efficacy and patient experience.A 34-year-old primiparous Caucasian female with no prior history or risk factors for infection and a normal body mass index (BMI) presented with severe abdominal pain, swelling, and extensive abdominal redness 7 days postemergency Cesarean section. Examination revealed extensive cellulitis with associated abdominal abscess. Staphylococcus aureus was identified in wound exudates and extensive surgical debridement undertaken day 11 postnatally due to continued febrile episodes and clinical deterioration, despite aggressive intravenous antibiotic therapy. Occlusive NPWT dressings were applied for a period of 3 weeks before discharge, as well as a further 5 weeks postdischarge into the community.NPWT was well tolerated and efficacious in infection clearance and wound healing during bacterial cellulitis. Wound healing averaged 1 cm per week before NPWT withdrawal; cessation of NPWT before full wound closure resulted in significantly reduced healing rate, increased purulent discharges, and skin irritation, highlighting the efficacy of NPWT. Five-month follow-up in the clinic found the wound to be fully healed with no additional scarring beyond the boundaries of the original Cesarean incision. The patient was pleased with treatment outcomes, reporting no lasting pain or discomfort from the scar. CONCLUSIONS This report represents the first documented use of NPWT to aid healing of an actively infected, open wound following extensive surgical debridement 10 days post-Cesarean section, confirming both the efficacy and tolerability of NPWT for the treatment of severe bacterial cellulitis in obstetric debridement.
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Affiliation(s)
- Christopher N.J. Young
- Department of Molecular Medicine, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Ka Ying Bonnie Ng
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
| | - Vanessa Webb
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
| | - Sarah Vidow
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
| | | | - Sameer Umranikar
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK
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Scalise A, Calamita R, Tartaglione C, Pierangeli M, Bolletta E, Gioacchini M, Gesuita R, Di Benedetto G. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature. Int Wound J 2016; 13:1260-1281. [PMID: 26424609 PMCID: PMC7950088 DOI: 10.1111/iwj.12492] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/20/2015] [Accepted: 08/07/2015] [Indexed: 01/01/2023] Open
Abstract
Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high-risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re-operation and re-hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15 human studies for a total of 6 randomized controlled trials, 5 prospective cohort studies, 7 retrospective analyses, were included. Human studies investigated the outcomes of 1042 incisions on 1003 patients. The literature shows a decrease in the incidence of infection, sero-haematoma formation and on the re-operation rates when using INPWT. Lower level of evidence was found on dehiscence, decreased in some studies, and was inconsistent to make a conclusion. Because of limited studies, it is difficult to make any assertions on the other variables, suggesting a requirement for further studies for proper recommendations on INPWT.
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Affiliation(s)
- Alessandro Scalise
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Roberto Calamita
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Caterina Tartaglione
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Marina Pierangeli
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Elisa Bolletta
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Matteo Gioacchini
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Rosaria Gesuita
- Interdepartmental Centre of EpidemiologyBiostatistics and Medical Informatics (EBI Centre), Università Politecnica delle MarcheAnconaItaly
| | - Giovanni Di Benedetto
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
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Abstract
Skin graft has been known to be prone to failure. This study was aimed to make a simplification of the negative pressure wound therapy (NPWT), which follows EASEPort (effective, affordable, safe, easily handled, and portable) concept to support the take of skin graft. The design of the EASEPort-NPWT was then made and technically verified. Thereafter, an animal experimental study comparing the EASEPort-NPWT to the classic tie-over technique on skin graft over exudative wound was conducted. The EASEPort-NPWT was verified to be able to yield and sustain the subatmospheric pressure needed. In the animal study, the treatment group showed better skin graft survival rate (97.55 ± 11.18% take) than the control group (54.88 ± 19.73%) on day-7. Histopathology examination showed good quality of the skin structures taken from the treatment group, which was better than the structures of the skin in the control group. In summary, this study has been able to fulfill its objective to create a device following EASEPort concept. Subsequently, the EASEPort-NPWT was able to enhance skin graft survival rate in exudative wound.
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Conservative Management of Wound Dehiscence Following Pediatric Cavus Foot Surgery: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e590. [PMID: 26894015 PMCID: PMC4727699 DOI: 10.1097/gox.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Cavus foot surgeries are relatively common procedures in pediatric orthopedics. Following surgery, the tensile forces exerted on the wound by the newly corrected foot may hinder soft tissue healing and lead to wound dehiscence. Treatments including skin grafting and other plastic surgery procedures have been described in order to manage this complication. However, the effectiveness of conservative treatment regimens in cases of large dehiscence of these wounds has not yet been reported. Methods: The charts of 7 patients between the ages of 7 and 19 who had surgical correction of severe cavus deformity and who developed wound dehiscence postoperatively were reviewed. All patients were treated conservatively with regular cleaning with chlorhexedine and application of different ointments and dressings along with surgical debridements. Three patients also received antibiotics. The primary outcome was wound healing as documented by clinical notes and photographs. Results: The treatment was successful in producing the desired outcome in all cases with no other systemic or wound complications developing. Complete wound healing was obtained within a median time of 6 months and 5 days of treatment without the need for skin grafting or other plastic surgery procedures. Conclusions: In pediatric patients with wound dehiscence postcavus foot surgery, conservative management with minimal surgical debridement and regular cleaning and dressing of the wound is a viable treatment option that has been shown to be effective in 7 cases. It should be considered in such patients before proceeding to more invasive surgical treatment.
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Salvo P, Smajda R, Dini V, Saxby C, Voirin G, Romanelli M, Di Francesco F. A D-optimal design to model the performances of dressings and devices for negative pressure wound therapy. J Tissue Viability 2016; 25:83-90. [PMID: 26818777 DOI: 10.1016/j.jtv.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/23/2015] [Accepted: 01/04/2016] [Indexed: 10/01/2022]
Abstract
A D-optimal design was used to identify and model variables that affect the transit time of wound exudate through an illustrative dressing used for negative pressure wound therapy. Many authors have addressed the clinical benefits of negative pressure wound therapy, but limited information is available on how to assess performances of dressings. In this paper, the transit time of wound exudate through a dressing was chosen as a model parameter to show how experimental design (DOE) can be used for this purpose. Results demonstrated that rate of exudate production, temperature and dressing thickness were the variables with the largest impact on transit time. The DOE approach could be used to model other dressing properties, like for example capability of absorbing excess exudate or breathability.
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Affiliation(s)
- P Salvo
- Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi 13, 56124, Pisa, Italy.
| | - R Smajda
- CSEM SA, Rue Jaquet-Droz 1, 2002 Neuchâtel, Switzerland
| | - V Dini
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Via Roma, 67, 56126 Pisa, Italy.
| | - C Saxby
- Smith & Nephew, Hessle Road 101, Hull, England, UK
| | - G Voirin
- CSEM SA, Rue Jaquet-Droz 1, 2002 Neuchâtel, Switzerland
| | - M Romanelli
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Via Roma, 67, 56126 Pisa, Italy.
| | - F Di Francesco
- Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi 13, 56124, Pisa, Italy.
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Fischer S, Wall J, Pomahac B, Riviello R, Halvorson EG. Extra-large negative pressure wound therapy dressings for burns - Initial experience with technique, fluid management, and outcomes. Burns 2016; 42:457-65. [PMID: 26774601 DOI: 10.1016/j.burns.2015.08.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 07/16/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The use of negative-pressure-wound-therapy (NPWT) is associated with improved outcomes in smaller burns. We report our experience using extra-large (XL) NPWT dressings to treat ≥15% total body surface area (TBSA) burned and describe our technique and early outcomes. We also provide NPWT exudate volume for predictive fluid resuscitation in these critically ill patients. METHODS We retrospectively reviewed patients treated with XL-NPWT from 2012 to 2014. Following excision/grafting, graft and donor sites were sealed with a layered NPWT dressing. We documented wound size, dressing size, NPWT outputs, graft take, wound infections, and length of stay (LOS). Mean NPWT exudate volume per %TBSA per day was calculated. RESULTS Twelve burn patients (mean TBSA burned 30%, range 15-60%) were treated with XL-NPWT (dressing TBSA burned and skin graft donor sites range 17-44%). Average graft take was 97%. No wound infections occurred. Two patients had burns ≥50% TBSA and their LOS was reduced compared to ABA averages. XL-NPWT outputs peaked at day 1 after grafting followed by a steady decline until dressings were removed. Average XL-NPWT dressing output during the first 5 days was 101±66mL/%BSA covered per day. 2 patients developed acute kidney injury. CONCLUSION The use of XL-NPWT to treat extensive burns is feasible with attention to application technique. NPWT dressings appear to improve graft take, and to decrease risk of infection, LOS, and pain and anxiety associated with wound care. Measured fluid losses can improve patient care in future applications of NPWT to large burn wounds.
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Affiliation(s)
- Sebastian Fischer
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States; Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, Research Group "Trauma meets Burn", University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
| | - Jennifer Wall
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States
| | - Bohdan Pomahac
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States
| | - Robert Riviello
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States
| | - Eric G Halvorson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States.
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Murphy P, Lee K, Dubois L, DeRose G, Forbes T, Power A. Negative pressure wound therapy for high-risk wounds in lower extremity revascularization: study protocol for a randomized controlled trial. Trials 2015; 16:504. [PMID: 26537879 PMCID: PMC4634141 DOI: 10.1186/s13063-015-1026-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/21/2015] [Indexed: 01/07/2023] Open
Abstract
Background Rates of surgical site infections (SSIs) following groin incision for femoral artery exposure are much higher than expected of a clean operation. The morbidity and mortality is high, particularly with the use of prosthetic grafts. The vascular surgery population is at an increased risk of SSIs related to peripheral vascular disease (PVD), diabetes, obesity, previous surgery and presence of tissue loss. Negative pressure wound therapy (NPWT) dressings have been used on primarily closed incisions to reduce surgical site infections in other surgical disciplines. We have not come across any randomized controlled trials to support the prophylactic use of negative pressure wound therapy in high-risk vascular patients undergoing lower limb revascularization. Methods/design In this single-center, prospective randomized controlled trial, patients scheduled for a lower limb revascularization requiring open femoral artery exposure who are at a high risk (BMI > 30 kg/m2, previous femoral cutdown or Rutherford V or VI category for chronic limb ischemia) will be eligible for the study. A total of 108 groin incisions will be randomized to the use of a negative pressure wound device or standard adhesive gauze dressing. Patients will be followed in hospital and reassessed within the first 30 days postoperatively. The primary outcome is SSI within the first 30 days of surgery and will be determined using the intention-to-treat principle. Secondary outcomes include length of stay, emergency room visits, reoperation, amputation and mortality. A cost analysis will be performed. Discussion The trial is expected to define the role of NPWT in SSI prophylaxis for lower limb revascularization in high-risk vascular patients. The results of the study will be used to inform current best practice for perioperative care and the minimization of SSIs. Trial registration NCT02084017, March 2014
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Affiliation(s)
- Patrick Murphy
- Division of General Surgery, Department of Surgery, Western University, 1151 Richmond Street, London, ON, N6A 5A5, Canada.
| | - Kevin Lee
- Division of Vascular Surgery, Department of Surgery, Western University, 800 Commissioners Road East, London, ON, N6A 4G5, Canada.
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, 800 Commissioners Road East, London, ON, N6A 4G5, Canada.
| | - Guy DeRose
- Division of Vascular Surgery, Department of Surgery, Western University, 800 Commissioners Road East, London, ON, N6A 4G5, Canada.
| | - Thomas Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.
| | - Adam Power
- Division of Vascular Surgery, Department of Surgery, Western University, 800 Commissioners Road East, London, ON, N6A 4G5, Canada.
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Mihaljevic AL, Schirren R, Müller TC, Kehl V, Friess H, Kleeff J. Postoperative negative-pressure incision therapy following open colorectal surgery (Poniy): study protocol for a randomized controlled trial. Trials 2015; 16:471. [PMID: 26482031 PMCID: PMC4617637 DOI: 10.1186/s13063-015-0995-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality, and remain one of the most frequent surgical complications. In prospective trials with adequate follow-up, more than 20 % of patients undergoing elective colorectal surgery are affected and methods to reduce surgical site infections are urgently needed. Negative-pressure incision therapy is a novel intervention that holds promise to reduce postoperative wound infection rates, but has not yet been rigorously tested in a randomized controlled trial. METHODS/DESIGN The aim is to investigate whether the postoperative application of a negative-pressure incision therapy device for 5-7 days reduces the rate of surgical site infections following open elective colorectal surgery by 50 %. This is a randomized, controlled, observer-blinded multicentre clinical trial with two parallel study groups. The primary outcome measure will be the rate of surgical site infections within 30 days postoperatively. Surgical site infections are defined according to criteria of the US Centers for Disease Control and Prevention. Statistical analysis of the primary endpoint measure will be based on the intention-to-treat population. The global level of significance is set at 5 % (two-sided) and the sample size (n = 170 per group) is determined to assure a power of 80 %. DISCUSSION The Poniy trial will explore whether the rate of surgical site infections can be reduced by the application of a negative-pressure incision therapy device in patients undergoing open elective colorectal surgery. Its pragmatic design guarantees high external validity and clinical relevance. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00006199 .
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Affiliation(s)
- André L Mihaljevic
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Rebekka Schirren
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Tara C Müller
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universtität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Jörg Kleeff
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany. .,Current affiliation: The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool L7 8XP, UK. .,Department of General-, Visceral- and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Matsumoto T, Parekh SG. Use of Negative Pressure Wound Therapy on Closed Surgical Incision After Total Ankle Arthroplasty. Foot Ankle Int 2015; 36:787-94. [PMID: 25736324 DOI: 10.1177/1071100715574934] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wound healing problems of the anterior ankle incision are among the most common complications after total ankle arthroplasty, possibly resulting in exposure of the prostheses and infection. The aim of this study was to investigate the role of negative pressure wound therapy (NPWT) in decreasing the rate of wound healing problems after total ankle arthroplasty. METHODS This is a retrospective cohort study including consecutive patients who underwent total ankle arthroplasty by a single surgeon at a single institution between 2009 and 2013. The incisional negative pressure dressing was applied to all patients who underwent total ankle arthroplasty between 2012 and 2013 with a continuous application of -80 mm Hg negative pressure for 6 days postoperatively. The control group consisted of patients who underwent total ankle arthroplasty between 2009 and 2012 with a conventional nonadherent gauze dressing. Seventy-four patients were involved in this study: 37 in the control group and 37 in the incisional NPWT group. RESULTS All patients tolerated the incisional NPWT to completion without any dressing failures or skin problems. Both groups showed similar distributions in demographics and perioperative risk factors for wound healing. There were 9 (24%) wound healing problems in the control group and 1 (3%) in the incisional NPWT group. Incisional NPWT was found to reduce wound healing problems with an odds ratio of 0.10 (95% CI, 0.01-0.50; P = .004). CONCLUSIONS Our study demonstrated that there was a decreased incidence of wound healing problems following total ankle arthroplasty with incisional NPWT dressings. This is the first study evaluating the efficacy of incisional NPWT as an adjunct treatment for wound healing after total ankle arthroplasty. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Duke Fuqua School of Business, Durham, NC, USA
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Ghatak PD, Schlanger R, Ganesh K, Lambert L, Gordillo GM, Martinsek P, Roy S. A Wireless Electroceutical Dressing Lowers Cost of Negative Pressure Wound Therapy. Adv Wound Care (New Rochelle) 2015; 4:302-311. [PMID: 26005596 DOI: 10.1089/wound.2014.0615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/27/2015] [Indexed: 01/19/2023] Open
Abstract
Objective: To test whether the use of a wireless electroceutical dressing (WED) (Procellera®) in conjunction with a 5-day negative pressure wound therapy (NPWT) may reduce the number of dressing changes required per week with this therapy. Approach: At the Ohio State University Comprehensive Wound Center, chronic wound patients (n=30) undergoing NPWT were randomized into two arms following consent as approved by the institutional review board. The control arm received standard of care NPWT, where the dressing change was performed thrice a week. The test arm received the same care except that the WED was added as an interface layer and dressing change was limited to twice a week. Results: A reduced cost of care was achieved using the WED in conjunction with NPWT. Despite fewer dressing changes in wounds dressed with the WED, closure outcomes were comparable with no overt signs of any wound complication, including infection. The cost of NPWT care during the week was significantly lower (from $2918 to $2346) in the WED-treated group compared with patients in the control arm. Innovation: This work introduces a novel technology platform involving a WED, which may be used in conjunction with NPWT. If used as such, NPWT is effective in decreasing the frequency of dressing change and lowering the cost of care. Conclusion: This work points toward the benefit of using the WED combined with NPWT. A larger clinical trial investigating the cost-effectiveness of WED in wound care is warranted.
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Affiliation(s)
- Piya Das Ghatak
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard Schlanger
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kasturi Ganesh
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lynn Lambert
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gayle M. Gordillo
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Patsy Martinsek
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sashwati Roy
- Comprehensive Wound Center, Departments of Surgery and Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Orr K, Chien P. Sepsis in obese pregnant women. Best Pract Res Clin Obstet Gynaecol 2015; 29:377-93. [DOI: 10.1016/j.bpobgyn.2014.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Chaboyer W, Anderson V, Webster J, Sneddon A, Thalib L, Gillespie BM. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT. Healthcare (Basel) 2014; 2:417-28. [PMID: 27429285 PMCID: PMC4934567 DOI: 10.3390/healthcare2040417] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 01/15/2023] Open
Abstract
Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing) and 46 women received standard care (Comfeel Plus(®) dressing). All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38-1.68); for the number of complications excluding SSI it was 0.98 (95% CI 0.34-2.79). A sample size of 784 (392 per group) would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
| | - Vinah Anderson
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
| | - Joan Webster
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
- Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia.
| | - Anne Sneddon
- Women's and Newborn Health, Gold Coast University Hospital, Southport, QLD 4215, Australia.
| | - Lukman Thalib
- Department of Community Medicine (Biostatistics), Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD 4222, Australia.
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30
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The incidence and risk factors for lower limb skin graft failure. Dermatol Res Pract 2014; 2014:582080. [PMID: 25132847 PMCID: PMC4123529 DOI: 10.1155/2014/582080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/01/2014] [Indexed: 12/02/2022] Open
Abstract
Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors.
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31
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Lewis LS, Convery PA, Bolac CS, Valea FA, Lowery WJ, Havrilesky LJ. Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions. Gynecol Oncol 2014; 132:684-9. [DOI: 10.1016/j.ygyno.2014.01.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/05/2014] [Accepted: 01/13/2014] [Indexed: 01/12/2023]
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32
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Blume PA, Donegan R, Schmidt BM. The role of plastic surgery for soft tissue coverage of the diabetic foot and ankle. Clin Podiatr Med Surg 2014; 31:127-50. [PMID: 24296022 DOI: 10.1016/j.cpm.2013.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The goal of wound healing is to obtain the best closure through the least morbid means. In the surgical treatment of the diabetic foot and ankle, the reconstructive foot and ankle surgeon is tasked with the challenge of repairing a variety of tissue defects. The decision for wound closure depends on the location of the wound and host factors. In order of increasing complexity, the clinician should consider the reconstruction decision ladder algorithm. Wound evaluation coupled with the knowledge of various closure techniques and their indications will arm the surgeon with the tools for a successful closure.
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Affiliation(s)
- Peter A Blume
- Orthopedics and Rehabilitation, and Anesthesia, Yale School of Medicine, 800 Howard Street, New Haven, CT 06519, USA.
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Gillespie BM, Chaboyer W, Allen P, Morely N, Nieuwenhoven P. Wound care practices: a survey of acute care nurses. J Clin Nurs 2013; 23:2618-26. [DOI: 10.1111/jocn.12479] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Brigid M Gillespie
- NHMRC Research Centre for Clinical Excellence in Nursing Interventions for Hospitalised Patients (NCREN); Griffith Health Institute; Griffith University; Gold Coast QLD Australia
- Research Centre for Clinical and Community Practice Innovation (RCCCPI); Griffith Health Institute; Griffith University; Gold Coast QLD Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients (NCREN); Griffith Health Institute; Griffith University; Gold Coast QLD Australia
- Research Centre for Clinical and Community Practice Innovation (RCCCPI); Griffith Health Institute; Griffith University; Gold Coast QLD Australia
| | - Pamela Allen
- Gold Coast Health Services District; Gold Coast QLD Australia
| | - Nicola Morely
- Vascular Services; Gold Coast Health Services District; Gold Coast QLD Australia
| | - Paul Nieuwenhoven
- Division of Surgery Services; GCH Gold Coast Health Service District; Gold Coast QLD Australia
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34
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The relationship between obesity and surgical site infections in women undergoing caesarean sections: An integrative review. Midwifery 2013; 29:1331-8. [DOI: 10.1016/j.midw.2012.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/14/2012] [Accepted: 12/20/2012] [Indexed: 01/28/2023]
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35
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Shankaran V, Brooks M, Mostow E. Advanced therapies for chronic wounds: NPWT, engineered skin, growth factors, extracellular matrices. Dermatol Ther 2013; 26:215-21. [PMID: 23742282 DOI: 10.1111/dth.12050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Advanced wound care implies the use of products or procedures that are specialized. Although dermatologists are used to being specialists of the skin, hair, and nails, chronic wound care has evolved such that there are some specific treatment options that are more commonly ordered and performed in wound care clinics. Wound care clinics are staffed by specialists and generalists including dermatologists, but also orthopedic surgeons, vascular surgeons, infectious disease specialists, internists, family practitioners, hyperbaric oxygen-trained physicians from a variety of backgrounds, podiatrists, physician assistants, and nurse practitioners. The care of chronic wounds has almost become its own specialty, with so-called advanced therapies now including the use of growth factors, extracellular matrices, engineered skin, and negative pressure wound therapy. It is critical that the dermatologists understand the treatments such that they can appropriately apply or order them directly, or be involved with the care of their patients receiving these therapies.
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36
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Nicoli F, Balzani A, Lazzeri D, Gentile P, Chilgar RM, Di Pasquali C, Nicoli M, Bocchini I, Agovino A, Cervelli V. Severe hidradenitis suppurativa treatment using platelet-rich plasma gel and Hyalomatrix. Int Wound J 2013; 12:338-43. [PMID: 23834343 DOI: 10.1111/iwj.12117] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/28/2013] [Accepted: 06/01/2013] [Indexed: 12/11/2022] Open
Abstract
Hidradenitis suppurativa (HS) can be a debilitating chronic disease. The underlying cause of the disease is still not clear. HS may be managed through numerous different medical or surgical procedures. Surgical treatment may consist of local excisions and reconstruction using a variety of methods: perforator flaps, skin grafts, local flaps, primary closure or secondary wound healing with vacuum and other devices. This report describes our experience with surgical excision and closure using platelet-rich plasma (PRP) gel and Hyalomatrix PA (HPA) in a patient with severe HS involving most of the body surface. We treated the patient with resection of severe HS of the nuchae and closure with PRP gel prepared with the RegenKit(®) to promote neovascularisation and HPA, a delivery system for hyaluronic acid, to induce a neodermis at the wound bed and to stimulate regeneration in a humid and protected environment. Complete wound healing was achieved after 2 months. The obtained result proved the efficacy of this treatment without complications. No recurrence was observed during the 1 year after the surgical procedure. Severe HS can be safely and effectively managed with wide excision, PRP gel and Hyalomatrix to achieve a successful outcome.
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Affiliation(s)
- Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
| | - Alberto Balzani
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
| | - Davide Lazzeri
- Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Pisa, Italy
| | - Pietro Gentile
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
| | - Ram M Chilgar
- Department of Plastic and Reconstructive Surgery, Maharashtra University of Health Sciences, Nashik, India
| | - Camilla Di Pasquali
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
| | - Marzia Nicoli
- Department of Immunology, 'La Sapienza' University, Rome, Italy
| | - Ilaria Bocchini
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
| | - Annarita Agovino
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, 'Policlinico Casilino' University of Tor Vergata in Rome, Rome, Italy
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37
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Upton D, Andrews A. Pain and trauma in negative pressure wound therapy: a review. Int Wound J 2013; 12:100-5. [PMID: 23489350 DOI: 10.1111/iwj.12059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/17/2013] [Accepted: 02/04/2013] [Indexed: 11/27/2022] Open
Abstract
Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT-related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well-being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care.
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Affiliation(s)
- Dominic Upton
- Institute of Health & Society, University of Worcester, Worcester, UK
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38
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Lancerotto L, Bayer LR, Orgill DP. Mechanisms of action of microdeformational wound therapy. Semin Cell Dev Biol 2012; 23:987-92. [PMID: 23036531 DOI: 10.1016/j.semcdb.2012.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/25/2012] [Indexed: 02/07/2023]
Abstract
Microdeformational Wound Therapy (MDWT) is a class of medical devices that have revolutionized the treatment of complex wounds over the last 20 years. These devices, are a subset of Negative Pressure Wound Therapy (NPWT), in which there is a highly porous interface material placed between the wound and a semi-occlussive dressing and connected to suction. The porous interface material acts to deform the wound on a micro scale promoting cellular proliferation. These devices appear to significantly improve the speed of healing in many wounds, facilitate granulation tissue formation and reduce the complexity of subsequent reconstructive operations. The mechanisms through which such effects are obtained are beginning to be better understood through basic research and clinical trials. Further work in this field is likely to yield devices that are designed to treat specific wound types.
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Affiliation(s)
- Luca Lancerotto
- Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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