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Wang H, Sun S, Wang G, Huang Q, Zhang Z. Analysis of Vacuum-Assisted Closure-Assisted Antibiotic Irrigation in Treatment of Severe Neurosurgical Central Nervous System Infections. Surg Infect (Larchmt) 2023; 24:803-810. [PMID: 37910866 DOI: 10.1089/sur.2023.129] [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: 11/03/2023] Open
Abstract
Objective: Severe neurosurgical central nervous system infections (sNCNSIs) are among the most serious complications of neurosurgical disease. Conventional methods have shown a poor prognosis. This study aims to analyze the clinical characteristics of vacuum-assisted closure (VAC) in sNCNSIs with the help of antibiotic irrigation treatment. Patients and Methods: A retrospective study was performed for patients diagnosed with sNCNSIs. A VAC device was placed on the incision after debridement and the surgical cavity was rinsed with antibiotic agents in the VAC group. Meanwhile the surgical cavity was drained after debridement in the control group. Medical data were reviewed and analyzed. Results: Twenty-eight patients met the inclusion criteria, including 18 cases in the VAC group and 10 cases in the control group. The basic medical data showed no differences. Bacteria was isolated from 24 (85.7%) patients. The cure rate was significantly higher in the VAC group (p < 0.05). The cure rate in patients with multi-drug-resistant (MDR) infections was significantly higher in patients treated with VAC therapy (p < 0.05). The prognosis evaluated by Glasgow Outcome Score (GOS) between the two groups showed significant difference (p < 0.05). No re-infection in the VAC group occurred in the follow-up period. Conclusions: It is suggested that VAC-assisted antibiotic irrigation is safe and effective for patients with severe NCNSIs and can improve the prognosis dramatically. The results can provide a new effective and reasonable therapeutic strategy for patients with sNCNSIs.
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Affiliation(s)
- Huaqing Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Shengnan Sun
- Department of Nursing, Shandong Medical College, Jinan, Shandong Province, P.R. China
| | - Guanghui Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Qibing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Zeli Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
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Souza SCD, Mendes CMC, Meneses JVL, Dias RM. Simplified vacuum dressing system: effectiveness and safety in wounds management. Acta Cir Bras 2022; 37:e370906. [PMID: 36515315 DOI: 10.1590/acb370906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Negative pressure wound therapy (NPWT) has revolutionized wound care, but its high cost reduces the procedure's availability. To solve the problem, streamlined vacuum dressings systems have been proposed, but the utility of these devices has been poorly studied. The objective of this study was to evaluate a simplified vacuum dressing system model (SVDM). METHODS Randomized clinical trial in which wounds were treated with SVDM compared to a complex occlusive dressing (silver hydrofiber, SHF). The analyzed outcomes were cleaning, presence of granulation tissue, clinical appearance, and indication for surgical closure of wounds. RESULTS Fifty injuries were treated (25 in each group), most located on lower limbs. SVDM proved to be more effective than SHF in the evaluated outcomes. Wound recalcitrance reduced the effectiveness of the equipment used. Despite its efficacy, complications occurred, the most frequent related to dressing changes: minor bleeding, foam adherence to a wound bed, and pain. Only for bleeding no favorable risk-benefit ratio was found. There were no severe complications, worsening conditions of injuries, or deaths. CONCLUSIONS SVDM proved to be an effective and acceptably safe device for managing studied wounds.
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Affiliation(s)
- Sandro Cilindro de Souza
- Ph.D. Universidade Federal da Bahia - Instituto de Ciências de Saúde - Programa de Pós-Graduação - Salvador (BA), Brazil
| | - Carlos Maurício Cardeal Mendes
- Ph.D. Universidade Federal da Bahia - Instituto de Ciências de Saúde - Programa de Pós-Graduação - Salvador (BA), Brazil
| | - José Valber Lima Meneses
- Ph.D. Universidade Federal da Bahia - Faculdade de Medicina - Departamento de Cirurgia Plástica - Salvador (BA), Brazil
| | - Rosana Menezes Dias
- Nurse. Secretaria da Saúde do Estado da Bahia - Hospital Carvalho Luz - Salvador (BA), Brazil
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Birk H, Demand A, Kandregula S, Notarianni C, Meram A, Kosty J. Wound vacuum-assisted closure as a bridge therapy in the treatment of infected cranial gunshot wound in a pediatric patient: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21489. [PMID: 36130545 PMCID: PMC9379617 DOI: 10.3171/case21489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The authors reported the first pediatric case of a craniocerebral gunshot injury successfully treated with a wound vacuum-assisted closure (VAC) device after dehiscence and infection of the initial cranial wound. OBSERVATIONS A 17-year-old boy suffered several gunshots to the left hemisphere, resulting in significant damage to the scalp, calvaria, and brain. Emergency hemicraniectomy was performed, with reconstruction of a complicated scalp wound performed at the initial surgery. The scalp was devitalized and ultimately dehisced, resulting in a cranial infection. It was treated first with a repeated attempt at primary closure, which failed because of persistent devitalized tissue, and was then treated with aggressive debridement followed by placement of a wound VAC device over the exposed brain as a bridge therapy to reconstruction. This procedure was deemed necessary given the active infection. LESSONS The patient received delayed reconstruction with a free split-thickness skin graft and made a remarkable recovery, with cranioplasty performed 6 months later. The authors reviewed the literature on wound VAC use in cranial wound treatment and proposed it as a legitimate bridge therapy to definitive reconstruction in the setting of dirty wounds, active infection, or even hemodynamically unstable patients.
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Affiliation(s)
| | | | | | | | - Andrew Meram
- Oral and Maxillofacial Surgery, Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana
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Oh BH, Park YY, Park JK, Park YS. Vacuum-Assisted Closure with Temporalis Muscle Reconstruction for Recurrent Scalp Erosion Following Deep Brain Stimulation: A Case Report. JOURNAL OF PARKINSONS DISEASE 2021; 11:1465-1469. [PMID: 33843699 DOI: 10.3233/jpd-212651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Scalp erosion is not an uncommon complication of deep brain stimulation (DBS) surgery. Although various methods have been proposed to prevent and manage complications, there are still challenges. We introduce a case of recurrent scalp erosion after DBS surgery treated with vacuum-assisted closure. CASE DESCRIPTION This article reports the case of a patient who underwent DBS for advanced Parkinson's disease and suffered from recurrent scalp erosion with device extrusion through the skin. Scalp erosion occurred 2 years after DBS and repeated improvement and deterioration despite scalp reconstruction using a skin flap. We opened the wound and performed temporal muscle reconstruction to cover the burr hole site, and we changed the exposed cable and applied vacuum-assisted closure. During the follow-up period, no signs of erosion or infection occurred, and DBS efficacy was preserved. CONCLUSION To date, the available management strategies for scalp erosion after DBS are revision with debridement and scalp reconstruction using skin flaps or skin grafts. However, if erosion occurs repeatedly despite the above management strategies, vacuum-assisted closure with temporalis muscle reconstruction could be a suitable option. We suggest that if the condition of the scalp is weakened, it is worth considering this approach preferentially.
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Affiliation(s)
- Byeong Ho Oh
- Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yoon Young Park
- Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ji Kang Park
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Seok Park
- Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Institute for Stem Cell & Regenerative Medicine (ISCRM), Chungbuk National University, Cheongju, Republic of Korea
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Gigliotti MJ, Patel N, McLaughlin C, Rothermel A, Henry C, Rizk E. Osteoradionecrosis and microvascular free flap failure managed with negative pressure wound therapy: A case report. Br J Neurosurg 2021; 37:1-6. [PMID: 34148435 DOI: 10.1080/02688697.2021.1940845] [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: 10/09/2020] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
A 56-year-old female with a history of meningioma status post subtotal resection (Simpson grade IV) and extensive radiation therapy presented with osteoradionecrosis (O.R.N.) managed previously with a microvascular free flap (MVFF). The evaluation revealed worsening O.R.N. and a scalp defect of 15 × 10 cm. The patient underwent MVFF reconstruction utilizing a free latissimus muscle flap covered by meshed split-thickness skin graft (STSG). Her surgery was complicated by delayed free flap failure and Serratia marcescens growth, which occurred sometime after discharge from the hospital. This was managed with removal of the free muscle flap and skin graft, serial debridement's, antibiotics, and replacements of a synthetic dural matrix and negative pressure wound therapy (NPWT). Once a clean wound bed was again obtained, the patient underwent fasciocutaneous anterolateral thigh (A.L.T.) MVFF reconstruction, which was complicated by left hypoglossal nerve injury, dehiscence of the flap inset, and dehiscence of the neck access incision requiring revision surgery. On the last follow-up 2 weeks after her surgery, the patient had 100% flap viability and a 2 × 1.5 cm on the left parietal aspect of the flap healing be secondary intent. We demonstrate that NPWT is successful in managing open calvarial wounds due to O.R.N.
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Affiliation(s)
- Michael J Gigliotti
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
| | - Neel Patel
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
| | - Caroline McLaughlin
- Department of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
| | - Alexis Rothermel
- Department of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
| | - Cathy Henry
- Department of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
| | - Elias Rizk
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, USA
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Stroder M, Litt JS, Litofsky NS. Complex Multidisciplinary Cranial and Scalp Reconstruction for Patient Salvage. World Neurosurg 2021; 152:e549-e557. [PMID: 34144172 DOI: 10.1016/j.wneu.2021.06.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE/BACKGROUND Patients can develop scalp and cranial defects as a result of neoplasm, trauma, or infection. Reconstruction of these defects can be difficult in some patients and may require a multidisciplinary approach using creative solutions usually used for disease processes in other areas of the body, such as severe burns. METHODS A series of 9 patients were treated using multidisciplinary techniques for reconstruction of complex cranial and scalp defects. Data on patient characteristics, initial treatment, and preparatory and definitive reconstructive treatment were retrospectively collected. Outcomes were measured as full solution, partial solution, or failure. RESULTS Three patients had a full solution/wound closure, 5 had a partial solution, and 1 failed reconstructive attempt. Full solution patients tended to be younger, received reconstruction treatment modalities for longer periods of time, and had more definitive surgeries. Initial and preparatory surgeries did not tend to promote a full solution, though having fewer preparatory surgeries that were not related to wound vacuum-assisted closure use tended to be associated with a better outcome. Infection of the scalp or cranium did not tend to change the result. CONCLUSIONS Reconstructive salvage of complex cranial and scalp defects takes time, so patience and earlier recognition of need for atypical reconstruction is beneficial. Patient characteristics may influence outcomes, but judicious choice of materials and techniques is more critical to patient success. Use of a multidisciplinary approach to complex cranial and scalp reconstruction is a beneficial option for many patients for whom standard reconstruction methods are not viable.
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Affiliation(s)
- Madelyn Stroder
- Division of Neurological Surgery, University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri, USA
| | - Jeffrey S Litt
- Division of Acute Care Surgery, University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri, USA
| | - N Scott Litofsky
- Division of Neurological Surgery, University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri, USA.
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Werner C, Mathkour M, Scullen T, Houghton D, Lea G, Dallapiazza RF, Kahn L, Smith RD. Effects of Medical Comorbidities on the Surgical Outcomes of Deep Brain Stimulation for Parkinson Disease: A Retrospective, Single-Institution Study. World Neurosurg 2020; 144:e347-e352. [PMID: 32853766 DOI: 10.1016/j.wneu.2020.08.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Advancing age and greater number of medical comorbidities are well-known risk factors for higher rates of surgical complications and undesirable outcomes. We sought to determine the risk of increasing medical comorbidities on surgical outcomes for patients with Parkinson disease undergoing deep brain stimulation (DBS) surgery. METHODS We retrospectively reviewed 107 consecutive patients who underwent DBS for Parkinson disease at Ochsner Medical Center in 2008-2018. Patients were stratified into 3 groups based on Elixhauser comorbidity index (ECI) at the time of surgery: 0, 1, or ≥2. Outcome measures were changes in Unified Parkinson's Disease Rating Scale III scores, changes in medications, and surgical complications. Analysis of variance, paired t test, and nonparametric equivalents were used for statistical analysis. RESULTS Of patients, 31 (29.0%) had ECI score 0, 44 (41.1%) had ECI score 1, and 32 (29.9%) had ECI score ≥2. For all groups, Unified Parkinson's Disease Rating Scale III scores decreased significantly postoperatively (P = 0.0014, P < 0.0001, P < 0.0001). All groups had a reduction in mean levodopa equivalent daily dose after surgery; however, only the group with ≥2 comorbidities achieved statistical significance (P = 0.0026). The rate of postoperative complications was significantly correlated with comorbidity score on univariate logistic regression analysis (P = 0.0425). CONCLUSIONS Our findings indicate that DBS is efficacious in patients with multiple medical comorbidities. However, patients with ≥1 medical comorbidities may be more likely to have complications. The most common observed complication was wound infection. Patients with medical comorbidities may still benefit significantly from DBS when performed at experienced centers.
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Affiliation(s)
- Cassidy Werner
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Tyler Scullen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - David Houghton
- Department of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Georgia Lea
- Department of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | | | - Lora Kahn
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Roger D Smith
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
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Ozkan B, Markal Ertas N, Bali U, Uysal CA. Clinical Experiences with Closed Incisional Negative Pressure Wound Treatment on Various Anatomic Locations. Cureus 2020; 12:e8849. [PMID: 32626631 PMCID: PMC7328693 DOI: 10.7759/cureus.8849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Closed incisional negative pressure wound treatment (ciNPWT) is one of the promising methods for the prevention of complications in surgical incisions. The mechanisms of ciNPWT have previously been elucidated and in this series, we demonstrate various, as of yet, underreported uses for the technology. Our aim is to share our experience with ciNPWT on various anatomic sites with novel indications. Materials and methods ciNPWT was used in 24 patients. The mean age was 49.6. All the incisions were sutured, clean, and non-infected. Patients’ sex, age, comorbidities, anatomic location of the wound, and the indications for ciNPWT were recorded. Results The mean number of applications was three per patient. One suture dehiscence after one session of ciNPWT was encountered in a flap donor site of an infant operated for meningomyelocele. Late-term seroma and hematoma formation were encountered in two patients. No surgical site infection, wound dehiscence, and ciNPWT related complications were seen in other patients. The majority of the applications were on the trunk, lower extremity, pelvis, upper extremity, and scalp respectively. Indications for ciNPWT utilization were preventing dehiscence, seroma, and hematoma formation in the majority of the patients. Conclusion ciNPWT is reliable and effective in the prevention of post-operative wound dehiscence and surgical site infections. It can be used safely in various locations and different indications for preventingcomplications such as preventing dehiscence in revision surgeries, cerebrospinal fluid (CSF) fistula formation in the scalp, and wound breakdown in chronic corticosteroid use,
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Affiliation(s)
- Burak Ozkan
- Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Ankara, TUR
| | - Nilgun Markal Ertas
- Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Ankara, TUR
| | - Ulas Bali
- Plastic Surgery, Celal Bayar Üniversitesi, Manisa, TUR
| | - Cagri A Uysal
- Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Ankara, TUR
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Use of Vacuum-Assisted Wound Closure and Tissue Expansion in Revision Cranioplasty for a Large-Sized Composite Defect in a Child. J Craniofac Surg 2019; 30:838-840. [PMID: 30845080 DOI: 10.1097/scs.0000000000005181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cranioplasty is generally defined as the procedure to reconstruct cranial bone defect arising from congenital or acquired process. As a surgical remedy, it can restore the function of original anatomical structure and produce a satisfactory cosmetic outcome. Although with available options for treating pediatric cranioplasty, large format (ie, >25 cm) cranioplasty of the aborted one with a composite defect is still a challenging procedure for plastic surgeons. The authors herein present a case of child who suffered failed cranioplasty with polyetheretherketone caused by postoperative infection, leading to skin ulcer and exposure of the polyetheretherketone. The treatments of the patient are performed sequentially. After thorough debridement of the wound, vacuum-assisted wound closure and autologous split-thickness skins are successively used to cover the defect following finally adopted strategy of tissue expansion of the scalp with a 3-dimensional-printed epoxide acrylate maleic composite material to repair the large-sized cranial defect.
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Joubert C, Sellier A, Morvan JB, Beucler N, Bordes J, Dagain A. Vacuum-assisted closure (VAC) for craniocerebral wounds in severely injured patients: technical note of a damage control procedure. J ROY ARMY MED CORPS 2019; 165:e1. [PMID: 30992341 DOI: 10.1136/jramc-2019-001201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/04/2022]
Abstract
The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described-but not exclusively trauma-cases with no secondary cerebrospinal fluid leakage encountered.
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Affiliation(s)
- Christophe Joubert
- Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
| | - A Sellier
- Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
| | - J-B Morvan
- Ear, Nose, Throat and Cervicofacial Surgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
| | - N Beucler
- Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
| | - J Bordes
- Anesthesiology and Intensive Care Unit, HIA Sainte Anne, Toulon Armees, France
| | - A Dagain
- Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
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Pereira S, Malta W, Canha A, Polónia J. Vacuum-assisted closure therapy after resection of giant basal cell carcinoma of the scalp. J Surg Case Rep 2017; 2017:rjx122. [PMID: 28690778 PMCID: PMC5495935 DOI: 10.1093/jscr/rjx122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/14/2017] [Indexed: 12/13/2022] Open
Abstract
Management of complicated wounds is a challenge in head and neck reconstruction. Although the negative pressure wound therapy or wound vacuum-assisted closure has been widely used in complicated wounds and shows promising results, its application in the head and neck region after reconstruction for the head and neck cancer is rarely presented. A 77-year-old woman underwent a radical resection of an extensive basal cell carcinoma of the scalp and forehead involving the periosteum, where classic reconstruction was difficult, but successfully treated with negative pressure wound therapy. Negative pressure wound therapy is an efficacious tool in cases of complex and extensive defects, when we expect immediate reconstruction with poor results, as would be probable with this scalp lesion.
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Affiliation(s)
- Silvia Pereira
- General Surgery Service, Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
| | - Wilson Malta
- General Surgery Service, Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
| | - António Canha
- General Surgery Service (Extradigestive Unit), Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
| | - José Polónia
- General Surgery Service (Extradigestive Unit), Department of Surgery, Santo António Hospital-Oporto Hospital Centre, Oporto, Portugal
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13
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Mellott AJ, Zamierowski DS, Andrews BT. Negative Pressure Wound Therapy in Maxillofacial Applications. Dent J (Basel) 2016; 4:dj4030030. [PMID: 29563472 PMCID: PMC5806940 DOI: 10.3390/dj4030030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/10/2016] [Accepted: 08/30/2016] [Indexed: 12/15/2022] Open
Abstract
Negative pressure wound therapy has greatly advanced the field of wound healing for nearly two decades, by providing a robust surgical adjunct technique for accelerating wound closure in acute and chronic wounds. However, the application of negative pressure wound therapy in maxillofacial applications has been relatively under utilized as a result of the physical articulations and contours of the head and neck that make it challenging to obtain an airtight seal for different negative pressure wound therapy systems. Adapting negative pressure wound therapies for maxillofacial applications could yield significant enhancement of wound closure in maxillofacial applications. The current review summarizes the basic science underlying negative pressure wound therapy, as well as specific maxillofacial procedures that could benefit from negative pressure wound therapy.
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Affiliation(s)
- Adam J Mellott
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - David S Zamierowski
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Brian T Andrews
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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