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Cuthbert C, Zaghloul T, Bhatia S, Mothi SS, Davis E, Heavens HG, Bishop MW, Talbot LJ, Neel MD, Abdelhafeez AH. Use of Vacuum-Assisted Closure to Reduce the Likelihood of Wound Complications After Limb-Sparing Resection of Pediatric Primary Bone Sarcomas of the Femur. J Pediatr Surg 2024; 59:1735-1739. [PMID: 38548494 DOI: 10.1016/j.jpedsurg.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Limb-sparing surgery is the standard of care for primary bone tumors. However, such procedures are associated with high rates of wound complications, specifically in lower-extremity surgeries. Therefore, identifying and implementing interventions to minimize the likelihood of wound complications after limb-sparing resection of the lower extremity is crucial. METHODS Patients who underwent limb-sparing osteosarcoma or Ewing sarcoma resection during a 7-year period at a single institution were retrospectively reviewed. Data were collected on 39 patients who underwent limb-sparing resection of the femur. Patient demographics, tumor characteristics, and perioperative and postoperative data were extracted and analyzed. Patients who underwent resection before April 2017 received conventional postoperative incision dressings. Starting in April 2017, patients received vacuum-assisted closure (VAC) with the 3 M™ Prevena VAC system after surgical closure. Eighteen patients received conventional postoperative incision dressing, and 21 received incisional wound VAC. A wound complication was defined as any Clavien-Dindo classification greater than 0 within a 28-day postoperative period. RESULTS Patients who received postoperative incisional wound VAC had lower rates of wound complications than those who received conventional incision dressings (14% vs. 50%; p = 0.035). Additionally, patients in whom wound complications developed had a longer average hospital stay than those without wound complications (5 days vs. 4 days; p = 0.029). CONCLUSIONS Wound complications prolong the hospital stay and can delay adjuvant chemotherapy for bone tumors. The use of postoperative incisional wound VAC is associated with less likelihood of wound complications and should be considered in any high-risk surgical closure. LEVEL OF EVIDENCE Level III Treatment Study.
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Affiliation(s)
- Chance Cuthbert
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tarek Zaghloul
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Shalini Bhatia
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Erma Davis
- Center for Advanced Practice, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Heather G Heavens
- Center for Advanced Practice, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Lindsay J Talbot
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Michael D Neel
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA.
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Stanek R, Pointner E, de Cerchi KC, Pomberger G, Benkoe T, Hölzenbein T, Mousavi M. Negative pressure wound therapy for extensive soft tissue defects of the lower extremity in a teenager: A case study. Clin Case Rep 2024; 12:e9188. [PMID: 39161666 PMCID: PMC11331009 DOI: 10.1002/ccr3.9188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 08/21/2024] Open
Abstract
Key Clinical Message Negative pressure wound therapy (NPWT) aided in the management of complex soft tissue injury in a 14-year-old girl by managing moisture, reducing oedema, and stimulating wound granulation less than 2 months after the accident and prepared the skin for skin grafting, thus successfully saving the limb. Abstract This case study describes the use of a tubular bandage encompassing the whole limb to deliver successful NPWT in the treatment and reconstruction of extensive soft tissue damage extending from the right lower extremity to the hip in a 14-year-old female.
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Affiliation(s)
- Rainer Stanek
- Clinic DonaustadtDepartment for Pediatric and Adolescent SurgeryViennaAustria
| | - Eva‐Maria Pointner
- Clinic DonaustadtDepartment for Pediatric and Adolescent SurgeryViennaAustria
| | | | - Gerhard Pomberger
- Clinic DonaustadtDepartment for Pediatric and Adolescent SurgeryViennaAustria
| | - Thomas Benkoe
- Clinic DonaustadtDepartment for Pediatric and Adolescent SurgeryViennaAustria
| | - Thomas Hölzenbein
- Clinic DonaustadtDepartment for General Surgery, Division Vascular SurgeryViennaAustria
| | - Mehdi Mousavi
- Clinic DonaustadtDepartment of Orthopedics and Trauma‐SurgeryViennaAustria
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Holbert MD, Duff J, Wood F, Holland AJA, Teague W, Frear C, Crellin D, Phillips N, Storey K, Martin L, Singer Y, Dimanopoulos TA, Cuttle L, Vagenas D, McPhail S, Calleja P, De Young A, Kimble RM, Griffin BR. Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study. J Pediatr Nurs 2024; 77:e520-e530. [PMID: 38762422 DOI: 10.1016/j.pedn.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. METHODS A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. RESULTS Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. CONCLUSION Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
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Affiliation(s)
- Maleea D Holbert
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia.
| | - Jed Duff
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Australia
| | - Fiona Wood
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Andrew J A Holland
- The Burns Unit, The Children's Hospital at Westmead, NSW 2145, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW 2050, Australia
| | - Warwick Teague
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Cody Frear
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dianne Crellin
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Nursing, The University of Melbourne, Victoria 3010, Australia
| | - Natalie Phillips
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia
| | - Kristen Storey
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Lisa Martin
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Yvonne Singer
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Tanesha A Dimanopoulos
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Dimitrios Vagenas
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Steven McPhail
- Australian Centre for Health Services Innovation, and Centre for Healthcare Transformation, School of Public health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Pauline Calleja
- College of Healthcare Sciences, James Cook University, Cairns 4870, Australia
| | - Alexandra De Young
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Roy M Kimble
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Bronwyn R Griffin
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
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Kumata Y, Ishii D, Ishii S, Motoki K, Ueno N, Hinooka R, Miyagi H. A case series of prophylactic negative pressure wound therapy use with purse-string closure in stoma closure wounds in infants. Surg Case Rep 2024; 10:20. [PMID: 38228981 DOI: 10.1186/s40792-024-01818-9] [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: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The study introduces the application of negative pressure wound therapy (NPWT) in pediatric stoma closure, emphasizing the importance of enhancing aesthetics and minimizing surgical site infections (SSI). CASE PRESENTATION The case series involves four infants undergoing non-umbilical stoma closure with a combination of purse-string closure (PSC) and NPWT, focusing on aesthetic outcomes and infection prevention. NPWT was initiated immediately after surgery, and patients were monitored every 3-4 days. Notably, none of the four infants experienced SSI or other complications. The patients adequately tolerated NPWT, with no significant adverse events. Furthermore, Manchester Scar Scale (MSS) was 9 [7-10], and Patient and Observer Scar Assessment Scale (POSAS) (observer) was 12.5 [12-19], POSAS (patient) was 12.5 [11-16] (all median values [minimum-maximum]), indicating that excellent aesthetic outcomes were achieved. DISCUSSION We emphasizes the significance of aesthetics in pediatric patients; in addition, our findings demonstrate that four infants who received NPWT combined with PSC achieved superior outcomes that did the most recent four infants who underwent PSC only at our institution. It also addresses the risk of SSI in stoma closure and discusses the pros and potential cons of using NPWT in pediatric cases, underlining the need for further research and the accumulation of additional reports. CONCLUSIONS This is the inaugural report of prophylactic NPWT for pediatric stoma closure, emphasizing the effectiveness of combining PSC and NPWT for SSI prevention and improved aesthetics. The study calls for additional research and reports on NPWT in pediatric cases to further solidify its benefits in this patient population.
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Affiliation(s)
- Yuka Kumata
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Daisuke Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.
| | - Seiya Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Keita Motoki
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naomi Ueno
- Nursing Department, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Ranko Hinooka
- Nursing Department, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Hisayuki Miyagi
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
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Masson R, Parvathala N, Ma E, Shih T, Atluri S, Sayed CJ, Hogeling M, Shi VY, Hsiao JL. Efficacy of procedural treatments for pediatric hidradenitis suppurativa: A systematic review. Pediatr Dermatol 2023. [PMID: 37092729 DOI: 10.1111/pde.15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/01/2023] [Indexed: 04/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a painful, inflammatory skin disease that has historically been understudied in the pediatric population. Procedural interventions, such as surgical excisions, skin grafts, and lasers, are important for comprehensive HS disease management. However, there is a lack of data on procedural treatments for HS in pediatric patients. The purpose of this study was to conduct a systematic review of the literature on the efficacy and safety of procedural treatments for HS in pediatric patients. In April 2022, MEDLINE and EMBASE databases were searched for articles on the efficacy of procedural treatments for HS in patients <18 years of age. Two independent reviewers extracted data from relevant studies. From 1974 to 2021, 23 articles with 81 patients were identified. Patients' Hurley stages included stage I (9.1%, 1/11), II (36.4%, 4/11), and III (54.5%, 6/11). The most extensively studied procedural interventions include negative pressure wound therapy (n = 30), surgical excision with skin graft/flap (n = 19), and endoscopic electrode or laser treatment (n = 11). In all, promising response rates for procedural management strategies were observed in the literature but the findings were largely based on case reports/series. Randomized controlled trials (RCTs), especially those geared toward minimally invasive procedural treatments, are needed to help guide clinicians on the most efficacious treatment modalities for pediatric patients with HS.
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Affiliation(s)
- Rahul Masson
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Neha Parvathala
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Elaine Ma
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Swetha Atluri
- College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Christopher J Sayed
- Department of Dermatology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marcia Hogeling
- Division of Dermatology, University of California, Los Angeles, California, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
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Tedesco BAN, De Onofre ALR, de Amorim PCH, Lourenção PLTDA, Ortolan EVP. Letter to the Editor in regard to: Vacuum-assisted closure (VAC) prevents wound dehiscence following posterior sagittal anorectoplasty (PSARP): An exploratory case-control study. J Pediatr Surg 2022; 57:1174-1176. [PMID: 35027210 DOI: 10.1016/j.jpedsurg.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Bruna Aliotto Nalin Tedesco
- Department of Surgery and Orthopedics, Botucatu Medical School UNESP, District of Rubião Jr, s / n. Green Annex, Botucatu, São Paulo 18618-687, Brazil.
| | - Ana Luiza Rodakowski De Onofre
- Department of Surgery and Orthopedics, Botucatu Medical School UNESP, District of Rubião Jr, s / n. Green Annex, Botucatu, São Paulo 18618-687, Brazil
| | - Paulo Cezar Haddad de Amorim
- Department of Surgery and Orthopedics, Botucatu Medical School UNESP, District of Rubião Jr, s / n. Green Annex, Botucatu, São Paulo 18618-687, Brazil
| | - Pedro Luiz Toledo de Arruda Lourenção
- Department of Surgery and Orthopedics, Botucatu Medical School UNESP, District of Rubião Jr, s / n. Green Annex, Botucatu, São Paulo 18618-687, Brazil
| | - Erika Veruska Paiva Ortolan
- Department of Surgery and Orthopedics, Botucatu Medical School UNESP, District of Rubião Jr, s / n. Green Annex, Botucatu, São Paulo 18618-687, Brazil
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Nissen M, Romanova A, Weigl E, Petrikowski L, Alrefai M, Hubertus J. Vacuum-assisted staged omphalocele reduction: A preliminary report. Front Pediatr 2022; 10:1053568. [PMID: 36507134 PMCID: PMC9730811 DOI: 10.3389/fped.2022.1053568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Omphalocele represents a rare congenital abdominal wall defect. In giant omphalocele, due to the viscero-abdominal disproportion, gradual reintegration of eviscerated organs is often associated with medical challenges. We report our preliminary experience combining staged gravitational reduction with vacuum (VAC) therapy as a novel approach for treatment of giant omphalocele. PATIENTS AND METHODS Retrospective chart review of six patients (five females) born between September 2018 and May 2022 who underwent staged reduction of giant omphalocele in conjunction with VAC therapy was conducted. Treatment was performed at two German third-level Pediatric Surgery Departments. Biometric and periprocedural data were assessed. Main outcome measure was the feasibility of VAC therapy for giant omphalocele. Data are reported as median and interquartile range (Q1-Q3). RESULTS Gestational age was 37 (37-38) weeks, and birth weight was 2700 (2500-3000) g. VAC dressing was changed every 3 (3-4) days until abdominal fascia closure at the age of 9 (3-13) days. Time to first/full oral feeds was 3 (1-5)/20 (12-24) days with a hospital stay of 22 (17-30) days. Follow-up was 8 (5-22) months and complications were of minor extent (none: n = 2; Clavien-Dindo I: n = 3; Clavien-Dindo II: n = 1), comprising a delayed neo-umbilical cord rest separation (n = 2) and/or concomitant neo-umbilical site infection (n = 2) with no repeat surgery. CONCLUSION In neonates with giant omphalocele, VAC constitutes a promising and technically feasible enhancement of the staged gravitational reduction method. This study shows evidence that VAC may accelerate restoration of the abdominal wall integrity in giant omphalocele, thus minimizing associated comorbidities inherent to a prolonged hospitalization.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Anna Romanova
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Elena Weigl
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Laura Petrikowski
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Mohamad Alrefai
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Marien Hospital Witten, Ruhr-University Bochum, Germany
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Osawa I, Tsuboi N, Nosaka N, Nishimura N, Nakagawa S. Impact of extensive negative pressure wound therapy on neonatal respiration: A case report. Clin Case Rep 2021; 9:e05008. [PMID: 34721866 PMCID: PMC8543050 DOI: 10.1002/ccr3.5008] [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: 07/26/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
An extensive topical negative pressure wound therapy (NPWT) from the abdominal to chest walls in neonates may decrease the compliance of the chest wall. Therefore, it is important to monitor respiratory function carefully during the procedure.
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Affiliation(s)
- Ichiro Osawa
- Critical Care MedicineDepartment of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagaya‐kuJapan
| | - Norihiko Tsuboi
- Critical Care MedicineDepartment of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagaya‐kuJapan
| | - Nobuyuki Nosaka
- Critical Care MedicineDepartment of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagaya‐kuJapan
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityBunkyo‐kuJapan
| | - Nao Nishimura
- Critical Care MedicineDepartment of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagaya‐kuJapan
| | - Satoshi Nakagawa
- Critical Care MedicineDepartment of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagaya‐kuJapan
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Pedrazzi NE, Naiken S, La Scala G. Negative Pressure Wound Therapy in Pediatric Burn Patients: A Systematic Review. Adv Wound Care (New Rochelle) 2021; 10:270-280. [PMID: 32320366 DOI: 10.1089/wound.2019.1089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Significance: Negative pressure wound therapy (NPWT) requires the placement of a dressing over a wound, covered with an adhesive film, and applying to these dressing a negative pressure in a controlled fashion. This therapy is a powerful complement to surgical care of wounds. Data are however poor on its use in pediatric burns. Recent Advances: This systematic review, including a total of 466 patients, shows that NPWT as the initial treatment for burned children and after skin grafting has been shown to produce promising results. In the majority of studies, skin graft take rate is close to 100%. This therapy is particularly beneficial in the pediatric population because of less frequent dressing changes and early mobilization. NPWT devices accurately quantify burns water losses and allow tailoring liquid resuscitation. Critical Issues: NPWT is not in the subject of controlled clinical trials in pediatric; most publications are case reports or retrospective reviews. The sporadic complications include bleeding, local infections, and mechanical device issues. Future Directions: NPWT has been used in 2-month up to 18-year-old children with deep second- to third-degree burn of multiple etiologies, from a few days up to several months, on small to 40% total body surface area (%), and in difficult areas. Data gathered provide empirical guidelines on NPWT use in pediatric burns using continuous mode with a pressure of -50 to -75 mmHg for children younger than 2 years, and -75 to -125 mmHg in children over 2 years of age. Prospective randomized studies are needed to provide validated rules.
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Affiliation(s)
| | - Surennaidoo Naiken
- Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland
| | - Giorgio La Scala
- Pediatric Plastic Surgery, Department of Pediatrics, University of Geneva Children's Hospitals, Geneva, Switzerland
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Enescu DM, Stoicescu S, Tomiţă M, Nacea I, Ioniţă D, Tatar R. Management of lower extremity traumatic injuries with negative pressure wound therapy: Experience of a pediatric plastic surgery department. Injury 2020; 51 Suppl 4:S9-S15. [PMID: 32284186 DOI: 10.1016/j.injury.2020.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Extensive lower limb traumatic injuries are particularly challenging when they associate skin and soft tissue defects, moreover when the patient is a child. In view of more frequent recommendations and reports of negative pressure wound therapy (NPWT) use for severe trauma and extensive soft tissue defects of the lower extremity, we aimed at reviewing the indications and outcomes of this technique in our pediatric plastic surgery department. METHOD We performed a retrospective study for the period 2016-2019, in order to identify patients having suffered injuries of the ankle and foot, for who NPWT was used in the therapeutic protocol. RESULTS For the study period we identified a total of 9 children with ankle and foot injuries who had NPWT in their therapeutic protocol. The average age was 10 years (range 3 years 5 months to 14 years 4 months) and 8 of them were pedestrians, victims of traffic accidents. Five patients presented with associated injuries and fractures in other anatomic locations. NPWT was started 1-3 days after admission and it was used in average for 21.77 days, with good results in all cases. For 8 patients NPWT was sufficient to contract the wound and cover exposed bone and tendons before closing with split thickness skin graft (STSG). One patient needed also a free muscular flap transfer before grafting. All patients achieved complete healing and started physical therapy before discharging. CONCLUSION NPWT has proven to be an easy to use, safe and effective therapeutic tool for pediatric patients, with considerable improvement for healing in case of traumatic injuries of foot and ankle, presenting extensive skin and soft tissue defects and bone exposure in children. NPWT is also suitable for children since its use implies less frequent dressing changes, and decreases the level of pain and anxiety, and spares donor areas needed for more complicated procedures and, by creating an optimal grafting bed, it ensures good outcomes, in the short term and long term as well.
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Affiliation(s)
- Dan Mircea Enescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Plastic Reconstructive Surgery and Burns, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest Romania
| | - Simona Stoicescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Plastic Reconstructive Surgery and Burns, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest Romania.
| | - Maria Tomiţă
- Department of Plastic Reconstructive Surgery and Burns, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest Romania
| | - Iulia Nacea
- Department of Plastic Reconstructive Surgery and Burns, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest Romania
| | - Dan Ioniţă
- Department of Plastic Reconstructive Surgery and Burns, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest Romania
| | - Raluca Tatar
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Plastic Reconstructive Surgery and Burns, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest Romania
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Frear CC, Cuttle L, McPhail SM, Chatfield MD, Kimble RM, Griffin BR. Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children. Br J Surg 2020; 107:1741-1750. [PMID: 32926410 PMCID: PMC7692881 DOI: 10.1002/bjs.11993] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/17/2020] [Accepted: 07/21/2020] [Indexed: 12/03/2022]
Abstract
Background The efficacy of negative pressure wound therapy (NPWT) in the acute management of burns remains unclear. The purpose of this trial was to compare standard Acticoat™ and Mepitel™ dressings with combined Acticoat™, Mepitel™ and continuous NPWT to determine the effect of adjunctive NPWT on re‐epithelialization in paediatric burns. Methods This two‐arm, single‐centre RCT recruited children with acute thermal burns covering less than 5 per cent of their total body surface area. The primary outcome was time to re‐epithelialization. Blinded assessments were performed using photographs captured every 3–5 days until discharge. Secondary measures included pain, itch, grafting, perfusion and scar management referrals. Results Some 114 patients were randomized. Median time to re‐epithelialization was 8 (i.q.r. 7–11) days in the NPWT group and 10 (8–14) days in the control group. In a multivariable model, NPWT decreased the expected time to wound closure by 22 (95 per cent c.i. 7 to 34) per cent (P = 0·005). The risk of referral to scar management was reduced by 60 (18 to 81) per cent (P = 0·013). Four participants in the control group and one in the NPWT group underwent grafting. There were no statistically significant differences between groups in pain, itch or laser Doppler measures of perfusion. Adverse events were rare and minor, although NPWT carried a moderate treatment burden, with ten patients discontinuing early. Conclusion Adjunctive NPWT hastened re‐epithelialization in small‐area burn injuries in children, but had a greater treatment burden than standard dressings alone. Registration number: ACTRN12618000256279 (
http://ANZCTR.org.au).
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Affiliation(s)
- C C Frear
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - L Cuttle
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - S M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - M D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Australia
| | - R M Kimble
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,Queensland Children's Hospital, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - B R Griffin
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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12
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Pouzet L, Lancien U, Hamel A, Perrot P, Duteille F. Negative Pressure Wound Therapy in children: A 25 cases series. ANN CHIR PLAST ESTH 2020; 66:242-249. [PMID: 32665064 DOI: 10.1016/j.anplas.2020.06.002] [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: 05/06/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022]
Abstract
Negative Pressure Wound Therapy is a device applied to a wound that causes local depression. There are a few series showing the effectiveness of this treatment in Pediatric. The objective of this work is to try to clarify the indications in children. This is a retrospective series of 25 children between 2004 and 2019. The inclusion criteria were all children with a wound treated with Negative Pressure Wound Therapy. The characteristics retained were their age, the context of occurrence, the treatment time, the depression applied, the technique of skin covering wound and the average healing time. We included 25 patients. The average age was 8.8 years. The context of the wound occurrence was mainly a road (44%) or a domestic (36%) accident. Substance losses were mainly located in the lower limb (84%). The depression applied was -90mmHg. The healing time was 18.4 days. Thin skin grafting was the main method chosen (88%). No complications related to Negative Pressure Wound Therapy equipment have been identified. Despite the weakness of the literature and the lack of consensus regarding its use, Negative Pressure Wound Therapy is an essential therapy in pediatric. It is a simple and effective technique in children. It can reduce the need for flaps coverage, even in the event of exposure of noble elements. The flaps should not, however, be excluded from the decision-making algorithm, on pain of complications or sequelae.
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Affiliation(s)
- L Pouzet
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Plastic and reconstructive surgery department, hôpital Maison-Blanche, CHU Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
| | - U Lancien
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - A Hamel
- Pediatric orthopedics department, hôpital-Mère-Enfant, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Perrot
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - F Duteille
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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13
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McNamara SA, Hirt PA, Weigelt MA, Nanda S, de Bedout V, Kirsner RS, Schachner LA. Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review. J Wound Care 2020; 29:321-334. [PMID: 32530778 DOI: 10.12968/jowc.2020.29.6.321] [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: 02/05/2023]
Abstract
OBJECTIVE Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.
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Affiliation(s)
- Stephanie A McNamara
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Penelope A Hirt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Maximillian A Weigelt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Sonali Nanda
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Valeria de Bedout
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Lawrence A Schachner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
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14
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Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients. J Surg Res 2020; 254:197-205. [PMID: 32450421 DOI: 10.1016/j.jss.2020.04.025] [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: 07/29/2019] [Revised: 04/05/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of our study was to leverage a population-level analysis to advance our current knowledge about outpatient NPWT use in pediatric patients. MATERIALS AND METHODS We analyzed the Truven Health Analytics MarketScan Commercial Claims Database from 2006 to 2014 to identify children treated with NPWT. We compared patient characteristics, indications, complications before and after NPWT, health care utilization within 30 d of NPWT initiation, and health care cost profile of patients treated with NPWT primarily as outpatients versus inpatients. Outpatient NPWT was defined as patients with ≤50% of NPWT coded during an inpatient hospitalization, whereas inpatient NPWT was defined as patients with >50% of NPWT. RESULTS We identified 3184 patients (1621 inpatients and 1563 outpatients) aged 0-17 y, who were treated with NPWT from 2006 to 2014. Outpatient NPWT was implemented across multiple ages, comorbidities, and indications, with a low complication rate (2.4%). After controlling for hematologic comorbidity and indications, outpatient NPWT was associated with lower risk of complications (odds ratio: 0.57, 95% confidence interval 0.38-0.86) and lower median total costs ($5602.03) compared with inpatient ($15,233.21) therapy. CONCLUSIONS Outpatient NPWT management in pediatric patients was associated with low complication rates. Additional studies are necessary to determine the most overall cost-effective treatment setting for NPWT in the pediatric population.
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