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Çelik M, Öztürk V, Çatal T, Bayrak A, Duramaz A, Bilgili MG. The efficacy of the Bogota Bag technique for wound closure in limb fasciotomy patients: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06292-4. [PMID: 39235618 DOI: 10.1007/s00264-024-06292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE Fasciotomy is a surgical procedure that involves the incision of fascial compartments in the body to relieve pressure, prevent tissue damage, and maintain blood flow. This study aimed to investigate the effectiveness of the Bogota Bag technique in closing fasciotomy wounds in patients with lower limb compartment syndrome. METHODS A prospective cohort study was conducted between October 2022 and October 2023 to document our experience in employing the Bogota Bag technique for fasciotomy closure. The study included the evaluation of medical files from fifteen patients aged 17 to 61. RESULTS The outcomes of the study present the initial series of limb fasciotomies treated with the Bogota Bag technique. Fifteen patients (14 male, 1 female) were included in the study. The average age of the patients was 34.73 ± 13.9 years and the average hospitalization was 8.33 ± 3.2 days. The average closure time of fasciotomy is 3.6 ± 1.4 days. CONCLUSION This report makes a significant contribution as the first documented series of limb fasciotomies treated with the Bogota Bag technique. This method exhibits simplicity in execution, cost-effectiveness, and a low incidence of complications.
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Affiliation(s)
- Malik Çelik
- Bakırkoy Dr. Sadi Konuk Research and Training Hospital Orthopaedics and Traumatology Clinic, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Istanbul, 34147, Turkey.
| | - Vedat Öztürk
- Bakırkoy Dr. Sadi Konuk Research and Training Hospital Orthopaedics and Traumatology Clinic, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Istanbul, 34147, Turkey
| | - Tevfik Çatal
- Orthopaedics and Traumatology Clinic, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, MD, Turkey
| | - Alkan Bayrak
- Bakırkoy Dr. Sadi Konuk Research and Training Hospital Orthopaedics and Traumatology Clinic, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Istanbul, 34147, Turkey
| | - Altuğ Duramaz
- Bakırkoy Dr. Sadi Konuk Research and Training Hospital Orthopaedics and Traumatology Clinic, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Istanbul, 34147, Turkey
| | - Mustafa Gökhan Bilgili
- Bakırkoy Dr. Sadi Konuk Research and Training Hospital Orthopaedics and Traumatology Clinic, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Istanbul, 34147, Turkey
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Unterfrauner I, Bragatto-Hess N, Studhalter T, Farshad M, Uçkay I. General skin and nasal decolonization with octenisan® set before and after elective orthopedic surgery in selected patients at elevated risk for revision surgery and surgical site infections-a single-center, unblinded, superiority, randomized controlled trial (BALGDEC trial). Trials 2024; 25:461. [PMID: 38978089 PMCID: PMC11229206 DOI: 10.1186/s13063-024-08173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The preoperative body surface and nasal decolonization may reduce the risk of surgical site infections (SSI) but yields conflicting results in the current orthopedic literature. METHODS We perform a single-center, randomized-controlled, superiority trial in favor of the preoperative decolonization using a commercial product (octenidine® set). We will randomize a total number of 1000 adult elective orthopedic patients with a high risk for SSI and/or wound complications (age ≥ 80 years, chronic immune-suppression, American Society of Anesthesiologists score 3-4 points) between a decolonization (octenisan® wash lotion 1 × per day and octenisan® md nasal gel 2-3 × per day; during 5 days) and no decolonization. Decolonized patients will additionally fill a questionnaire regarding the practical difficulties, the completeness, and the adverse events of decolonization. The primary outcomes are SSI and revision surgeries for postoperative wound problems until 6 weeks postoperatively (or 1 year for surgeries with implants or bone). Secondary outcomes are unplanned revision surgeries for non-infectious problems and all adverse events. With 95% event-free surgeries in the decolonization arm versus 90% in the control arm, we formally need 2 × 474 elective orthopedic surgeries included during 2 years. DISCUSSION In selected adult orthopedic patients with a high risk for SSI, the presurgical decolonization may reduce postoperative wound problems, including SSI. TRIAL REGISTRATION ClinicalTrial.gov NCT05647252. Registered on 9 December 2022. PROTOCOL VERSION 2 (5 December 2022).
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Affiliation(s)
- Ines Unterfrauner
- Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Nadja Bragatto-Hess
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Studhalter
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Medical Direction, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Ilker Uçkay
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Uçkay I, Bomberg H, Risch M, Müller D, Betz M, Farshad M. Broad-spectrum antibiotic prophylaxis in tumor and infected orthopedic surgery-the prospective-randomized, microbiologist-blinded, stratified, superiority trials: BAPTIST Trials. Trials 2024; 25:69. [PMID: 38243311 PMCID: PMC10799415 DOI: 10.1186/s13063-023-07605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/26/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The perioperative antibiotic prophylaxis with 1st or 2nd generation cephalosporins is evidence-based in orthopedic surgery. There are, however, situations with a high risk of prophylaxis-resistant surgical site infections (SSI). METHODS We perform a superiority randomized controlled trial with a 10% margin and a power of 90% in favor of the broad-spectrum prophylaxis. We will randomize orthopedic interventions with a high risk for SSI due to selection of resistant pathogens (open fractures, surgery under therapeutic antibiotics, orthopedic tumor surgery, spine surgery with American Society of Anesthesiologists (ASA) score ≥ 3 points) in a prospective-alternating scheme (1:1, standard prophylaxis with cefuroxime versus a broad-spectrum prophylaxis of a combined single-shot of vancomycin 1 g and gentamicin 5 mg/kg parenterally). The primary outcome is "remission" at 6 weeks for most orthopedic surgeries or at 1 year for surgeries with implant. Secondary outcomes are the risk for prophylaxis-resistant SSI pathogens, revision surgery for any reason, change of antibiotic therapy during the treatment of infection, adverse events, and the postoperative healthcare-associated infections other than SSI within 6 weeks (e.g., urine infections or pneumonia). With event-free surgeries to 95% in the broad-spectrum versus 85% in the standard prophylaxis arm, we need 2 × 207 orthopedic surgeries. DISCUSSION In selected patients with a high risk for infections due to selection of prophylaxis-resistant SSI, a broad-spectrum combination with vancomycin and gentamycin might prevent SSIs (and other postoperative infections) better than the prophylaxis with cefuroxime. TRIAL REGISTRATION ClinicalTrial.gov NCT05502380. Registered on 12 August 2022. Protocol version: 2 (3 June 2022).
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Affiliation(s)
- Ilker Uçkay
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Hagen Bomberg
- Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Markus Risch
- Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Daniel Müller
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Betz
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kuenlen A, Waked K, Eisenburger M, Oramary A, Alsherawi A, Ninkovic M. Influence of VAC Therapy on Perfusion and Edema of Gracilis Flaps: Prospective Case-control Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4964. [PMID: 37124381 PMCID: PMC10145892 DOI: 10.1097/gox.0000000000004964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Abstract
The gracilis muscle flap is a popular choice in reconstructive surgery to repair soft tissue defects or for functional restoration. Little is known on the influence of postoperative application of VAC (vacuum-assisted closure; Kinetic Concepts Inc., San Antonio, Tex.) therapy on perfusion and postoperative flap edema of free gracilis muscle flaps. Methods In total, 26 patients with soft tissue defects of lower extremity underwent gracilis muscle flap reconstruction. The study group (VAC, n = 13) was supplied with postoperative negative pressure therapy as a dressing; the control group (NVAC, n = 13) was supplied with conventional fat gauze dressing. Postoperative measurements of micro- and macroperfusion were performed intraoperatively, on postoperative day (POD) 3 and POD 5. Flap edema measurement was performed intraoperatively, on POD 5 and 2 weeks after operation. Results The VAC group showed significantly better macroflow during intraoperative VAC treatment, as well on POD 3 and POD 5. Venous outflow was also better with lower hemoglobin levels. Microflow was better in the NVAC group with higher measured oxygen levels. All gracilis muscle flaps of the VAC group showed significantly less flap edema compared with the control group. Conclusions VAC application on free gracilis muscle flaps leads to significantly less postoperative flap edema, improved arterial macroflow, and improved venous outflow. VAC therapy can be used without any danger for patient's safety, as flap survival is not endangered, and presents an easy to handle and pleasant dressing regimen for nursing staff and patients.
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Affiliation(s)
- Anian Kuenlen
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michael Eisenburger
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Alan Oramary
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Abeer Alsherawi
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery - Bogenhausen Academic Hospital, Munich, Germany
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Karonen E, Eek F, Butt T, Acosta S. Prophylactic and Therapeutic Fasciotomy for Acute Compartment Syndrome after Revascularization for Acute Lower Limb Ischemia - Renal and Wound Outcomes. Ann Vasc Surg 2022; 88:154-163. [PMID: 36058463 DOI: 10.1016/j.avsg.2022.07.018] [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: 04/15/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Acute Compartment Syndrome (ACS) is a significant complication after revascularization for Acute Lower Limb Ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. METHODS A retrospective cohort study including 76 patients undergoing PF (n=40) or TF (n=36) after revascularization for ALI between 2006 and 2018. Estimated Glomerular Filtration Rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (ANOVA) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pearson's chi2- and log-rank test, respectively. RESULTS E-GFR improved over the in-hospital period with 8.2ml/min/1.73m2 (95% CI 2.4-14.1, p=0.007) in the PF group and 4.4ml/min/1.73m2 (95% CI 1.2-7.7, p=0.010) in the TF group, with no significant difference between the two groups (0.3ml/min/1.73m2, 95% CI -6.7-7.4, p=0.93). The rate of wound infections was higher after TF (PF=60.6 % and TF=82.4 %, p=0.048), whereas rate of other wound complications (PF=61.3 % and TF=35.3%, p=0.036) was higher after PF. CONCLUSION Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies and reduce wound complications, while have the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.
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Affiliation(s)
- Emil Karonen
- Department of Clinical Sciences, Malmö, Lund University, Sweden; Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Talha Butt
- Department of Clinical Sciences, Malmö, Lund University, Sweden; Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Sweden; Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Cikirikcioglu M, Ponchant K, Murith N, Meyer P, Yilmaz N, Huber C. Treatment of HeartMate III-LVAD driveline infection by negative pressure wound therapy: Result of our case series. Int J Artif Organs 2021; 44:912-916. [PMID: 34558333 PMCID: PMC8559168 DOI: 10.1177/03913988211047250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Driveline infection is one of the most frequent complications following left ventricular assist device (LVAD) treatment and there is no consensus for its management. The standard approach to treat foreign-body infection is complete device ablation, which is not always feasible and therefore not an elected method for LVAD driveline infections. Here we share the results from a series of cases successfully treated for driveline infection by negative pressure wound therapy (NPWT) therapy. Between 2016 and 2020, five male patients were hospitalized in our unit with a driveline infection of HeartMate III-LVAD®. Ultrasonography and/or thoraco-abdominal CT confirmed the diagnosis, infection localization, and abscess formation. Following an antibiotic treatment, an urgent surgical abscess drainage and debridement of the infected tissues were performed. At the end of the procedure, NPWT was applied. NPWT re-dressing and debridement of wound was performed every 3-4 days. The wound was closed surgically after obtaining negative culture results and good healing. The patients were discharged in good condition, without signs of infection. Two patients underwent successful heart transplantation after 1 and 13 months. Other patients did not show any residual or recurrent infection during the follow-up within 25 months. Driveline infection following LVAD implantation is a significant complication and a challenging in terms of management for both; the surgical team and the patient. These results from our case series report a successful and less invasive approach by using NPWT for the treatment of LVAD driveline infections.
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Affiliation(s)
- Mustafa Cikirikcioglu
- Division of Cardiovascular Surgery,
Department of Surgery, University Hospitals and Faculty of Medicine, Geneva,
Switzerland
- Mustafa Cikirikcioglu, Division of
Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva,
Rue Gabrielle Perret-Gentil 4, Geneva 1211, Switzerland.
| | - Kevin Ponchant
- Division of Cardiovascular Surgery,
Department of Surgery, University Hospitals and Faculty of Medicine, Geneva,
Switzerland
| | - Nicolas Murith
- Division of Cardiovascular Surgery,
Department of Surgery, University Hospitals and Faculty of Medicine, Geneva,
Switzerland
| | - Philippe Meyer
- Division of Cardiology, Department of
Internal Medicine, University Hospitals and Faculty of Medicine, Geneva,
Switzerland
| | - Nurcan Yilmaz
- Division of Cardiovascular Surgery,
Department of Surgery, University Hospitals and Faculty of Medicine, Geneva,
Switzerland
| | - Christoph Huber
- Division of Cardiovascular Surgery,
Department of Surgery, University Hospitals and Faculty of Medicine, Geneva,
Switzerland
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Alkhalifah MK, Almutairi FSH. Optimising Wound Closure Following a Fasciotomy: A narrative review. Sultan Qaboos Univ Med J 2019; 19:e192-e200. [PMID: 31728216 PMCID: PMC6839671 DOI: 10.18295/squmj.2019.19.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/11/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022] Open
Abstract
Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening complications. This narrative review aimed to present the available methods of wound closure and preferential factors for using each technique. Viable and non-infected wounds were most often treated by gradual approximation techniques, such as the simple or modified shoelace technique, the prepositioned intracutaneous suture or several commercially-available mechanical devices. In addition, applying negative pressure therapy was found to be feasible, particularly when combined with approximation techniques. Skin grafting was reserved for severely-dehiscent wounds while other non-invasive approaches were considered for other subsets of patients with inadvisable surgical interventions. Treatment decision should be made in view of the patient’s condition, ease of application, availability of resources, cost of treatment and aesthetic outcomes.
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Pintor-Tortolero J, Sánchez-Arteaga A, Tallón-Aguilar L, Padillo-Ruiz FJ. Fasciotomy wound secondary to necrotizing fasciitis closure using combination of negative pressure wound therapy and progressive primary closure. ANZ J Surg 2019; 89:E49. [PMID: 30756498 DOI: 10.1111/ans.14959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Affiliation(s)
- José Pintor-Tortolero
- General and Digestive Surgery Department, University Hospital Virgen del Rocío, Seville, Spain
| | | | - Luis Tallón-Aguilar
- General and Digestive Surgery Department, University Hospital Virgen del Rocío, Seville, Spain
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Chen X, Liu L, Nie W, Deng R, Li J, Fu Q, Fei J, Wang C. Vacuum Sealing Drainage Therapy for Refractory Infectious Wound on 16 Renal Transplant Recipients. Transplant Proc 2018; 50:2479-2484. [PMID: 30316382 DOI: 10.1016/j.transproceed.2018.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/03/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Refractory infectious wounds on renal transplantation (RT) recipients significantly prolong hospital stay, increase medical costs, and threaten allograft survival. Vacuum sealing drainage (VSD) therapy is a new technique for managing wounds based on the principle of application of controlled negative pressure. The aim of this study was to summarize the efficacy and safety of VSD therapy in the management of refractory infectious wounds following RT. MATERIALS AND METHODS This is a retrospective study of a cohort of 661 consecutive patients who received renal transplants over a period of 3 years in which the data were collected and analyzed retrospectively. RESULTS Out of the 661 patients, 16 (2.4%) developed refractory wound infection following RT. Nineteen organisms were identified by culture from all patients, including 10 patients infected with 1 or more bacteria, 2 patients with fungal infection, and 4 patients with both. Specifically, mucormycosis was demonstrated in 4 patients, pan-resistant Klebsiella pneumoniae in 2 patients, and Acinetobacter baumannii in 2 patients. All 16 patients were treated with VSD therapy for a median of 37 days (range, 6-111 days). The number of VSD sets used ranged from 4 to 28 sets (mean, 11.1 sets). A combination of antibiotics, debridement, and VSD therapy lead to 100% (16 of 16) wound healing. No VSD-relevant adverse events were observed. CONCLUSIONS VSD therapy is an effective and safe adjunct to conventional treatment modalities for the management of refractory wound infection following RT.
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Affiliation(s)
- X Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - L Liu
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - W Nie
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - R Deng
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - J Li
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Q Fu
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - J Fei
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - C Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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10
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Routine use of PICO dressings may reduce overall groin wound complication rates following peripheral vascular surgery. J Hosp Infect 2018; 99:75-80. [DOI: 10.1016/j.jhin.2017.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/27/2017] [Indexed: 11/23/2022]
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11
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Karkos CD, Papoutsis I, Giagtzidis IT, Pliatsios I, Mitka MA, Papazoglou KO, Kambaroudis AG. Management of Postfasciotomy Wounds and Skin Defects Following Complex Vascular Trauma to the Extremities Using the External Tissue Extender System. INT J LOW EXTR WOUND 2018; 17:113-119. [DOI: 10.1177/1534734618765343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Management of large postfasciotomy wounds and/or skin and soft tissue defects after major vascular trauma to the extremities can be challenging. The External Tissue Extender (Blomqvist; ETE), a skin-stretching device, which consists of silicone tapes and plastic stoppers, approximates wound margins and facilitates delayed primary closure. We describe our experience with the use of ETE in 5 patients (4 males) with a total of 8 wounds (7 postfasciotomy, 1 soft tissue defect) over the past 12 years. The mean patient age was 32 (range 17-61) years. The wounds involved the lower limb in 3 patients and the upper limb in 2, whereas the injured arteries were the popliteal in 3, the axillary in 1, and the brachial in 1. The mean wound length was 24 cm (range 9-37 cm), and the mean number of ETE silicone tapes used per wound was 13 (range 5-19). The median duration of ETE therapy was 7 days (range 4-7). ETE therapy resulted in sufficient wound approximation to allow complete closure with conventional suturing in 7 out of the 8 wounds. Of these, one developed infection that required drainage, debridement, and resuturing. All wounds achieved satisfactory healing status and all limbs had been salvaged. In conclusion, the ETE is a useful, easy-to-use, and simple adjunct that may facilitate delayed primary closure of large postfasciotomy wounds or extensive skin and soft tissue defects following complex vascular trauma to the extremities.
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12
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Shirley ED, Mai V, Neal KM, Kiebzak GM. Wound closure expectations after fasciotomy for paediatric compartment syndrome. J Child Orthop 2018; 12:9-14. [PMID: 29456748 PMCID: PMC5813119 DOI: 10.1302/1863-2548.12.170102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Acute compartment syndrome often requires additional surgery to achieve wound closure. Little information exists regarding the expected number of surgeries, techniques and complications after closure in paediatric patients. METHODS A retrospective chart review identified patients treated for acute compartment syndrome at four hospitals over a ten-year period. The cause of injury, type of dressing, number of surgeries, type of closure and complications were recorded. RESULTS In all, 32 patients (mean 10.9 years, 1 to 17) who underwent 18 lower and 14 upper extremity fasciotomies met inclusion criteria. Definitive wound closure technique was delayed primary in 72%, split thickness skin graft in 25%, and primary in 3% of patients. Closure required a mean 2.4 surgeries (0 to 4) over a mean 7.7 days (0 to 34). Days to closure and number of surgeries required were not significantly affected by mechanism of injury, fasciotomy location or type of dressing used. A total of 23.1% of patients with upper extremity and 0% with lower extremity fasciotomies had concerns about the scar appearance. Other complications included neurapraxia (6.7%), stiffness (6.7%), swelling (3.3%), scar pain (3.3%) and weakness (3.3%). CONCLUSIONS The most common complication after paediatric compartment syndrome is an unpleasant scar. Wound closure after upper or lower extremity fasciotomies in paediatric patients requires a split thickness skin graft in approximately one in four patients. However, avoiding a skin graft does not guarantee the absence of cosmetic concerns, which are more likely following upper extremity fasciotomies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E. D. Shirley
- Paediatric Orthopaedic Associates, Atlanta, GA, USA,
Correspondence should be sent to E. D. Shirley, 900 Towne Lake Parkway, Woodstock 30189, GA, United States. E-mail:
| | - V. Mai
- University of North Florida, Jacksonville, FL, USA
| | - K. M. Neal
- Nemours Children’s Specialty Care, Jacksonville, FL, USA
| | - G. M. Kiebzak
- Nemours Children’s Specialty Care, Jacksonville, FL, USA
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Mittal N, Bohat R, Virk JS, Mittal P. Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases. Strategies Trauma Limb Reconstr 2017; 13:35-41. [PMID: 29039127 PMCID: PMC5862706 DOI: 10.1007/s11751-017-0299-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/08/2017] [Indexed: 11/30/2022] Open
Abstract
Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36 h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achieved, good if sutures had to be applied for protective care and poor if wounds needed to be skin-grafted. In the dermotaxis group, results were excellent in 15, good in 8 and poor in 2 cases. In the loop suture technique group, results were excellent in 20, good in 4 and poor in 1 case. Dermal apposition using inexpensive, readily available equipment is an alternative method for closure of fasciotomy wounds. If limb oedema has settled sufficiently, closure using a loop suture can be done in a single stage. If the limb remains oedematous, gradual closure can be done using dermotaxis.
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Affiliation(s)
- Naveen Mittal
- , #3732 Sector 46-c, Chandigarh, India. .,Government Medical College Hospital, Sector-32, Chandigarh, India.
| | - Robin Bohat
- Government Medical College Hospital, Sector-32, Chandigarh, India
| | | | - Payal Mittal
- Government Medical College Hospital, Sector-32, Chandigarh, India
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Hake ME, Etscheidt J, Chadayammuri VP, Kirsch JM, Mauffrey C. Age and dressing type as independent predictors of post-operative infection in patients with acute compartment syndrome of the lower leg. INTERNATIONAL ORTHOPAEDICS 2017; 41:2591-2596. [DOI: 10.1007/s00264-017-3576-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 11/30/2022]
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Jauregui JJ, Yarmis SJ, Tsai J, Onuoha KO, Illical E, Paulino CB. Fasciotomy closure techniques. J Orthop Surg (Hong Kong) 2017; 25:2309499016684724. [PMID: 28176601 DOI: 10.1177/2309499016684724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We evaluated the risks and success rates of the three major techniques for compartment syndrome fasciotomy closure by reviewing all literature published to date. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically evaluated the Medline (PubMed) database until July 2015, utilizing the Boolean search sting "compartment syndrome OR fasciotomy closure." Two authors independently assessed all studies published in the literature to ensure validity of extracted data. The data was compiled into an electronic spreadsheet, and the wound closure rate with each technique was assessed utilizing a proportion random model effect. Success was defined as all wounds that could be closed without skin grafting, amputation, or death. The highest success rate was observed for dynamic dermatotraction and gradual suture approximation, whereas vacuum-assisted closure had the lowest complication rate.
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Affiliation(s)
- Julio J Jauregui
- 1 Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Samantha J Yarmis
- 2 Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA
| | - Justin Tsai
- 2 Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA
| | - Kemjika O Onuoha
- 2 Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA
| | - Emmanuel Illical
- 2 Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA
| | - Carl B Paulino
- 2 Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA
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Acosta S, Björck M, Wanhainen A. Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery. Br J Surg 2016; 104:e75-e84. [PMID: 27901277 DOI: 10.1002/bjs.10403] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Indications for negative-pressure wound therapy (NPWT) in vascular surgical patients are expanding. The aim of this review was to outline the evidence for NPWT on open and closed wounds. METHODS A PubMed, EMBASE and Cochrane Library search from 2007 to June 2016 was performed combining the medical subject headings terms 'wound infection', 'abdominal aortic aneurysm (AAA)', 'fasciotomy', 'vascular surgery' and 'NPWT' or 'VAC'. RESULTS NPWT of open infected groin wounds was associated with shorter duration of wound healing by 47 days, and was more cost-effective than alginate dressings in one RCT. In one RCT and six observational studies, NPWT-related major bleeding and graft preservation rates were 0-10 and 83-100 per cent respectively. One retrospective comparative study showed greater wound size reduction per day, fewer dressing changes, quicker wound closure and shorter hospital stay with NPWT compared with gauze dressings for lower leg fasciotomy. NPWT and mesh-mediated fascial traction after AAA repair and open abdomen was associated with high primary fascial closure rates (96-100 per cent) and low risk of graft infection (0-7 per cent). One retrospective comparative study showed a significant reduction in surgical-site infection, from 30 per cent with standard wound care to 6 per cent with closed incisional NPWT. CONCLUSION NPWT has a central role in open and infected wounds after vascular surgery; the results of prophylactic care of closed incisions are promising.
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Affiliation(s)
- S Acosta
- Department of Clinical Sciences, Vascular Centre, Lund University, Malmö, Sweden
| | - M Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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Abstract
BACKGROUND When disaster strikes, the number of patients requiring treatment can be overwhelming. In low-income countries, resources to assist the injured in a timely fashion may be limited. As a consequence, necrosis and wound infection in disaster patients is common and frequently leads to adverse health outcomes such as amputations, chronic wounds, and loss of life. In such compromised health care environments, low-tech and cheap wound care options are required that are in ready supply, easy to use, and have multiple therapeutic benefits. Maggot debridement therapy (MDT) is one such wound care option and may prove to be an invaluable tool in the treatment of wounds post-disaster. DISCUSSION This report provides an overview of the wound burden experienced in various types of disaster, followed by a discussion of current treatment approaches, and the role MDT may play in the treatment of complex wounds in challenging health care conditions. Maggot debridement therapy removes necrotic and devitalized tissue, controls wound infection, and stimulates wound healing. These properties suggest that medicinal maggots could assist health care professionals in the debridement of disaster wounds, to control or prevent infection, and to prepare the wound bed for reconstructive surgery. Maggot debridement therapy-assisted wound care would be led by health care workers rather than physicians, which would allow the latter to focus on reconstructive and other surgical interventions. Moreover, MDT could provide a larger window for time-critical interventions, such as fasciotomies to treat compartment syndrome and amputations in case of life-threatening wound infection. RECOMMENDATIONS There are social, medical, and logistic hurdles to overcome before MDT can become widely available in disaster medical aid. Thus, research is needed to further demonstrate the utility of MDT in Disaster Medicine. There is also a need for reliable MDT logistics and supply chain networks. Integration with other disaster management activities will also be essential. CONCLUSIONS In the aftermath of disasters, MDT could play an important role facilitating timely and efficient medical treatment and improving patient outcomes. Existing social, medical, and logistic barriers will need to be overcome for MDT to be mainstreamed in Disaster Medicine.
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Milcheski DA, Ferreira MC, Nakamoto HA, Pereira DD, Batista BN, Tuma P. Subatmospheric pressure therapy in the treatment of traumatic soft tissue injuries. Rev Col Bras Cir 2015; 40:392-6. [PMID: 24573588 DOI: 10.1590/s0100-69912013000500008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/05/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs. METHODS One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT). RESULTS Of the 178 patients who underwent SPT, 129 (72.5%) were male and 49 (27.5%) were aged between 18 and 40 years. Degloving injuries to the limbs were the most common type of traumatic wounds, being responsible for the hospitalization of 83 (46.6%) patients. Mean hospital stay was 17.5 days. A total of 509 procedures were performed (average 2.9 per patient). SPT was used in 287 procedures, 209 (72.8%) on traumatic wounds and 78 (27.2%) of skin grafts. The number of exchanges of the SPT apparel per patient was 1.6 and the mean time of use, 8.5 days. CONCLUSION SPT significantly reduced morbidity and healing time of injuries when compared with previously performed dressing treatments. The subatmospheric pressure therapy is a useful method in treating acute traumatic wounds, acting as a bridge between the emergency treatment and the final coverage of the skin lesions, being better when compared with more traditional methods of plastic surgery.
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Chen K, Huang JY, Wang L, Zheng XT. Femorofemoral bypass allowed limb preservation after late diagnosis of left common iliac artery thrombosis due to blunt trauma: A case report. SAGE Open Med Case Rep 2015; 3:2050313X14567892. [PMID: 27489675 PMCID: PMC4857317 DOI: 10.1177/2050313x14567892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/07/2014] [Indexed: 11/16/2022] Open
Abstract
Objective: Acute common iliac artery occlusion which results from blunt abdominal trauma is rare and potentially leads to a late diagnosis. Methods: We report a case of a 58-year-old patient who suffered a late diagnosed acute left common iliac artery occlusion secondary to abdominal trauma. An emergency exploratory laparotomy was performed to stop intra-abdominal bleeding, while his left limb ischemia was not noticed until 32 h later and femorofemoral bypass was then successfully performed for revascularization. Compartment syndrome was observed postoperatively, and fasciotomy was performed promptly. The wound was temporarily covered with Vaccum Sealing Drainage due to high skin tension. Patient underwent skin-grafting after leg swelling subsided. Results: The follow-up turned out that these managements were valid in the preservation of the limb viability. Conclusions: This case highlights the prudent recognition of the acute lower extremity ischemia in the abdominal trauma and immediate remedy for acute iliac artery occlusion after a late diagnosis.
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Affiliation(s)
- Kai Chen
- Department of Orthopedic, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jing-Yong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Lu Wang
- Department of Orthopedic, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiang-Tao Zheng
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Abstract
Early fasciotomy is the gold standard of prevention and treatment of compartment syndrome; however, the resulting wounds may significantly increase morbidity. To address the challenge of timely and safe closure of fasciotomy wounds, numerous methods have been described. A thorough search of medical databases PubMed/MEDLINE, ScienceDirect, SCOPUS, EMBASE, and Google Scholar was conducted for articles published between 1976 and 2013 using the search terms “limb fasciotomy wound closure,” “open wound management,” “skin stretching,” and “fasciotomy complications.” A total of 49 articles on technique descriptions, case reports of 2 or more patients, and of complications and comparative studies regarding limb fasciotomy wound closure were included. Details of the duration of treatment, advantages and disadvantages, direct cost, and complications were data extracted for each technique from the 49 studies included in this overview. Thorough knowledge of available techniques and their comparative advantages is essential for their clinical implementation, careful selection of patients, management of possible complications, decreased morbidity, and hospital recovery time and is also crucial for optimization of functional and aesthetic outcomes.
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Wilkin G, Khogali S, Garbedian S, Slagel B, Blais S, Gofton W, Liew A, Renaud JM, Papp S. Negative-pressure wound therapy after fasciotomy reduces muscle-fiber regeneration in a pig model. J Bone Joint Surg Am 2014; 96:1378-85. [PMID: 25143498 DOI: 10.2106/jbjs.m.01010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Negative-pressure wound therapy (NPWT) can improve fasciotomy wound closure, but its effects on skeletal muscle are largely unknown. The purpose of this study was to evaluate NPWT effects on skeletal muscle after fasciotomy for compartment syndrome in an animal model and to assess regional variability in muscle fiber regeneration. METHODS Compartment syndrome was induced in the hindlimb of twenty-two adult female pigs with use of a continuous intracompartmental serum-infusion model. Fasciotomy was performed after six hours, and animals were randomized to receive either wet-to-dry gauze dressings (control group) or NPWT dressings (-125 mm Hg, continuous suction) for seven days. Delayed primary wound closure was attempted at seven days, and the peroneus tertius was harvested for analysis seven days or twenty-one days after fasciotomy. Muscles were weighed, and hematoxylin and eosin-stained samples from four regions of the muscle (superficial central, deep central, lateral, and proximal) were mapped for different cellular morphologies. RESULTS Muscle weight was greater in the affected limb at all time points with no difference between treatment groups. At seven days, only the deep central samples in the NPWT group had a significantly greater cross-sectional area containing normal fibers as compared with that found in the controls. By twenty-one days, the deep central, lateral, and proximal regions of the NPWT-treated muscles had a smaller cross-sectional area containing normal fiber morphology and a greater cross-sectional area containing only mononucleated cells as compared with the controls. CONCLUSIONS NPWT did not decrease muscle weight. At twenty-one days, the extent of muscle fiber regeneration after fasciotomy for compartment syndrome was reduced in muscles treated with NPWT for seven days compared with the values in the control group treated with wet-to-dry gauze dressings. CLINICAL RELEVANCE NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
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Affiliation(s)
- Geoffrey Wilkin
- Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. E-mail address for G. Wilkin:
| | - Shiemaa Khogali
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Shawn Garbedian
- Division of Orthopaedic Surgery, North York General Hospital, 4001 Leslie Street, Toronto, ON M2K 1E1, Canada
| | - Bradley Slagel
- Division of Orthopaedic Surgery, Sault Area Hospital, 240 McNabb Street, Sault Ste. Marie, ON P6B 1Y5, Canada
| | - Simon Blais
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Wade Gofton
- Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. E-mail address for G. Wilkin:
| | - Allan Liew
- Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. E-mail address for G. Wilkin:
| | - Jean-Marc Renaud
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Steven Papp
- Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. E-mail address for G. Wilkin:
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Saziye K, Afksendiyos K. The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts. Vascular 2014; 23:144-50. [PMID: 24879657 DOI: 10.1177/1708538114537488] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5-10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. METHODS A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. RESULTS The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. CONCLUSION We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement.
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Affiliation(s)
- Karaca Saziye
- Department of Cardiovascular surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Kalangos Afksendiyos
- Department of Cardiovascular surgery, University Hospital of Geneva, Geneva, Switzerland
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Bengezi O, Vo A. Elevation as a treatment for fasciotomy wound closure. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2014; 21:192-4. [PMID: 24421654 DOI: 10.1177/229255031302100303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are currently numerous techniques described in the literature that attempt to optimize wound closure following a fasciotomy. However, primary closure of fasciotomy wounds continues to be difficult to accomplish successfully because of the underlying edema sustained from the compartment syndrome. The approach described in the present report is simple and physiologically sound, and addresses the underlying pathology. The authors focus on alleviating edema by strictly elevating the limb, followed by primary closure. Twelve consecutive fasciotomy wounds, referred from 2005 to 2012, were closed using this approach. The average wound closure time was 3.4 days (range three to five days) following the initial consultation. All 12 fasciotomy wounds responded with no revisions, complications, failures or loss of skin sensation. The approach was successful in all anatomical locations that were closed and conversion to any techniques currently available in the literature was not necessary. There are no costs associated with this approach, making it practical in settings with limited resources. It has a high success rate, superior cosmetic results and, most importantly, it achieves an efficient closure time. Therefore, this approach is superior to current techniques and should be a part of a plastic surgeon's armamentarium.
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Affiliation(s)
| | - Anthony Vo
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
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Li RG, Ren GH, Tan XJ, Yu B, Hu JJ. Free flap transplantation combined with skin grafting and vacuum sealing drainage for repair of circumferential or sub-circumferential soft-tissue wounds of the lower leg. Med Sci Monit 2013; 19:510-7. [PMID: 23807087 PMCID: PMC3699537 DOI: 10.12659/msm.883963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background This study is aimed at evaluating the operation techniques and clinical significance of free flap transplantation combined with skin grafting and vacuum sealing drainage (VSD) in repairing severe traumatic extensive circumferential or semi-circumferential soft-tissue defects of the lower leg. Material/Methods Thirty patients with severe lower leg injuries were treated by free flap transplantation combined with skin grafting and VSD from January 2008 to June 2011. The size of the wounds ranged from 23×8 cm to 44×28 cm and all affected more 70% of the low leg circumferential area. Wounds were complicated by exposure, necrosis, or infection of deep tissues. The wounds were first debrided and covered by VSD. When the condition of the wound had improved (5 to 7 days later), free flaps were harvested to reconstruct damaged tissue and skin grafts and VSD was used to cover granulation tissues around the transplanted flap. Results Granulation tissues developed and the area requiring flap cover decreased in all 30 patients after debridement and VSD. In 28 of 30 cases, the transplanted flaps grew well without complication. Peripheral necrosis was observed in only 2 cases, which required a second debridement and skin graft. Ten wound areas covered by grafts were left with scattered peripheral wounds, which healed with the help of 1 more skin graft or dressing change. Morphological appearance and functional recovery were satisfactory in all 30 cases. Conclusions Initial debridement and the temporary VSD cover followed after several days by free flap transplantation combined with skin grafting and VSD protection is a reliable treatment regimen for traumatic large circumferential or sub-circumferential soft tissue wounds of the lower leg with deep tissue exposure.
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Affiliation(s)
- Run-guang Li
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Walker T, Gruler M, Ziemer G, Bail DHL. The use of a silicon sheet for gradual wound closure after fasciotomy. J Vasc Surg 2012; 55:1826-8. [PMID: 22277688 DOI: 10.1016/j.jvs.2011.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/02/2011] [Accepted: 12/02/2011] [Indexed: 11/26/2022]
Abstract
We present a silicon sheet for temporary wound covering and gradual wound closure after open fasciotomy. Fasciotomy was performed in a total of 70 limbs with compartment syndrome (CS). The main etiology of CS was predominantly vascular. All patients were treated with a silicon sheet to cover the soft tissue defect and gradually reapproximate the skin margins. In 53% of the patients, a delayed final wound closure was achieved after a mean of 11.9 days. This method allows final closure of fasciotomy wounds without scar contractures, marginal necrosis, infection, or significant pain.
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Affiliation(s)
- Tobias Walker
- Department of Thoracic, Cardiac, and Vascular Surgery, University of Tuebingen, Tuebingen, Germany
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