Filling the vacuum: Role of negative pressure wound therapy in open wound management in cats

Exploring an Innovative Approach: Integrating Negative-Pressure Wound Therapy with Silver Nanoparticle Dressings in Skin Graft Procedures

BACKGROUND

Skin grafting is a helpful instrument in a plastic surgeon's arsenal. Several types of dressings were designed to facilitate the process of graft integration. Negative-pressure wound therapy is a proven dressing method, enhancing graft survival through several mechanisms: aspiration of secretions, stimulation of neoangiogenesis, and promotion of an anti-inflammatory environment. Silver nanoparticle dressings also bring multiple benefits by bearing an antimicrobial effect and providing a humid medium, which are favorable for epithelialization. The combination of NPWT (negative-pressure wound therapy) with AgNPs (silver nanoparticles) has not been widely studied.

MATERIALS AND METHODS

This study aimed to compare the outcomes of silver nanoparticle sheets with the combination of negative-pressure wound therapy and silver nanoparticle dressings. We conducted a comparative prospective study on 80 patients admitted to the Plastic Surgery Department of "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital between 1st of January 2020 and 31st of December 2022. The study population was randomized to receive either silver nanoparticle dressings or negative-pressure wound therapy (NPWT) combined with silver nanoparticle dressings. Various parameters were monitored, including patient comorbidities and graft-related data such as defect etiology, graft integration, and graft size. Dressings were changed, and graft status was evaluated at 7, 10, and 14 days postoperatively. Additionally, baseline C-reactive protein (CRP) levels were measured before surgery and 7, 10, and 14 days postoperatively.

RESULTS

The study demonstrated an enhanced integration of skin grafts at all evaluation stages when employing NPWT combined with AgNPs, particularly evident 10 days post operation. Significant variations in graft integration were also observed based on factors such as diabetes, cardiovascular disease, graft size, or the origin of the grafted defect. Moreover, dynamic C-reactive protein monitoring showed a statistically significant decrease in CRP levels 10 days post operation among patients treated with NPWT in conjunction with silver dressing, consistent with the nearly complete integration of skin grafts at this evaluation threshold.

CONCLUSION

Several factors influence the postoperative evolution of split-skin grafts. Postoperative dressings target local factors to enhance graft integration further. Our research demonstrated that the innovative combination of NPWT-assisted dressings, complemented by a silver nanoparticle sheet, resulted in improved benefits for graft integration and the alleviation of systemic inflammation.

Combined Oxygen-Ozone Therapy for Mesh Skin Graft in a Cat with a Hindlimb Extensive Wound

This case report describes a new therapeutic approach for a domestic shorthaired female cat, who has an extensive posttraumatic wound in the right hind limb. After patient stabilization, general anesthesia was started and the wound was cleaned and debrided of devitalized tissues, followed by the application of ozone therapy and bandage. Eight sessions of ozone therapy were performed for 17 days until the application of the skin graft. Three more sessions of ozone therapy were performed every 3 days postoperatively. The bagging method and the perilesional infiltration method were used. The ozone therapy ensured an accelerated recovery of the patient without any complications. According to our knowledge, this is the first case report with the use of ozone therapy to support a free skin graft in a cat. The new therapeutic approach could be used to accelerate healing of the wounds with a significant lack of substance, by supporting pre- and post-operative skin grafts.

Use of omentum flap for induction of free skin graft healing

ABSTRACT The objective of this study was to assess healing induction of free skin grafts following transposition of omental flap through a subcutaneous tunnel to the recipient bed. Macroscopic and microscopic evaluations were performed. Nineteen piglets were used. Two surgical wounds were created of each subject. The graft removed from the left side (LS) was placed on the right side (RS) without the omental flap in the graft-bed (control group-CG). On the LS, an omental flap was placed between the graft removed from the RS and the recipient bed (omentum group-OG). Macroscopic evaluations showed edema, which gradually decreased on both groups. Suture dehiscence was highest at day 10 compared to other days in both groups. The CG had a higher incidence of unvitalized tissue compared to OG, although no difference was found among days of postoperative evaluation. The presence of unvitalized tissue was seen on 32% on OG and 53% on CG. Microscopic evaluations revealed higher collagenization, reepithelization, keratinization and less swelling in the OG compared to CG. In conclusion, mesh skin grafts evolved satisfactorily in swine even in newly created bedding without granulation tissue, but with appropriate vascularization. The omentum flap provided better macroscopic and microscopic outcomes regarding graft integration.

Negative pressure wound therapy over two ipsilateral external skeletal fixators for management of high grade open fractures in a cat

Case summary

A 7-month-old female neutered Bengal cat was referred to the Queen Mother Hospital for Animals following unknown trauma. Clinical and radiographic examination revealed a grade IIIB open, comminuted, mid-diaphyseal fracture of the left tibia and fibula, and grade IIIB open mid-diaphyseal fractures of the left metatarsals II-V. The fractures were stabilised with tibial and metatarsal external skeletal fixators. The open wounds were initially debrided surgically using conventional dressings, resulting in a small amount of circumferential granulation tissue formation by 10 days postoperatively. Following this 10-day period of conventional wound management, negative pressure wound therapy (NPWT) was applied over the external skeletal fixators and wounds. After 8 days of NPWT complete granulation tissue coverage was achieved in the tibial wound, and only small areas of two metatarsals remained exposed. The tibial wound was left to heal by second intention; a free meshed skin graft was applied to the pedal wound. Twenty weeks postoperatively, all wounds had completely healed and revision surgery with internal fixation was performed to treat a non-union of the tibia. Thirty weeks after the initial surgery, radiographic union of the tibia and metatarsals II-IV was confirmed.

Relevance and novel information

This is the first report of NPWT application over external fixation for the management of wounds associated with open fractures in veterinary medicine. This case was presented to introduce a novel, well-tolerated and simple technique for the management of tissue loss over an open fracture immobilised with external fixation.