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Lin B, Zhang H, Sun S, Lin C, Chi Y. Application and Prognostic Analysis of Vacuum Sealing Drainage in the Incision Infection in Patients With Stage II-III Colorectal Cancer. Am Surg 2024:31348241265133. [PMID: 39030681 DOI: 10.1177/00031348241265133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
INTRODUCTION This study aims to explore the application value of vacuum sealing drainage (VSD) technology in the treatment of incision infection dehiscence after surgery in patients with stage II-III colorectal cancer and analyze its impact on prognosis. METHODS This retrospective study included patients who experienced incision infection dehiscence after surgery for colorectal cancer between February 2014 and August 2019. Clinical and pathological data, short-term outcomes, and long-term outcomes were compared between the traditional group and the VSD group. RESULTS A total of 97 patients were included in this study. There was no significant difference in clinical and pathological data between the traditional group and the VSD group (P > 0.05). The VSD group had fewer dressing changes, lower pain scores during dressing changes, and better granulation tissue growth grading than the traditional group, with statistical significance (P < 0.05). The VSD group started adjuvant chemotherapy earlier and had a higher proportion of ≥4 cycles of chemotherapy. The three-year overall survival rate in the VSD group was better than the traditional group, but the difference was not statistically significant (P > 0.05). CONCLUSION The application of VSD technology can promote granulation tissue growth, accelerate incision healing, and facilitate patients to complete subsequent adjuvant chemotherapy. However, further verification of its long-term impact on prognosis requires longer-term follow-up results.
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Affiliation(s)
- Bao Lin
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Hongjian Zhang
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Shijie Sun
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Changqing Lin
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
| | - Yuanlong Chi
- Department of Gastrointestinal Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China
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Allen D, Mann S, Robinson T, Schmidt M, Kieswetter K. Preclinical Assessments of a Novel Peel and Place Extended-Wear Negative-Pressure Wound Therapy Dressing for up to 35 Days in a Porcine Model. Adv Wound Care (New Rochelle) 2024; 13:291-307. [PMID: 38205649 DOI: 10.1089/wound.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Objective: While the use of negative pressure wound therapy (NPWT) with reticulated open cell foam (ROCF) is well established, the characteristics of ROCF do not allow for extended-wear use. There is the potential for dressing tissue ingrowth if left in place for greater than the recommended 2-3 days. An easy to use, novel peel and place dressing has been designed for extended wear with the wound management advantages of ROCF while alleviating the challenges of tissue ingrowth. Approach: Paraspinal, full-thickness or deep muscle excisional wounds were created in 11 and 2 swine, respectively, dressings applied with continuous negative pressure at -125 mmHg, and dressings changed weekly. Full-thickness excisional wounds were treated for 13 days and deep muscle wounds for 35 days. Wound dimensions were assessed. Granulation tissue thickness and re-epithelialization were measured via digital morphometry. Tissue quality, fibrinous material prevalence, and dressing removal peel force were analyzed. Results: The peel and place dressing substantially reduces dressing tissue ingrowth, is easy to remove with markedly low dressing peel force and promotes more granulation tissue at day 13 than ROCF with an interface layer. The extended-wear peel and place dressing, when applied to deep muscle wounds with weekly dressing changes, was applied for a total of 35 days. Successful wound closure was evident without any negative impact on wound healing. Innovation: This study assessed the wound management capabilities of an extended-wear peel and place NPWT dressing used until wound closure. Conclusion: The peel and place dressing is a suitable extended-wear NPWT dressing.
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Affiliation(s)
- Diwi Allen
- Medical Solutions Division, 3M Health Care, San Antonio, Texas, USA
| | - Samantha Mann
- Medical Solutions Division, 3M Health Care, San Antonio, Texas, USA
| | - Timothy Robinson
- Medical Solutions Division, 3M Health Care, San Antonio, Texas, USA
| | - Marisa Schmidt
- Medical Solutions Division, 3M Health Care, San Antonio, Texas, USA
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Bhardwaj H, Joshi R, Gupta A. Updated Scenario on Negative Pressure Wound Therapy. INT J LOW EXTR WOUND 2024:15347346241228788. [PMID: 38327069 DOI: 10.1177/15347346241228788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Negative pressure wound therapy (NPWT) is a widely used and effective treatment for managing complex wounds. This document discusses how NPWT can be used in wound care in an updated way. The updated scenario on NPWT provides a concise overview of the current state of NPWT and its implications in clinical practice. It highlights recent developments in NPWT, as well as the advancements in this field. As part of NPWT, vacuum-assisted closure is used and negative pressure is applied to the wound bed. It discusses the key components and mechanisms. In addition to improving wound healing, NPWT also reduces infection rates and improves patient comfort, among other benefits. In addition, this document discusses the specific indications and contraindications of NPWT, as well as the types of wounds that can be treated with NPWT, including diabetic foot ulcers, pressure ulcers, and traumatic wounds. The document emphasizes the importance of choosing patients appropriately and assessing wounds to ensure optimal outcomes. In addition, it provides evidence-based guidelines and clinical recommendations on NPWT. In addition to reviewing the latest research findings supporting NPWT in a variety of clinical settings, it also discusses randomized controlled trials and systematic reviews. In addition, it discusses the potential complications and challenges associated with NPWT, including pain, bleeding, and device malfunction. The purpose of this document is to shed light on the role of NPWT in wound care management by providing an updated scenario. NPWT can be incorporated into clinical practice by healthcare professionals if they understand its principles, benefits, indications, and limitations. Healthcare providers can optimize patient outcomes and improve wound healing in diverse patient populations by staying abreast of the latest advancements in NPWT.
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Affiliation(s)
- Harish Bhardwaj
- University Institute of Pharmacy, Pt.Ravishankar Shukla University, Raipur, India
| | - Renjil Joshi
- Rungta College of Pharmaceutical Sciences and Research Bhilai, Kohka-Kurud, Chhatisgarh, India
| | - Anshita Gupta
- Rungta College of Pharmaceutical Sciences and Research Nandanvan, Raipur, Chhattisgarh, India
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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Allen D, Robinson T, Schmidt M, Kieswetter K. Preclinical assessment of novel longer-duration wear negative pressure wound therapy dressing in a porcine model. Wound Repair Regen 2023; 31:349-359. [PMID: 37074154 DOI: 10.1111/wrr.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
While reticulated open cell foam (ROCF) is a well-established dressing for negative pressure wound therapy (NPWT), there is the known potential for granulation tissue ingrowth if left in place for longer than 72 h. This may cause wound bed disruption, bleeding, and pain upon dressing removal. In addition, any retained foam fragments may elicit an adverse tissue reaction. A novel, easy to use dressing designed to utilise the advantages of ROCF while addressing its challenges has recently been created. This 7 day study investigated the utility of a novel NPWT dressing under longer-duration wear circumstances while assessing the prevalence of tissue ingrowth and ease of dressing removal in full-thickness excisional wounds utilising a porcine model. Histopathology and morphometry evaluations indicated thicker granulation tissue with, depending on the parameters assessed, either comparable or better tissue quality for wounds treated with the novel dressing. Greater re-epithelialization levels were also evident compared with ROCF. Three-dimensional imaging analysis indicated faster wound fill with a corresponding decrease in wound area with the novel dressing. Furthermore, tissue ingrowth was limited to only ROCF-treated wounds, which was not unexpected in this longer-duration wear study. The force required to remove the novel dressing was considerably lower compared with ROCF, correlating to the tissue ingrowth results. Results of this study illustrate that the novel dressing provided more favourable wound healing results compared with traditional ROCF. In addition, reduction in the risk of tissue ingrowth and low dressing peel force may allow it to be used as a longer-wear dressing.
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Affiliation(s)
- Diwi Allen
- Medical Solutions Division, 3M Company, San Antonio, Texas, USA
| | | | - Marisa Schmidt
- Medical Solutions Division, 3M Company, San Antonio, Texas, USA
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Kuenlen A, Waked K, Eisenburger M, Oramary A, Alsherawi A, Ninkovic M. Influence of VAC Therapy on Perfusion and Edema of Gracilis Flaps: Prospective Case-control Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4964. [PMID: 37124381 PMCID: PMC10145892 DOI: 10.1097/gox.0000000000004964] [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: 01/25/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Abstract
The gracilis muscle flap is a popular choice in reconstructive surgery to repair soft tissue defects or for functional restoration. Little is known on the influence of postoperative application of VAC (vacuum-assisted closure; Kinetic Concepts Inc., San Antonio, Tex.) therapy on perfusion and postoperative flap edema of free gracilis muscle flaps. Methods In total, 26 patients with soft tissue defects of lower extremity underwent gracilis muscle flap reconstruction. The study group (VAC, n = 13) was supplied with postoperative negative pressure therapy as a dressing; the control group (NVAC, n = 13) was supplied with conventional fat gauze dressing. Postoperative measurements of micro- and macroperfusion were performed intraoperatively, on postoperative day (POD) 3 and POD 5. Flap edema measurement was performed intraoperatively, on POD 5 and 2 weeks after operation. Results The VAC group showed significantly better macroflow during intraoperative VAC treatment, as well on POD 3 and POD 5. Venous outflow was also better with lower hemoglobin levels. Microflow was better in the NVAC group with higher measured oxygen levels. All gracilis muscle flaps of the VAC group showed significantly less flap edema compared with the control group. Conclusions VAC application on free gracilis muscle flaps leads to significantly less postoperative flap edema, improved arterial macroflow, and improved venous outflow. VAC therapy can be used without any danger for patient's safety, as flap survival is not endangered, and presents an easy to handle and pleasant dressing regimen for nursing staff and patients.
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Affiliation(s)
- Anian Kuenlen
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michael Eisenburger
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Alan Oramary
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Abeer Alsherawi
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
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Shrateh ON, Jobran AWM, Adwan R, Al-Maslamani Z, Tarifi A. Successful management of extensive stage four sacral pressure ulcer in a paraplegic patient: A case report. Int J Surg Case Rep 2023; 105:107990. [PMID: 36934652 PMCID: PMC10033982 DOI: 10.1016/j.ijscr.2023.107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Pressure ulcers (known as pressure injuries) occur when a bony prominence, such as the sacrum, is subjected to prolonged pressure and can result in soft tissue injury. Continuous and attentive repositioning is necessary to prevent and cure pressure-induced wounds. CASE PRESENTATION A 49-year-old patient who presented to the hospital with a case of paraplegia post spinal injury due to Road Traffic Accident, with a huge infected sacral bed sore and complaints of generalized weakness and fever. His ulcer was 15 cm ∗ 15 cm ∗ 8 cm, grade 4. He underwent flap reconstruction, was post-operatively transferred into the ward, and started on IV antibiotics and analgesia. The flap is well vascularized with no signs of infection or dehiscence. CLINICAL DISCUSSION Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue. However, operational care in more severe cases or to encourage patient satisfaction may be necessary. CONCLUSION The bilobed flap is the best technique for healing sacral pressure ulcers. It has a plentiful supply of blood. The layout is uncomplicated and straightforward. The fact that it has a low risk of complications is crucial. It ought to be taken into account as a component of the local flap arsenal for sacral pressure ulcers.
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Affiliation(s)
- Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | | - Rabee Adwan
- Deparment of Infectious Diseases, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine
| | - Zeyad Al-Maslamani
- Department of General Surgery, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine.
| | - Ayman Tarifi
- Department of General Surgery, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine.
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Huang T, Liu T, Shang M, Han G. Clinical application of improved VSD and VSD in the treatment of SSI after abdominal surgery: A retrospective randomized clinical study. Medicine (Baltimore) 2023; 102:e32785. [PMID: 36820532 PMCID: PMC9907897 DOI: 10.1097/md.0000000000032785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
By comparing the efficacy and cost of improved vacuum-sealing drainage devices and vacuum-sealing drainage (VSD) devices in the treatment of postoperative abdominal surgical site infection, the clinical applicability and promotion of improved vacuum-sealing drainage devices were assessed. In our institution, between October 2019 and December 2021, 55 patients with surgical site infection after abdominal surgery were retrospectively analyzed, including 30 patients treated with improved VSD and 25 patients treated with VSD. The efficacy of wound healing, total dressing change cost throughout therapy, total hospital costs, hospital days, and bacterial culture results of wound secretions before and after treatment were compared between the 2 groups. Both groups achieved wound healing following vacuum sealing-drainage treatment, with no significant differences in wound healing time or secondary suture rate. However, the total hospitalization and dressing change costs in the improved VSD group were significantly lower than those in the VSD group. Similar to VSD, improved VSD is effective in the treatment of surgical site infections after abdominal surgery. Compared with VSD, the improved VSD device has lower dressing change costs and total hospitalization costs during the treatment process. The improved VSD has a wide range of applications and is suitable for clinical use and promotion.
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Affiliation(s)
- Tao Huang
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Qingshan District, Wuhan, Hubei, China
| | - Tong Liu
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Nanguan District, Changchun, Jilin, China
| | - Mei Shang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Nanguan District, Changchun, Jilin, China
| | - Gang Han
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Nanguan District, Changchun, Jilin, China
- * Correspondence: Gang Han, Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun, Jilin, China (e-mail: )
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Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A systematic review and meta-analysis. Surgery 2022; 172:949-954. [PMID: 35779950 DOI: 10.1016/j.surg.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wound complications are a common cause of postoperative morbidity and incur significant healthcare costs. Recent studies have shown that negative pressure wound dressings reduce wound complication rates, particularly surgical site infections, after elective laparotomies. The clinical utility of prophylactic negative pressure wound dressings for closed emergency laparotomy incisions remains controversial. This meta-analysis investigated the rates of wound complications after emergency laparotomy when a negative pressure wound dressing was applied. METHODS A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Cochrane Registry, Web of Science, and Clinialtrials.gov databases were searched from January 1, 2005, to April 1, 2022. All studies comparing negative pressure wound dressings to standard dressings on closed emergency laparotomy incisions were included. RESULTS A total of 1,199 (negative pressure wound dressings: 566, standard dressing: 633) patients from 7 (prospective: 4, retrospective: 3) studies were identified. Overall, the surgical site infection (superficial/deep) rate was 13.6% (77/566) vs 25.1% (159/633) in the negative pressure wound dressing versus standard dressing groups, respectively (odds ratio 0.43, 95% confidence interval 0.30-0.62). Wound breakdown (skin/fascial dehiscence) was significantly lower in the negative pressure wound dressing (7.7%) group compared to the standard dressing (16.9%) group (odds ratio 0.36, 95% confidence interval 0.19-0.72). The incidence of overall wound complications was significantly lower in the negative pressure wound dressing (15.9%) group compared to the standard dressing (30.4%) group (odds ratio 0.41, 95% confidence interval 0.28-0.59). No significant differences were found in hospital length-of-stay and readmission rates. CONCLUSION Prophylactic negative pressure wound dressings for closed emergency laparotomy incisions were associated with a significant reduction in surgical site infections, wound breakdown, and overall wound complications, thus supporting its clinical use.
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Torretta A, Kaludova D, Roy M, Bhattacharya S, Valente R. Simultaneous early surgical repair of post-cholecystectomy major bile duct injury and complex abdominal evisceration: A case report. Int J Surg Case Rep 2022; 94:107110. [PMID: 35658286 PMCID: PMC9093007 DOI: 10.1016/j.ijscr.2022.107110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/16/2022] [Accepted: 04/16/2022] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Major bile duct injuries (BDIs) are hazardous complications during 0.4%-0.6% of laparoscopic cholecystectomies. Major BDIs usually require surgical repair, ideally either immediately or at least six weeks after the damage. The complexity of our case lies in the coexistence of early BDI followed by 2-week biliary peritonitis with massive midline evisceration which, in combination, has over 40% mortality risk. METHODS & CASE REPORT We describe the case of a 65-year-old male, transferred to our tertiary HPB service on day 14 after common bile duct complete transection during cholecystectomy and postoperative laparotomy. The patient presented with biliary peritonitis along with full wound dehiscence and extensive evisceration. During emergency peritoneal wash-out surgery we deemed immediate BDI repair feasible by primary Roux-en-Y hepaticojejunostomy (HJ), with multi-stage abdominal closure. In the following days we performed progressive abdominal wall closure in multiple sessions under general anesthesia, aided by vacuum-assisted wound closure and intraperitoneal mesh-mediated fascial traction-approximation (VAWCM) with permeable mesh. An expected late incisional hernia was eventually repaired through component separation and biological mesh. DISCUSSION & CONCLUSION The simultaneous use of Roux-en-Y HJ and VAWCM has proven safe and effective in the treatment of BDI and 2-week biliary peritonitis with massive midline evisceration.
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Affiliation(s)
- Alfredo Torretta
- Department of General Surgery, "Val Vibrata" Hospital, ASL Teramo, Italy; HPB Surgery Service, Barts and the London Centre, Barts Health NHS Trust, London, UK
| | - Dimana Kaludova
- HPB Surgery Service, Barts and the London Centre, Barts Health NHS Trust, London, UK.
| | - Mayank Roy
- HPB Surgery Service, Barts and the London Centre, Barts Health NHS Trust, London, UK
| | - Satya Bhattacharya
- HPB Surgery Service, Barts and the London Centre, Barts Health NHS Trust, London, UK.
| | - Roberto Valente
- HPB Surgery Service, Barts and the London Centre, Barts Health NHS Trust, London, UK; Department of Surgery and Interventional Science, University College London, UK; Department of Surgery, Ospedale Policlinico San Martino Genova, Italy.
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Erratico S, Belicchi M, Meregalli M, Di Silvestre D, Tripodi L, De Palma A, Jones R, Ferrari E, Porretti L, Trombetta E, Merlo GR, Mauri P, Torrente Y. Effective high-throughput isolation of enriched platelets and circulating pro-angiogenic cells to accelerate skin-wound healing. Cell Mol Life Sci 2022; 79:259. [PMID: 35474498 PMCID: PMC9042989 DOI: 10.1007/s00018-022-04284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Delayed wound healing and chronic skin lesions represent a major health problem. Over the past years, growth factors mediated by platelet-rich plasma (PRP) and cell-based therapies were developed as effective and affordable treatment able to improve wound healing capacity. We have advanced existing concepts to develop a highly efficient high-throughput protocol with proven application for the isolation of PRP and pro-angiogenic cells (AngioPRP). This protocol outlines the effectiveness of AngioPRP in promoting the critical healing process including wound closure, re-epithelialization, granulation tissue growth, and blood vessel regeneration. We coupled this effect with normalization of mechanical properties of rescued mouse wounds, which is sustained by a correct arrangement of elastin and collagen fibers. Proteomic analysis of treated wounds demonstrated a fingerprint of AngioPRP based on the up-regulation of detoxification pathway of glutathione metabolism, correlated to a decrease in inflammatory response. Overall, these results have enabled us to provide a framework for how AngioPRP supports wound healing, opening avenues for further clinical advances.
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Affiliation(s)
| | - Marzia Belicchi
- Unit of Neurology, Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, via Francesco Sforza 35, 20122, Milan, Italy
| | - Mirella Meregalli
- Unit of Neurology, Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, via Francesco Sforza 35, 20122, Milan, Italy
| | - Dario Di Silvestre
- Institute of Technologies in Biomedicine, National Research Council (ITB-CNR), Via Fratelli Cervi, 93, Segrate, 20090, Milan, Italy
| | - Luana Tripodi
- Novystem Spa, viale Piave 21, 20129, Milan, Italy.,Unit of Neurology, Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, via Francesco Sforza 35, 20122, Milan, Italy
| | - Antonella De Palma
- Institute of Technologies in Biomedicine, National Research Council (ITB-CNR), Via Fratelli Cervi, 93, Segrate, 20090, Milan, Italy
| | - Rebecca Jones
- Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126, Turin, Italy
| | - Emanuele Ferrari
- Institute of Technologies in Biomedicine, National Research Council (ITB-CNR), Via Fratelli Cervi, 93, Segrate, 20090, Milan, Italy
| | - Laura Porretti
- Flow Cytometry Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122, Milan, Italy
| | - Elena Trombetta
- Flow Cytometry Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122, Milan, Italy
| | - Giorgio R Merlo
- Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126, Turin, Italy
| | - Pierluigi Mauri
- Institute of Technologies in Biomedicine, National Research Council (ITB-CNR), Via Fratelli Cervi, 93, Segrate, 20090, Milan, Italy
| | - Yvan Torrente
- Unit of Neurology, Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, via Francesco Sforza 35, 20122, Milan, Italy.
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Abstract
This article summarizes the current views and proposed approaches to treating soft tissue defects of the hand. The article also outlines some key considerations of digital reconstruction. There are many options in treating soft tissue defects. For defects of the hand, local flaps are primarily considered if the defects are small or moderate in size. A vascularized free flap is only considered for a defect of large size (3 cm long or larger). Thumb reconstruction is of primary importance, while reconstruction of two fingers is necessary when all fingers are lost. Reconstructions of a missing distal part of a finger or reconstruction of an entire finger if only one finger is lost are cosmetic restorations; functionally these defects do not need reconstruction. Sensation is of great importance in repair or reconstruction of the tip of the thumb or finger. Therefore, sensory evaluation is a key factor in assessing and selecting the best options of surgery.
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Affiliation(s)
- Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - David Elliot
- St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
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Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, Hortal J, Lasso J, Mestres CA, Miró JM, Navas E, Nieto M, Parra A, Pérez de la Sota E, Rodríguez-Abella H, Rodríguez-Créixems M, Rodríguez-Roda J, Sánchez Espín G, Sousa D, Velasco García de Sierra C, Muñoz P, Kestler M. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections ( SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery ( SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases ( CIBERES). J Clin Med 2021; 10:5566. [PMID: 34884268 PMCID: PMC8658224 DOI: 10.3390/jcm10235566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | | | - Juan Gálvez
- Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Francisco Gutiérrez-Díez
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | - Javier Hortal
- Anesthesia and Intensive Care Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - José Lasso
- Plastic Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Carlos A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - José M. Miró
- Infectious Diseases Services, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Enrique Navas
- Infectious Diseases Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
| | - Mercedes Nieto
- Cardiovascular Unit, Intensive Care Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Antonio Parra
- Department of Radiology, Marquez de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | | | - Hugo Rodríguez-Abella
- Cardiac Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Marta Rodríguez-Créixems
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | - Gemma Sánchez Espín
- Heart Clinical Management Unit, Virgen de la Victoria University Hospital, 29006 Malaga, Spain;
| | - Dolores Sousa
- Infectious Diseases Department, A Coruña Hospital Complex, 15006 A Coruña, Spain;
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | - Martha Kestler
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
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Liu W, Gu W, Jin X, Wang J. Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China. Infect Drug Resist 2021; 14:4091-4096. [PMID: 34675554 PMCID: PMC8502109 DOI: 10.2147/idr.s334203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Surgical drainage is an essential part of treatment for deep neck infections (DNIs) or deep neck multiple-space infections (DNMIs). With the emergence and application of new technologies and new materials, vacuum-assisted closure (VAC) in the treatment of DNMIs has been reported. However, reports on the timing of VAC placement are limited. Herein, we compared simultaneous versus staged VAC placement in the treatment of DNMIs. Patients and Methods Medical data from 24 patients with DNMIs who had received VAC treatment in the last five years were analyzed. The patients were classified into a simultaneous VAC placement group (11 patients) and a staged VAC placement group (13 patients) according to the timing of VAC placement when incision and drainage were performed. Results No differences in baseline characteristics were found between the two groups. All patients in the two groups survived and recovered. The hospitalization duration (days), time to wound healing (days), number of debridement procedures, and disease course (days) in the simultaneous VAC placement group and staged VAC placement group were 10 (4–18) and 22 (8–35), 21 (4–39) and 50 (9–86), one (1–2) and two (1–4), and 31.5 (11–49) and 56 (19–98), respectively. The results in the simultaneous VAC placement group were better than those in the staged VAC placement group (P = 0.001, 0.016, 0.045, and 0.016, respectively). The numbers of VAC sponge changes in the simultaneous VAC placement group and staged VAC placement group were two (1–2) and two (1–4), respectively, with no statistically significant difference (P = 0.336). Conclusion Simultaneous VAC placement during incision and drainage may shorten the wound healing time, hospitalization duration, and disease course and may reduce the number of debridement procedures.
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Affiliation(s)
- Weijiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital Pinggu Campus, Capital Medical University, Beijing, People's Republic of China
| | - Wei Gu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaofeng Jin
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Haidari S, IJpma FFA, Metsemakers WJ, Maarse W, Vogely HC, Ramsden AJ, McNally MA, Govaert GAM. The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7742227. [PMID: 34722772 PMCID: PMC8548908 DOI: 10.1155/2021/7742227] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI. METHODS A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale. RESULTS After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens. CONCLUSION This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed.
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Affiliation(s)
- Susan Haidari
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, Groningen, Netherlands
| | | | - Wies Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - H. Charles Vogely
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alex J. Ramsden
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Bone Infection Unit, Nuffield Orthopedic Centre, Oxford, UK
| | | | - Geertje A. M. Govaert
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
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Logan J, Scott G, Peake C, Watson JJ, Jose R. Topical Negative Pressure Wound Dressing and Its Applications in the Hand—A Review of the Literature. J Hand Microsurg 2021; 14:276-283. [DOI: 10.1055/s-0041-1729467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractThe use of topical negative pressure wound therapy (NPWT) has become increasingly popular in the management of complex wounds. There are many theories as to the mechanism of action of NPWT, but the essential components of the various systems remain consistent. There are many attractive potential properties of negative pressure dressings that lend themselves to the management of upper limb injuries. This article explores the technique of negative pressure wound dressing, the theories pertaining to mechanism of action, and the increasingly broad indications described for the use of NPWT in the hand. The literature pertaining to the efficacy of NPWT in general is also discussed.
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Affiliation(s)
- James Logan
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Georgia Scott
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Christopher Peake
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jay James Watson
- Department of Trauma and Orthopedics, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Rajive Jose
- Department of Hand Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. ROFO-FORTSCHR RONTG 2021; 194:384-390. [PMID: 34649288 DOI: 10.1055/a-1586-3652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Lymphoceles often occur within several weeks or even months after surgery. Mostly asymptomatic and therefore undiagnosed, they may be self-healing without any treatment. A small percentage of postoperative lymphoceles are symptomatic with significant pain, infection, or compression of vital structures, thus requiring intervention. Many different treatment options are described in the literature, like drainage with or without sclerotherapy, embolization of lymph vessels, and surgical approaches with laparoscopy or laparotomy. Inspired by reports stating that postoperative suction drainage can prevent the formation of lymphoceles, we developed a simple protocol for vacuum-assisted drainage of symptomatic lymphoceles, which proved to be successful and which we would therefore like to present. MATERIALS AND METHOD Between 2008 and 2020, 35 patients with symptomatic postoperative lymphoceles were treated with vacuum-assisted suction drainage (in total 39 lymphoceles). The surgery that caused lymphocele formation had been performed between 8 and 572 days before. All lymphoceles were diagnosed based on biochemical and cytologic findings in aspirated fluid. The clinical and imaging data were collected and retrospectively analyzed. RESULTS In total, 43 suction drainage catheters were inserted under CT guidance. The technical success rate was 100 %. One patient died of severe preexisting pulmonary embolism, sepsis, and poor conditions (non-procedure-related death). In 94.8 % of symptomatic lymphoceles, healing and total disappearance could be achieved. 4 lymphoceles had a relapse or dislocation of the drainage catheter and needed a second drainage procedure. Two lymphoceles needed further surgery. The complication rate of the procedure was 4.6 % (2/43, minor complications). The median indwelling time of a suction drainage catheter was 8-9 days (range: 1-30 days). CONCLUSION The positive effects of negative pressure therapy in local wound therapy have been investigated for a long time. These positive effects also seem to have an impact on suction drainage of symptomatic lymphoceles with a high cure rate. KEY POINTS · Suction drainage of lymphoceles is an easy and successful method to cure symptomatic lymphoceles at various locations.. · We believe this to be due to the induction of cavity collapse and surface adherence.. · In most cases rapid clinical improvement could be obtained.. CITATION FORMAT · Franke M, Saager C, Kröger J et al. Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1586-3652.
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Ezanno AC, Fougerousse AC, Guillem P. The role of negative-pressure wound therapy in the management of axillary hidradenitis suppurativa. Int Wound J 2021; 19:802-810. [PMID: 34590422 PMCID: PMC9013599 DOI: 10.1111/iwj.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Anne-Cecile Ezanno
- Department of Gastrointestinal and Endocrine Surgery, Bégin Military Hospital, Saint-Mandé, France
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19
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Tong Y, Yu S, Guo K, Wang X, Wu Y, Xia Z, Li G, Hu H, Yu M, Zhu Z. First known case of successful pressure ulcer treatment in a lung transplant patient with post-COVID-19 pneumonia. J Wound Care 2021; 30:594-597. [PMID: 34382848 DOI: 10.12968/jowc.2021.30.8.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases.
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Affiliation(s)
- Yilan Tong
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sijiong Yu
- Beijing University of Agriculture, Animal Science and Technology College, China
| | - Kaijun Guo
- Beijing University of Agriculture, Animal Science and Technology College, China
| | - Xiangsheng Wang
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Wu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guang Li
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Haifeng Hu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mosheng Yu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhanyong Zhu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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20
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Moog P, Jensch M, Betzl J, Bauer AT, Cerny MK, Schmauss D, Kükrek H, Erne H, Machens HG, Megerle K. Bacterial bioburden of wounds: influence of debridement and negative-pressure wound therapy (NPWT). J Wound Care 2021; 30:604-611. [PMID: 34382852 DOI: 10.12968/jowc.2021.30.8.604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To clarify the role of microbiological swabs in surgical decision-making, we investigated the effect of negative-pressure wound therapy (NPWT) and serial surgical debridement on bacterial bioburden in hard-to-heal wounds and ultimately correlated them with the success of surgical closure. METHOD All patients were treated with surgical debridement, jet lavage and NPWT before their wounds were finally closed. The treatment effect was assessed by correlating microbiological swabs obtained immediately after intervention with those obtained after removal of the dressings during the following surgical procedures. The result of the last microbiological swab taken before definitive surgical closure was correlated with the requirement for revision surgery. RESULTS We included the results of 704 microbiological swabs from 97 patients in 110 wound localisations in this monocentric, retrospective study. NPWT did not improve bacterial bioburden in 77% of cases and the duration of NPWT did not affect the result. Furthermore, no significant effect of NPWT could be found for either anaerobic (p=0.96) or aerobic bacteria (p=0.43). In contrast, surgical debridement decreased bacterial load in approximately 60% of cases. If sterile wound swabs could be obtained at all, it was during the first four surgical debridements in 60% of patients; after that only 10% became sterile. CONCLUSIONS Sterile microbiological wound swabs before surgical closure were associated with lower rates of revision surgery, while low or medium bacterial loads did not increase revision rates.
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Affiliation(s)
- Philipp Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Maryna Jensch
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Julia Betzl
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Anna-Theresa Bauer
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Michael K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Daniel Schmauss
- Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Haydar Kükrek
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Holger Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Hans-Günther Machens
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Kai Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
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Liu Q, He F, Zhou P, Xie M, Wang H, Yang H, Huo W, Zhang M, Yu S, Wang M. HMGB2 promotes chondrocyte proliferation under negative pressure through the phosphorylation of AKT. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2021; 1868:119115. [PMID: 34333060 DOI: 10.1016/j.bbamcr.2021.119115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022]
Abstract
Cells in articular cartilage are zonal arranged. Cells in superficial zone cartilage are generally small and proliferative. Appropriate negative pressure stimulation is beneficial to cell survival and tissue repair. Whether negative pressure has promotive impact on the proliferation activity of the superficial zone chondrocytes is of interest. In this study, we isolated superficial chondrocytes from the mandibular condylar cartilage of rats. After negative pressure treatment, the cells were collected for RNA-sequencing, quantitative real-time PCR and western blotting assays, aiming to detect the proliferative responses of chondrocytes to negative pressure and explore the potential molecular mechanisms. Data from RNA-sequencing analysis indicated that the superficial chondrocytes responded to the 4 h -10 kPa treatment by a significant increase in proliferation. In addition, the expression of high-mobility group box 2 (HMGB2) and the phosphorylation of AKT were obviously promoted. Knockdown of HMGB2 decreased AKT phosphorylation and diminished the negative pressure-induced proliferation of chondrocytes, as shown by decreased expression of Ki67 and cyclin-dependent kinase 6 (CDK6). In contrast, overexpression of HMGB2 enhanced AKT phosphorylation and further promoted proliferative activity. Moreover, LY294002, an AKT inhibitor, suppressed the proliferative activity of chondrocytes under negative pressure, while SC79, an activator of AKT phosphorylation, enhanced the proliferation of chondrocytes. Our data demonstrated that HMGB2 exhibits a promotion impact on chondrocyte proliferation under negative pressure via the phosphorylation of AKT. These results provide a new perspective for superficial zone chondrocytes proliferation under negative pressure, which should be benefit for cartilage regeneration.
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Affiliation(s)
- Qian Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Feng He
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Peng Zhou
- School of Stomatology, the Jiamusi University, Jiamusi, China
| | - Mianjiao Xie
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Helin Wang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases, Department of Medical Rehabilitation, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Hongxu Yang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Wanqiu Huo
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Mian Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Shibin Yu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Meiqing Wang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Department of Oral Anatomy and Physiology and TMD, School of Stomatology, the Fourth Military Medical University, Xi'an, China.
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22
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Haspeslagh M, Van Hecke LL, Hermans K, Chiers K, Pint E, Wilmink JM, Martens AM. Limited added value of negative pressure wound therapy compared with calcium alginate dressings for second intention healing in a noncontaminated and contaminated equine distal limb wound model. Equine Vet J 2021; 54:592-600. [PMID: 34115409 DOI: 10.1111/evj.13487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/18/2021] [Accepted: 05/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distal limb wounds in horses often show aberrant healing due to a slow inflammatory response. In human medicine, negative pressure wound therapy (NPWT) is used for the treatment of chronic wounds with a similar inflammatory response. OBJECTIVES To compare the effect of NPWT to calcium alginate dressings on the healing of (non) contaminated equine distal limb wounds. STUDY DESIGN Controlled experiment. METHODS Circular wounds were created on the left and right dorsomedial metacarpus of 10 horses. In five horses, the wounds were contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. In all horses, one limb was treated with NPWT, the other with calcium alginate dressings. Treatments were applied during nine days for noncontaminated wounds and six days for contaminated wounds. Noninvasive (clinical assessment, bacteriology swabs, thermographic images and wound dimensions) and invasive (biopsies for histology and growth factor analysis) measurements were taken regularly for 71 and 29 days respectively. Effects of selected parameters on continuous dependent variables were analysed using ANOVA, while for discrete dependent variables, logistic regression was applied. RESULTS In noncontaminated wounds, there was significantly less wound retraction in the early healing stages when treated with NPWT (mean difference [95% CI] = 19.2% [13.3%-25.1%]; P = .005), although wound size was not significantly different between NPWT and control wounds at later healing stages. Noncontaminated control wounds had a significantly higher neutrophil influx (OR [95% CI] = 1.99 [1.49-2.66]; P < .001) and lower macrophage influx (OR [95% CI] = 0.75 [0.60-0.93]; P = .008) compared with NPWT-treated wounds. Bacterial load and the presence of growth factors did not differ between treatments in noncontaminated wounds. In contaminated wounds, no differences between treatments were observed in wound size, histological parameters, bacterial load or growth factor concentration. MAIN LIMITATIONS Sample size is small. CONCLUSIONS No long-term advantage was detected with NPWT compared with calcium alginate dressings in noncontaminated or contaminated equine distal limb wounds healing by second intention.
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Affiliation(s)
- Maarten Haspeslagh
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lore L Van Hecke
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Katleen Hermans
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Koen Chiers
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eva Pint
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Ann M Martens
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Zhou R, Qiu L, Xiao J, Mao X, Yuan X. Early wound repair versus later scar repair in children with treadmill hand friction burns. J Burn Care Res 2021; 43:269-276. [PMID: 34015124 DOI: 10.1093/jbcr/irab083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (9 patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (P>0.05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (P<0.05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.
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Affiliation(s)
- Rong Zhou
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Lin Qiu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Jun Xiao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Xiaobo Mao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Xingang Yuan
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
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Faisal M, Berend PD, Seemann R, Janik S, Grasl S, Ritzengruber A, Mendel H, Jamshed A, Hussain R, Erovic BM. Impact of Previous Irradiation on Wound Healing after Negative Pressure Wound Therapy in Head and Neck Cancer Patients-A Systematic Review. Cancers (Basel) 2021; 13:cancers13102482. [PMID: 34069610 PMCID: PMC8160636 DOI: 10.3390/cancers13102482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Negative pressure wound therapy (NPWT) has been effectively used for wound management in comparison to traditional dressings. The purpose of this study was to provide an evidence-based review of NPWT in head and neck cancer patients, as well as the impact of previous irradiation and other risk factors on wound healing. (2) Material and Methods: We conducted a comprehensive search in PubMed, Medline, Embase, Web of Science, and Cochrane Library databases for relevant literature. (3) Results: 15 studies fulfilled the inclusion criteria. The most common etiologies requiring NPWT were defects post tumor resection and flap reconstruction and oro/pharyngo-cutaneous fistulas. The neck was found to be the most common site of involvement (47.3%). The overall wound healing response rate was 87.5%. The median negative pressure recorded was 125 mm of Hg, with a median dressing change time of three days. Previous irradiation (p = 0.01; OR = 4.07) and diabetes mellitus (DM) (p = 0.001; OR = 5.62) were found to be significantly associated with delayed wound healing after NPWT. (4) Conclusion: NPWT treats complex wounds in head and neck cancer patients and should represent a significant armamentarium in head and neck cancers. Previous irradiation and DM have detrimental effects on wound healing after NPWT.
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Affiliation(s)
- Muhammad Faisal
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.)
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan; (A.J.); (R.H.)
| | - Peter D. Berend
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (P.D.B.); (S.J.); (S.G.)
| | - Rudolf Seemann
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.)
| | - Stefan Janik
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (P.D.B.); (S.J.); (S.G.)
| | - Stefan Grasl
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (P.D.B.); (S.J.); (S.G.)
| | | | - Herbert Mendel
- Department of General Surgery, Evangelical Hospital, 1180 Vienna, Austria;
| | - Arif Jamshed
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan; (A.J.); (R.H.)
| | - Raza Hussain
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan; (A.J.); (R.H.)
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.)
- Correspondence: ; Tel.: +43-1-40422-4518
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Miura T, Yamamoto Y, Murao N, Maeda T, Osawa M, Hayashi T, Funayama E. Combined internal and external negative pressure wound therapy: breakthrough treatment for lymphocutaneous intractable fistula. Surg Today 2021; 51:1630-1637. [PMID: 33993364 DOI: 10.1007/s00595-021-02283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Lymphocutaneous fistula after lymph node dissection is intractable, yet there is no established treatment strategy. This study demonstrates the wound closure time achieved by a new method of combined internal and external negative pressure wound therapy (CIEN) in patients with lymphocutaneous fistula. METHODS The subjects of this study were six consecutive patients with lymphocutaneous fistula after lymphatic surgery, who were treated with CIEN between 2018 and 2020. The CIEN technique can be summarized as follows: first, internal foam is inserted into the fistula from the opening of the fenestration. Next, a slightly larger area of external foam is applied above the fistula flap outside the external margin of the foam-filled fistula. After bridging the internal foam and external foam, negative-pressure wound therapy is carried out on this bridging foam block. RESULTS CIEN led to rapid and complete wound healing in all six patients. Fistula flap margin ischemia developed in one patient, but adjusting the mode and pressure settings resulted in improvement. Three patients suffered contact dermatitis. There were no signs of tumor or fistula recurrence in any patients after at least 3 months of follow-up. CONCLUSION CIEN is an effective and less invasive treatment modality than the conventional method of managing lymphocutaneous fistula.
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Affiliation(s)
- Takahiro Miura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masayuki Osawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
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Ren L, Zhang C, Zhao L, Li C, Zhang L, Xue X. Influence of incentive nursing intervention on recovery of burn patients after vacuum sealing drainage. Int Wound J 2021; 18:787-795. [PMID: 33738955 PMCID: PMC8613383 DOI: 10.1111/iwj.13582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022] Open
Abstract
To observe the effect of application of incentive nursing intervention (INI) on recovery in burn patients undergoing vacuum sealing drainage (VSD). From January 2017 to January 2020, a total of 82 consecutive burn patients were prospectively enrolled, and divided into INI group and routine nursing intervention (RNI) group according to random number table method. The causes of inadequate drainage were collected, the incidence was calculated, and the occurrence of inadequate drainage at different locations was compared. The pain degree and comfort status before and after the intervention were observed, and the wound healing time, hospital stay, and satisfaction after the intervention were recorded. The reasons for inadequate drainage during the treatment of VSD included negative pressure insufficient, drainage tube blockage because of escharosis, replacement of negative pressure internal sac not standard, loose sealing of the semi-permeable membrane, and the negative pressure tube fell off, compressed or reflexed. The baseline characteristics between the two groups were comparable (P > .05). The incidence of each cause and total incidence of inadequate drainage in INI group were lower than those in RNI group (P < .05, respectively). The incidences of inadequate drainage of all burn sites in INI group were lower than those in RNI group, and the difference of limbs wound between the two group was statistically significant (P < .05). After intervention, the pain intensity of INI group was lower than that of RNI group (P < .05), and the holistic comfort of INI group was higher than that of RNI group (P < .05). The wound healing time and hospital stay time in INI group were lower than those in RNI group, and the total satisfaction rate in INI group was higher than that in RNI group (P < .05, respectively). Applying INI can effectively reduce the incidence of insufficient drainage, reduce pain, improve comfort, shorten wound healing time and hospital stay, and thus improve the overall satisfaction rate of patients, which is worthy of clinical promotion and application.
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Affiliation(s)
- Liqing Ren
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cuina Zhang
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lihua Zhao
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cuikun Li
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li Zhang
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Xue
- Department of Burn and Plastic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
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Jiang ZY, Yu XT, Liao XC, Liu MZ, Fu ZH, Min DH, Guo GH. Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials. Burns 2021; 47:747-755. [PMID: 33814213 DOI: 10.1016/j.burns.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Although skin grafts are widely used in reconstruction of large skin defect and complex wounds, many factors lead to suboptimal graft take. Negative-pressure wound therapy (NPWT) reportedly increases the graft take rates when added to skin grafting, but a summary analysis of the data of randomized controlled trials has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to compare the effectiveness and safety of NPWT and non-NPWT for patients with skin grafts. METHODS We searched PubMed, Embase, Cochrane Library, and CNKI for relevant trials based on predetermined eligibility criteria from database establishment to February 2020. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heterogeneity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis. RESULTS Ten randomized controlled trials with 488 patients who underwent NPWT or non-NPWT were included. Compared with non-NPWT, NPWT yielded an improved the percentage of graft take, a reduction in days from grafting to discharge, with lower relative risk of re-operation, and no increased relative risk of adverse event. Further, the subgroup analysis showed an improved the percentage of graft take in negative pressure of 80 mmHg, and no improved the percentage of graft take in negative pressure of 125 mmHg. CONCLUSION NPWT is more effective than non-NPWT for the integration of skin grafts, and the negative pressure of 80 mmHg can be recommended. Data on adverse events and negative pressure are, however, limited. A better understanding of complications after NPWT and the ideal negative pressure for the integration of skin grafts is imperative.
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Affiliation(s)
- Zheng-Ying Jiang
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Xiao-Ting Yu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Xin-Cheng Liao
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Ming-Zhuo Liu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Zhong-Hua Fu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Ding-Hong Min
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Guang-Hua Guo
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China.
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Prophylactic Negative-pressure Dressings Reduce Wound Complications and Resource Burden After Emergency Laparotomies. J Surg Res 2021; 257:22-31. [DOI: 10.1016/j.jss.2020.07.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 12/11/2022]
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Patro BP, Khuntia S, Sahu NK, Das G, Patra SK. Negative Pressure Wound Therapy Assisted Closure: An Effective Mode of Management for Infected and Contaminated Wound With Non-Union Fracture Femur. Cureus 2020; 12:e9037. [PMID: 32782859 PMCID: PMC7410510 DOI: 10.7759/cureus.9037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
High-energy open fractures are often associated with significant soft tissue damage and can have contamination. Infection of a fracture can be the most detrimental factor for fracture union. Control of infection and soft tissue coverage over exposed bone plays a vital role in its overall outcome. Negative pressure wound therapy (NPWT) assisted closure has depicted encouraging results for helping control of infection and wound closure. NPWT assisted closure promotes reduction of bacterial load in the wound, facilitates removal of secretion from the wound, promotes the formation of granulation tissue, and decreases wound size. We present a case of open fracture femur with severe infection and exposed bone. Along with infection and comminution of fracture, there was collection of necrotic tissue at the fracture site. Infection settled with debridement of wound and application of NPWT. With the application of NPWT, there was formation of granulation tissue and a decrease in wound size. The wound healed completely following application of secondary sutures. Any form of plastic procedures, such as muscle pedicle graft and split-thickness skin grafting, was not required for wound closure. NPWT-assisted closure is a promising mode of wound management in grossly infected wounds and obviates the need for further plastic procedures. The effect can be extrapolated to all open wounds with infection but must follow a thorough debridement and lavage.
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Affiliation(s)
- Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Susanta Khuntia
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Nabin K Sahu
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Gurudip Das
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Saroj K Patra
- Trauma & Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
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Dong J, Qing C, Song F, Wang X, Lu S, Tian M. Potential molecular mechanisms of negative pressure in promoting wound healing. Int Wound J 2020; 17:1428-1438. [PMID: 32515909 DOI: 10.1111/iwj.13423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022] Open
Abstract
Negative pressure wound therapy (NPWT) has been widely used in various lesions. This study aimed to explore the biological effects of negative pressure on the polymorphonuclear neutrophils (PMNs), macrophages, and epidermal keratinocyte cells involved in wound healing. PMNs differentiated from HL-60, macrophages were derived from THP-1 monocytes, and keratinocytes were cultured in vitro, and they were treated with 0, -0.03 mp, and -0.05 mp, respectively. Cell ultrastructure; viability; apoptosis; and protein factors such as tumour necrosis factor-α (TNF-α), interferon-γ (IFN-γ), epidermal growth factor (EGF), epidermal growth factor receptor (EGFR), interleukin-17 (IL-17), and cell division cycle 42 (Cdc42) were determined by transmission electron microscopy (TEM), CCK8, flow cytometry (FCM), ELISA, and simple Western assays, respectively. After negative pressure stimulation, the cell ultrastructure of PMNs and macrophages cells was presented with a marked increase of lysosomes and a relative decrease of mitochondria. In addition, the cell viability was enhanced in PMNs and macrophages in a pressure-dependent manner and apoptosis ratios were significantly reduced in PMNs and macrophages. In addition, under -0.05 negative pressure, IFN-γ and IL-17 were significantly increased in PMNs or macrophages. Moreover, increased EGF and EGFR and Cdc42 levels in keratinocytes induced by the -0.05 mpa were detected, indicating that the migration chemotaxis of keratinocyte cells was enhanced. Negative pressure might promote cell proliferation, accelerate inflammatory responses, and promote epithelialisation during wound healing by increasing IFN-γ, IL-17, Cdc42, EGF, and EGFR in PMNs, macrophages, or keratinocytes under different negative pressures.
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Affiliation(s)
- Jiaoyun Dong
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Qing
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Song
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiqiao Wang
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuliang Lu
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Tian
- Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kang Y, Pan X, Wu Y, Ma Y, Liu J, Rui Y. Subacute reconstruction using flap transfer for complex defects of the upper extremity. J Orthop Surg Res 2020; 15:134. [PMID: 32264917 PMCID: PMC7140501 DOI: 10.1186/s13018-020-01647-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries. METHODS From July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm2. The mean time of flap reconstruction was 14 days (range 5-29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed. RESULTS The overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S1 in three cases, S2 in eight cases, S3 in 15 cases, and S4 in nine cases. There were no donor site complications other than three cases with scar hyperplasia. CONCLUSIONS The severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.
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Affiliation(s)
- Yongqiang Kang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, NO.999 Liangxi Road, Wuxi City, 214062, Jiangsu Province, China
| | - Xiaoyun Pan
- Orthopaedic Institute, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Yongwei Wu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, NO.999 Liangxi Road, Wuxi City, 214062, Jiangsu Province, China
| | - Yunhong Ma
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, NO.999 Liangxi Road, Wuxi City, 214062, Jiangsu Province, China
| | - Jun Liu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, NO.999 Liangxi Road, Wuxi City, 214062, Jiangsu Province, China
| | - Yongjun Rui
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, NO.999 Liangxi Road, Wuxi City, 214062, Jiangsu Province, China.
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Sabater González M, Mayer J. Technological Advances in Wound Treatment of Exotic Pets. Vet Clin North Am Exot Anim Pract 2019; 22:451-470. [PMID: 31395325 DOI: 10.1016/j.cvex.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although most research about the use of technological advances for wound healing was performed in laboratory animals but oriented to human medicine, recent technological advances allowed its application not only to small animals but also to exotic pets. This article reviews the literature available about some of these techniques (negative wound pressure therapy, photobiomodulation [laser therapy], electrical stimulation therapy, therapeutic ultrasonography, hyperbaric oxygen therapy), and other advances in wound management (skin expanders, xenografts, and bioengineered autologous skin substitutes) in exotic pet species.
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Affiliation(s)
| | - Jörg Mayer
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
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Kirsner R, Dove C, Reyzelman A, Vayser D, Jaimes H. A prospective, randomized, controlled clinical trial on the efficacy of a single-use negative pressure wound therapy system, compared to traditional negative pressure wound therapy in the treatment of chronic ulcers of the lower extremities. Wound Repair Regen 2019; 27:519-529. [PMID: 31087729 PMCID: PMC6852528 DOI: 10.1111/wrr.12727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 04/24/2019] [Accepted: 05/09/2019] [Indexed: 12/27/2022]
Abstract
Multicenter, phase‐4, randomized, comparative‐efficacy study in patients with VLUs or DFUs comparing for noninferiority the percentage change in target ulcer dimensions (area, depth, and volume) a single‐use negative pressure wound therapy (s‐NPWT) system versus traditional NPWT (t‐NPWT) over a 12‐week treatment period or up to confirmed healing. Baseline values were taken at the randomization visit. Randomized by wound type and size, 164 patients with non‐infected DFUs and VLUs were included. The ITT population was composed of 161 patients (101 with VLUs, 60 with DFUs) and 115 patients completed follow‐up (64 in the s‐NPWT group and 51 in the t‐NPWT group) (PP population). The average age for all patients was 61.5 years, 36.6% were women, and treatment groups were statistically similar at baseline. Primary endpoint analyses on wound area reduction demonstrated statistically significant reduction in favor of s‐NPWT (p = 0.003) for the PP population and for the ITT population (p < 0.001). Changes in wound depth (p = 0.018) and volume (p = 0.013) were also better with s‐NPWT. Faster wound closure was observed with s‐NPWT (Cox Proportional Hazards ratio (0.493 (0.273, 0.891); p = 0.019) in the ITT population. Wound closure occurred in 45% of patients in the s‐NPWT group vs. 22.2% of patients in the t‐NPWT group (p = 0.002). Median estimate of the time to wound closure was 77 days for s‐NPWT. No estimate could be provided for t‐NPWT due to the low number of patients achieving wound closure. Device‐related AEs were more frequent in the t‐NPWT group (41 AEs from 29 patients) than in the s‐NPWT group (16 AEs from 12 patients). The s‐NPWT system met noninferiority and achieved statistical superiority vs. t‐NPWT in terms of wound progression toward healing over the treatment period. When NPWT is being considered for the management of challenging VLUs and DFUs, s‐NPWT should be considered a first choice over other types of NPWT.
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Affiliation(s)
- Robert Kirsner
- Chairman and Harvey Blank Professor, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Alex Reyzelman
- Associate Professor, Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University, Co-Director UCSF Center for Limb Preservation, San Francisco, CA
| | - Dean Vayser
- Scripps Clinic Medical Group, Department of Orthopedics/Foot & Ankle Center, Chief, Wound Care Division, San Diego, CA
| | - Henry Jaimes
- Global Senior Medical Director-Wounds Smith and Nephew, London, UK
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Beidas OE, Garwe T, Wicks RF, Jalla A, Bryant C, Sarwar Z, Albrecht RM. Equivalent outcomes with once versus thrice weekly dressing changes in midline laparotomy wounds treated with negative pressure wound therapy. Am J Surg 2019; 217:1065-1071. [DOI: 10.1016/j.amjsurg.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Lu Y, Wang Y, Zhang J, Hu X, Yang Z, Guo Y, Wang Y. In-situ doping of a conductive hydrogel with low protein absorption and bacterial adhesion for electrical stimulation of chronic wounds. Acta Biomater 2019; 89:217-226. [PMID: 30862548 DOI: 10.1016/j.actbio.2019.03.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/23/2022]
Abstract
Electrical stimulation (ES) via electrodes is promising for treating chronic wounds, but this electrode-based strategy is unable to stimulate the whole wound area and the therapeutic outcome may be compromised. In this study, a conductive poly(2-hydroxyethyl methacrylate) (polyHEMA)/polypyrrole (PPY) hydrogel was developed, and 3-sulfopropyl methacrylate was covalently incorporated in the hydrogel's network to in-situ dope the PPY and maintain the hydrogel's conductivity in the weak alkaline physiological environment. The obtained hydrogel was superior to the commercial Hydrosorb® dressing for preventing bacterial adhesion and protein absorption, and this is helpful to reduce the possibilities of infection and secondary damage during dressing replacement. The in vitro scratch assay demonstrates that ES through the hydrogel enhanced fibroblast migration, and this enhancement effect remained even after the ES was ended. The in vivo assay using diabetic rats shows that when ES was conducted with this polyHEMA/PPY hydrogel, the healing rate was faster than that achieved by the electrode-based ES strategy. Therefore, this polyHEMA/PPY hydrogel shows a great potential for developing the next generation of ES treatment for chronic wounds. STATEMENT OF SIGNIFICANCE: Electrical stimulation (ES) via separated electrodes is promising for treating chronic wounds, but this electrode-based strategy is unable to stimulate the whole wound area, compromising the therapeutic outcome. Herein, a hydrogel was developed with stable electrical conductivity in the physiological environment and strong resistance to protein absorption and bacterial adhesion. The in vitro and in vivo tests proved that ES applied through the flexible and conductive hydrogel that covered the wound was superior to ES through electrodes for promoting the healing of the chronic wound. This hydrogel-based ES strategy combines the advantages of ES and hydrogel dressing and will pave the way for the next generation of ES treatment for chronic wounds.
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Negative-Pressure Wound Therapy for Managing Complicated Wounds at Extracorporeal Membrane Oxygenation Sites. Adv Skin Wound Care 2019; 32:183-189. [PMID: 30889018 DOI: 10.1097/01.asw.0000553596.11034.d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of negative-pressure wound therapy (NPWT) for management of wound complications at extracorporeal membrane oxygenation (ECMO) removal sites. METHODS The authors retrospectively reviewed patients who underwent NPWT at ECMO removal sites followed by the development of wound complications including skin necrosis, lymphorrhea, and femoral vessel exposure. A nonadhesive bacteria-binding mesh was used as a wound contact layer of NPWT application. Patient characteristics and clinical outcomes were evaluated. RESULTS Nine patients underwent NPWT for complicated wounds at ECMO sites. The mean age of patients was 49.2 years (range, 14-64 years). All patients exhibited wound complications with lymphorrhea and skin necrosis. Seven of nine patients had wound cultures that were positive for microorganisms, but culture conversion to negative was achieved after NPWT application for a mean period of 21.2 days (range, 12-30 days). Lymphorrhea was successfully managed, and formation of fresh granulation tissue was observed in all patients. Wound healing either by primary closure, skin graft, or secondary healing was achieved without recurrence of wound complications. There were no cases of femoral vessel injury or aneurysm during NPWT application. CONCLUSIONS Negative-pressure wound therapy appears to be a safe and effective treatment option in the management of complicated wounds at ECMO sites.
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Ramadhar AJ, Abraham F, McAllen C. "Gravity" - a new simple negative pressure wound therapy self-build design for low income countries. J Med Eng Technol 2019; 42:518-524. [PMID: 30875268 DOI: 10.1080/03091902.2019.1576791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Negative Pressure Wound Therapy (NPWT) is prohibitively expensive at the moment and therefore not easily accessible in low-income countries. An additional problem is the requirement of consistent reliable electricity to power the devices. A new low-cost NPWT device was designed from low cost and simple materials and it can be built and operated following a simple set of instructions. The so-called Gravity device was made from parts costing just under £6 GBP (May 2016) and it creates a constant pressure of 125 mmHg. Gravity operated from 4 hours and 40 minutes up to 5 hours and 18 minutes before needing to be reset. This reset can be achieved without patient involvement. Gravity was taken to Kenya by a Doctor on 5 May 2016 to be evaluated. A NPWT device prototype was successfully made and positive feedback was received from Kenya.
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Affiliation(s)
| | - Frank Abraham
- a University of Plymouth, School of Engineering , Plymouth , United Kingdom
| | - Christoph McAllen
- b University Hospitals Plymouth NHS Trust , Plymouth , United Kingdom
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Wu M, Sun M, Dai H, Xu J, Wang X, Guo R, Wang Y, Xue C. The application of keystone flap combined with vacuum‐assisted closure in the repair of sacrococcygeal skin defect after tumor resection. J Surg Oncol 2019; 119:974-978. [PMID: 30714165 DOI: 10.1002/jso.25397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Minliang Wu
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Mengyan Sun
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Haiying Dai
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Jianguo Xu
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Xinwei Wang
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Rui Guo
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Yuchong Wang
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
| | - Chunyu Xue
- Department of Plastic SurgeryChanghai Hospital, Second Military Medical UniversityShanghai China
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Li Y, Li PY, Sun SJ, Yao YZ, Li ZF, Liu T, Yang F, Zhang LY, Bai XJ, Huo JS, He WB, Ouyang J, Peng L, Hu P, Zhu YA, Jin P, Shao QF, Wang YF, Dai RW, Hu PY, Chen HM, Wang GF, Wang YG, Jin HX, Zhu CJ, Zhang QY, Shao B, Sang XG, Yin CL. Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review. Chin J Traumatol 2019; 22:1-11. [PMID: 30850324 PMCID: PMC6529401 DOI: 10.1016/j.cjtee.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023] Open
Abstract
Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.
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Affiliation(s)
- Yang Li
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Pei-Yuan Li
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shi-Jing Sun
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yuan-Zhang Yao
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhan-Fei Li
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Tao Liu
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Fan Yang
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lian-Yang Zhang
- Trauma Center of PLA, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
| | - Xiang-Jun Bai
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Jing-Shan Huo
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangzhou Province, China
| | - Wu-Bing He
- Fujian Provincial Hospital, Fuzhou, China
| | - Jun Ouyang
- Emergency Surgery of the First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Autonomous Region, China
| | - Lei Peng
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Ping Hu
- Chongqing Emergency Medical Center, Chongqing, China
| | - Yan-An Zhu
- Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
| | - Ping Jin
- Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang Province, China
| | - Qi-Feng Shao
- Ninth People's Hospital of Zhengzhou, Zhengzhou, China
| | | | - Rui-Wu Dai
- Chengdu Military General Hospital, Chengdu, China
| | - Pei-Yang Hu
- Tiantai County People's Hospital, Tiantai, Zhejiang, China
| | - Hai-Ming Chen
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ge-Fei Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong-Gao Wang
- Department of Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong-Xu Jin
- Shenyang Military General Hospital, Shenyang, China
| | - Chang-Ju Zhu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi-Yong Zhang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Biao Shao
- The First People's Hospital of Kunming, Kunming, China
| | | | - Chang-Lin Yin
- The First Affiliated Hospital of Third Military Medical University, Chongqing, China
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Management of established pressure ulcer infections in spinal cord injury patients. Med Mal Infect 2019; 49:9-16. [DOI: 10.1016/j.medmal.2018.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/31/2017] [Accepted: 05/29/2018] [Indexed: 12/20/2022]
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Negative Pressure Wound Therapy in Necrotizing Fasciitis of the Head and Neck. J Oral Maxillofac Surg 2019; 77:87-92. [DOI: 10.1016/j.joms.2018.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/11/2018] [Accepted: 08/14/2018] [Indexed: 01/22/2023]
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Bellot GL, Dong X, Lahiri A, Sebastin SJ, Batinic-Haberle I, Pervaiz S, Puhaindran ME. MnSOD is implicated in accelerated wound healing upon Negative Pressure Wound Therapy (NPWT): A case in point for MnSOD mimetics as adjuvants for wound management. Redox Biol 2019; 20:307-320. [PMID: 30390545 PMCID: PMC6218638 DOI: 10.1016/j.redox.2018.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/30/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
Negative Pressure Wound Therapy (NPWT), a widely used modality in the management of surgical and trauma wounds, offers clear benefits over conventional wound healing strategies. Despite the wide-ranging effects ascribed to NPWT, the precise molecular mechanisms underlying the accelerated healing supported by NPWT remains poorly understood. Notably, cellular redox status-a product of the balance between cellular reactive oxygen species (ROS) production and anti-oxidant defense systems-plays an important role in wound healing and dysregulation of redox homeostasis has a profound effect on wound healing. Here we investigated potential links between the use of NPWT and the regulation of antioxidant mechanisms. Using patient samples and a rodent model of acute injury, we observed a significant accumulation of MnSOD protein as well as higher enzymatic activity in tissues upon NPWT. As a proof of concept and to outline the important role of SOD activity in wound healing, we replaced NPWT by the topical application of a MnSOD mimetic, Mn(III) meso-tetrakis(N-ethylpyridinium-2-yl)porphyrin (MnTE-2-PyP5+, MnE, BMX-010, AEOl10113) in the rodent model. We observed that MnE is a potent wound healing enhancer as it appears to facilitate the formation of new tissue within the wound bed and consequently advances wound closure by two days, compared to the non-treated animals. Taken together, these results show for the first time a link between NPWT and regulation of antioxidant mechanism through the maintenance of MnSOD activity. Additionally this discovery outlined the potential role of MnSOD mimetics as topical agents enhancing wound healing.
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Affiliation(s)
- Gregory Lucien Bellot
- Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiaoke Dong
- Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Amitabha Lahiri
- Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Sandeep Jacob Sebastin
- Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Ines Batinic-Haberle
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Shazib Pervaiz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Medical Science Cluster Cancer Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Cancer Institute, National University Health System, Singapore, Singapore; NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore; School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.
| | - Mark Edward Puhaindran
- Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore.
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Pironi L, Corcos O, Forbes A, Holst M, Joly F, Jonkers C, Klek S, Lal S, Blaser AR, Rollins KE, Sasdelli AS, Shaffer J, Van Gossum A, Wanten G, Zanfi C, Lobo DN. Intestinal failure in adults: Recommendations from the ESPEN expert groups. Clin Nutr 2018; 37:1798-1809. [PMID: 30172658 DOI: 10.1016/j.clnu.2018.07.036] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Intestinal failure (IF) is defined as "the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth". Functionally, it may be classified as type I acute intestinal failure (AIF), type II prolonged AIF and type III chronic intestinal failure (CIF) The ESPEN Workshop on IF was held in Bologna, Italy, on 15-16 October 2017 and the aims of this document were to highlight the current state of the art and future directions for research in IF. METHODS This paper represents the opinion of experts in the field, based on current evidence. It is not a formal review, but encompasses the current evidence, with emphasis on epidemiology, classification, diagnosis and management. RESULTS IF is the rarest form of organ failure and can result from a variety of conditions that affect gastrointestinal anatomy and function adversely. Assessment, diagnosis, and short and long-term management involves a multidisciplinary team with diverse expertise in the field that aims to reduce complications, increase life expectancy and improve quality of life in patients. CONCLUSIONS Both AIF and CIF are relatively rare conditions and most of the published work presents evidence from small, single-centre studies. Much remains to be investigated to improve the diagnosis and management of IF and future studies should rely on multidisciplinary, multicentre and multinational collaborations that gather data from large cohorts of patients. Emphasis should also be placed on partnership with patients, carers and government agencies in order to improve the quality of research that focuses on patient-centred outcomes that will help to improve both outcomes and quality of life in patients with this devastating condition.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola Hospital, University of Bologna, Italy.
| | - Olivier Corcos
- Intestinal Stroke Center (SURVI)/ Gastroenterology, IBD and Nutrition Support Department, Beaujon Hospital, and Laboratory for Vascular Translational Science UMR 1148, University Paris VII, France
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Mette Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Denmark
| | - Francisca Joly
- Gastroenterology, IBD and Nutrition Support Department, Beaujon Hospital, and Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies UMR 1149, University Paris VII, France
| | - Cora Jonkers
- Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal & Manchester University, Manchester, UK
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Katie E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Anna S Sasdelli
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola Hospital, University of Bologna, Italy
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal & Manchester University, Manchester, UK
| | - Andre Van Gossum
- Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chiara Zanfi
- Department of Organ Failure and Transplantation, Sant'Orsola Hospital, University of Bologna, Italy
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Lin PY, Liou TL, Lin KC, Hsieh MH, Chien CY, Hsieh CH. Immediate Negative Pressure Wound Therapy After Free Flap Transfer for Head and Neck Cancer Surgery. Laryngoscope 2018; 128:2478-2482. [PMID: 30247762 DOI: 10.1002/lary.27169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Pao-Yuan Lin
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine; Kaohsiung Republic of China
| | - Tz-Luen Liou
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine; Kaohsiung Republic of China
| | - Ko-Chien Lin
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine; Kaohsiung Republic of China
| | - Mu-Han Hsieh
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine; Kaohsiung Republic of China
| | - Chih-Yen Chien
- Department of Otolaryngology; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine; Kaohsiung Republic of China
| | - Ching-Hua Hsieh
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine; Kaohsiung Republic of China
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A Novel Tube-Drainage Technique of Negative Pressure Wound Therapy for Fistulae after Reconstructive Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1885. [PMID: 30324066 PMCID: PMC6181514 DOI: 10.1097/gox.0000000000001885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/13/2018] [Indexed: 12/11/2022]
Abstract
Background: Patients with head and neck or esophageal cancer who undergo resection and reconstructive surgery sometimes develop fistulae that exhibit delayed wound healing. We developed a novel negative pressure wound therapy (NPWT) that employs a Penrose drain. This case series report describes its effect on the wound healing and treatment duration of cancer patients with postoperative fistulae. Methods: This consecutive case series consisted of all patients from February 2014 to February 2017 who underwent resection and reconstruction for head and neck or esophageal cancer and who then developed a fistula that was treated with either NPWT or a second flap that did not resolve the fistula or led to fistula recurrence and was then treated with NPWT. A Penrose drainage tube was inserted into the fistula, and a NPWT device was applied. Results: Eleven patients (10 males, 1 female; mean age, 67.4 years) underwent NPWT for fistulae that arose after tumor resection and reconstruction (n = 6) or after fistula reconstruction (n = 5). The resection was for esophageal (n = 4), laryngeal (n = 3), oral (n = 2), and hypopharyngeal (n = 2) cancer. In 9 cases, 1 week of NPWT led to rapid and complete wound healing. In 2 cases, complete healing occurred after 3–4 weeks of NPWT. Conclusions: Our NPWT applies continuous negative pressure inside the fistula only and dramatically promoted fistula healing. This approach may work by cleaning the fistula and promoting mucosal surface adhesion. It is particularly effective when the tissue surrounding the fistula is soft due to fresh tissue transfer.
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Looby MA, Vogel RI, Bangdiwala A, Hyer B, Das K. Prophylactic Negative Pressure Wound Therapy in Obese Patients Following Cesarean Delivery. Surg Innov 2017; 25:43-49. [PMID: 29090986 DOI: 10.1177/1553350617736652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Negative pressure therapy (NPT) offers the potential to reduce infection in obese patients. The goal of this study was to explore the association between NPT use and infection after cesarean delivery among obese women. METHODS We initiated a hospital protocol wherein women with a body mass index (BMI) of 40 kg/m2 or greater who delivered after January 1, 2011 were to receive NPT following cesarean section. A retrospective comparison of surgical site infection (SSI) in women receiving the intervention to a similar group with a BMI of 40 kg/m2 or greater, a historical control group of women who delivered before January 1, 2011. Incidence of SSI was compared between time periods using logistic regression models. RESULTS A total of 233 patients in the preintervention (control) group and 234 patients in the intervention group were included in the analysis. In the control group, 23 (9.9%) developed SSI, compared with 13 (5.6%) in the intervention group. After adjustment for potential confounding factors, women in the postintervention period experienced a statistically significant reduction in SSI rates (adjusted odds ratio =0.45, 95% CI = 0.22-0.95); P = .04). CONCLUSION Implementation of a hospital protocol of NPT following cesarean delivery in obese women resulted in reduced incidence of postoperative SSI. This study suggests that using NPT after cesarean delivery in women with a BMI ≥40 kg/m2 is an efficacious method to reduce incidence of postoperative wound infections.
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Affiliation(s)
- Maureen Ayers Looby
- 1 HealthPartners Department of Obstetrics and Gynecology, St Paul, MN, USA.,2 University of Minnesota, Minneapolis, MN, USA
| | | | | | - Barbara Hyer
- 1 HealthPartners Department of Obstetrics and Gynecology, St Paul, MN, USA
| | - Kamalini Das
- 1 HealthPartners Department of Obstetrics and Gynecology, St Paul, MN, USA
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Affiliation(s)
- Amy Cray
- Staff Nurse, Dermatology, Nottingham NHS Treatment Centre
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Florczyk A, Rosser J. Negative-Pressure Wound Therapy as Management of a Chronic Distal Limb Wound in the Horse. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pereira S, Malta W, Canha A, Polónia J. Vacuum-assisted closure therapy after resection of giant basal cell carcinoma of the scalp. J Surg Case Rep 2017; 2017:rjx122. [PMID: 28690778 PMCID: PMC5495935 DOI: 10.1093/jscr/rjx122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/14/2017] [Indexed: 12/13/2022] Open
Abstract
Management of complicated wounds is a challenge in head and neck reconstruction. Although the negative pressure wound therapy or wound vacuum-assisted closure has been widely used in complicated wounds and shows promising results, its application in the head and neck region after reconstruction for the head and neck cancer is rarely presented. A 77-year-old woman underwent a radical resection of an extensive basal cell carcinoma of the scalp and forehead involving the periosteum, where classic reconstruction was difficult, but successfully treated with negative pressure wound therapy. Negative pressure wound therapy is an efficacious tool in cases of complex and extensive defects, when we expect immediate reconstruction with poor results, as would be probable with this scalp lesion.
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Affiliation(s)
- Silvia Pereira
- General Surgery Service, Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
| | - Wilson Malta
- General Surgery Service, Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
| | - António Canha
- General Surgery Service (Extradigestive Unit), Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
| | - José Polónia
- General Surgery Service (Extradigestive Unit), Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
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