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Ravindhran B, Schafer N, Howitt A, Carradice D, Smith G, Chetter I. Molecular mechanisms of action of negative pressure wound therapy: a systematic review. Expert Rev Mol Med 2023; 25:e29. [PMID: 37853784 DOI: 10.1017/erm.2023.24] [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: 10/20/2023]
Abstract
Negative pressure wound therapy (NPWT) has significantly advanced wound care and continues to find new applications. Its effects at a molecular level however, remain a subject of debate. The aim of this systematic review is to summarize the current evidence regarding the molecular mechanisms of action of NPWT. Medline, Embase, EBSCO databases and clinical trial registries were searched from inception to January 2023. Clinical studies, animal models or in-vitro studies that quantitatively or semi-quantitatively evaluated the influence of NPWT on growth factors, cytokine or gene-expression in the circulation or wound-bed were included. Risk of Bias assessment was performed using the RoBANS tool for non-randomized studies, the COCHRANE's Risk of Bias 2(ROB-2) tool for randomized clinical studies, OHAT tool for in-vitro studies or the SYRCLE tool for animal model studies. A descriptive summary was collated and the aggregated data is presented as a narrative synthesis. This review included 19 clinical studies, 11 animal studies and 3 in-vitro studies. The effects of NPWT on 43 biomarkers and 17 gene expressions were studied across included studies. NPWT stimulates modulation of numerous local and circulating cytokines and growth factor expressions to promote an anti-inflammatory profile. This is most likely achieved by downregulation of TNFα, upregulation of VEGF, TGF-β and fibronectin.
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Affiliation(s)
- Bharadhwaj Ravindhran
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
- Department of Health Sciences, University of York, York, UK
| | - Nicole Schafer
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Annabel Howitt
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | | | - George Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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Arundel C, Mott A. Recruitment and retention interventions in surgical and wound care trials: A systematic review. PLoS One 2023; 18:e0288028. [PMID: 37471398 PMCID: PMC10358880 DOI: 10.1371/journal.pone.0288028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Recruitment and retention to surgical trials has previously been reported to be problematic, resulting in research waste. Surgery often results in wounds, meaning these trials are likely to have similar populations. There is currently no systematic assessment of effective strategies for these populations and hence, systematic assessment of these was deemed to be of importance. METHODS A systematic review was conducted. Studies were eligible if they were randomised controlled trials undertaken to test an intervention to improve recruitment or retention within a surgical or wound based host randomised controlled trial. MEDLINE, EMBASE, Cochrane Library, ORRCA Database and the Northern Ireland Hub for Trials Methodology Research SWAT Repository Store were searched. Two independent reviewers screened the search results and extracted data for eligible studies using a piloted extraction form. A narrative synthesis was used due to a lack of heterogeneity between strategies which prevented meta-analysis. RESULTS A total of 2133 records were identified which resulted in 13 ultimately being included in the review; seven on recruitment and six on retention. All included studies were based within surgical host trials. Four of the seven recruitment studies focussed on the provision of consent information to participants, one focussed on study set up and one on staff training, with only one relating to consent information finding any significant effect. A range of retention strategies were assessed by the included studies, however only two found (pen vs no pen, mailing strategies) found any significant effect. CONCLUSION The included studies within a trial were all conducted within surgical trials. There was significant variation in strategies used, and limited replications and therefore further assessment may be warranted. Given the lack of studies embedded within wound care trials, further studies in this area are recommended. TRIAL REGISTRATION PROSPERO (CRD42020205475).
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Affiliation(s)
- Catherine Arundel
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Andrew Mott
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, United Kingdom
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Fu M, chen Y, Li J, Zhang X, Jiang X, Ou W, Chen K, Xiao W, Xie Y, Zhuang Y, Yang M, Shouxing D. Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates.. [DOI: 10.21203/rs.3.rs-2517931/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Background
Abdominal Wound Dehiscence (AWD), occupying a large proportion of neonatal surgery is an essential complication of abdominal surgery, which can leads to severe consequences, including life-threatening. This study aims at exploring prediction value for AWD with potential joint factors of hypoproteinemia and incision type.
Method
The Cox proportional-hazards model (the Cox model) was applied to analyze clinical data came from 453 patients underwent neonatal laparotomy from June 2009 to June 2020. According to application of the random numbers, 453 cases were divided into two separate models randomly involving training set with 318 observations (70%) and validation set with 135 observations (30%), and then the models trained were validated based on the validation set. Investigation in the connection between hypoproteinemia, incision type, combined factors and AWD, were used for comparing those prediction values for AWD.
Results
With a median follow-up of 15 months, the incidence of neonatal AWD was 6.0% (27/453). Based on the univariate and multivariate Analysis using the Cox Regression Analysis, hypoproteinemia(HR = 7.005, P = 0.001) and joint factor༈HR = 6.901, P < 0.001༉were both the independent risk factors for neonatal AWD in training set. Meanwhile, hypoproteinemia and joint factor༈HR = 5.497, P = 0.045༉were both also the independent risk factors for neonatal AWD in validation models, which indicated that joint factor was the independent risk factor in both models. The summary ROC curve was estimated, and the area under the ROC curve (AUC) was calculated as a criterion for validating the models trained. The findings illustrated that AUC of joint prediction factor for AWD was higher than either that of hypoproteinemia༈0.759 vs. 0.638) or incision type factor ༈0.759 vs. 0.671༉singly.
Conclusion
The contribution of hypoproteinemia and incision type combined factor for predicting AWD is superior than that of them individually, resulting in a significant promotion in prediction efficiency and accuracy of predicting neonatal AWD.
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Affiliation(s)
- Maxian Fu
- Huazhong university of science and technology union shenzhen hospital (Nanshan Hospital)
| | | | - Jianhong Li
- The Second Affiliated Hospital of Shantou University Medical College
| | - Xuan Zhang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University
| | - Xuewu Jiang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University
| | - Wenhui Ou
- The Second Affiliated Hospital of Shantou University Medical College
| | - Kaihong Chen
- The Second Affiliated Hospital of Shantou University Medical College
| | - Wenfeng Xiao
- The Second Affiliated Hospital of Shantou University Medical College
| | - Yao Xie
- Cancer Hospital of Shantou University Medical College
| | | | - Min Yang
- Shantou University Medical College
| | - Duan Shouxing
- Huazhong university of science and technology union shenzhen hospital (Nanshan Hospital)
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Pađen L, Griffiths J, Cullum N. “Negotiating a new normality” - a longitudinal qualitative exploration of the meaning of living with an open surgical wound. Int J Qual Stud Health Well-being 2022; 17:2123932. [PMID: 36102138 PMCID: PMC9481149 DOI: 10.1080/17482631.2022.2123932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds. Methods A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines. Results We found that the meaning of living with open surgical wounds is shaped by five subthemes: “enduring healing”, “life disruption”, “adapting to a new reality”, “striving for healing” and “returning to normal life;” all under an overarching theme of “negotiating a new normality”. Conclusion Participants’ well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical “chronicity” trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals’ experience of living with open surgical wounds.
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Affiliation(s)
- Ljubiša Pađen
- Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
| | - Jane Griffiths
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
- Research & Innovation Division, Manchester University NHS Foundation Trust Research Office, Manchester, UK
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Seidel D. Ambulatory negative pressure wound therapy of subcutaneous abdominal wounds after surgery: results of the SAWHI randomized clinical trial. BMC Surg 2022; 22:425. [PMID: 36503505 PMCID: PMC9743503 DOI: 10.1186/s12893-022-01863-x] [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: 10/04/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The SAWHI study showed that negative pressure wound therapy (NPWT) reduced treatment time by 7.8 days and had a 20.2% higher wound closure rate, but required a 2.1-day longer hospital stay than conventional wound treatment (CWT). The majority of study participants began treatment in the hospital and were discharged within 42 days. METHODS As an add-on to a multicenter randomized clinical trial, selected aspects of hospital discharge, outpatient treatment continuation, and subsequent wound closure outcomes are compared between the treatment arms in patients with subcutaneous abdominal wound healing impairment after surgery without fascia dehiscence in the per protocol population. RESULTS Within 42 days, wound closure rates were higher for outpatients in the NPWT arm than for outpatients in the CWT arm (27 of 55 [49.1%]) for both outpatient continuation of NPWT (8 of 26 [30.8%]) and outpatient CWT after NPWT was finished (27 of 121 [22.3%]). Time to wound closure was shorter for outpatients in the NPWT arm (outpatient transfer with: NPWT Mean ± standard error 28.8 ± 8.0 days; CWT 28.9 ± 9.5 days) than in the conventional treatment arm (30.4 ± 8.0 days). Nevertheless, within 30 study sites with patient enrollment, outpatient NPWT was performed in only 20 study sites for 65 of 157 study participants in the treatment arm. CONCLUSIONS Outpatient NPWT of postsurgical abdominal wounds with healing impairment is feasible and successful and should be encouraged whenever possible. Study site specific avoidance of outpatient NPWT emerges as an additional reason for the prolonged hospitalization time. Trial Registration ClinicalTrials.gov Identifier NCT01528033. Date of registration: February 7, 2012, retrospectively registered.
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Affiliation(s)
- Dörthe Seidel
- grid.412581.b0000 0000 9024 6397Institut Für Forschung in der Operativen Medizin, Witten/Herdecke University, Cologne, Germany
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González CVS, Carvalho EOD, Galvão NS, Nogueira PC, Santos VLCDG. Prevalence of complicated surgical wounds and related factors among adults hospitalized in public hospitals. Rev Esc Enferm USP 2022; 56:e20210477. [PMID: 35926076 DOI: 10.1590/1980-220x-reeusp-2021-0477en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of complicated surgical wounds and its related factors in hospitalized adults. METHOD In this cross-sectional study, information from 251 patients hospitalized in seven public hospitals in Manaus, Brazil, and at risk of suffering surgical site complications after undergoing surgery was analyzed. Data were collected via interviews, physical examinations, and a medical record review from March to June 2015. Prevalence rate was estimated as the ratio between individuals with complications and patients at risk. To explore associated variables, individuals with and without complications were compared via 5% significant logistic regression and bivariate analyses. This study was approved by a research ethics committee. RESULTS Overall, 15 patients (6%) showed complicated surgical wounds. General hospitalization (p < 0.003), presence of ecchymosis, (p < 0.001), and men (p = 0.047) increased patients' probability of developing complications in 13.9, 10.1, and 8.2 times, respectively. CONCLUSION Assessing the prevalence of complicated surgical wounds and its associated factors in adults contributes to their epidemiological understanding, highlighting prevention targets and making data available for scientific comparisons.
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Affiliation(s)
- Carol Viviana Serna González
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, São Paulo, SP, Brazil
| | | | | | - Paula Cristina Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil
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Herrod PJ, Doleman B, Hardy EJ, Hardy P, Maloney T, Williams JP, Lund JN. Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus. Cochrane Database Syst Rev 2022; 5:CD013439. [PMID: 35593897 PMCID: PMC9121912 DOI: 10.1002/14651858.cd013439.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds. OBJECTIVES To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting. SEARCH METHODS In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low. AUTHORS' CONCLUSIONS At present, the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further.
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Affiliation(s)
| | - Brett Doleman
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | | | - Paul Hardy
- Department of Tissue Viability, Royal Derby Hospital, Derby, UK
| | - Trevor Maloney
- Department of Tissue Viability, Royal Derby Hospital, Derby, UK
| | - John P Williams
- Department of Surgery and Anaesthesia, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Jon N Lund
- Division of Health Sciences, School of Medicine, University of Nottingham, Derby, UK
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Wong N, Zloty D. Secondary Intention Healing Over Exposed Bone on the Scalp, Forehead, and Temple Following Mohs Micrographic Surgery. J Cutan Med Surg 2022; 26:274-279. [PMID: 35134314 DOI: 10.1177/12034754221077903] [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: 11/16/2022]
Abstract
BACKGROUND Removal of skin cancers on the scalp, forehead, and temple can result in surgical defects with exposed bone. In such cases, reconstruction becomes challenging due to limited vascularity for flap or graft repair. OBJECTIVE Demonstrate the usefulness of secondary intention healing of scalp, forehead, and temple defects over exposed bone. METHODS/MATERIALS A retrospective case series of 41 patients who had Mohs Micrographic Surgery with post-surgical scalp, forehead, or temple defects involving exposed bone. These patients then underwent secondary intention healing. RESULTS 90% of patients successfully healed. Average time to complete granulation was 92 days, and average time to full re-epithelialization was 186 days. Visual analog scale assessment of final scar quality resulted in 57% being good, 35% being fair, and 8% being poor. No patient had infection or other serious complication. Mean follow-up duration was 272 days. CONCLUSION This case series shows the viability of secondary intention healing of scalp wounds over exposed bone. Study power was not adequate to predict time to complete healing based on defect size, or allow association of patient factors with the risk of nonhealing. Managing patient expectations, and emphasizing the importance of early occlusive wound care is paramount for healing success.
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Affiliation(s)
- Noelle Wong
- 8166119508 Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, Canada
| | - David Zloty
- 8166119508 Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, Canada
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Betzler A, Betzler J, Reissfelder C. Aktuelles Wund- und Fistelmanagement in der Viszeralchirurgie. Zentralbl Chir 2022; 147:6-9. [DOI: 10.1055/a-1209-5874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alexander Betzler
- Chirurgische Klinik, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Johanna Betzler
- Chirurgische Klinik, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Christoph Reissfelder
- Chirurgische Klinik, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany
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González CVS, Carvalho EOD, Galvão NS, Nogueira PC, Santos VLCDG. Prevalência de ferida operatória complicada e fatores associados em adultos internados em hospitais públicos. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0477pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: Estimar a prevalência de Ferida Operatória Complicada e seus fatores associados, em adultos hospitalizados. Método: Estudo transversal, aprovado por comitê de ética. Foram analisadas informações de 251 pacientes submetidos à cirurgia e com risco de complicação do sítio cirúrgico, internados em sete hospitais públicos em Manaus (Brasil); cujos dados foram coletados por meio de entrevista, exame físico e revisão de prontuários, no período de março a junho de 2015. A taxa de prevalência foi calculada como a razão entre os indivíduos com complicação e os pacientes em risco. Para exploração de variáveis associadas, foram comparados indivíduos com e sem complicação por meio de análises bivariadas e regressão logística, com significância de 5%. Resultados: 15 pacientes (6%) apresentaram ferida operatória complicada. A presença de equimose (p < 0,001), ajustada pelo sexo masculino (p = 0,047) e a internação na clínica geral (p < 0,003) aumentaram a probabilidade de desenvolver a complicação em 10,1; 8,2 e 13,9 vezes, respectivamente. Conclusão A identificação da prevalência da ferida operatória complicada em adultos e seus fatores associados contribuem para a sua compreensão epidemiológica, destacando alvos de prevenção e disponibilizando dados para comparação científica.
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Chetter I, Arundel C, Martin BC, Hewitt C, Fairhurst C, Joshi K, Mott A, Rodgers S, Goncalves PS, Torgerson D, Wilkinson J, Blazeby J, Macefield R, Dixon S, Henderson E, Oswald A, Dumville J, Lee M, Pinkney T, Stubbs N, Wilson L. Negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention (SWHSI-2 trial): study protocol for a pragmatic, multicentre, cross surgical specialty, randomised controlled trial. Trials 2021; 22:739. [PMID: 34696784 PMCID: PMC8543414 DOI: 10.1186/s13063-021-05662-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The majority of surgical wounds are closed (for example with sutures or staples) and so heal by primary intention. Where closure is not possible, or the wound subsequently breaks down, wounds may be left to heal from the bottom up (healing by secondary intention). Surgical wound healing by secondary intention (SWHSI) frequently presents a significant management challenge. Additional treatments are often required during the course of healing, and thus a significant financial burden is associated with treating these wounds. Increasingly, negative pressure wound therapy (NPWT) is used in the management of SWHSI. This wound dressing system provides a negative pressure (vacuum) to the wound, removing fluid into a canister, which is believed to be conducive to wound healing. Despite the increasing use of NPWT, there is limited robust evidence for the effectiveness of this device. A well-designed and conducted randomised controlled trial is now required to ascertain if NPWT is a clinically and cost-effective treatment for SWHSI. METHODS SWHSI-2 is a pragmatic, multi-centre, cross surgical specialty, two arm, parallel group, randomised controlled superiority trial. Adult patients with a SWHSI will be randomised to receive either NPWT or usual care (no NPWT) and will be followed up for 12 months. The primary outcome will be time to healing (defined as full epithelial cover in absence of a scab) in number of days since randomisation. Secondary outcomes will include key clinical events (hospital admission or discharge, treatment status, reoperation, amputation, antibiotic use and death), wound infection, wound pain, health-related quality of life, health utility and resource use. DISCUSSION Given the increasing use of NPWT, despite limited high-quality supporting evidence, the SWHSI-2 Trial will provide robust evidence on the clinical and cost-effectiveness of NPWT in the management of SWHSI. The SWHSI-2 Trial opened to recruitment in May 2019 and is currently recruiting across 20 participating centres. TRIAL REGISTRATION ISRCTN 26277546 . Prospectively registered on 25 March 2019.
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Affiliation(s)
- Ian Chetter
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK.
| | - Belen Corbacho Martin
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Kalpita Joshi
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Andrew Mott
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Pedro Saramago Goncalves
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jacqueline Wilkinson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jane Blazeby
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Rhiannon Macefield
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Stephen Dixon
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Eileen Henderson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Angela Oswald
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jo Dumville
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Matthew Lee
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Thomas Pinkney
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Nikki Stubbs
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Lyn Wilson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
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12
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Abstract
Surgical site infections (SSI) are the most frequent nosocomial infection in Germany. They are defined as an infection of the surgical site that occurs within 30 days after a surgical procedure. The diagnostic criteria include localized pain or tenderness, localized swelling, erythema, excess warmth, purulent drainage from the incision and cultural detection of pathogens in an aseptically obtained specimen from the incision. Wound infections are differentiated into superficial incisional (grade 1), deep incisional (grade 2) and infections of organs and body cavities in the region of the operation (grade 3). Risk factors for SSI include anemia, immunosuppression, diabetes mellitus, obesity, smoking and malnutrition. The crucial preoperative preventive measures are antisepsis of the surgical area and antibiotic prophylaxis. Intraoperative subcutaneous wound irrigation with an antiseptic solution reduces SSI in visceral surgery. The primary treatment encompasses the liberal debridement of the wound.
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Affiliation(s)
- Rahel Strobel
- Klinik für Allgemein- und Viszeralchirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - Martin Kreis
- Klinik für Allgemein- und Viszeralchirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Johannes Christian Lauscher
- Klinik für Allgemein- und Viszeralchirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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13
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Cable Tie Dynamic Wound Closure. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Buckley H, Dumville J, Hodgkinson M, Wearmouth D, Barlow G, van der Woude M, Cullum N, Chetter I, Lagos D. Characterisation of baseline microbiological and host factors in an inception cohort of people with surgical wounds healing by secondary intention reveals circulating IL-6 levels as a potential predictive biomarker of healing. Wellcome Open Res 2020; 5:80. [PMID: 34104801 PMCID: PMC8160585 DOI: 10.12688/wellcomeopenres.15688.2] [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] [Accepted: 11/10/2020] [Indexed: 11/20/2022] Open
Abstract
Background: More than 2 million people per year are treated for surgical wounds in the UK. Over a quarter of these wounds are estimated to heal by secondary intention (from the "bottom up") resulting in further complications and requiring increased healthcare resources. Identification of microbiological or host biomarkers that can predict healing outcomes may help to optimize the management of surgical wounds healing by secondary intention. However, the microbial and host factor heterogeneity amongst this diverse population is completely unexplored. Methods: We demonstrate feasibility of determining presence and levels of wound microbes and systemic host factors in an inception cohort of 54 people presenting with surgical wounds healing by secondary intention, who were subsequently followed-up for a period of 12-21 months. We present descriptive statistics for plasma levels of inflammatory, angiogenic cytokines and microRNAs, and we identify a range of wound colonizing microbes. We tentatively explore association with healing aiming to generate hypotheses for future research. Results: We report a potential correlation between poor healing outcomes and elevated interleukin (IL)-6 plasma levels at presentation (ρ=0.13) which requires confirmation. Conclusions: This study demonstrates the degree of biological heterogeneity amongst people with surgical wounds healing by secondary intention and proves the feasibility of embedding a biomarker discovery study in a cohort study in surgical wounds. Our results are essential for designing large biomarker discovery studies to further investigate the potential validity of circulating IL-6 or other factors as novel predictive biomarkers of healing for surgical wounds healing by secondary intention.
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Affiliation(s)
- Hannah Buckley
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9NT, UK
| | - Michael Hodgkinson
- York Biomedical Research Institute, Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Debbie Wearmouth
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - Gavin Barlow
- York Biomedical Research Institute, Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Marjan van der Woude
- York Biomedical Research Institute, Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9NT, UK.,Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9PL, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School / Hull University Teaching Hospital NHS Trust, Hull, HU3 2JZ, UK
| | - Dimitris Lagos
- York Biomedical Research Institute, Hull York Medical School, University of York, York, YO10 5DD, UK
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15
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Chetter I, Arundel C, Bell K, Buckley H, Claxton K, Corbacho Martin B, Cullum N, Dumville J, Fairhurst C, Henderson E, Lamb K, Long J, McCaughan D, McGinnis E, Oswald A, Goncalves PS, Sheard L, Soares MO, Stubbs N, Torgerson D, Welton N. The epidemiology, management and impact of surgical wounds healing by secondary intention: a research programme including the SWHSI feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Most surgical incisions heal by primary intention (i.e. wound edges are apposed with sutures, clips or glue); however, some heal by secondary intention (i.e. the wound is left open and heals by formation of granulation tissue). There is, however, a lack of evidence regarding the epidemiology, management and impact on patients’ quality of life of these surgical wounds healing by secondary intention, resulting in uncertainty regarding effective treatments and difficulty in planning care and research.
Objectives
To derive a better understanding of the nature, extent, costs, impact and outcomes of surgical wounds healing by secondary intention, effective treatments, and the value and nature of further research.
Design
Cross-sectional survey; inception cohort; cost-effectiveness and value of implementation analyses; qualitative interviews; and pilot, feasibility randomised controlled trial.
Setting
Acute and community care settings in Leeds and Hull, Yorkshire, UK.
Participants
Adults (or for qualitative interviews, patients or practitioners) with previous experience of a surgical wound healing by secondary intention. Inclusion criteria varied between the individual workstreams.
Interventions
The pilot, feasibility randomised controlled trial compared negative-pressure wound therapy – a device applying a controlled vacuum to a wound via a dressing – with usual care (no negative-pressure wound therapy).
Results
Survey data estimated that treated surgical wounds healing by secondary intention have a point prevalence of 4.1 per 10,000 population (95% confidence interval 3.5 to 4.7 per 10,000 population). Surgical wounds healing by secondary intention most frequently occurred following colorectal surgery (n = 80, 42.8% cross-sectional survey; n = 136, 39.7% inception cohort) and were often planned before surgery (n = 89, 47.6% cross-sectional survey; n = 236, 60.1% inception cohort). Wound care was frequently delivered in community settings (n = 109, 58.3%) and most patients (n = 184, 98.4%) received active wound treatment. Cohort data identified hydrofibre dressings (n = 259, 65.9%) as the most common treatment, although 29.3% (n = 115) of participants used negative-pressure wound therapy at some time during the study. Surgical wounds healing by secondary intention occurred in 81.4% (n = 320) of participants at a median of 86 days (95% confidence interval 75 to 103 days). Baseline wound area (p ≤ 0.01), surgical wound contamination (determined during surgery; p = 0.04) and wound infection at any time (p ≤ 0.01) (i.e. at baseline or postoperatively) were found to be predictors of prolonged healing. Econometric models, using observational, cohort study data, identified that, with little uncertainty, negative-pressure wound therapy treatment is more costly and less effective than standard dressing treatment for the healing of open surgical wounds. Model A (ordinary least squares with imputation) effectiveness: 73 days longer than those who did not receive negative-pressure wound therapy (95% credible interval 33.8 to 112.8 days longer). Model A cost-effectiveness (associated incremental quality-adjusted life-years): observables –0.012 (standard error 0.005) and unobservables –0.008 (standard error 0.011). Model B (two-stage model, logistic and linear regression) effectiveness: 46 days longer than those who did not receive negative-pressure wound therapy (95% credible interval 19.6 to 72.5 days longer). Model B cost-effectiveness (associated incremental quality-adjusted life-years): observables –0.007 (standard error 0.004) and unobservables –0.027 (standard error 0.017). Patient interviews (n = 20) identified initial reactions to surgical wounds healing by secondary intention of shock and disbelief. Impaired quality of life characterised the long healing process, with particular impact on daily living for patients with families or in paid employment. Patients were willing to try any treatment promising wound healing. Health professionals (n = 12) had variable knowledge of surgical wound healing by secondary intention treatments and, frequently, favoured negative-pressure wound therapy, despite the lack of robust evidence. The pilot feasibility randomised controlled trial screened 248 patients for eligibility and subsequently recruited and randomised 40 participants to receive negative-pressure wound therapy or usual care (no negative-pressure wound therapy). Data indicated that it was feasible to complete a full randomised controlled trial to provide definitive evidence for the clinical effectiveness and cost-effectiveness of negative-pressure wound therapy as a treatment for surgical wounds healing by secondary intention. Key elements and recommendations for a larger randomised controlled trial were identified.
Limitations
This research programme was conducted in a single geographical area (i.e. Yorkshire and the Humber, UK) and local guidelines and practices may have affected treatment availability, and so may not represent UK-wide treatment choices. A wide range of wound types were included; however, some wound types may be under-represented, meaning that this research may not represent the overall surgical wound healing by secondary intention population. The lack of randomised controlled trial data on the relative effects of negative-pressure wound therapy in surgical wounds healing by secondary intention resulted in much of the economic modelling being based on observational data. Observational data, even with extensive adjustment, do not negate the potential for unresolved confounding to affect the results, which can reduce confidence in conclusions drawn from observational data. Definitive evidence from a randomised controlled trial may be the only way to overcome this lack of confidence.
Conclusions
This research has provided new information regarding the nature, extent, costs, impacts and outcomes of surgical wounds healing by secondary intention, treatment effectiveness, and the value and nature of future research, while addressing previous uncertainties regarding the problem of surgical wounds healing by secondary intention. Aspects of our research indicate that negative-pressure wound therapy is more costly and less effective than standard dressing for the healing of open surgical wounds. However, because this conclusion is based solely on observational data, it may be affected by unresolved confounding. Should a future randomised controlled trial be considered necessary, its design should reflect careful consideration of the findings of this programme of research.
Future work
This research signals the importance of further research on surgical wound healing by secondary intention. Key research questions raised by this programme of research include (1) which treatments are clinically effective and cost-effective for surgical wound healing by secondary intention for all patients or for particular patient subgroups? (2) Can particular prognostic factors predict time to healing of surgical wound healing by secondary intention? And (3) do psychosocial interventions have the potential to improve quality of life in people with hard-to-heal surgical wound healing by secondary intention? Given that negative-pressure wound therapy has been widely adopted, with relatively little evidence to support its use, the design and outcomes of a randomised controlled trial would need to be carefully considered. We focused in this research on wound healing, and maintain, based on the findings of patient interviews, that this is a key outcome for future research. Impacts of negative-pressure wound therapy on outcomes such as infection and reoperation should also be considered, as should patients’ views of the treatment. The type of patient group recruited and the outcomes of interest will all influence the duration of follow-up of any planned study. The comparator in any future study will also need careful consideration.
Trial registration
Current Controlled Trials ISRCTN12761776.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 7. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Ian Chetter
- Hull York Medical School, University of York, York, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Hannah Buckley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
| | | | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Judith Long
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Angela Oswald
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | - Marta O Soares
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Nicky Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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16
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Prevalence of Chronic Skin Wounds and Their Risk Factors in an Inpatient Hospital Setting in Northern China. Adv Skin Wound Care 2020; 33:1-10. [DOI: 10.1097/01.asw.0000694164.34068.82] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Andrade EG, Guerra JJ, Punch L. A Multi-Modal Approach to Closing Exploratory Laparotomies Including High-Risk Wounds. Cureus 2020; 12:e9087. [PMID: 32789037 PMCID: PMC7417030 DOI: 10.7759/cureus.9087] [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] [Indexed: 12/05/2022] Open
Abstract
Background Laparotomy incisions with contamination have a high incidence of surgical site infection (SSI). One strategy to reduce SSI has been to allow these wounds to heal by secondary intention; however, this results in an ongoing need for wound care after discharge. Methods A prospectively maintained Acute and Critical Care Surgery database was queried for patients who underwent exploratory laparotomy during 2008-2018. Patients were stratified into two groups: 2008-2015 (no protocol [NP]) and 2016-2018 (closure protocol [CP]). CP patients were operated on by a single surgeon utilizing a multi-modal high-risk incisional closure protocol, which included dilute chlorhexidine lavage, closed suction drains for incisions deeper than 3 centimeters, and incisional negative-pressure wound therapy (iNPWT). The CDC (Centers for Disease Control and Prevention) guidelines were used to determine wound classification and SSI based on chart review. Groups were compared using univariate and multivariate analysis. Results A total of 139 patients met the study criteria. The overall SSI rate, including superficial and deep space infections, was no different in NP versus CP (21.6 vs. 24.1%; p=0.74). The rate of superficial SSI was similar between NP and CP (11.8 vs. 8.4%; p=0.53). Rates of wound closure at discharge were higher in the CP group than the NP group across wound classes, with the greatest difference among dirty wounds (50.0% NP vs. 94.9% CP; p<0.01). CP significantly increased the likelihood of wound closure (OR=179.2; p<0.001) even after controlling for body mass index, wound classification, ASA (American Society of Anesthesiologists) status, and initially open abdomen. Conclusions By addressing both tissue factors and bacterial burden through the use of a multi-modal high-risk incisional closure protocol involving iNPWT, all wounds can be considered for closure without increasing the risk of SSI.
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Affiliation(s)
| | | | - Laurie Punch
- Surgery, Barnes-Jewish Hospital, Washington University, St. Louis, USA
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18
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Buckley H, Dumville J, Hodgkinson M, Wearmouth D, Barlow G, van der Woude M, Cullum N, Chetter I, Lagos D. Characterisation of baseline microbiological and host factors in an inception cohort of people with surgical wounds healing by secondary intention reveals circulating IL-6 levels as a potential predictive biomarker of healing. Wellcome Open Res 2020; 5:80. [DOI: 10.12688/wellcomeopenres.15688.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: More than 2 million people per year are treated for surgical wounds in the UK. Over a quarter of these wounds are estimated to heal by secondary intention (from the “bottom up”) resulting in further complications and requiring increased healthcare resources. Identification of microbiological or host biomarkers that can predict healing outcomes may help to optimize the management of surgical wounds healing by secondary intention. However, the microbial and host factor heterogeneity amongst this diverse population is completely unexplored. Methods: We demonstrate feasibility of determining presence and levels of wound microbes and systemic host factors in an inception cohort of 54 people presenting with surgical wounds healing by secondary intention, who were subsequently followed-up for a period of 12-21 months. We present descriptive statistics for plasma levels of inflammatory, angiogenic cytokines and microRNAs, and we identify a range of wound colonizing microbes. We tentatively explore association with healing aiming to generate hypotheses for future research. Results: We report a potential correlation between poor healing outcomes and elevated interleukin (IL)-6 plasma levels at presentation (ρ=0.13) which requires confirmation. Conclusions: This study demonstrates the degree of biological heterogeneity amongst people with surgical wounds healing by secondary intention and proves the feasibility of embedding a biomarker discovery study in a cohort study in surgical wounds. Our results are essential for designing large biomarker discovery studies to further investigate the potential validity of circulating IL-6 or other factors as novel predictive biomarkers of healing for surgical wounds healing by secondary intention.
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19
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention: A qualitative study. J Clin Nurs 2020; 29:2557-2571. [PMID: 32279371 DOI: 10.1111/jocn.15279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 01/18/2023]
Abstract
AIMS AND OBJECTIVES To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention. BACKGROUND Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as "healing by secondary intention." These wounds are often slow to heal, prone to infection and complex to manage. DESIGN A qualitative, descriptive approach, using semi-structured interviews. METHODS Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of "Framework" approach. Consolidated criteria for reporting qualitative research guided the study report. RESULTS Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. CONCLUSIONS Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. RELEVANCE FOR CLINICAL PRACTICE Clinical decision-making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments.
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Affiliation(s)
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research and Innovation Division, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS Trust, Hull, UK
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20
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Herrod PJ, Doleman B, Hardy EJ, Hardy P, Maloney T, Williams JP, Lund JN. Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus. Cochrane Database Syst Rev 2019. [DOI: 10.1002/14651858.cd013439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Brett Doleman
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham; Department of Surgery and Anaesthesia; Uttoxeter New Road Derby UK DE22 3DT
| | | | - Paul Hardy
- Royal Derby Hospital; Department of Tissue Viability; Derby UK
| | - Trevor Maloney
- Royal Derby Hospital; Department of Tissue Viability; Derby UK
| | - John P Williams
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham; Department of Surgery and Anaesthesia; Uttoxeter New Road Derby UK DE22 3DT
| | - Jon N Lund
- University of Nottingham; Division of Health Sciences, School of Medicine; Medical School, Royal Derby Hospital, Uttoxeter Road Derby UK DE22 3DT
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21
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Souza AK, Souza TR, Siqueira das Neves LM, de Paula Marcondes Ferreira Leite G, Garcia SB, Roberto de Jesus Guirro R, Barbosa RI, Caldeira de Oliveira Guirro E. Effect of High Voltage Pulsed Current on the integration of total skin grafts in rats submitted to nicotine action. J Tissue Viability 2019; 28:161-166. [DOI: 10.1016/j.jtv.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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22
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Pađen L, Griffiths J, Cullum N. A cross-sectional survey of patients with open surgical wounds in Slovenia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e213-e222. [PMID: 30549131 DOI: 10.1111/hsc.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Most surgical wounds heal by primary intention, that is, the wound is closed with sutures, clips, or glue. However, some surgical wounds are either left open to heal from the bottom up ("healing by secondary intention") or break open partially or fully after primary closure. There is little basic knowledge about the occurrence and natural history of surgical wounds healing by secondary intention (SWHSI); therefore, the aim of this survey was to estimate the number of people with SWHSI in Slovenia, the nature of these wounds, and to investigate how they are managed. A multiservice, cross-sectional survey was carried out over a 2-week period in the city of Ljubljana, Slovenia (population 288,919). Healthcare professionals across health and social care settings completed one anonymised form for each patient with a SWHSI. Forms were completed for 110 patients. The point prevalence of SWHSI was 0.38 per 1,000 of the population (95% CI: 0.33-0.44). Patients' mean age was 50.5 years. The majority of SWHSI were planned to heal by secondary intention before surgery (76/110, 69%). Of SWHSI, 83% (92/110) were treated with wound dressings, and 6% were treated with negative pressure wound therapy. Data were missing for 11 cases. This survey is the first to provide essential information about the extent, nature, and treatment of SWHSI in Slovenia. Furthermore, it is one of the latest of a very small number of studies to have contributed to knowledge about SWHSI globally. The results from the survey can be used for planning future research, health resources management, and policy development.
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Affiliation(s)
- Ljubiša Pađen
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Department of Nursing, University of Ljubljana, Ljubljana, Slovenia
| | - Jane Griffiths
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Research & Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
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23
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Yapp JH, Raja Ahmad RMK, Mahmud R, Mohtarrudin N, Mohamad Yusof L, Abdul Rahim E, Ahmad SA, Abu Bakar MZ. Determining weight‐bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: Implications for pressure ulcer prevention. Wound Repair Regen 2019; 27:225-234. [DOI: 10.1111/wrr.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Jong Heng Yapp
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Raja Mohd Kamil Raja Ahmad
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Rozi Mahmud
- Cancer Resource and Education Center, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Loqman Mohamad Yusof
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary MedicineUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Ezamin Abdul Rahim
- Department of Imaging, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Md Zuki Abu Bakar
- Department of Veterinary Pre‐Clinical Science, Faculty of Veterinary MedicineUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
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24
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Curran T, Alvarez D, Pastrana Del Valle J, Cataldo TE, Poylin V, Nagle D. Prophylactic closed-incision negative-pressure wound therapy is associated with decreased surgical site infection in high-risk colorectal surgery laparotomy wounds. Colorectal Dis 2019; 21:110-118. [PMID: 30047611 PMCID: PMC7380040 DOI: 10.1111/codi.14350] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Abstract
AIM Surgical site infection in colorectal surgery is associated with significant healthcare costs, which may be reduced by using a closed-incision negative-pressure therapy device. The aim of this study was to assess the impact of closed-incision negative-pressure therapy on the incidence of surgical site infection. METHOD In this retrospective cohort study we evaluated all patients who had undergone high-risk open colorectal surgery at a single tertiary care centre from 2012 to 2016. We compared the incidence of surgical site infection between those receiving standard postoperative wound care between 2012 and 2014 and those receiving closed-incision negative-pressure therapy via a customizable device (Prevena Incision Management System, KCI, an Acelity company, San Antonio, Texas, USA) between 2014 and 2016. A validated surgical site infection risk score was used to create a 1:1 matched cohort subset. RESULTS Negative pressure therapy was used in 77 patients and compared with 238 controls. Negative pressure patients were more likely to have a stoma (92% vs 48%, P < 0.01) and to be smokers (33% vs 15%, P < 0.01). Surgical site infection was higher in control patients (15%, n = 35/238) compared with negative pressure patients (7%, n = 5/77) (P = 0.05). On regression analysis, negative pressure therapy was associated with decreased surgical site infection (OR 0.27; 95% CI 0.09-0.78). These differences persisted in the matched analysis. CONCLUSION Negative pressure therapy was associated with decreased surgical site infection. Negative pressure therapy offers significant potential for quality improvement.
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Affiliation(s)
- T. Curran
- Division of Colon and Rectal SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - D. Alvarez
- Division of Colon and Rectal SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - J. Pastrana Del Valle
- Division of Colon and Rectal SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - T. E. Cataldo
- Division of Colon and Rectal SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - V. Poylin
- Division of Colon and Rectal SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - D. Nagle
- Division of Colon and Rectal SurgeryDepartment of SurgeryBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Patients with surgical wounds healing by secondary intention: A prospective, cohort study. Int J Nurs Stud 2019; 89:62-71. [DOI: 10.1016/j.ijnurstu.2018.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 11/20/2022]
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26
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Raykha C, Botros ASR, Roden Y, Murchan P. Negative Pressure Wound Therapy with Instillation as Conservative Management for a Large Abdominal Wound Following Incarcerated Parastomal Hernia Repair. Cureus 2018; 10:e3728. [PMID: 30788207 PMCID: PMC6373885 DOI: 10.7759/cureus.3728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parastomal herniation is a common complication following stoma creation, necessitating surgical repair in up to one-quarter of cases, including emergency cases of incarceration or strangulation. Following hernia repair with or without mesh placement, surgical sites are at risk of infection post-operatively and this is typically resolved by removing the mesh, which can be technically challenging. Few studies have assessed conservative management options for these types of cases. Here, we present a case where negative pressure wound therapy (NPWT) with instillation was utilized for secondary intention healing of a large abdominal wound (20 cm x 23 cm x 5 cm) following mesh infection post-parastomal hernia repair. The patient’s wound was completely healed after eight weeks and she had no long-term complications at the one-year follow-up. NPWT with instillation is an option for the conservative management of large abdominal wounds, which can be considered on a case-by-case basis.
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Affiliation(s)
| | | | - Yasmine Roden
- General Surgery, South Tipperary General Hospital, Clonmel, IRL
| | - Peter Murchan
- General Surgery, South Tipperary General Hospital, Clonmel, IRL
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Spira JAO, Borges EL, Silva PAB, Abreu MNS, Guedes ACM, Pires-Júnior JF. Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study. Rev Lat Am Enfermagem 2018; 26:e3052. [PMID: 30328975 PMCID: PMC6201706 DOI: 10.1590/1518-8345.2274.3052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/26/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE to identify factors associated with complex surgical wounds in the breasts and abdomen in outpatients. METHOD observational case-control study involving 327 patients, distributed into 160 cases (complex surgical wound) and 167 controls (simple surgical wound). Data were extracted from the medical records and a binary logistic regression model was used for analysis, considering a significance level of 5%. RESULTS the factors associated with greater chance of occurrence of complex surgical wound were 18 to 59 years of age (p = 0.003), schooling < 8 years (p = 0.049), radiotherapy (p < 0.001), hysterectomy (p = 0.003), glycemia (≤ 99 mg/dL) and arterial hypertension (p = 0.033), while quadrantectomy (p = 0.025) served as a protective factor. CONCLUSION radiotherapy was the most significant factor for surgical wound complications. Glycemic alteration was an unexpected result and shows the need for further studies related to this topic.
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Affiliation(s)
| | - Eline Lima Borges
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, MG, Brazil
| | | | | | | | - José Ferreira Pires-Júnior
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, MG, Brazil
- Instituto Mario Penna, Hospital Luxemburgo, Belo Horizonte, MG,
Brazil
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28
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Acker A, Leonard J, Seamon MJ, Holena DN, Pascual J, Smith BP, Reilly PM, Martin ND. Leaving Contaminated Trauma Laparotomy Wounds Open Reduces Wound Infections But Does Not Add Value. J Surg Res 2018; 232:450-455. [PMID: 30463756 DOI: 10.1016/j.jss.2018.05.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/12/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of surgical site infection (SSI) has become a key quality indicator following clean and clean/contaminated surgical procedures. In contrast, contaminated and dirty wounds have garnered little attention with this quality metric because of the expected higher complication incidence. We hypothesized that wound management strategies in this high-risk population vary significantly and might not add value to the overall care. MATERIALS AND METHODS This is a retrospective, observational study of trauma patients who underwent an exploratory laparotomy at an urban, academic, level 1 trauma center from 2014 to 2016. Deaths before hospital discharge were excluded. Wounds were classified using the Centers for Disease Control and Prevention definition on review of the operative reports. SSI was determined by review of the medical record, also per Centers for Disease Control and Prevention definition. Wound management strategies were categorized as either primary skin closure or closure by secondary intention. Outcomes were compared using Chi square or Kruskal-Wallis test. RESULTS There were 128 patients who met study criteria. Fifty-five (42.9%) wounds were left open to close by secondary intention. In the wounds that were closed primarily (n = 73), eight (10.9%) developed an SSI. There were significant differences in the average length of stay (25.0 versus 11.6 d, P = 0.032), number of office visits (3.0 versus 1.8, P = 0.008), and time from last laparotomy to the last wound care office visit (112.8 versus 57.4, P = 0.012) between patients who were treated with secondary intention closure compared to those closed primarily who did not suffer from SSI. CONCLUSIONS There is significant incidence of SSI in contaminated and dirty traumatic abdominal wounds; however, wound management strategies vary widely within this cohort. Closure by secondary intention requires significantly more resource utilization. Isolating risk factors for SSI may allow additional patients to undergo primary skin closure and avoid the morbidity of closure by secondary intention.
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Affiliation(s)
- Andrew Acker
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Leonard
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jose Pascual
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick M Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Niels D Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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30
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Yapp JH, Kamil R, Rozi M, Mohtarrudin N, Loqman MY, Ezamin AR, Ahmad SA, Abu Bakar Z. Trends of reactive hyperaemia responses to repetitive loading on skin tissue of rats - Implications for pressure ulcer prevention. J Tissue Viability 2017; 26:196-201. [PMID: 28438463 DOI: 10.1016/j.jtv.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022]
Abstract
Tissue recovery is important in preventing tissue deterioration, which is induced by pressure and may lead to pressure ulcers (PU). Reactive hyperaemia (RH) is an indicator used to identify people at risk of PU. In this study, the effect of different recovery times on RH trend is investigated during repetitive loading. Twenty-one male Sprague-Dawley rats (seven per group), with body weight of 385-485 g, were categorised into three groups and subjected to different recovery times with three repetitive loading cycles. The first, second, and third groups were subjected to short (3 min), moderate (10 min), and prolonged (40 min) recovery, respectively, while fixed loading time and pressure (10 min and 50 mmHg, respectively). Peak hyperaemia was measured in the three cycles to determine trends associated with different recovery times. Three RH trends (increasing, decreasing, and inconsistent) were observed. As the recovery time is increased (3 min vs. 10 min vs. 40 min), the number of samples with increasing RH trend decreases (57% vs. 29% vs. 14%) and the number of samples with inconsistent RH trend increases (29% vs. 57% vs. 72%). All groups consists of one sample with decreasing RH trend (14%). Results confirm that different recovery times affect the RH trend during repetitive loading. The RH trend may be used to determine the sufficient recovery time of an individual to avoid PU development.
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Affiliation(s)
- Jong-Heng Yapp
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Raja Kamil
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia.
| | - M Rozi
- Cancer Resource and Education Center, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - M Y Loqman
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - A R Ezamin
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Zuki Abu Bakar
- Department of Veterinary Pre-Clinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
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Norman G, Dumville JC, Mohapatra DP, Owens GL, Crosbie EJ. Antibiotics and antiseptics for surgical wounds healing by secondary intention. Cochrane Database Syst Rev 2016; 3:CD011712. [PMID: 27021482 PMCID: PMC6599835 DOI: 10.1002/14651858.cd011712.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Following surgery, incisions are usually closed by fixing the edges together with sutures (stitches), staples, adhesives (glue) or clips. This process helps the cut edges heal together and is called 'healing by primary intention'. However, a minority of surgical wounds are not closed in this way. Where the risk of infection is high or there has been significant loss of tissue, wounds may be left open to heal by the growth of new tissue rather than by primary closure; this is known as 'healing by secondary intention'. There is a risk of infection in open wounds, which may impact on wound healing, and antiseptic or antibiotic treatments may be used with the aim of preventing or treating such infections. This review is one of a suite of Cochrane reviews investigating the evidence on antiseptics and antibiotics in different types of wounds. It aims to present current evidence related to the use of antiseptics and antibiotics for surgical wounds healing by secondary intention (SWHSI). OBJECTIVES To assess the effects of systemic and topical antibiotics, and topical antiseptics for the treatment of surgical wounds healing by secondary intention. SEARCH METHODS In November 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched three clinical trials registries and the references of included studies and relevant systematic reviews. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials which enrolled adults with a surgical wound healing by secondary intention and assessed treatment with an antiseptic or antibiotic treatment. Studies enrolling people with skin graft donor sites were not included, neither were studies of wounds with a non-surgical origin which had subsequently undergone sharp or surgical debridement or other surgical treatments or wounds within the oral or aural cavities. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS Eleven studies with a total of 886 participants were included in the review. These evaluated a range of comparisons in a range of surgical wounds healing by secondary intention. In general studies were small and some did not present data or analyses that could be easily interpreted or related to clinical outcomes. These factors reduced the quality of the evidence.Two comparisons compared different iodine preparations with no antiseptic treatment and found no clear evidence of effects for these treatments. The outcome data available were limited and what evidence there was low quality.One study compared a zinc oxide mesh dressing with a plain mesh dressing. There was no clear evidence of a difference in time to wound healing between groups. There was some evidence of a difference in measures used to assess wound infection (wound with foul smell and number of participants prescribed antibiotics) which favoured the zinc oxide group. This was low quality evidence.One study reported that sucralfate cream increased the likelihood of healing open wounds following haemorrhoidectomy compared to a petrolatum cream (RR: 1.50, 95% CI 1.13 to 1.99) over a three week period. This evidence was graded as being of moderate quality. The study also reported lower wound pain scores in the sucralfate group.There was a reduction in time to healing of open wounds following haemorrhoidectomy when treated with Triclosan post-operatively compared with a standard sodium hypochlorite solution (mean difference -1.70 days, 95% CI -3.41 to 0.01). This was classed as low quality evidence.There was moderate quality evidence that more open wounds resulting from excision of pyomyositis abscesses healed when treated with a honey-soaked gauze compared with a EUSOL-soaked gauze over three weeks' follow-up (RR: 1.58, 95% CI 1.03 to 2.42). There was also some evidence of a reduction in the mean length of hospital stay in the honey group. Evidence was taken from one small study that only had 43 participants.There was moderate quality evidence that more Dermacym®-treated post-operative foot wounds in people with diabetes healed compared to those treated with iodine (RR 0.61, 95% CI 0.40 to 0.93). Again estimates came from one small study with 40 participants. AUTHORS' CONCLUSIONS There is no robust evidence on the relative effectiveness of any antiseptic/antibiotic/anti-bacterial preparation evaluated to date for use on SWHSI. Where some evidence for possible treatment effects was reported, it stemmed from single studies with small participant numbers and was classed as moderate or low quality evidence. This means it is likely or very likely that further research will have an important impact on our confidence in the estimate of effect, and may change this estimate.
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Affiliation(s)
- Gill Norman
- School of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK, M13 9PL
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