1
|
Gkotsoulias E. Split Thickness Skin Graft of the Foot and Ankle Bolstered With Negative Pressure Wound Therapy in a Diabetic Population: The Results of a Retrospective Review and Review of the Literature. Foot Ankle Spec 2020; 13:383-391. [PMID: 31370687 PMCID: PMC7493201 DOI: 10.1177/1938640019863267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Split thickness skin graft (STSG) is a versatile procedure performed for the treatment of wounds resulting from varying pathology. This remains very useful because of its ability for quick healing and low complication rate. The surface of the foot and ankle is an area frequently affected by severe skin and soft tissue structure infections (SSTIs) whose treatment results in wounds. These infections and resultant surgical wounds are commonly seen patients with diabetes. The objective of the present study was to retrospectively evaluate initial healing and immediate post-operative outcomes following STSG application in a diabetic population when negative pressure wound therapy (NPWT) was used as a bolster. Ten patients were identified, including 11 surgical wounds, who underwent STSG bolstered with NPWT from January 2016 to October 2018. Mean follow-up was 13 months (range 1-33 months) with an average time to heal of 17 days (range 14-30 days) for 11 surgical wounds averaging 57 cm2 (range 6.3 - 91 cm2). Consistent improved outcomes have been demonstrated when compared to alternative bolstering techniques available in the literature making a STSG bolstered with NPWT a powerful tool in the reconstruction of diabetic foot wounds resulting from the treatment of infection.Levels of Evidence: Level IV.
Collapse
|
2
|
Geierlehner A, Horch RE, Müller-Seubert W, Arkudas A, Ludolph I. Limb salvage procedure in immunocompromised patients with therapy-resistant leg ulcers-The value of ultra-radical debridement and instillation negative-pressure wound therapy. Int Wound J 2020; 17:1496-1507. [PMID: 32573103 PMCID: PMC7948940 DOI: 10.1111/iwj.13428] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to analyse the outcome of our established triple treatment strategy in therapy‐resistant deep‐thickness chronic lower leg ulcers. This limb salvage approach consists of ultra‐radical surgical debridement, negative‐pressure wound therapy (NPWT) with or without instillation, and split‐thickness skin grafting. Between March 2003 and December 2019, a total of 16 patients and 24 severe cases of lower leg ulcers were eligible for inclusion in this highly selective population. A total of seven patients received immunosuppressive medication. Complete wound closure was achieved in 25% and almost 90% of included lower leg ulcer cases after 3 and 24 months of our triple treatment strategy, respectively. The overall limb salvage rate was 100%. Bacterial colonisation of these wounds was significantly reduced after multiple surgical debridements and NPWT. Fasciotomy and radical removal of devitalised tissue such as deep fascia, tendons, and muscles combined with NPWT showed promising results in terms of the overall graft take rate. This treatment strategy was considered as last resort for limb salvage in such a critically ill and immunocompromised patient population. Surgeons should be aware of its efficacy and consider the triple treatment strategy especially if no other limb salvage option remains.
Collapse
Affiliation(s)
- Alexander Geierlehner
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Wibke Müller-Seubert
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| |
Collapse
|
3
|
Rivolo M, Dionisi S, Olivari D, Ciprandi G, Crucianelli S, Marcadelli S, Zortea RR, Bellini F, Martinato M, Gabrielli A, Pomponio G. Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management. Adv Wound Care (New Rochelle) 2020; 9:332-347. [PMID: 32286202 PMCID: PMC7155923 DOI: 10.1089/wound.2019.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/12/2019] [Indexed: 12/27/2022] Open
Abstract
Significance: A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers. Recent Advances: A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength. Critical Issues: The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2 in vitro studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle-brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement. Future Directions: We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.
Collapse
Affiliation(s)
- Massimo Rivolo
- Independent Tissue Viability Nurse Consultant, Turin, Italy
| | | | - Diletta Olivari
- Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Lima RVKS, Coltro PS, Farina JA. Negative pressure therapy for the treatment of complex wounds. Rev Col Bras Cir 2018; 44:81-93. [PMID: 28489215 DOI: 10.1590/0100-69912017001001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/01/2016] [Indexed: 01/05/2023] Open
Abstract
The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.
Collapse
Affiliation(s)
| | - Pedro Soler Coltro
- - Ribeirao Preto Medical School, University of Sao Paulo, Division of Plastic Surgery, Ribeirao Preto, Sao Paulo State, Brazil
| | - Jayme Adriano Farina
- - Ribeirao Preto Medical School, University of Sao Paulo, Division of Plastic Surgery, Ribeirao Preto, Sao Paulo State, Brazil
| |
Collapse
|
5
|
Meyer-Lindenberg A, Nolff MC. Vakuumassistierte Wundbehandlung (Negative Pressure Wound Therapy, NPWT) in der Kleintiermedizin. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2017; 44:26-37; quiz 38. [DOI: 10.15654/tpk-150957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/13/2016] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDie Behandlung offener Wunden gehört zu den alltäglichen Herausforderungen in der Tiermedizin. In den letzten Jahren hat sich mit der vakuumassistierten Wundbehandlung (Negative Pressure Wound Therapy, NPWT) eine neue Therapieform entwickelt. Durch ihren Einsatz lassen sich die Heilung offener Wunden und die Einheilungsrate freier Hauttransplantate beim Kleintier signifikant verbessern. In diesem Überblick werden Wirkweise, Indikationen sowie Komplikationen der Negative Pressure Wound Therapy dargestellt.
Collapse
|
6
|
Günal Ö, Tuncel U, Turan A, Barut S, Kostakoglu N. The Use of Vacuum-Assisted Closure and GranuFoam Silver® Dressing in the Management of Diabetic Foot Ulcer. Surg Infect (Larchmt) 2015; 16:558-65. [PMID: 26114333 DOI: 10.1089/sur.2014.093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The aim of this retrospective study was to evaluate the efficacy of vacuum-assisted closure (VAC) and GranuFoam Silver® dressing (KCI, San Antonio, TX) compared with conventional GranuFoam® dressing in the management of diabetic foot ulcers. PATIENTS AND METHODS Twenty-one consecutive patients treated with conventional or silver-coated foam dressing were reviewed retrospectively. The wound duration was 6 mo. Group 1 (n=10) received conventional foam dressing (GranuFoam) and group 2 (n=11) received silver-coated foam dressing (GranuFoam Silver). The wound surface area, duration of treatment, bacteriology, and recurrence were compared between the groups. The mean age of the patients was 61.70±10.52 y in group 1 and 67.27±11.28 y in group 2. RESULTS In group 1, the average surface area of the wounds was 45.30±46.96 cm2 and 18.40±23.48 cm2 in the pre-treatment and post-treatment periods, respectively. There was a statistically significant difference between two measurements (p=0.005). Average duration of the treatment was 25.50±27.13 d in this group. In group 2, average surface area of the wounds in the pre-treatment and post-treatment periods were 41.55±36.03 cm2 and 7.64±3.91 cm2, respectively. There was a statistically significant difference between two measurements (p=0.003). Average duration of the treatment was 10.09±3.51 d in this group. The patients treated with silver-impregnated polyurethane foam dressing had reduced recurrence (2 vs. 7 wounds, p=0.030) and increased number of the culture-negative cases at the end of the treatment. CONCLUSION With the results of the study, it was concluded that VAC GranuFoam silver dressing can be superior to conventional GranuFoam dressing in reducing the recurrence rate of infected diabetic foot ulcers.
Collapse
Affiliation(s)
- Özgür Günal
- 1 Department of Infectious Diseases and Clinical Microbiolog, Gaziosmanpasa University Faculty of Medicine , Tokat, Turkey
| | - Umut Tuncel
- 2 Department of Plastic Reconstructive and Aesthetic Surgery, Gaziosmanpasa University Faculty of Medicine , Tokat, Turkey
| | - Aydin Turan
- 2 Department of Plastic Reconstructive and Aesthetic Surgery, Gaziosmanpasa University Faculty of Medicine , Tokat, Turkey
| | - Sener Barut
- 1 Department of Infectious Diseases and Clinical Microbiolog, Gaziosmanpasa University Faculty of Medicine , Tokat, Turkey
| | - Naci Kostakoglu
- 2 Department of Plastic Reconstructive and Aesthetic Surgery, Gaziosmanpasa University Faculty of Medicine , Tokat, Turkey
| |
Collapse
|
7
|
Stanger KM, Albert F, Kneser U, Bogdan C, Horch RE. Management of chronic osteomyelitis of the tibia with life-threatening complications under negative pressure wound therapy and isolation of Helcococcus kunzii. Int Wound J 2013; 12:443-6. [PMID: 23855685 DOI: 10.1111/iwj.12133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/06/2013] [Accepted: 06/16/2013] [Indexed: 01/28/2023] Open
Abstract
We report the case of an 86-year-old man with severe wound infection originating from a chronic crural ulcer of the lower limb, which under negative pressure wound therapy led to excessive tissue necrosis and perforation of the anterior tibial artery. A swab taken 10 and 7 days preoperatively was positive for Helcococcus kunzii. H. kunzii has been described as a potentially pathogenic organism. The questions whether the negative pressure wound therapy itself caused the bleeding or the negative pressure wound therapy, which generates an anaerobic atmosphere, has triggered the growth and invasion of the facultative anaerobic bacterium H. kunzii and owing to the infection the artery perforated or whether the bacteria has no influence at all remain currently unanswered. After surgical debridement the signs of infection were completely eliminated, and a free musculocutaneous flap led to rapid healing of the wound. Following which H. kunzii was no longer detectable.
Collapse
Affiliation(s)
- Katrin M Stanger
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frauke Albert
- Microbiology Institute, Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Bogdan
- Microbiology Institute, Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
8
|
Jianbing T, Biao C, Qin L, Yanhong W. Topical negative pressure coupled with split-thickness skin grafting for the treatment of hidradenitis suppurativa: a case report. Int Wound J 2013; 12:334-7. [PMID: 23834292 DOI: 10.1111/iwj.12116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/16/2013] [Accepted: 06/01/2013] [Indexed: 11/30/2022] Open
Abstract
Hidradenitis suppurativa is a cutaneous, chronic, recurrent inflammatory disease. Here, we report the case of a 66-year-old man who had hidradenitis suppurativa in the buttocks. He suffered from diabetes mellitus. In the past, he had perianal abscesses. Because of improper treatment of furuncle infections in the buttocks, skin ulcers formed, which worsened and resulted in multiple fistulas. The skin lesion surface was large and the infection was severe. After wound debridement treatment, topical negative pressure and nutritional support were given. After one and a half months, the wound healed with split-thickness skin grafting. In a 2-year follow-up, there was no evidence of hidradenitis suppurativa recurrence.
Collapse
Affiliation(s)
- Tang Jianbing
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| | - Cheng Biao
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| | - Li Qin
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| | - Wu Yanhong
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| |
Collapse
|
9
|
Dessy LA, Serratore F, Corrias F, Parisi P, Mazzocchi M, Carlesimo B. Retention of polyurethane foam fragments during VAC therapy: a complication to be considered. Int Wound J 2013; 12:132-6. [PMID: 23590296 DOI: 10.1111/iwj.12062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/02/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022] Open
Abstract
Vacuum-assisted closure (VAC) therapy is a closed-loop, non-invasive active system, characterised by a controlled and localised negative pressure applied on porous polyurethane absorbent foams. It promotes healing of acute and chronic wounds. Therapeutic effects of VAC therapy have been proved and demonstrated; however, this method can have some disadvantages. Even if it is a quite versatile device, only qualified medical/paramedical personnel should use it in order to avoid possible complications that can occur after an improper application. In this report, 11 cases of foam-fragment retention within the wound are presented. This rare complication did not promote healing, but further hindered it. On the basis of our experience, it is mandatory to define the indications, benefits and limitations of VAC therapy.
Collapse
Affiliation(s)
- Luca A Dessy
- Department of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | | | | | | | | | | |
Collapse
|
10
|
Upton D, Andrews A. Pain and trauma in negative pressure wound therapy: a review. Int Wound J 2013; 12:100-5. [PMID: 23489350 DOI: 10.1111/iwj.12059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/17/2013] [Accepted: 02/04/2013] [Indexed: 11/27/2022] Open
Abstract
Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT-related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well-being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care.
Collapse
Affiliation(s)
- Dominic Upton
- Institute of Health & Society, University of Worcester, Worcester, UK
| | | |
Collapse
|
11
|
Shi Z, Ma L, Wang H, Yang Y, Li X, Schreiber A, Sun W, Hu Z, Xue Y, Teng J, Zhao X, Lu W. Insulin and hypertonic glucose in the management of aseptic fat liquefaction of post-surgical incision: a meta-analysis and systematic review. Int Wound J 2013; 10:91-7. [PMID: 22325039 PMCID: PMC7950496 DOI: 10.1111/j.1742-481x.2012.00949.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A meta-analysis and systematic review assessing randomised controlled trials (RCTs) was sought to determine whether subcutaneous injection of insulin with hypertonic glucose promotes healing in postoperative incisions with aseptic fat liquefaction. We searched the Cochrane library, Pubmed, EMBASE, National Science Digital Library (NSDL) and China Biological Medicine Database (CBMdisc) for literature published from 1 January 1990 to 30 September 2011. RCTs that evaluated subcutaneous injection of insulin with hypertonic glucose as a treatment for postoperative wound with fat liquefaction were sought. Wound healing was the primary endpoint. Jadad score and Cochrane Collaboration's tool were used for assessing quality of studies and risk of bias. We abstracted data regarding time to wound healing, cost and adverse effects. The random-effects inverse variance model was used for all analyses using weighted mean difference and 95% confidence interval. Eight trials (414 participants) were identified that met the inclusion criteria. Subcutaneous injection of insulin with hypertonic glucose significantly reduces time to healing by 6·33 days compared with conventional drainage, with less cost. There was no report concerning adverse effects. Subcutaneous injection of insulin with hypertonic glucose may improve the healing process in postoperative wounds with aseptic fat liquefaction.
Collapse
Affiliation(s)
- Zhongjie Shi
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Does treatment of split-thickness skin grafts with negative-pressure wound therapy improve tissue markers of wound healing in a porcine experimental model? J Trauma Acute Care Surg 2012; 73:447-51. [PMID: 22846954 DOI: 10.1097/ta.0b013e31825aa9ea] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Negative-pressure wound therapy (NPWT) has been used for to treat wounds for more than 15 years and, more recently, has been used to secure split-thickness skin grafts. There are some data to support this use of NPWT, but the actual mechanism by which NPWT speeds healing or improves skin graft take is not entirely known. The purpose of this project was to assess whether NPWT improved angiogenesis, wound healing, or graft survival when compared with traditional bolster dressings securing split-thickness skin grafts in a porcine model. METHODS We performed two split-thickness skin grafts on each of eight 30 kg Yorkshire pigs. We took graft biopsies on postoperative days 2, 4, 6, 8, and 10 and submitted the samples for immunohistochemical staining, as well as standard hematoxylin and eosin staining. We measured the degree of vascular ingrowth via immunohistochemical staining for von Willenbrand's factor to better identify blood vessel epithelium. We determined the mean cross-sectional area of blood vessels present for each representative specimen, and then compared the bolster and NPWT samples. We also assessed each graft for incorporation and survival at postoperative day 10. RESULTS Our analysis of the data revealed that there was no statistically significant difference in the degree of vascular ingrowth as measured by mean cross-sectional capillary area (p = 0.23). We did not note any difference in graft survival or apparent incorporation on a macroscopic level, although standard hematoxylin and eosin staining indicated that microscopically, there seemed to be better subjective graft incorporation in the NPWT samples and a nonsignificant trend toward improved graft survival in the NPWT group. CONCLUSION We were unable to demonstrate a significant difference in vessel ingrowth when comparing NPWT and traditional bolster methods for split-thickness skin graft fixation. More studies are needed to elucidate the manner by which NPWT exerts its effects and the true clinical magnitude of these effects.
Collapse
|
13
|
Lee KT, Pyon JK, Lim SY, Mun GH, Oh KS, Bang SI. Negative-pressure wound dressings to secure split-thickness skin grafts in the perineum. Int Wound J 2012; 11:223-7. [PMID: 22958590 DOI: 10.1111/j.1742-481x.2012.01078.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Several researches have shown that negative-pressure wound dressings can secure split-thickness skin grafts and improve graft survival. However, in anatomically difficult body regions such as the perineum it is questionable whether these dressings have similar beneficial effects. In this study, we evaluated the effects of negative-pressure wound dressings on split-thickness skin grafts in the perineum by comparing wound healing rate and complication rate with that of tie-over dressings. A retrospective chart review was performed for the patients who underwent a split-thickness skin graft to reconstruct perineal skin defects between January 2007 and December 2011. After grafting, the surgeon selected patients to receive either a negative-pressure dressing or a tie-over dressing. In both groups, the initial dressing was left unchanged for 5 days, then changed to conventional wet gauze dressing. Graft success was assessed 2 weeks after surgery by a single clinician. A total of 26 patients were included in this study. The mean age was 56·6 years and the mean wound size was 273·1 cm(2). Among them 14 received negative-pressure dressings and 12 received tie-over dressings. Negative-pressure dressing group had higher graft taken rate (P = 0·036) and took shorter time to complete healing (P = 0·01) than tie-over dressing group. The patients with negative-pressure dressings had a higher rate of graft success and shorter time to complete healing, which has statistical significance. Negative-pressure wound dressing can be a good option for effective management of skin grafts in the perineum.
Collapse
Affiliation(s)
- Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Kangnam-ku, Seoul 135-710, Korea
| | | | | | | | | | | |
Collapse
|