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Kim KJ, Min JH, Yoo I, Kim SW, Lee J, Ryu S, You YH, Park JS, Jeong WJ, Cho YC, Oh SK, In YN, Ahn HJ, Kang CS, Kyung H, Lee BK, Lee DH, Lee DH. Negative pressure wound therapy for skin necrosis prevention after snakebite in the emergency department: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e24290. [PMID: 33546055 PMCID: PMC7837876 DOI: 10.1097/md.0000000000024290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
This retrospective cohort study aimed to compare the effectiveness of conventional treatment and ultra-early application of negative pressure wound therapy (NPWT) in patients with snakebites.Patients who visited the emergency department within 24 hours after a snakebite were assigned to the non- NPWT or NPWT group. Swelling resolution time and rates of necrosis, infection, and operations were compared between the 2 groups. The Stony Brook Scar Evaluation Scale was used to measure short- and long-term wound healing results.Among the included 61 patients, the swelling resolution time was significantly shorter in the NPWT group than in non- NPWT group (P = .010). The NPWT group showed lower necrosis (4.3% versus 36.8%; P = .003) and infection (13.2% and 4.3%; P = .258) rates than the non- NPWT group. The median Stony Brook Scar Evaluation Scale scores were higher in the NPWT group than in the non- NPWT group (P< .001).These findings suggest that ultra-early application of NPWT reduces edema, promotes wound healing, and prevents necrosis in patients with snakebites.
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Affiliation(s)
- Kwan Jae Kim
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Jin Hong Min
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
- Department of Emergency Medicine
| | - Insool Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, 282
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
| | - Seung Whan Kim
- Department of Emergency Medicine, Chungnam National University Hospital, 282
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
| | - Jinwoong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, 282
- Department of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | | | | | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Chang Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, 282
| | - Hyunwoo Kyung
- Department of Plastic Surgery, Chungnam National University Sejong Hospital, 7, Bodam-ro, Sejong
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University School of Medicine
- Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju
| | - Dong Hoon Lee
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, 47, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea
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Ota H, Danno K, Ohta K, Matsumura T, Komori T, Okamura S, Okano M, Ogawa A, Tamagawa H, Uemura M, Matsuda C, Mizushima T, Yamamoto H, Nezu R, Doki Y, Eguchi H. Efficacy of Negative Pressure Wound Therapy Followed by Delayed Primary Closure for Abdominal Wounds in Patients with Lower Gastrointestinal Perforations: Multicenter Prospective Study. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:114-121. [PMID: 32743113 PMCID: PMC7390614 DOI: 10.23922/jarc.2019-043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
Objectives: The efficacy of negative pressure wound therapy (NPWT) and its application to severely contaminated wounds sustained during surgery remain to be established. Here, we evaluated the efficacy of utilizing NPWT until delayed primary closure (DPC) by assessing the infection rates in patients with lower gastrointestinal perforations. Methods: This prospective multicenter cohort study included 56 patients that underwent abdominal surgery for lower gastrointestinal perforations in eight institutions, from February 2016 to May 2017. All patients received NPWT after surgery before attempting DPC. The extent of peritonitis was categorized according to Hinchey's classification. Patients in stages II-IV were included. Results: Five patients had surgical site infections (SSIs) during NPWT and did not receive a DPC (9%). Of the 51 patients that received DPCs, 44 had no infection (91%) and 7 developed SSIs after the DPC (13.7%). For stages II, III, and IV, the SSI rates were 0%, 22.6%, and 35.7%, respectively; the median (range) times to wound healing were 15 (10-36), 19 (11-99), and 19 (10-53) days, respectively. There were no significant differences between the stages. Conclusions: NPWT followed by DPC resulted in low infection rates in each peritonitis stage. This approach appears promising as an alternative to traditional DPC alone for treating lower gastrointestinal perforations.
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Affiliation(s)
- Hirofumi Ota
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Digestive Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Katsuki Danno
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Minoh City Hospital, Minoh, Japan
| | - Katsuya Ohta
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Tae Matsumura
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Takamichi Komori
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Shu Okamura
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Miho Okano
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Kaizuka City Hospital, Kaizuka, Japan
| | - Atsuhiro Ogawa
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Tane General Hospital, Osaka, Japan
| | - Hiroshi Tamagawa
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Otemae Hospital, Osaka, Japan
| | - Mamoru Uemura
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chu Matsuda
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunekazu Mizushima
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirofumi Yamamoto
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Riichiro Nezu
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Yuichiro Doki
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetoshi Eguchi
- The Multi-Center Clinical Study Group of Osaka, Colorectal Cancer Treatment Group (MCSGO).,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Otterness K, J Singer A. Updates in emergency department laceration management. Clin Exp Emerg Med 2019; 6:97-105. [PMID: 30947489 PMCID: PMC6614056 DOI: 10.15441/ceem.18.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023] Open
Abstract
Lacerations are a common reason for patients to seek medical attention, and are often acutely managed in the emergency department. Recent studies pertaining to closure techniques, sedation and analgesia, advances in wound care, and various other topics have been published, which may enhance our understanding of this injury and improve our management practices. This article will review pertinent studies published in the past few years relevant to laceration management. Understanding the current literature and appreciating which areas warrant further investigation will help us optimize outcomes for patients who sustain laceration injuries.
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Affiliation(s)
- Karalynn Otterness
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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[Surgical treatment of bites]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:321-341. [PMID: 30209521 DOI: 10.1007/s00064-018-0563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. INDICATIONS Acute traumatic and late presented bite injuries. CONTRAINDICATIONS General contraindication for anesthesia or surgery. SURGICAL TECHNIQUE Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. POSTOPERATIVE MANAGEMENT Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. RESULTS Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
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Iheozor‐Ejiofor Z, Newton K, Dumville JC, Costa ML, Norman G, Bruce J. Negative pressure wound therapy for open traumatic wounds. Cochrane Database Syst Rev 2018; 7:CD012522. [PMID: 29969521 PMCID: PMC6513538 DOI: 10.1002/14651858.cd012522.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Traumatic wounds (wounds caused by injury) range from abrasions and minor skin incisions or tears, to wounds with extensive tissue damage or loss as well as damage to bone and internal organs. Two key types of traumatic wounds considered in this review are those that damage soft tissue only and those that involve a broken bone, that is, open fractures. In some cases these wounds are left open and negative pressure wound therapy (NPWT) is used as a treatment. This medical device involves the application of a wound dressing through which negative pressure is applied and tissue fluid drawn away from the area. The treatment aims to support wound management, to prepare wounds for further surgery, to reduce the risk of infection and potentially to reduce time to healing (with or without surgical intervention). There are no systematic reviews assessing the effectiveness of NPWT for traumatic wounds. OBJECTIVES To assess the effects of NPWT for treating open traumatic wounds in people managed in any care setting. SEARCH METHODS In June 2018 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 for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Published and unpublished randomised controlled trials that used NPWT for open traumatic wounds involving either open fractures or soft tissue wounds. Wound healing, wound infection and adverse events were our primary outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, extracted data, carried out a 'Risk of bias' assessment and rated the certainty of the evidence. Data were presented and analysed separately for open fracture wounds and other open traumatic wounds (not involving a broken bone). MAIN RESULTS Seven RCTs (1377 participants recruited) met the inclusion criteria of this review. Study sample sizes ranged from 40 to 586 participants. One study had three arms, which were all included in the review. Six studies compared NPWT at 125 mmHg with standard care: one of these studies did not report any relevant outcome data. One further study compared NPWT at 75 mmHg with standard care and NPWT 125mmHg with NPWT 75 mmHg.Open fracture wounds (four studies all comparing NPWT 125 mmHg with standard care)One study (460 participants) comparing NPWT 125 mmHg with standard care reported the proportions of wounds healed in each arm. At six weeks there was no clear difference between groups in the number of participants with a healed, open fracture wound: risk ratio (RR) 1.01 (95% confidence interval (CI) 0.81 to 1.27); moderate-certainty evidence, downgraded for imprecision.We pooled data on wound infection from four studies (596 participants). Follow-up varied between studies but was approximately 30 days. On average, it is uncertain whether NPWT at 125 mmHg reduces the risk of wound infection compared with standard care (RR 0.48, 95% CI 0.20 to 1.13; I2 = 56%); very low-certainty evidence downgraded for risk of bias, inconsistency and imprecision.Data from one study shows that there is probably no clear difference in health-related quality of life between participants treated with NPWT 125 mmHg and those treated with standard wound care (EQ-5D utility scores mean difference (MD) -0.01, 95% CI -0.08 to 0.06; 364 participants, moderate-certainty evidence; physical component summary score of the short-form 12 instrument MD -0.50, 95% CI -4.08 to 3.08; 329 participants; low-certainty evidence downgraded for imprecision).Moderate-certainty evidence from one trial (460 participants) suggests that NPWT is unlikely to be a cost-effective treatment for open fractures in the UK. On average, NPWT was more costly and conferred few additional quality-adjusted life years (QALYs) when compared with standard care. The incremental cost-effectiveness ratio was GBP 267,910 and NPWT was shown to be unlikely to be cost effective at a range of cost-per-QALYs thresholds. We downgraded the certainty of the evidence for imprecision.Other open traumatic wounds (two studies, one comparing NPWT 125 mmHg with standard care and a three-arm study comparing NPWT 125 mmHg, NPWT 75 mmHg and standard care)Pooled data from two studies (509 participants) suggests no clear difference in risk of wound infection between open traumatic wounds treated with NPWT at 125 mmHg or standard care (RR 0.61, 95% CI 0.31 to 1.18); low-certainty evidence downgraded for risk of bias and imprecision.One trial with 463 participants compared NPWT at 75 mmHg with standard care and with NPWT at 125 mmHg. Data on wound infection were reported for each comparison. It is uncertain if there is a difference in risk of wound infection between NPWT 75 mmHg and standard care (RR 0.44, 95% CI 0.17 to 1.10; 463 participants) and uncertain if there is a difference in risk of wound infection between NPWT 75 mmHg and 125 mmHg (RR 1.04, 95% CI 0.31 to 3.51; 251 participants. We downgraded the certainty of the evidence for risk of bias and imprecision. AUTHORS' CONCLUSIONS There is moderate-certainty evidence for no clear difference between NPWT and standard care on the proportion of wounds healed at six weeks for open fracture wounds. There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds. Moderate-certainty evidence means that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. It is uncertain whether there is a difference in risk of wound infection, adverse events, time to closure or coverage surgery, pain or health-related quality of life between NPWT and standard care for any type of open traumatic wound.
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Affiliation(s)
| | - Katy Newton
- North Western DeaneryGeneral Surgery4th Floor3 PiccadillyManchesterUKM1 3BN
| | - 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 HealthManchesterUKM13 9PL
| | - Matthew L Costa
- University of Oxford, John Radcliffe HospitalNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Kadoorie CentreHeadley WayOxfordOxfordshireUKOX3 9DU
| | - 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 HealthManchesterUKM13 9PL
| | - Julie Bruce
- University of WarwickWarwick Clinical Trials UnitGibbet Hill RdCoventryUKCV4 7AL
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von Beckerath O, Zapenko A, Dissemond J, Kröger K. Ten-year analyses of the German DRG data about negative pressure wound therapy. Int Wound J 2016; 14:501-507. [PMID: 27374835 DOI: 10.1111/iwj.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 12/17/2022] Open
Abstract
Exact data regarding the clinical role of negative pressure wound therapy (NPWT) for wound care in a specific country are not available. Thus, we analysed the use of NPWT in hospitalised patients in Germany. Detailed lists of all hospitalised cases treated with NPWT in Germany for each of the years from 2005 to 2014 were obtained from the Federal Statistical Office, as well as lists of the 15 most frequent principal and additional diagnoses documented with NPWT in 2014. Within the 10-year time period of the study, the number of cases treated with NPWT increased by 349%, from 37 053 in 2005 to 129 269 in 2014. The rate of all hospitalised cases treated with NPWT increased form 0·22% to 0·66% in Germany. In 2014, wounds affecting skin and subcutaneous tissue (5-916.a0) are the most frequent documented indication for NPWT followed by deep wounds involving bones and joints at the limbs (5-916.a1). Open abdomens (5-916.a3) count for higher numbers than deep wounds of the thorax, mediastinum and sternum (5-916.a2). Fifty percent of all cases hospitalised for stage IV pressure ulcers at sacrum or ischium and around one third (32.2%) of cases with pyothorax received NPWT. Every fourth to fifth case hospitalised for disruption of surgical wounds or infections following a procedure (24·1%), as well as for infections and inflammations because of internal joint prosthesis or because of an internal fixation device was treated with NPWT (22·9%). In cases with diabetic foot syndrome, it is still every tenth case (10·1%). This analysis shows a substantial increase in the use of NPWT in the last decade for hospitalised patients. NPWT has a fixed role in the treatment of stage IV pressure ulcers at sacrum or ischium, pyothorax, infection and inflammation because of internal joint prosthesis or an internal fixation device and diabetic foot syndrome.
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Affiliation(s)
- Olga von Beckerath
- Department of Vascular Medicine, HELIOS Klinik Krefeld GmbH, Krefeld, Germany
| | - Alexander Zapenko
- Department of Vascular Medicine, HELIOS Klinik Krefeld GmbH, Krefeld, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Knut Kröger
- Department of Vascular Medicine, HELIOS Klinik Krefeld GmbH, Krefeld, Germany
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