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Gupta A, Kundal A, Mani R, Gajula B, Sindhuri G, Chennat J, Kumar U, Rajput D. Negative pressure wound therapy in surgical practice: an Institutional experience from a tertiary centre of North India. POLISH JOURNAL OF SURGERY 2022; 95:1-5. [PMID: 36806166 DOI: 10.5604/01.3001.0015.8170] [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: 11/13/2022]
Abstract
<b>Introduction:</b> Negative pressure wound therapy (NPWT) has been suggested as a gold standard for managing complex wounds and to reduce the time of healing and overall morbidity and mortality of the patient. </br></br> <b>Aim:</b> We have done a retrospective study to observe the outcome in patients managed with negative pressure wound therapy for varied etiologies. </br></br> <b> Methods:</b> Patients with complicated wounds including lower limb wounds post-debridement, upper limb wounds post-debridement, postoperative abdominal wound dehiscence, abdominal and chest abscess wounds post-debridement and amputation stumps, managed with negative pressure wound therapy were studied on the basis of wound outcome, total hospital stay, days of NPWT application and pressure and mode of NPWT. </br></br> <b>Results:</b> A total of 42 patients with complicated wounds were included in the study. Mean hospital stay was 16.2 days and mean NPWT application time was 8.29 days with NPWT being applied on average for 3.91 days post-procedure like debridement or amputation or after wound dehiscence in which debridement was not done. As many as 41.5% of wounds were closed with suturing, 48.8% healed by secondary intention and 9.8% were covered with split-thickness skin grafts. A significant observation was made for lower pressure being used for abdominal wound dehiscence (75 mmHg) compared to other wounds on limbs (mean 98.33 mmHg) (P < 0.001). Re-debridement after the 1st cycle of NPWT was needed in 40% of wounds managed with intermittent mode compared to 6.2% in continuous mode (P = 0.028). </br></br> <b>Conclusion:</b> NPWT can reduce and manage wound complications with improvement in the quality of life of patients when used at an appropriate time with knowledge of its mechanism and functionality.
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Affiliation(s)
- Amit Gupta
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Ashikesh Kundal
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Rishit Mani
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Bhargav Gajula
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Geetha Sindhuri
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Jaine Chennat
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Utkarsh Kumar
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
| | - Deepak Rajput
- Department of Surgery All India Institute Of Medical Sciences, Rishikesh Uttarakhand, India
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Paolini G, Sorotos M, Firmani G, Gravili G, Ceci D, Santanelli di Pompeo F. Low-vacuum negative pressure wound therapy protocol for complex wounds with exposed vessels. J Wound Care 2022; 31:78-85. [PMID: 35077217 DOI: 10.12968/jowc.2022.31.1.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. METHOD The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (-80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72-96 hours. RESULTS This protocol was followed in five male patients (aged 23-68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20-61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. CONCLUSION The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.
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Affiliation(s)
- Guido Paolini
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy.,Sant'Andrea Hospital in Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, PhD School of Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | - Guido Firmani
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
| | | | - Diego Ceci
- Sant'Andrea Hospital in Rome, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
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Abstract
There are multiple techniques to treat tendon defects in the event end-to-end repair cannot be achieved after débridement. In general, the choice of treatment technique is based on size of the resultant gap. Although each treatment technique has literature to support its use, there are no data to support the use of one technique over another. Treatment should be based on the experience and discretion of the treating surgeon. This article proposes an algorithm for wound breakdown, infection, and rerupture after Achilles tendon surgery. This algorithm should be used as a guide.
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Affiliation(s)
- Jordan Liles
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, USA.
| | - Samuel B Adams
- Duke University Medical Center, 40 Duke Medicine Circle, Room 5309 (Orange), Durham, NC 27710, USA
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Santosa KB, Keller M, Olsen M, Keane AM, Sears ED, Snyder-Warwick AK. Negative-Pressure Wound Therapy in Infants and Children: A Population-Based Study. J Surg Res 2019; 235:560-568. [PMID: 30691843 PMCID: PMC6364568 DOI: 10.1016/j.jss.2018.10.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/27/2018] [Accepted: 10/25/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although the safety and benefits of negative-pressure wound therapy (NPWT) have been clearly demonstrated in the adult population, studies evaluating the safety and describing the use of NPWT in the pediatric population have been limited. Given this paucity, the goals of this study were to (1) evaluate the literature dedicated to NPWT use in infants and children and (2) leverage a population-level analysis to describe the experience of NPWT use in the pediatric population. MATERIALS AND METHODS We performed a literature review and analyzed the Truven Health Analytics MarketScan Commercial Claims Databases from 2006 to 2014 to identify infants and children treated with NPWT. We evaluated patient characteristics, indications, complications before and after NPWT placement, and health care utilization within 30 d of NPWT placement. RESULTS We identified 457 articles, 11 of which fit our inclusion criteria. Most studies (65.2%) were case reports or series with less than 10 patients. In addition, we identified 3184 patients aged younger than of 18 y who were treated with NPWT between 2006 and 2014. Serious incident complications within 30 d after NPWT placement were rare (bleeding 0.6%, septicemia 0.5%, and sepsis 0.5%). CONCLUSIONS Despite the lack of robust studies, NPWT is widely used for many indications and across different ages and providers. Given the low incidence of serious complications, we conclude that NPWT use in infants and children is safe and can be effectively used by different providers spanning surgical and nonsurgical disciplines.
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Affiliation(s)
- Katherine B. Santosa
- Postdoctoral Research Fellow, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110;
| | - Matt Keller
- Senior Statistical Data Analyst, Division of Infectious Diseases, Department of Internal Medicine, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Margaret Olsen
- Professor, Division of Infectious Diseases, Department of Internal Medicine, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Alexandra M. Keane
- Medical Student, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Erika D. Sears
- Assistant Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive Ann Arbor, MI 48109
| | - Alison K. Snyder-Warwick
- Assistant Professor, Division of Plastic Surgery, Department of Surgery, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110 St. Louis, MO
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 304] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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Wetzig T, Kohn D. Longitudinale Sehnenspreizung in Kombination mit Unterdrucktherapie zur Therapie freiliegender Achillessehnen. J Dtsch Dermatol Ges 2017; 15:1050-1052. [DOI: 10.1111/ddg.13334_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tino Wetzig
- Klinik für Dermatologie, Dermatochirurgie und Allergologie; Asklepios Klinik Weißenfels
| | - Diana Kohn
- Klinik für Dermatologie, Dermatochirurgie und Allergologie; Asklepios Klinik Weißenfels
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Wetzig T, Kohn D. Longitudinal slit procedure combined with negative-pressure wound therapy for exposed Achilles tendons. J Dtsch Dermatol Ges 2017; 15:1050-1052. [PMID: 28898538 DOI: 10.1111/ddg.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tino Wetzig
- Department of Dermatology, Dermatosurgery, and Allergology, Asklepios Medical Center, Weißenfels, Germany
| | - Diana Kohn
- Department of Dermatology, Dermatosurgery, and Allergology, Asklepios Medical Center, Weißenfels, Germany
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Saku I, Kanda S, Saito T, Fukushima T, Akiyama T. Wound management with negative pressure wound therapy in postoperative infection after open reconstruction of chronic Achilles tendon rupture. Int J Surg Case Rep 2017; 37:106-108. [PMID: 28654850 PMCID: PMC5487296 DOI: 10.1016/j.ijscr.2017.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 11/28/2022] Open
Abstract
NPWT can treat postoperative infection following chronic Achilles tendon repair. NPWT is also applicable in cases of tendon loss. NPWT has good functional outcome in postoperative infection for chronic Achilles tendon rupture.
Introduction Deep infection after reconstruction of chronic Achilles tendon rupture is a major and intractable complication. Case report We report a case of late deep infection following a surgery for chronic Achilles tendon rupture, and its simple and successful treatment with negative pressure wound therapy (NPWT). Six months following the reconstruction of chronic Achilles tendon rupture, a deep infection developed and reconstructed part of the tendon ruptured again. After appropriate debridement. Discussion There is no definitive treatment strategy for postoperative infection following open Achilles tendon repair. NPWT was applied to the wound, to promote wound healing and healthy granulation. In our case, NPWT promoted the wound healing and the infected Achilles tendon with tendon loss formed a healthy bridge with granulation tissue spontaneously. The patient resumed her normal activities of daily living, without requiring tendon transfer surgery. NPWT seems to be a simple and successful candidate for this situation. Conclusion NPWT seems to be effective for the treatment of postoperative infection following Achilles tendon repair, even in cases of tendon loss.
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Affiliation(s)
- Isaku Saku
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan.
| | - Shotaro Kanda
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan.
| | - Toshihiro Saito
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan.
| | - Takashi Fukushima
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan.
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan.
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Mosser P, Kelm J, Anagnostakos K. Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture. J Foot Ankle Surg 2014; 54:2-6. [PMID: 25451209 DOI: 10.1053/j.jfas.2014.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Indexed: 02/03/2023]
Abstract
Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.
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Affiliation(s)
- Philipp Mosser
- Resident, Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jens Kelm
- Orthopaedic Surgeon and Assistant Professor, Chirurgisch-orthopädisches Zentrum Illingen, Illingen, Germany
| | - Konstantinos Anagnostakos
- Orthopaedic Surgeon and Assistant Professor, Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Negosanti L, Sgarzani R, Nejad P, Pinto V, Tavaniello B, Palo S, Oranges CM, Fabbri E, Michelina VV, Zannetti G, Morselli PG, Cipriani R. VAC therapy for wound management in patients with contraindications to surgical treatment. Dermatol Ther 2013; 25:277-80. [PMID: 22913447 DOI: 10.1111/j.1529-8019.2012.01451.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with vacuum assisted closure (VAC)) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC when surgical procedures are contraindicated.
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Affiliation(s)
- Luca Negosanti
- Plastic Surgery Department, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Advances in wound healing: a review of current wound healing products. PLASTIC SURGERY INTERNATIONAL 2012; 2012:190436. [PMID: 22567251 PMCID: PMC3335515 DOI: 10.1155/2012/190436] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/16/2012] [Indexed: 01/20/2023]
Abstract
Successful wound care involves optimizing patient local and systemic conditions in conjunction with an ideal wound healing environment. Many different products have been developed to influence this wound environment to provide a pathogen-free, protected, and moist area for healing to occur. Newer products are currently being used to replace or augment various substrates in the wound healing cascade. This review of the current state of the art in wound-healing products looks at the latest applications of silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative pressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications, and hyperbaric oxygen as an adjunct in wound healing. With the abundance of available products, the goal is to find the most appropriate modality or combination of modalities to optimize healing.
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12
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Kollrack YBM, Moellenhoff G. Infected internal fixation after ankle fractures--a treatment path. J Foot Ankle Surg 2012; 51:9-12. [PMID: 22196454 DOI: 10.1053/j.jfas.2011.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Indexed: 02/03/2023]
Abstract
In the emergency treatment of infected internal fixation after ankle fractures, the infection needs to be resolved quickly to protect the implants, bone, and tendons. Vacuum wound therapy (topical negative pressure therapy) has been used for more than 15 years to assist in closure and to accelerate healing of a wide range of wounds. In the present report, we describe the results of treatment of 7 angiopathic (dysvascular) patients who developed a deep wound infection after ankle osteosynthesis. Each patient was treated with initial surgical debridement, followed by vacuum wound therapy and meshed split-thickness skin graft transplantation. The mean inpatient length of vacuum wound therapy was 14.0 ± 4.31 days, and the mean total duration of vacuum treatment was 54.43 ± 7.74 days.
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Affiliation(s)
- Yvonne Bernadette Maria Kollrack
- Department of Traumatology, Raphaelsklinik Muenster, Academic Teaching Hospital Wilhelms University Muenster, Muenster, Germany.
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13
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Abstract
The goals of burn wound care are removal of nonviable tissue, prevention of infection, and facilitation of wound healing, while controlling pain and maximizing outcome. This article reviews the basic pathophysiology of burn wounds; describes the evaluation of the depth, location, and extent of the wound; and discusses the myriad of wound care products on the market including their strengths and weaknesses. This article guides the reader through wound assessment and designing the appropriate treatment plan.
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Affiliation(s)
- Karen J Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas SW Medical Center, Dallas, TX 75390-9055, USA.
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14
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Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus. Injury 2011; 42 Suppl 1:S1-12. [PMID: 21316515 DOI: 10.1016/s0020-1383(11)00041-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
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Abstract
BACKGROUND Should osteosynthesis infection occur after ankle fractures in patients with microangiopathy, the infection needs to be cured quickly and safely to protect implants, bone, and tendons. Vacuum therapy (TNP) provides a perfect treatment plan that keeps the inpatient time low whilst ensuring high patient comfort. METHODS AND PATIENTS Four angiopathic patients with deep wound infection after ankle osteosynthesis were treated. At admission, loss of stability and spread of the infection were the immediate risks. To prevent this, we treated the patients with vacuum therapy after initial debridement until skin cover was achieved. RESULTS In all cases stability was secured and after 2 dressing changes, the swabs were sterile. The inpatient time was 13 days; overall vacuum therapy time was 59 days. Patient satisfaction was high. DISCUSSION Vacuum therapy is a perfect strategy after surgical debridement and before secondary mesh grafting. It protects the stability of the bone and open-lying delicate structures in patients with infected osteosynthesis of the ankle and angiopathy and offers an easy, safe, and successful treatment path with a short inpatient time.
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Stannard JP, Robinson JT, Anderson ER, McGwin G, Volgas DA, Alonso JE. Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. ACTA ACUST UNITED AC 2006; 60:1301-6. [PMID: 16766975 DOI: 10.1097/01.ta.0000195996.73186.2e] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the use of negative pressure wound therapy (NPWT) to augment healing of surgical incisions and hematomas after high-energy trauma. MATERIALS This study is a prospective randomized evaluation of NPWT in trauma patients, randomizing patients with draining hematomas to either a pressure dressing (group A) or a VAC (group B). Additionally, patients with calcaneus, pilon, and high-energy tibial plateau fractures were randomized to either a standard postoperative dressing or a VAC over the sutures. RESULTS There were 44 patients randomized into the hematoma study. Group A drained a mean of 3.1 days, compared with only 1.6 days for group B. This difference was significant (p=0.03). The infection rate for group A was 16%, compared with 8% in group B. An additional 44 patients have been randomized into the fracture study. Again, a significant difference (p=0.02) was present when comparing drainage in group A (4.8 days) and group B (1.8 days). No significant difference was present at current enrollment for infection or wound breakdown. DISCUSSION NPWT has been used on many complex traumatic wounds. Potential mechanisms of action include angiogenesis, increased blood flow, and decreased interstitial fluid. This ongoing randomized study has demonstrated decreased drainage and improved wound healing following both hematomas and severe fractures.
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Affiliation(s)
- James P Stannard
- Department of Surgery, Orthopaedic Division, University of Alabama at Birmingham, Birmingham, Alabama 35294-3295, USA.
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Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg 2006; 117:127S-142S. [PMID: 16799380 DOI: 10.1097/01.prs.0000222551.10793.51] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Treatment of wounds has been the cornerstone of plastic surgery since its inception. Vacuum-assisted closure provides a new paradigm that can be used in concert with a wide variety of standard existing plastic surgery techniques. It was originally developed as an alternative treatment for debilitated patients with chronic wounds. It has rapidly evolved into a widely accepted treatment of chronic and acute wounds, contaminated wounds, burns, envenomations, infiltrations, and wound complications from failed operations. The ease of technique and a high rate of success have encouraged its adaptation by thoracic, general, trauma, burn, orthopedic, urologic, as well as plastic surgeons. This article discusses multidisciplinary advances in the use of the vacuum-assisted closure technique over the past 10 years and its status as of 2006. Creative surgeons continue to regularly adapt the system to difficult problems. This technique in trained surgical hands greatly enhances the scope and safety of wound treatment.
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Affiliation(s)
- Louis C Argenta
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1075, USA.
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19
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Page JC, Newswander B, Schwenke DC, Hansen M, Ferguson J. Retrospective Analysis of Negative Pressure Wound Therapy in Open Foot Wounds with Significant Soft Tissue Defects. Adv Skin Wound Care 2004; 17:354-64. [PMID: 15343085 DOI: 10.1097/00129334-200409000-00015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare treatment outcomes of open foot wounds with significant soft tissue defects using either negative pressure wound therapy (NPWT) or standard wet-to-moist saline-soaked gauze dressings. SUBJECTS : Forty-seven subjects with open wounds with significant soft tissue defects. DESIGN A retrospective analysis of sequentially selected records of patients treated with NPWT or standard wet-to-moist dressings. RESULTS Risk of complications, subsequent foot surgeries, and hospital readmissions (secondary outcomes) were all reduced by 70% or more for the patients treated with NPWT. Length of stay during readmissions tended to be shorter; rates of wound cavity filling and wound healing (primary outcomes) tended to be greater with NPWT, although the differences were not statistically significant. CONCLUSION Patients included in the study treated with NPWT had fewer foot-related complications, less additional foot surgery, and fewer readmissions for the study foot than did patients treated with standard therapy. Further research using randomized clinical trials is needed to confirm the findings of the current study's data. CLINICAL RELEVANCE Wound cavity filling time and time to complete closure were similar in both study groups, despite the fact that patients receiving NPWT were older, had larger wounds, and had poorer nutrition. NPWT may be an effective modality for the healing of open wounds with significant defects and for reducing subsequent care.
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Affiliation(s)
- Jeffrey C Page
- Arizona Podiatric Medicine Program, Midwestern University-Glendale, Glendale, AZ, USA
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