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Zhu Y, Lin Y, Xie S, Yang M, Zhang W, Wu M, Liu Y, Xu D, Xian S, Tong X, Huang J, Jiang L, Guo X, Gu M, Yu H, Ding X, Li Y, Du Y, He H, Lu J, Huang R, Ji S. Mapping intellectual structures and research hotspots of chronic wound in global perspective. Regen Ther 2025; 30:47-62. [PMID: 40491561 PMCID: PMC12146492 DOI: 10.1016/j.reth.2025.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 04/17/2025] [Accepted: 05/04/2025] [Indexed: 06/11/2025] Open
Abstract
Background Chronic wounds included but were not limited to diabetes foot ulcers, venous leg ulcers and pressure ulcers. The challenge of difficult healing placed a heavy burden on patients and society. Our objective was to explain the healing process of chronic wounds and the development of treatment technologies in the past few years and to provide relevant, valuable information. Methods Our scientific publications were retrieved from the core collection of the Web of Science (WoSCC) database collection. The bibliometric visualization and analysis were performed by the software Biblioshiny based on R-bibliometrix. VOSviewer software and Citespace software were responsible for the validation of the results. Results A total of 8129 articles related to wound healing in chronic wounds were retrieved. The countries, institutions, and journals with the highest number of publications were the USA, the N8 research partnership, and the Journal of Wound Care, respectively. Armstrong DG and Dumville JC were the most influential authors in this field. The keyword analysis showed two key clusters of keywords, including "dressings" and "management". Trend topics analysis revealed frequent keywords in recent years, including "nanofibers" and "injectable hydrogels". Conclusion Our research was the first to reveal the cellular and molecular mechanisms and key clinical management strategies in the healing process of chronic wounds in the future through metrological and systematic evaluation, which may have important translational value in the future.
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Affiliation(s)
- Yushu Zhu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Yizhen Lin
- Naval Medical University, Shanghai, 200025, China
| | - Sujie Xie
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | | | - Wei Zhang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Minjuan Wu
- Department of Histology and Embryology, Naval Military Medical University, Shanghai 200433, China
| | - Yifan Liu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Dayuan Xu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Shuyuan Xian
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Xirui Tong
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Jie Huang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Luofeng Jiang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Xinya Guo
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Minyi Gu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Hengkai Yu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Xinran Ding
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Yixu Li
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Yiyao Du
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Heng He
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Jianyu Lu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Runzhi Huang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
| | - Shizhao Ji
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, China
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Feng M, Gadkaree SK, Derakhshan A. Vacuum assisted therapy in the head and neck. Curr Opin Otolaryngol Head Neck Surg 2025:00020840-990000000-00192. [PMID: 40402849 DOI: 10.1097/moo.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2025]
Abstract
PURPOSE OF REVIEW To review the utility of negative pressure wound therapy (NPWT) in the management of head and neck wounds. RECENT FINDINGS NPWT has broad applications in the management of head and neck wounds. NPWT has demonstrated success in the treatment of head and neck fistulas and necrotizing soft tissue infections. Immediate application after free flap reconstruction is also shown to be safe, with benefits of reduced tissue edema and promotion of wound healing. NPWT can further be used to prepare chronic wounds for reconstruction, particularly in patients who have undergone radiotherapy. The addition of intermittent saline instillation and dwell time has shown promise in treating head and neck fistulas. SUMMARY NPWT has been shown to improve wound healing times, reduce length of hospital stays, decrease frequency of dressing changes, and lower pain scores compared to conventional wound care. However, existing evidence is largely limited to case reports and retrospective studies, with few prospective comparative studies. Larger prospective studies are needed to further investigate the efficacy and safety of NPWT in the head and neck.
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Affiliation(s)
- Max Feng
- Department of Otolaryngology Head & Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Shekhar K Gadkaree
- Department of Otolaryngology Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Adeeb Derakhshan
- Department of Otolaryngology Head & Neck Surgery, Loma Linda University Health, Loma Linda, California
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
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Atfeh J, Guerre P, Carre E, Besse JL, Huot L. Incisional Negative Pressure Wound Therapy devices applied after Total Ankle Arthroplasty: A Hospital-Based Health Technology Assessment. PLoS One 2025; 20:e0322327. [PMID: 40299881 PMCID: PMC12040113 DOI: 10.1371/journal.pone.0322327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 03/18/2025] [Indexed: 05/01/2025] Open
Abstract
INTRODUCTION A portable, single-use incisional Negative Pressure Wound Therapy (iNPWT) device could be used directly on the wound incision following Total Ankle Arthroplasty (TAA). In order to support local decision-making in a French university hospital for the adoption of such device in this indication, a three-dimensional (clinical, economic and organizational) Hospital Based-Health Technology Assessment (HB-HTA) was conducted. MATERIALS AND METHODS The HB-HTA was based on: a literature review; results from the PICO-PTC single-site randomized controlled trial (ClinicalTrial.gov identifier NCT03886818); and semi-structured interviews with healthcare professionals. RESULTS Two comparative retrospective cohort studies were retrieved from the literature review. They suggested a decreased incidence of wound healing complications with iNPWT compared to standard dressings, although no difference was found in the PICO-PTC study. There was no significant difference in the PICO-PTC study on Medicine-Surgery-Obstetrics hospital costs between the two strategies: €10,639.65 [CI 95% (7,997.45; 17,988.68)] in the iNPWT group versus €9,672.59 [CI 95% (7,966.29; 13,393.65)] in the standard dressings group. Adoption of this prophylactic strategy would result in an approval to pay a 1.5% supplement to the Medicine-Surgery-Obstetrics hospitalization costs. It could also improve professionals' workflow, and facilitate wound healing monitoring for nurses in orthopedic departments compared to standard dressings. CONCLUSION The clinical effectiveness of the iNPWT single-use portable device could not be demonstrated compared to standard dressings for prophylactic use, in terms of the incidence of wound healing complications, in patients scheduled for TAA and not selected on the basis of risk factors. However, as this strategy may bring organizational benefits and has not been associated with significant economic costs, the adoption of iNPWT in orthopedic departments could be made according to the surgeon's clinical expertise, based for instance on the patient's risk factors for complications.
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Affiliation(s)
- Jamal Atfeh
- Hospices Civils de Lyon, Pôle de Santé Publique, Service d’Evaluation Economique en Santé, Lyon, France
- Université Lyon 1, Inserm U1290 Research on Healthcare Performance (RESHAPE), Lyon, France
| | - Pascale Guerre
- Hospices Civils de Lyon, Pôle de Santé Publique, Service d’Evaluation Economique en Santé, Lyon, France
- Université Lyon 1, Laboratoire Parcours Systémique en Santé, Lyon, France
| | - Emmanuelle Carre
- Hospices Civils de Lyon, Pharmacie Centrale, Saint Genis Laval, France
| | - Jean-Luc Besse
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologie, Pierre-Bénite, France
| | - Laure Huot
- Hospices Civils de Lyon, Pôle de Santé Publique, Service d’Evaluation Economique en Santé, Lyon, France
- Université Lyon 1, Inserm U1290 Research on Healthcare Performance (RESHAPE), Lyon, France
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Yu G, Huang X, Lin R, Zheng S. Efficacy and safety of negative pressure wound therapy in the treatment of patients with cardiovascular implantable electronic devices pocket infection. BMC Cardiovasc Disord 2025; 25:305. [PMID: 40269780 PMCID: PMC12016077 DOI: 10.1186/s12872-025-04769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 04/15/2025] [Indexed: 04/25/2025] Open
Abstract
OBJECTIVES To evaluate the efficacy of negative-pressure wound therapy (NPWT) for cardiac implantable electronic device (CIED) pocket infection, eliminating the need for CIED and leads extraction. METHODS The NPWT cohort consisted of 42 patients with CIED infection who were treated with NPWT from 2013 to 2023. Among them, 3 patients had a systemic infection and 1 patient had incomplete data. We performed a case-control study in which the NPWT group was compared with the conservative treatment group (40 patients). Main outcomes included failure rate (CIED/lead extraction during the 1-year follow-up, 30-day mortality/chronic infection, or infection-related mortality/recurrence) and infection-free time, with cure defined as absence of failure criteria. RESULTS A total of 38 patients with pocket infections were treated with NPWT from 2013 to 2023. NPWT was curative in 78.9% (n = 30 of 38) of patients who remained free of infection [median follow-up 12.63 months, interquartile range (IQR): 12.30-34.10 months]. Compared with patients who were treated conservatively, the two groups demonstrated balanced baseline characteristics. Patients who were treated with NPWT had a significantly higher cure rate (78.9% vs. 55.0%, n = 22 of 40; p = 0.025) and a longer mean infection-free time at the 1-year follow-up (338.00 vs. 285.20 days, p = 0.034). CONCLUSION NPWT is an effective alternative for patients with CIED pocket infections who are unsuitable or unwilling to undergo CIED and leads extraction. TRIAL REGISTRATION This study was approved by the Chinese Clinical Trial Registry (Clinicaltrials.gov number: ChiCTR2300073560) on July 07, 2023.
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Affiliation(s)
- Genmiao Yu
- Department of Burn and Plastic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350000, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
| | - Xiongmei Huang
- Department of Burn and Plastic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350000, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
| | - Rongjia Lin
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350000, China
| | - Shengwu Zheng
- Department of Burn and Plastic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350000, China.
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China.
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Mucha AW, Strandby RB, Nerup NA, Achiam MP. Treatment of intrathoracic anastomotic leakage following esophagectomy for gastroesophageal cancer: a systematic review. Dis Esophagus 2025; 38:doaf016. [PMID: 40048658 DOI: 10.1093/dote/doaf016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/20/2024] [Accepted: 02/24/2025] [Indexed: 05/13/2025]
Abstract
Anastomotic leakage (AL) is a significant complication following esophagectomy. AL affects 8%-17% of patients and is associated with increased morbidity, mortality, and hospital stay. To this date, no consensus exists on the most optimal treatment. This systematic review aimed to determine the most effective treatment approach. A systematic search of Medline, Web of Science, Cochrane, Scopus, and Embase databases was conducted. Only studies reporting on the treatment of intrathoracic anastomotic leakage after esophagectomy with gastric conduit reconstruction for cancer were included. Studies investigating other esophageal disorders or failing to report the location of the anastomosis were excluded. The methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale for cohort studies. Out of 12,966 identified studies, 38 were included for analysis after removing duplicates and screening titles, abstracts, and full texts. Of these, five were found to be of poor methodological quality and 33 were of moderate quality. The most researched treatment methods were Endoluminal vacuum therapy (EVT), naso-fistula tube drainage (NFTD), and stent treatment. The success and mortality rates for EVT were 82% and 10.7%, for NFTD, 94% and 5.2%, and, for stent treatment, 75.1% and 13.5%, respectively. AL can be effectively treated with EVT, stent treatment, and NFTD. The NFTD approach appeared to have a higher success rate and lower mortality than other treatment modalities. However, it requires a longer treatment duration. Due to limitations within the included studies, a definitive recommendation regarding the optimal treatment for AL cannot be made.
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Affiliation(s)
- Andreas Weise Mucha
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Rune Broni Strandby
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Nikolaj Albeck Nerup
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Michael Patrick Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Tan APP, Chng JK. Fish Skin Acellular Dermal Matrix Combined With Negative Pressure Wound Therapy for Diabetic Foot Ulcers. Cureus 2025; 17:e80488. [PMID: 40225439 PMCID: PMC11991860 DOI: 10.7759/cureus.80488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2025] [Indexed: 04/15/2025] Open
Abstract
Background Managing diabetic foot ulcers (DFUs) is challenging due to poor blood supply, which leads to chronic wounds, increased susceptibility to infections, ischemia, and necrosis. The compromised quality of surrounding tissues, combined with complex underlying conditions and weakened immune systems, often hinders proper wound healing. Fish skin acellular dermal matrix (ADM) has emerged as an effective treatment option to promote healing in such wounds. Objective This study is the first to explore the use of fish skin ADM combined with negative pressure wound therapy (NPWT) for treating DFUs in the Asian population. The aim is to demonstrate the efficacy and effectiveness of this combined treatment approach. Methods Six patients with DFUs who visited the vascular surgery department between November 2022 and June 2023 were included in the study. Their wounds were treated with Kerecis® Omega3 Wound dressing for definitive closure, while NPWT was applied as an adjunct therapy to enhance graft uptake when suitable. Results The average initial wound size was 34.30 cm², with a complete healing rate of 100% achieved over an average of 19 weeks using Kerecis® Omega3 Wound dressing and adjunct NPWT. By the 12-week mark, the average reduction in wound size was 80.50%. Conclusions Fish skin ADM offers a biocompatible and sustainable solution for improving wound healing in difficult-to-treat DFUs. The addition of NPWT appears to enhance graft uptake, shorten the time to complete wound closure, and lower the risk of infections commonly associated with chronic diabetic foot wounds.
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Affiliation(s)
| | - Jack Kian Chng
- Vascular Surgery, Singapore General Hospital, Singapore, SGP
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Hu S, Xiao J, Nie X, Wang C. Vacuum sealing drainage combined with continuous irrigation for the treatment of oral and maxillofacial abscesses-a retrospective study. BMC Oral Health 2025; 25:257. [PMID: 39966789 PMCID: PMC11837351 DOI: 10.1186/s12903-025-05634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 02/11/2025] [Indexed: 02/20/2025] Open
Abstract
OBJECTIVE The conventional treatment for oral and maxillofacial abscesses involves incision and drainage. However, postoperative dressing changes often cause pain and other discomfort to patients. Therefore, we explored the use of vacuum sealing drainage (VSD) technology for treating oral and maxillofacial abscesses. In this retrospective study, we evaluated the efficacy and value of VSD combined with continuous irrigation using physiological saline to treat oral and maxillofacial abscesses. MATERIALS AND METHODS Data from 115 patients with oral and maxillofacial abscesses were collected. Patients were divided into two groups based on the treatment strategy: 68 received traditional treatment (Group 1) and 47 were treated with the VSD device (Group 2). The treatment period, incision length and numerical rating scale (NRS) score were compared between the two groups. Postoperative complications were also recorded. RESULTS All patients were successfully treated and discharged. Group 2 had a longer treatment duration (10.00 ± 5.87 days) than Group 1 (8.07 ± 3.47 days; p < 0.05) but demonstrated shorter incision lengths (3.04 ± 0.31 cm vs. 3.57 ± 0.44 cm; p < 0.01) and lower NRS scores on postoperative day 1 (1.83 ± 0.70 vs. 2.96 ± 0.83; p < 0.01). Complications included two allergic reactions to adhesive material in Group 2 and higher reoperation rates (Group 2: 4 cases; Group 1: 1 case). CONCLUSION VSD treatment for localized oral and maxillofacial abscesses is comfortable for patients and can reduce the length of surgical incisions. However, the therapeutic effect for maxillofacial multispace infection is still controversial.
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Affiliation(s)
- Sunqiang Hu
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wenzhou Medical University, 373 West College Road, Wenzhou, 325000, Zhejiang, China
| | - Jin Xiao
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wenzhou Medical University, 373 West College Road, Wenzhou, 325000, Zhejiang, China
| | - Xin Nie
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wenzhou Medical University, 373 West College Road, Wenzhou, 325000, Zhejiang, China
| | - Chi Wang
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wenzhou Medical University, 373 West College Road, Wenzhou, 325000, Zhejiang, China.
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Gefen A, Russo S, Ciliberti M. Revisiting negative pressure wound therapy from a mechanobiological perspective supported by clinical and pathological data. Int Wound J 2024; 21:e70098. [PMID: 39694469 PMCID: PMC11655127 DOI: 10.1111/iwj.70098] [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: 04/23/2024] [Revised: 09/30/2024] [Accepted: 09/30/2024] [Indexed: 12/20/2024] Open
Abstract
Negative pressure wound therapy is used often in the management of surgical incisions, chronic wounds and subacute lesions, and there are numerous publications discussing its clinical application and outcomes. However, whilst clinical use and associated literature have expanded since these systems became commercially available in the 90s, important research and discussion around the mode of action have waned, leading to a deficit in the understanding of how this important therapy influences healing. Further, much research and many publications are predominantly reflective, discussing early theorem, some of which have been proven incorrect, or at least not fully resolved leading to misunderstandings as to how the therapy works, thus potentially denying the clinician the opportunity to optimise use towards improved clinical and economic outcomes. In this narrative review, we discuss established beliefs and challenges to same where appropriate and introduce important new research that addresses the manner in which mechanical strain energy (i.e., deformations) is transferred to tissue and how this influences biological response and healing. In addition, we assess and discuss the effect of different negative pressure dressing formats, how they influence the mode of action and how this understanding can lead to more efficient and effective use and clinical economic outcomes.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Department of Mathematics and Statistics and the Data Science Institute, Faculty of SciencesHasselt UniversityHasseltBelgium
| | - Serena Russo
- Mediterranean Institute for Transplantation and Highly Specialized Therapies (ISMETT)PalermoItaly
| | - Marino Ciliberti
- Wound Care Centre (Centro Aziendale di Riparazione Tissutale)Castellammare di StabiaItaly
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Liu YT, Lin SH, Peng C, Huang RW, Lin CH, Hsu CC, Chen SH, Lin YT, Lee CH. Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis. Int J Surg 2024; 110:8107-8125. [PMID: 39806749 PMCID: PMC11634157 DOI: 10.1097/js9.0000000000002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 11/05/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Deep sternal wound infection (DSWI) is a severe and life-threatening complication following cardiovascular surgery. Negative pressure wound therapy (NPWT) has emerged as a promising therapeutic bridging option for DSWI. In this systematic review and meta-analysis, the authors aimed to evaluate the impact of NPWT on clinical outcomes in patients with DSWI. MATERIAL AND METHODS A comprehensive literature search was conducted according to the PRISMA guideline in electronic databases, including PubMed, Embase, and Cochrane Library. Data extraction was performed independently by two reviewers, and risk of bias was assessed by ROBINS-I tool. The primary outcomes assessed were mortality rate and reinfection rate. The secondary outcomes assessed were length of hospital stay and ICU stay. RESULTS In this systematic review identified a total of 36 studies, comprising 3681 patients with DSWI who received treatment. The meta-analysis revealed that NPWT was associated with a significant reduction in mortality rate (RR 0.46, 95% CI: 0.35-0.61, P<0.000001) and reinfection rate (RR 0.43, 95% CI: 0.25-0.74, P=0.002) compared to conventional wound management. Furthermore, pooling of these studies showed significant difference between the NPWT and conventional treatment groups in length of hospital stay (mean difference: -4.49, 95% CI: -8.14 to -0.83; P=0.02) and length of ICU stay (mean difference: -1.11, 95% CI: -2.18 to -0.04; P=0.04). CONCLUSION This systematic review and meta-analysis provide evidence that NPWT is superior to conventional treatment for patients with DSWI following cardiovascular surgery.
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Affiliation(s)
- Yen-Ting Liu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Han Lin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi Peng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
| | - Che-Hsiung Lee
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan and College of Medical, Chang Gung University, Taoyuan, Taiwan
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Papadakos SP, Argyrou A, Katsaros I, Lekakis V, Mpouga G, Vergadis C, Fytili P, Koutsoumpas A, Schizas D. The Impact of EndoVAC in Addressing Post-Esophagectomy Anastomotic Leak in Esophageal Cancer Management. J Clin Med 2024; 13:7113. [PMID: 39685572 PMCID: PMC11642085 DOI: 10.3390/jcm13237113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 11/10/2024] [Accepted: 11/21/2024] [Indexed: 12/18/2024] Open
Abstract
Anastomotic leakage (AL) remains a major complication after esophagectomy, especially in patients with esophagogastric cancers who have undergone neoadjuvant therapies, which can impair tissue healing. Endoscopic vacuum-assisted closure (EndoVAC) is an innovative approach aimed at managing AL by facilitating wound drainage, reducing infection, and promoting granulation tissue formation, thus supporting effective healing. This review explores the role and effectiveness of EndoVAC in treating AL post-esophagectomy in esophageal cancer patients. We present an overview of its physiological principles, including wound contraction, enhanced tissue perfusion, and optimized microenvironment, which collectively accelerate wound closure. In addition, we examine clinical outcomes from recent studies, which indicate that EndoVAC is associated with improved leak resolution rates and potentially shorter hospital stays compared to traditional methods. Overall, this review highlights EndoVAC as a promising tool for AL management and underscores the need for continued investigation to refine its protocols and broaden its accessibility. By optimizing EndoVACs use, multidisciplinary teams can improve patient outcomes and advance esophageal cancer care.
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Affiliation(s)
- Stavros P. Papadakos
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece; (S.P.P.); (A.A.); (V.L.); (G.M.); (P.F.); (A.K.)
| | - Alexandra Argyrou
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece; (S.P.P.); (A.A.); (V.L.); (G.M.); (P.F.); (A.K.)
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece
| | - Vasileios Lekakis
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece; (S.P.P.); (A.A.); (V.L.); (G.M.); (P.F.); (A.K.)
| | - Georgia Mpouga
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece; (S.P.P.); (A.A.); (V.L.); (G.M.); (P.F.); (A.K.)
| | | | - Paraskevi Fytili
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece; (S.P.P.); (A.A.); (V.L.); (G.M.); (P.F.); (A.K.)
| | - Andreas Koutsoumpas
- Department of Gastroenterology, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece; (S.P.P.); (A.A.); (V.L.); (G.M.); (P.F.); (A.K.)
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 115 27 Athens, Greece
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11
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Jeong JW, Lee S, Park JH. Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction. BMC Geriatr 2024; 24:906. [PMID: 39497041 PMCID: PMC11533407 DOI: 10.1186/s12877-024-05526-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/29/2024] [Indexed: 11/06/2024] Open
Abstract
BACKGROUND Pressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps. METHODS A retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics. RESULTS In this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate. CONCLUSION Closed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care. TRIAL REGISTRATION The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20-2023-25, Date: Mar. 24 2023).
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Affiliation(s)
- Ji Won Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Seungkeun Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Jomaru-ro 170, Bucheon, 14584, Republic of Korea
| | - Jun Ho Park
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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12
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Du X, Liu W, Xu B, Luan J, Liu C. Novel Noninvasive Hybrid Flap Preconditioning Surpasses Surgical Delay in the Murine Model. Plast Reconstr Surg 2024; 154:1003-1012. [PMID: 38265270 DOI: 10.1097/prs.0000000000011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Ischemic necrosis in the distal portion of a flap is a challenging complication in plastic surgery. The authors hypothesized that a novel hybrid flap preconditioning (HFP) device combining foam-mediated external suction and nonsurgical delay can promote skin flap survival better than surgical delay. METHOD Twenty-eight mice were divided into 4 groups: a control group, in which a 4 × 1.5-cm dorsal flap was made with no preconditioning; a surgical delay group, in which surgical delay occurred 7 days before flap elevation; a foam-mediated external suction (FMES) group, in which foam-mediated external suction at -100 mm Hg was used 5 hours a day for 6 days, and the flap was elevated on the seventh day; and a hybrid flap preconditioning (HFP) group, in which silicone strips were applied along the contour of the foam interface. The same negative-pressure protocol was used as in the FMES group. Seven days after flap elevation, macroscopic, histologic, and Western blot analyses were performed. RESULTS The flap survival rate was 46.25% (8.12%) in the control group, 68.72% (7.00%) in the surgical delay group, 57.03% (8.17%) in the FMES group, and 80.66% (3.27%) in the HFP group. Immunohistologic analysis of CD31 + cells in the distal end of viable tissue procured 7 days after flap elevation showed significantly higher angiogenesis in the surgical delay and HFP groups. Western blot results showed an increased expression of vascular endothelial growth factor in the surgical delay and HFP groups. CONCLUSIONS The authors developed and fabricated a novel HFP device combining foam-mediated external suction and nonsurgical delay. The concept of HFP has proved to promote flap survival better than surgical delay. CLINICAL RELEVANCE STATEMENT This study presented an innovative noninvasive method of flap preconditioning, which has been demonstrated to be superior to surgical delay in a murine model and holds promise for potential application in clinical settings.
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Affiliation(s)
- Xingyi Du
- From the Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Wenyue Liu
- From the Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Boyang Xu
- From the Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jie Luan
- From the Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Chunjun Liu
- From the Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College
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13
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Lok E, Oe T, Ng S. Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting. Adv Wound Care (New Rochelle) 2024. [PMID: 39001834 DOI: 10.1089/wound.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Abstract
Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.
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Affiliation(s)
- Evania Lok
- Department of Plastic and Reconstructive Surgery, Austin Health, Melbourne, Australia
| | - Timothy Oe
- Department of Plastic and Reconstructive Surgery, Austin Health, Melbourne, Australia
| | - Sally Ng
- Department of Plastic and Reconstructive Surgery, Austin Health, Melbourne, Australia
- Department of Surgery (Austin Precinct), University of Melbourne, Australia
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14
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Fakouri A, Razavi ZS, Mohammed AT, Hussein AHA, Afkhami H, Hooshiar MH. Applications of mesenchymal stem cell-exosome components in wound infection healing: new insights. BURNS & TRAUMA 2024; 12:tkae021. [PMID: 39139205 PMCID: PMC11319788 DOI: 10.1093/burnst/tkae021] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024]
Abstract
The healing process at a wound is made up of many types of cells, growth factors, the extracellular matrix, nerves and blood vessels all interacting with each other in complex and changing ways. Microbial colonization and proliferation are possible at the place of injury, which makes infection more likely. Because of this, any cut has a chance of getting an infection. Researchers have found that wound infections make patients more upset and cost the healthcare system a lot of money. Surgical site infections happen a lot to people who have recently had surgery. This study shows that such surgical infection is linked to a high rate of illness and death. This is shown by the fact that 25% of patients get serious sepsis and need to be transferred to an intensive care unit. In both animal models and people, mesenchymal stem cells (MSCs) play an active role in all stages of wound healing and have positive effects. Exosomes are one of the main things MSCs release. They have effects that are similar to those of the parent MSCs. Various effector proteins, messenger RNA and microRNAs can be transported by extracellular vesicles to control the activity of target cells. This has a big impact on the healing process. These results suggest that using MSC-exosomes as a new type of cell-free therapy could be a better and safer option than whole cell therapy. This review is mostly about how to use parts of MSC-exosomes to help wound infections heal.
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Affiliation(s)
- Arshia Fakouri
- Student Research Committee, USERN Office, Lorestan University of Medical Sciences, Khorramabad 6813833946, Iran
| | - Zahra-Sadat Razavi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamed Afkhami
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
- Department of Medical Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
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15
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Miller-Mikolajczyk C, Beach K, Silverman R, Cooper M. The Evolution of Commercial Negative Pressure Wound Therapy Systems over the Past Three Decades. Adv Wound Care (New Rochelle) 2024; 13:375-390. [PMID: 38666695 DOI: 10.1089/wound.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Significance: Since the introduction of the first commercial negative pressure wound therapy (NPWT) system nearly three decades ago, several key technological innovations have led to the wide adoption of the therapy. This is a review of the history and innovation of commercial NPWT systems for adjunctive management of open wounds. Recent Advances: Technical modifications have broadened NPWT options to include innovative dressing interfaces, tubing configurations, power sources, capability of topical wound solution instillation or irrigation, canister versus canister-free configurations, smart technology, and disposable versus larger reusable therapy units. While these options complicate product selection, they have greatly expanded the potential to manage a wide variety of wounds in patients who previously may not have been candidates for NPWT. Critical Issues: Basic yet mandatory requirements of NPWT include delivering an accurate level of negative pressure to the wound bed, maintaining a seal, removing wound surface exudate through the dressing interface, and patient adherence to prescribed therapy. Meeting these requirements is challenging in the face of variable wound types, wound locations, exudate levels, and exudate viscosity. While there are a growing number of marketed NPWT systems, each may have different characteristics and performance. Evaluating the functionality of each system and relevant accessories is complicated, especially as additional manufacturers enter the market. Understanding the key innovations and specific challenges they are intended to solve may aid health care providers in selecting appropriate NPWT technologies for patients. Future Directions: Evolving technology, including artificial intelligence, will likely play a major role in redefining NPWT safety, simplicity, and reliability.
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Affiliation(s)
| | | | - Ronald Silverman
- Becton Dickinson and Company, Franklin, New Jersey, USA
- University of Maryland Medical System, Baltimore, Maryland, USA
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16
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Gonzalez MR, de Groot TM, Werenski JO, Fourman MS, Morse AS, Lozano-Calderon SA. Wound vacuum-assisted closure temporization after tumor resection of soft tissue sarcomas-A cost analysis in a propensity-score matched population. J Surg Oncol 2024; 130:301-309. [PMID: 38798273 DOI: 10.1002/jso.27698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Vacuum-assisted closure (VAC) temporization is a technique associated with high local control rates used in myxofibrosarcoma. We sought to compare the costs and postoperative outcomes of VAC temporization and single-stage (SS) excision/reconstruction. METHODS We conducted a retrospective analysis of patients with myxofibrosarcoma surgically treated at our institution between 2000 and 2022. Variables of interest included total, direct, and indirect costs for initial episode of care, 90 days and 1 year after initial admission, and postoperative outcomes. Costs were compared between the VAC temporization and SS groups. RESULTS After matching, 13 patients in the SS group and 23 in the VAC group were analyzed. We found no difference in median and mean total inpatient costs, between the VAC temporization and SS group. While total 90-day and 1-year costs were higher in the VAC group compared to the SS group, mean costs were similar. There were no differences in postoperative complications between groups. A subanalysis of the entire cohort (n = 139) revealed lower local recurrence and overall death rates in the VAC temporization group. CONCLUSION VAC temporization had similar inpatient costs and postoperative outcomes to SS excision/reconstruction. While median 90-day and 1-year costs were higher in the VAC group, mean costs did not differ.
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Affiliation(s)
- Marcos R Gonzalez
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom M de Groot
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph O Werenski
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell S Fourman
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
| | - Ashlyn S Morse
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderon
- Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Zhu J, Yan L, Hu R, Yang C, Wu M, An Y, Li S. Artificial dermis combined with negative pressure wound therapy and platelet-rich plasma to treat traumatic wounds: a retrospective study. J Wound Care 2024; 33:189-196. [PMID: 38451787 DOI: 10.12968/jowc.2024.33.3.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects. METHOD In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively. After surgical debridement, all wounds received ADM, PRP and delayed STSG, which were all aided with NPWT. RESULTS The patients consisted of five males and three females, with a mean age of 44 years. A total of six lower extremity wounds were located at the foot/ankle, with exposed tendon in five, bone exposure in three and both in two. Of the group, two patients had exposed tendon on arm/hand wounds. The size of wounds and ADM averaged 126cm2 and 42.3cm2, respectively. ADM was used to cover the exposed bone or tendon, the granulation and muscular tissue were covered with vacuum sealing drainage (VSD) directly, for NPWT. The survival rate of ADM averaged 98.9%. The average time for survival of ADM was 12.8 days and the mean uptake of autologous skin graft was 93.5%. Only one patient received repeated skin grafts. All patients achieved successful healing and reported no complications. The mean length of hospital stay was 36.1 days. CONCLUSION Our study revealed that ADM in conjunction with NPWT, PRP and STSG could be used for repairing large traumatic extremity wounds. Wound closure was achieved without flaps, the aesthetic and functional outcomes were acceptable, and only one patient developed a 35% loss of skin graft. DECLARATION OF INTEREST This work was supported by grants from the Natural Science Foundation of Hubei Province (grant no. 2020CFB464) and Youth Foundation of Wuhan Municipal Health Commission (grant no. WX20Q15). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Jin Zhu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Li Yan
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Rui Hu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Chunbao Yang
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Mingzheng Wu
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Ying An
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
| | - Shanqing Li
- Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan, China
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18
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Wang K, Wang Y, Shi W, Shen K, Tao K, Ling R, Huang Y, Fu X, Hu D. Diagnosis and treatment of diabetic foot ulcer complicated with lower extremity vasculopathy: Consensus recommendation from the Chinese Medical Association (CMA), Chinese Medical Doctor Association (CMDA). Diabetes Metab Res Rev 2024; 40:e3776. [PMID: 38402455 DOI: 10.1002/dmrr.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 02/26/2024]
Abstract
Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.
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Affiliation(s)
- Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yunchuan Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Wenlong Shi
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Ke Tao
- Department of Wound Repair, Wound Repair and Regenerative Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yuesheng Huang
- Department of Wound Repair, Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China
| | - Xiaobing Fu
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department and 4th Medical Center, PLA General Hospital and PLA Medical College, Beijing, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
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Sexton FC, Soh V, Yahya MS, Healy DA. Effectiveness of negative-pressure wound therapy to standard therapy in the prevention of complications after vascular surgery. Minerva Surg 2024; 79:48-58. [PMID: 37930087 DOI: 10.23736/s2724-5691.23.10096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Wound complications are common after vascular surgery and many may be preventable. Negative pressure wound therapy (NPWT) dressings may be able to reduce wound complications relating to closed incisions following vascular surgery and several devices are currently available along with a large body of literature. This review article will describe the use of NPWT dressings in vascular surgery. We will summarize the currently available systems, the likely mechanism of action of NWPT, the published studies to date and we will give our recommendations regarding the priorities for future research on this topic.
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Affiliation(s)
- Fiona C Sexton
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Vernie Soh
- Department of Vascular Surgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Muhammad S Yahya
- Department of Vascular Surgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Donagh A Healy
- Department of Vascular Surgery, Belfast Health and Social Care Trust, Belfast, UK -
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20
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Zuo J, Zhu Y, Yang F, Yang Y, Yang J, Huang ZL, Cheng B. Polyurethane foam dressing with non-adherent membrane improves negative pressure wound therapy in pigs. J Wound Care 2024; 33:xx-xxvii. [PMID: 38324420 DOI: 10.12968/jowc.2024.33.sup2a.xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Negative pressure wound therapy (NPWT) is considered to be an effective technique to promote the healing of various wounds. The aim of this study was to evaluate different wound dressings combined with NPWT in treating wounds in Wuzhishan pigs. METHOD Excisions were made in the backs of the pigs and were covered with polyvinyl alcohol (PVA) dressing, polyurethane (PU) dressing or PU dressing with non-adherent membrane (PU-non-ad). NPWT was applied to the wound site. In the control group, basic occlusive dressing (gauze) without NPWT was applied. On days 0, 3, 7, 14, 21 and 28 post-surgery, the wound size was measured during dressing change, and wound healing rate (WHR) was calculated. In addition, blood perfusion within 2cm of the surrounding wound was measured by laser doppler flowmetry. Dressing specimen was collected and microbiology was analysed. Granulation tissues from the central part of the wounds were analysed for histology, vascular endothelial growth factor (VEGF) and cluster of differentiation 31 (CD31) mRNA expression. RESULTS The PU-non-ad-NPWT significantly (p<0.01) accelerated wound healing in the pigs. Further pathological analysis revealed that the non-adherent membrane effectively protected granulation tissue formation in PU-NPWT treated wounds. The blood perfusion analysis suggested that the non-adherent membrane improved the blood supply to the wound area. Microbiological analysis showed that non-adherent membrane decreased the bacterial load in the PU-NPWT dressing. VEGF and CD31 mRNA expression was upregulated in the wound tissue from the PU-non-ad-NPWT treated groups. CONCLUSION In this study, the PU dressing with non-adherent membrane was an ideal dressing in NPWT-assisted wound healing.
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Affiliation(s)
- Jun Zuo
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China
- The Second Affiliated Hospital of University of South China, HengYang 421000, China
| | - Yi Zhu
- The Second Affiliated Hospital of University of South China, HengYang 421000, China
| | - Feng Yang
- The Second Affiliated Hospital of University of South China, HengYang 421000, China
| | - Yong Yang
- The Second Affiliated Hospital of University of South China, HengYang 421000, China
| | - JunTao Yang
- The Second Affiliated Hospital of University of South China, HengYang 421000, China
| | - Ze Lin Huang
- The Second Affiliated Hospital of University of South China, HengYang 421000, China
| | - Biao Cheng
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510000, China
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21
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Ozer AY, Keskin İ, Kelestemur T, Ayturk N, Ersavas C, Gunal MY. Efficacy of one-hour negative pressure wound therapy and magnetic field energy in wound healing. J Wound Care 2024; 33:i-ix. [PMID: 38197308 DOI: 10.12968/jowc.2024.33.sup1.i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Wound healing is an important aspect of health but needs further research to identify the effects and interactions of different treatment approaches on healing. The aims of this study were to investigate the effectiveness of one-hour negative pressure wound therapy (NPWT) and compare histological differences between one-hour NPWT and magnetic field energy (MFE) in rats on early-stage wound healing, wound size and angiogenesis. METHOD Standardised wounds were created on Wistar rats that were allocated and divided into NPWT, MFE and control groups. Both treatments were applied for 1 hour/day for 10 days. Wound size, histological changes and wound area blood flow were assessed. RESULTS The wound size of all groups was similar on days 0, 2 and 10. The MFE group's wound size was smaller than the NPWT group on days 4, 6 and 8 (p<0.05). Development of the granulation tissue in both the one-hour NPWT and MFE groups was greater than in the control group. Additionally, the inflammatory phase was shorter, and wounds entered the proliferative stage faster in the MFE group than both of the other groups. CONCLUSION Treatment with MFE may be more effective in terms of early stage wound closure and angiogenesis. On the other hand, the NPWT group's wound area blood flow was significantly greater than the other two groups. MFE is superior to one-hour NPWT in terms of wound area and angiogenesis. Furthermore, it is worthwhile to note that one-hour NPWT increases bloodflow in the wound area, which stimulates healing.
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Affiliation(s)
- Aysel Y Ozer
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Marmara University, Istanbul, Turkey
| | - İlknur Keskin
- Department of Histology and Embryology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Taha Kelestemur
- Department of Physiology, School of Medicine, Regenerative and Restorative Medical Research Center, Istanbul Medipol University, Istanbul, Turkey
| | - Nilufer Ayturk
- Department of Histology and Embryology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Cenk Ersavas
- Department of General Surgery, School of Medicine, Istanbul Arel University, Istanbul, Turkey
| | - Mehmet Y Gunal
- Department of Physiology, School of Medicine, Alanya Alaaddin Keykubat University Antalya, Turkey
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22
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Wang H, Sun S, Wang G, Huang Q, Zhang Z. Analysis of Vacuum-Assisted Closure-Assisted Antibiotic Irrigation in Treatment of Severe Neurosurgical Central Nervous System Infections. Surg Infect (Larchmt) 2023; 24:803-810. [PMID: 37910866 DOI: 10.1089/sur.2023.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Objective: Severe neurosurgical central nervous system infections (sNCNSIs) are among the most serious complications of neurosurgical disease. Conventional methods have shown a poor prognosis. This study aims to analyze the clinical characteristics of vacuum-assisted closure (VAC) in sNCNSIs with the help of antibiotic irrigation treatment. Patients and Methods: A retrospective study was performed for patients diagnosed with sNCNSIs. A VAC device was placed on the incision after debridement and the surgical cavity was rinsed with antibiotic agents in the VAC group. Meanwhile the surgical cavity was drained after debridement in the control group. Medical data were reviewed and analyzed. Results: Twenty-eight patients met the inclusion criteria, including 18 cases in the VAC group and 10 cases in the control group. The basic medical data showed no differences. Bacteria was isolated from 24 (85.7%) patients. The cure rate was significantly higher in the VAC group (p < 0.05). The cure rate in patients with multi-drug-resistant (MDR) infections was significantly higher in patients treated with VAC therapy (p < 0.05). The prognosis evaluated by Glasgow Outcome Score (GOS) between the two groups showed significant difference (p < 0.05). No re-infection in the VAC group occurred in the follow-up period. Conclusions: It is suggested that VAC-assisted antibiotic irrigation is safe and effective for patients with severe NCNSIs and can improve the prognosis dramatically. The results can provide a new effective and reasonable therapeutic strategy for patients with sNCNSIs.
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Affiliation(s)
- Huaqing Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Shengnan Sun
- Department of Nursing, Shandong Medical College, Jinan, Shandong Province, P.R. China
| | - Guanghui Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Qibing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Zeli Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
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23
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Cao L, Zeng R, Sun K, Fan H. Ultrasound-guided percutaneous micro-drainage tube irrigation combined with high negative pressure tube drainage versus debridement with closed suction irrigation for treating deep surgical site infection after spinal surgery. Int Wound J 2023; 21:e14435. [PMID: 37878524 PMCID: PMC10828718 DOI: 10.1111/iwj.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
It is difficult to avoid deep surgical site infection after spinal surgery. Debridement combined with closed suction irrigation (CSI) and other treatment methods lead to greater trauma and lower satisfaction. We developed a new method for the treatment of SSI, which has the advantages of less invasiveness and lower cost. The cohort of this retrospective study comprised 26 patients with SSI after undergoing spinal surgery in our hospital from August 2017 to March 2022. The patients were divided into CSI and microtube drainage group according to treatment methods. The durations of antibiotic use and hospital stay, hospitalization costs, and functional scores during follow-up were compared between the two groups. The only baseline characteristic that differed between the two groups was sex. Infection was controlled in both groups and there were no recurrences during follow-up. However, the length of hospital stay after the first operation and the total length of stay were significantly greater in the CSI group. Hospitalization costs and antibiotic costs were significantly higher in the CSI group. Additionally, the duration of intravenous antibiotic use was significantly longer in the CSI group. Both the CSI and microtube drainage groups had significantly improved of Short Form Health Survey (SF-36) scores 6 months postoperatively. However, 3 months postoperatively, SF-36 scores were significantly lower in the CSI group. Compared with debridement followed by CSI, percutaneous micro-drainage tube irrigation combined with high negative pressure tube drainage is a more efficient and economical means of treating SSI after spinal surgery.
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Affiliation(s)
- Le Cao
- Department of OrthopaedicsFuyang Hospital of Anhui Medical UniversityFuyangChina
| | - Ran Zeng
- Department of Intensive Care UnitFuyang Hospital of Anhui Medical UniversityFuyangChina
| | - Kai Sun
- Department of OrthopaedicsFuyang Hospital of Anhui Medical UniversityFuyangChina
| | - Haitao Fan
- Department of OrthopaedicsFuyang Hospital of Anhui Medical UniversityFuyangChina
- Department of OrthopaedicsThe First Affliated Hospital of Ningbo UniversityNingboChina
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24
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Ravindhran B, Schafer N, Howitt A, Carradice D, Smith G, Chetter I. Molecular mechanisms of action of negative pressure wound therapy: a systematic review. Expert Rev Mol Med 2023; 25:e29. [PMID: 37853784 DOI: 10.1017/erm.2023.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Negative pressure wound therapy (NPWT) has significantly advanced wound care and continues to find new applications. Its effects at a molecular level however, remain a subject of debate. The aim of this systematic review is to summarize the current evidence regarding the molecular mechanisms of action of NPWT. Medline, Embase, EBSCO databases and clinical trial registries were searched from inception to January 2023. Clinical studies, animal models or in-vitro studies that quantitatively or semi-quantitatively evaluated the influence of NPWT on growth factors, cytokine or gene-expression in the circulation or wound-bed were included. Risk of Bias assessment was performed using the RoBANS tool for non-randomized studies, the COCHRANE's Risk of Bias 2(ROB-2) tool for randomized clinical studies, OHAT tool for in-vitro studies or the SYRCLE tool for animal model studies. A descriptive summary was collated and the aggregated data is presented as a narrative synthesis. This review included 19 clinical studies, 11 animal studies and 3 in-vitro studies. The effects of NPWT on 43 biomarkers and 17 gene expressions were studied across included studies. NPWT stimulates modulation of numerous local and circulating cytokines and growth factor expressions to promote an anti-inflammatory profile. This is most likely achieved by downregulation of TNFα, upregulation of VEGF, TGF-β and fibronectin.
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Affiliation(s)
- Bharadhwaj Ravindhran
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
- Department of Health Sciences, University of York, York, UK
| | - Nicole Schafer
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Annabel Howitt
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | | | - George Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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25
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Castro-Núñez J, Sifuentes-Cervantes JS, Alemán BO, Rivera I, Bustillo J, Guerrero LM. Histologic features of bone regenerated by means of negative pressure in the context of odontogenic keratocyst. Oral Maxillofac Surg 2023; 27:421-426. [PMID: 35643989 DOI: 10.1007/s10006-022-01080-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The objective of the present research is to describe the histologic features of the bone regenerated by means of negative pressure (sugosteogenesis) in a group of patients diagnosed with odontogenic keratocyst (OKC) who underwent active decompression and distraction sugosteogenesis (ADDS) at our institution. MATERIALS AND METHODS The authors designed a retrospective case series study. The population included patients with a histologic diagnosis of odontogenic keratocyst in whom active decompression and distraction sugosteogenesis followed by enucleation was performed. All patients were seen and followed from July 2019 to January 2021. The investigation was approved by the Institutional Review Board, and it observed the Declaration of Helsinki on medical protocol. Variables of this study included age, gender, anatomic location (mandible or maxilla), and histologic characteristics of the bone regenerated by means of negative pressure. Histologic features were defined as being consistent or inconsistent with viable mature bone. RESULTS Bone biopsies of 6 patients were considered. In total, 83.33% of patients were males and 16.66% females. One hundred percent of the bone samples subjected to negative pressure showed features of viable mature bone. CONCLUSIONS In this study, the histological features of the bone subjected to negative pressure demonstrated the normal characteristics of the mature, normal bone.
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Affiliation(s)
- Jaime Castro-Núñez
- PGY 3Oral and Maxillofacial Surgery Residency ProgramSchool of Dental MedicineMedical Sciences Campus, University of Puerto Rico, Paseo Dr. José Celso Barbosa, San Juan, Puerto Rico, 00921.
| | - José S Sifuentes-Cervantes
- PGY 1, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Brayann O Alemán
- PGY 4, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Irelsy Rivera
- PGY 4, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Jairo Bustillo
- Oral and Maxillofacial Pathology Department, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Lidia M Guerrero
- Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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26
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Cantatore F, Pagliara E, Marcatili M, Bertuglia A. Negative-Pressure Wound Therapy (NPWT) in Horses: A Scoping Review. Vet Sci 2023; 10:507. [PMID: 37624295 PMCID: PMC10458497 DOI: 10.3390/vetsci10080507] [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: 07/08/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Obtaining a healthy wound environment that is conductive to healing in horses can be challenging. Negative-pressure wound therapy (NPWT) has been employed in humans to enhance wound healing for decades. The existing evidence for the effectiveness of NPWT remains uncertain in equine medicine. The aim of this review is to investigate NPWT applications and benefits in horses. A scoping review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for scoping reviews on three databases (PubMed, Web of Science-Thompson Reuters, and Wiley Online Library). Twenty-four manuscripts were considered. After removing duplicates, 17 papers underwent abstract screening. Of these, 16 + 1 (cited by others) were evaluated for eligibility according to PICOs, including no case reports/retrospective studies, four original articles, and three reviews. Fifteen manuscripts met the inclusion criteria. The focus of the articles was wound management; they included three reports of wounds communicating with synovial structures. Traumatic wounds and surgical-site infections are indications for NPWT. NPWT presents several advantages and few complications making it an attractive alternative to conventional wound management. However, randomized controlled trials should be performed to quantify the benefits and establish precise protocols in horses.
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Affiliation(s)
- Federica Cantatore
- Pool House Equine Clinic, IVC Evidensia, Crown Inn Farm, Fradley, Lichfield WS13 8RD, UK;
| | - Eleonora Pagliara
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (E.P.); (A.B.)
| | - Marco Marcatili
- Pool House Equine Clinic, IVC Evidensia, Crown Inn Farm, Fradley, Lichfield WS13 8RD, UK;
| | - Andrea Bertuglia
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; (E.P.); (A.B.)
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27
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Orgill DP, McNulty AK. Theoretical and Pre-Clinical Models of Vacuum Assisted Closure. Surg Innov 2023; 30:533-537. [PMID: 36446390 DOI: 10.1177/15533506221142690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Vacuum Assisted Closure (VAC) has changed how physicians treat complex and chronic wounds. For over 20 years, we have studied the mechanism of action of these devices in both an academic based research laboratory and in an industry-based laboratory.We performed a literature review of the theoretical and pre-clinical published studies from the two labs which related to the biomechanics of open pore reticulated polyurethane interfaces.The VAC device applies a direct mechanical interface to the wound surface. The interaction of the foam under suction with the wound surface causes surface deformation and cell stretch. The suction removes fluid from the tissues. There are increases in angiogenesis with better vessel morphology than standard dressings. The effect is dependent on the pore size of the foam, the pressure of application and the waveform of application. Undoubtedly, patient factors such as age, diabetes and radiation affect the response.Pre-clinical studies can help in the design and optimization of mechanical-based wound healing devices. Current work on the effects of these devices on lymphatics and scarring are areas of active investigation.
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Affiliation(s)
- Dennis P Orgill
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Amy K McNulty
- Research and Development, Medical Solutions Division, 3M Company, St. Paul, MN, USA
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28
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Freedman BR, Hwang C, Talbot S, Hibler B, Matoori S, Mooney DJ. Breakthrough treatments for accelerated wound healing. SCIENCE ADVANCES 2023; 9:eade7007. [PMID: 37196080 PMCID: PMC10191440 DOI: 10.1126/sciadv.ade7007] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/14/2023] [Indexed: 05/19/2023]
Abstract
Skin injuries across the body continue to disrupt everyday life for millions of patients and result in prolonged hospital stays, infection, and death. Advances in wound healing devices have improved clinical practice but have mainly focused on treating macroscale healing versus underlying microscale pathophysiology. Consensus is lacking on optimal treatment strategies using a spectrum of wound healing products, which has motivated the design of new therapies. We summarize advances in the development of novel drug, biologic products, and biomaterial therapies for wound healing for marketed therapies and those in clinical trials. We also share perspectives for successful and accelerated translation of novel integrated therapies for wound healing.
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Affiliation(s)
- Benjamin R. Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Charles Hwang
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
| | - Simon Talbot
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
| | | | - Simon Matoori
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canda
| | - David J. Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
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29
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Munro SP, Dearden A, Joseph M, O'Donoghue JM. Reducing donor-site complications in DIEP flap breast reconstruction with closed incisional negative pressure therapy: A cost-benefit analysis. J Plast Reconstr Aesthet Surg 2023; 78:13-18. [PMID: 36739647 DOI: 10.1016/j.bjps.2022.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Deep inferior epigastric perforator (DIEP) flaps are considered the gold standard for autologous breast reconstruction but create large abdominal incisions that risk donor-site morbidity during harvest. Closed incision negative pressure therapy (ciNPT) is emerging as an effective alternative to standard postoperative dressings, but there is a paucity of data in DIEP flap donor sites. METHODS We conducted a retrospective case-control study investigating the use of ciNPT in DIEP flap donor sites at a single institution between March 2017 and September 2021. Patients who underwent microsurgical autologous breast reconstruction with DIEP flaps were included. Patients were divided into those with donor incision sites managed with ciNPT (n = 24) and those with conventional postoperative wound dressings (n = 20). We compared patient demographics, wound drainage volumes and postoperative outcomes between the two groups. A cost-benefit analysis was employed to compare the overall costs associated with each complication and differences in length of stay between the two groups. RESULTS There was no statistically significant difference in age, body mass index (BMI), comorbidity burden or smoking status between the two groups. Both groups had similar lengths of stay and wound drainage volumes with no readmissions or reoperations in either group. There was a statistically significant reduction in donor-site complications (p = 0.018), surgical site infections (p = 0.014) and seroma formation (p = 0.016) in those with ciNPT. Upon cost-benefit analysis, the ciNPT group had a mean reduction in cost-per-patient associated with postoperative complications of £420.77 (p = 0.031) and £446.47 (p = 0.049) when also accounting for postoperative length of stay CONCLUSION: ciNPT appears to be an effective alternative incision management system with the potential to improve complication rates and postoperative morbidity in DIEP flap donor sites. Our analysis demonstrates improved cost-benefit outweighing the increase in costs associated with ciNPT. We recommend a multicentre prospective trial with formal cost-utility analysis to strengthen these findings.
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Affiliation(s)
- S P Munro
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom.
| | - A Dearden
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom
| | - M Joseph
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom
| | - J M O'Donoghue
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom
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30
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Slavkovic M, Zivanovic D, Dučić S, Lasić V, Bukvić N, Nikolić H, Martinović V. Comparison of Negative Pressure Wound Therapy (NPWT) and Classical Wet to Moist Dressing (WtM) in the Treatment of Complicated Extremity Wounds in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020298. [PMID: 36832427 PMCID: PMC9955583 DOI: 10.3390/children10020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patients in the study group exhibited a better result on a visual scar scale. The patients in the control group had a shorter hospital stay. Based on the recorded results, we were able to make treatment recommendations.
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Affiliation(s)
- Milan Slavkovic
- University Children’s Hospital, 11000 Belgrade, Serbia
- Correspondence:
| | - Dragoljub Zivanovic
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia
- University Clinical Center Nis, Clinic for Pediatric Surgery, Orthopedics and Traumatology, 18000 Niš, Serbia
| | - Siniša Dučić
- University Children’s Hospital, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Valentina Lasić
- Department of Pediatric Surgery Clinic for Surgery, University Clinical Hospital of Mostar, 88000 Mostar, Bosnia and Herzegovina
- Faculty of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Nado Bukvić
- Clinical Hospital Center Rijeka, Department for Pediatric Surgery, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Harry Nikolić
- Clinical Hospital Center Rijeka, Department for Pediatric Surgery, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Vlatka Martinović
- Department of Pediatric Surgery Clinic for Surgery, University Clinical Hospital of Mostar, 88000 Mostar, Bosnia and Herzegovina
- Faculty of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
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31
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Kalaiselvan R, Slade DAJ, Soop M, Burnett H, Lees NP, Anderson ID, Lal S, Carlson GL. Impact of negative pressure wound therapy on enteroatmospheric fistulation in the septic open abdomen. Colorectal Dis 2023; 25:111-117. [PMID: 36031878 DOI: 10.1111/codi.16318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
AIM The effect of negative pressure wound therapy (NPWT) on the pathogenesis and outcome of enteroatmospheric fistulation (EAF) in the septic open abdomen (OA) is unclear. This study compares the development and outcome of EAF following NPWT with that occurring in the absence of NPWT. METHODS Consecutive patients admitted with EAF following abdominal sepsis at a National Reference Centre for intestinal failure between 01 January 2005 and 31 December 2015 were included in this study. Patients were divided into two groups based on those that had been treated with NPWT and those that had not (non-NPWT) and characteristics of their fistulas compared. Clinical outcomes concerning nutritional autonomy at 4 years and time to fistula development, size of abdominal wall defect and complete fistula closure were compared between groups. RESULTS A total of 160 patients were admitted with EAF following a septic abdomen (31-NPWT and 129-non-NPWT). Median (range) time taken to fistulation after OA was longer with NPWT (18 [5-113] vs. 8 [2-60] days, p = 0.004); these patients developed a greater number of fistulas (3 [2-21] vs. 2 [1-10], p = 0.01), involving a greater length of small bowel (42.5 [15-100] cm vs. 30 [3.5-170] cm, p = 0.04) than those who did not receive NPWT. Following reconstructive surgery, nutritional autonomy was similar in both groups (77% vs. 72%) and a comparable number of patients were also fistula-free (100% vs. 97%). CONCLUSIONS Negative pressure wound therapy appears to be associated with more complex and delayed intestinal fistulation, involving a greater length of small intestine in the septic OA. This did not, however, appear to adversely affect the overall outcome of intestinal and abdominal wall reconstruction in this study.
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Affiliation(s)
- Ramya Kalaiselvan
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Dominic A J Slade
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Mattias Soop
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Hugh Burnett
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicholas P Lees
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Iain D Anderson
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Lal
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Gordon L Carlson
- Department of Surgery, National Reference Centre for Intestinal Failure, Salford Royal NHS Foundation Trust, Manchester, UK
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32
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Yamashiro T, Kushibiki T, Mayumi Y, Tsuchiya M, Ishihara M, Azuma R. Negative-Pressure Wound Therapy: What We Know and What We Need to Know. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1436:131-152. [PMID: 36922487 DOI: 10.1007/5584_2023_773] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Negative-pressure wound therapy (NPWT) promotes wound healing by applying negative pressure to the wound surface. A quarter of a century after its introduction, NPWT has been used in various clinical conditions, although molecular biological evidence is insufficient due to delay in basic research. Here, we have summarized the history of NPWT, its mechanism of action, what is currently known about it, and what is expected to be known in the future. Particularly, attention has shifted from the four main mechanisms of NPWT to the accompanying secondary effects, such as effects on various cells, bacteria, and surgical wounds. This chapter will help the reader to understand the current status and shortcomings of NPWT-related research, which could aid in the development of basic research and, eventually, clinical use with stronger scientific evidence.
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Affiliation(s)
- Toshifumi Yamashiro
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Yoshine Mayumi
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masato Tsuchiya
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Miya Ishihara
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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33
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Liebman RM, Hanubal KS, Dziegielewski PT. Negative Pressure Wound Therapy in the Head and Neck: A Summary of Uses and Application Techniques. Semin Plast Surg 2022; 37:9-18. [PMID: 36776812 PMCID: PMC9911220 DOI: 10.1055/s-0042-1759562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Negative pressure wound therapy (NPWT) has had an expanded role in the management of complex wounds including its increasing use for complex wounds in the head and neck region. Challenges for use in the head and neck region include variations in surface topography and the proximity of sensitive mouth, nose, ear, eye, and tracheal openings. Despite these challenges, NPWT has been used in the head and neck immediately following free flap surgery, to prepare wounds for skin grafting or local flaps, to treat orocutaneous and pharyngocutaneous fistulas, to treat necrotizing and deep neck space infections, to temporize and palliate, and to treat chronic wounds with exposed bone and hardware among others. This review demonstrates the proven track record of successful uses of NPWT in the aforementioned scenarios, provides suggestions to improve efficacy, as well as an algorithm for use in certain clinical situations.
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Affiliation(s)
- Robert Michael Liebman
- Otolaryngology-Head and Neck Surgery, Memorial Health University Medical Center, Savannah, Georgia,Address for correspondence Robert Michael Liebman, MD Otolaryngology-Head and Neck Surgery, Memorial Health University Medical Center4700 Waters Avenue, Building 400, Savannah, GA 31404
| | - Krishna S. Hanubal
- Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Peter T. Dziegielewski
- Division of Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida
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Komono A, Yoshimatsu G, Kajitani R, Matsumoto Y, Aisu N, Hasegawa S. Reconstruction with omental flap and negative pressure wound therapy after total pelvic exenteration of anal fistula cancer: a case report. Surg Case Rep 2022; 8:116. [PMID: 35718851 PMCID: PMC9206969 DOI: 10.1186/s40792-022-01472-z] [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: 03/02/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Surgery for anal fistula cancer (AFC) associated with Crohn’s disease usually entails extensive perineal wounds and dead space in the pelvis, which is often filled with a myocutaneous flap. However, use of a myocutaneous flap is invasive. We report a case of total pelvic exenteration (TPE) for AFC in which a myocutaneous flap was avoided by using an omental flap and negative pressure wound therapy (NPWT).
Case presentation
The patient was a 47-year-old woman who had been treated for Crohn’s disease involving the small and large intestine for 30 years and had repeatedly developed anal fistulas. She was referred with a diagnosis of AFC that had spread extensively in the pelvis. We performed laparoscopic TPE via a transperineal endoscopic approach. To prevent infection in the large skin defect and extensive pelvic dead space postoperatively, the perineal wound was reconstructed using an omental flap and NPWT. During 20 days of NPWT, the wound steadily decreased in size and closed on postoperative day (POD) 20. She was discharged without complications on POD 30.
Discussion
NPWT is useful for preventing perineal wound infection and promoting granulation tissue formation. However, direct contact with the intestine may lead to intestinal perforation. In this case, the combination of an omental flap with NPWT effectively prevented surgical site infection. The flap filled the large pelvic dead space and physically separated the intestine from the polyurethane foam used for NPWT.
Conclusion
NPWT and an omental flap may become an option when performing TPE.
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Mo J, Huang Y, Wang Q, Zhong H, Zhai Z, Nong Y, Yan X, Huang X, Huang J, Yang S, Sun J, Han J, Zhou X, Lu W. Autologous wound margin point columnar full‐thickness skin grafting combined with negative pressure wound therapy improves wound healing in refractory diabetic foot ulcers. Int Wound J 2022; 20:1506-1516. [PMID: 36307147 PMCID: PMC10088827 DOI: 10.1111/iwj.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022] Open
Abstract
Diabetic lower extremity ulcers (DLEUs) are a severe complication of diabetes mellitus (DM) and are difficult to heal. This study aimed to explore the efficacy of autologous point columnar full-thickness skin graft taken from the ulcer wound margin combined with negative pressure wound therapy (NPWT) in refractory DLEUs. This is a prospective cohort study. A total of 40 inpatients with refractory DLEUs were recruited in the Diabetes Foot Center of Guangxi Zhuang Autonomous Region People's Hospital from October 2019 to November 2021. According to the doctors' professional suggestions and the patients' personal wishes, these enrolled patients were divided into two groups based on different topical wound management: the graft group (n = 18) and the conventional wound therapeutic (CWT) group (n = 22). The efficacy evaluations included the time to complete re-epithelialization of the wound and healing speed within 14 days of graft treatment or after 14 days of graft treatment in the two groups. Before the treatment, the graft group had a significantly larger ulcer area than the CWT group [27.22 (15.28, 46.59) versus 10.92 (7.00, 24.93) cm2 , P < .01]. However, the time to complete wound re-epithelialization in the graft group was shorter than in the CWT group [58.22 ± 30.60 versus 86.09 ± 49.54 d, P < .05]. Meanwhile, the healing speed in graft group was markedly faster than in CWT group, whether within 14 days [0.60 (0.40, 0.92) versus 0.16 (0.07, 0.34) cm2 /d, P < .01] or after 14 days of graft treatment [0.57 (0.45, 0.91) versus 0.13 (0.08, 0.27) cm2 /d, P < .01]. However, the total treatment cost in the graft group was lower than in the CWT group [419.59 ± 137.20 versus 663.97 ± 497.02 $, P < .05]. The novel treatment modality of autologous full-thickness skin graft taken from the ulcer wound margin combined with NPWT has hereby proposed for the first time, and is a safe, effective, and reliable method with a good performance-to-cost ratio to promote wound healing and shorten the healing time for DLEUs.
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Affiliation(s)
- Jianming Mo
- The Department of Endocrinology and Metabolism Jinan University Guangzhou People's Republic of China
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Yuanjing Huang
- The Health Management Center Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Qiu Wang
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Hua Zhong
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Zhenwei Zhai
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Yuechou Nong
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Xiaodong Yan
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Xiulu Huang
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Jianhao Huang
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Suping Yang
- The Health Management Center Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Jingxia Sun
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Jiaxia Han
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Xing Zhou
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
| | - Wensheng Lu
- The Department of Endocrinology and Metabolism Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi People's Republic of China
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36
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Park JH, Park JU. Flap monitoring with incisional negative pressure wound therapy (NPWT) in diabetic foot patients. Sci Rep 2022; 12:15684. [PMID: 36127377 PMCID: PMC9489718 DOI: 10.1038/s41598-022-20088-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer. However, flap reconstruction for diabetic foot ulcer treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperative monitoring procedure implemented in conjunction with negative pressure wound therapy immediately after flap operations for treating diabetic foot. A retrospective analysis was performed on diabetic foot patients who underwent free flaps and perforator flaps from March 2019 through August 2021. The surgical outcomes of interest were the rates of survival and complications. On the third postoperative day, patients underwent computed tomography angiography to check for pedicle compression or fluid collection in the sub-flap plane. Monitoring time, as well as comparisons between NPWT and conventional methods, were analyzed. Statistical analysis was performed between the two groups. This study included 26 patients. Among patients, the negative pressure wound Therapy treated group included 14 flaps and the conventional monitoring group included 12 flaps. There was no significant intergroup difference in flap survival rate (p = 0.83). In addition, there was no significant intergroup difference in the diameters of perforators or anastomosed vessels before and after negative pressure wound therapy (p = 0.97). Compared with conventional monitoring, flap monitoring with incisional negative pressure wound therapy was associated with a significantly lower mean monitoring time per flap up to postoperative day 5. Although conventional monitoring is widely recommended, especially for diabetic foot ulcer management, the novel incisional negative pressure wound therapy investigated in this study enabled effortless serial flap monitoring without increasing complication risks. The novel flap monitoring technique is efficient and safe for diabetic foot patients and is a promising candidate for future recognition as the gold standard for flap monitoring.
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Affiliation(s)
- Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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37
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Li J, Wang Y, Shao X, Cheng T. The salvage of mesh infection after hernia repair with the use of negative pressure wound therapy (
NPWT
), a systematic review. ANZ J Surg 2022; 92:2448-2456. [DOI: 10.1111/ans.18040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital Sichuan University Chengdu China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
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Agarwal A. Evolution of Negative Pressure Wound Therapy in Orthopaedic Trauma. J Orthop Trauma 2022; 36:S1-S5. [PMID: 35994301 DOI: 10.1097/bot.0000000000002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
Negative Pressure Wound Therapy (NPWT) has evolved from open wound management to now include closed incision management. It has been a major advance in the management of open wounds and closed incisional wounds especially in orthopaedic trauma surgery. Because of the success of NPWT in the late 1990s and early 2000s, surgeons began using NPWT with adjuncts on closed incisions as a way to help prevent surgical wound dehiscence especially in at-risk patients for wound problems. It has been well established that obesity, diabetes, and smoking in addition to other comorbidities increase the risk of wound dehiscence and surgical site infections in orthopaedic patients. It is widely used for open wound management, often associated with open fractures, and in the mitigation of risk of surgical site infections over closed incisions (incisional negative pressure wound therapy). Newer systems allow the use of various topical wound solutions to be instilled in conjunction with NPWT, termed NPWTi-d. This has shown promising results in difficult wounds that may be resistant to standard NPWT. This article reviews the evolution and use of NPWT in orthopaedic trauma.
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Affiliation(s)
- Animesh Agarwal
- Division of Orthopaedic Trauma, University of Texas Health Science Center at San Antonio, Department of Orthopaedics, San Antonio, TX
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Gefen A. The influence zone: a critical performance measure for negative pressure wound therapy systems. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S12. [PMID: 35980923 DOI: 10.12968/bjon.2022.31.15.s8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article provides an introduction to the theory of, what is termed, the 'influence zone' in the context of negative pressure wound therapy (NPWT). It is a quantitative bioengineering performance measure for NPWT systems, to indicate their effectiveness, namely, how far from the wound bed edges a specific system is able to deliver effective mechano-stimulation into the periwound, and at which intensity. The influence zone therefore provides objective and standardised metrics of one of the fundamental modes of action of NPWT systems: the ability to effectively and optimally deform both the wound and periwound macroscopically and microscopically. Most important is the mechanical deformation of the periwound area to activate cells responsible for tissue repair, particularly (myo)fibroblasts. Notably, the influence zone must extend sufficiently into the periwound to stimulate (myo)fibroblasts in order that they migrate and progress the wound healing process, facilitating the formation of scar tissue, without overstretching the periwound tissues so as not cause or escalate further cell and tissue damage. The inclusion of the influence zone theory within research to investigate the efficacy of NPWT systems facilitates systematic comparisons of commercially available and potentially new systems. This approach has the capacity to guide not only research and development work, but also clinical decision-making. Recently published research found that inducing an effective influence zone first and foremost requires continuous delivery of the intended pressure to the wound bed.
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Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
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Orlov A, Gefen A. Effective negative pressure wound therapy for open wounds: The importance of consistent pressure delivery. Int Wound J 2022; 20:328-344. [PMID: 35818745 PMCID: PMC9885467 DOI: 10.1111/iwj.13879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/14/2022] [Indexed: 02/03/2023] Open
Abstract
Two distinct design concepts exist for single-use negative pressure wound therapy systems: Canister-based versus canisterless. The canister-based technology provides intrinsic stable delivery of the intended negative pressure, because exudate is constantly transferred from the wound into a canister, thereby preventing dressing saturation. In contrast, with a canisterless system, where delivery of the negative pressure depends on continuous evaporation of wound fluids from its dressing, loss of the intended wound-bed pressure may occur due to dressing saturation. To investigate whether these two designs differ in their mechanobiological effect with respect to magnitudes and distributions of tissue strain fields under the absorptive dressing, termed the influence zone, we integrated computational modelling with an animal study. This influence zone must be of biologically influential strain levels and extend sufficiently into the peri-wound for stimulating fibroblasts to migrate and progress the healing. We found that an effective influence zone requires continuous delivery of the intended pressure to the wound-bed. Loss of negative pressure at the wound-bed below 40 mmHg adversely lowered the peri-wound stimulation around a 120 × 70 mm sized wound to less than one-third of the baseline stimulation, and further pressure decreases to 20 mmHg or lower resulted in complete lack of peri-wound mechano-stimulation.
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Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
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"Negative Pressure Wound Therapy (NPWT) Yields Lower Wound Complication and Surgical Site Infection Rates Compared to Standard Surgical Dressings (SSDs) after Resection of a Malignancy: A Systematic Review and Meta-Analysis". Plast Reconstr Surg 2022; 150:655e-670e. [PMID: 35791292 DOI: 10.1097/prs.0000000000009448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Negative Pressure Wound Therapy (NPWT) offers many advantages over Standard Surgical Dressings (SSDs) in the treatment of open wounds including accelerated wound healing (72.3% vs 30.8%), cost savings (up to $1,607), and reduced complication rates (35% vs 53%).2-4 Contraindicated by device manufacturers in malignancy-resected wounds for hypothesized risk of tumor recurrence, NPWT is still applied post-operatively due to limited clinical support. A systematic review with meta-analysis was performed to compare NPWT outcomes with SSDs on open wounds with our null hypotheses stating there would be no outcome differences. METHODS A systematic review of the literature on NPWT and SSDs on malignancy-resected wounds was conducted following PRISMA guidelines using PubMed, EMBASE, CINAHL, and Cochrane Central databases. Meta-analysis compared group outcomes, including malignancy recurrence, wound complication, and surgical site infection (SSI) rates, with random effects model. RESULTS 1,634 studies were identified and 27 met eligibility criteria, including 4 randomized control trials (RCTs), 4 prospective cohort studies, and 19 retrospective reviews. Eighty-one percent of papers (n = 22) recommended NPWT use in malignancy-resected wounds. Meta-analysis determined NPWT yielded significantly lower overall SSI (P = 0.004) and wound complication rates (P = 0.01) than SSDs; however, there were no statistically significant differences found for other outcomes between the two groups. CONCLUSIONS This review demonstrates favorable outcomes of NPWT over SSDs for malignancy-resected wounds without an increased risk of malignancy recurrence. However, with limited RCTs (detailing only incisional wounds for limited malignancies and anatomic regions), additional high-power RCTs are recommended.
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Sapino G, Lanz L, Roesti A, Guillier D, Deglise S, De Santis G, Raffoul W, di Summa P. One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study. J Clin Med 2022; 11:jcm11123305. [PMID: 35743375 PMCID: PMC9224921 DOI: 10.3390/jcm11123305] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation.
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Affiliation(s)
- Gianluca Sapino
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.S.); (L.L.); (W.R.)
| | - Loise Lanz
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.S.); (L.L.); (W.R.)
| | - Aurore Roesti
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.R.); (S.D.)
| | - David Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery—University Hospital, Boulevard de Lattre de Tassigny, 21000 Dijon, France;
| | - Sebastien Deglise
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (A.R.); (S.D.)
| | - Giorgio De Santis
- Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Largo del Pozzo 71, 41100 Modena, Italy;
| | - Wassim Raffoul
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.S.); (L.L.); (W.R.)
| | - Pietro di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.S.); (L.L.); (W.R.)
- Correspondence:
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Resadita R, Seswandhana MR, Purnomo E, Anzhari S, Gabriela GC, Dachlan I, Aryandono T, Wirohadidjojo YW. The effect of NPWT in wound healing and bacterial count on deep dermal burn injury model: An experimental study. Ann Med Surg (Lond) 2022; 75:103367. [PMID: 35386807 PMCID: PMC8977920 DOI: 10.1016/j.amsu.2022.103367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background Sepsis is one of the main causes in burn victim's mortality. The use of negative pressure wound therapy (NPWT) provides an ideal environment to accelerate wound healing. We compare the use of normal saline (NS), intermittent NPWT, continuous NPWT and silver sulfadiazine in wound healing process. Method This study involved 6 Yorkshire pigs; each pig was induced with 20 burns on the flank area. Burns were divided into 4 treatment groups: NS gauze, intermittent NPWT, continuous NPWT, and silver sulfadiazine dressing. Burns were evaluated on day 1,3,7,14, and 21 for its morphology and bacterial colonization and on day 14 and 21 for the remaining burn surface area. Result Wound that received NPWT therapy appeared better in both granulation and crust formation. Remaining burn surface area (mm2) on day 14 in NS group, intermittent NPWT, continuous NPWT, and silver sulfadiazine were 107.43 ± 83.43, 178.07 ± 74.83, 146.10 ± 69.1, 126.03 ± 83.22, respectively(p = 0.457); on day 21 in NS group, intermittent NPWT, continuous NPWT, and silver sulfadiazine were 13.16 ± 16.86, 59.49 ± 20.72, 54.79 ± 46.59, 48.95 ± 39.84, respectively(p=0.169). There were no significant differences in each treatment group bacterial colonization(p>0.05). There were no significant correlation between bacterial colonization and remaining burn surface area (p>0.05). Conclusion While morphologically, the wound in NPWT treatment groups appeared better in granulation and crust formation, the remaining wound surface area and the number of bacterial colonization were not significantly difference compared to standard therapy (silver sulfadiazine and NS gauze). There were no significant correlation between the amount of bacterial colonization and remaining wound surface area on every treatment group.
Sepsis is one of cause burn injury mortality. NPWT is promising burn injury treatment. There was no significant difference of wound healing in various treatments.
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Affiliation(s)
- Reagan Resadita
- Division of Plastic, Reconstruction and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - M Rosadi Seswandhana
- Division of Plastic, Reconstruction and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Eko Purnomo
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Sharfan Anzhari
- Division of Plastic, Reconstruction and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Gita Christy Gabriela
- Division of Plastic, Reconstruction and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Ishandono Dachlan
- Division of Plastic, Reconstruction and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Yohanes Widodo Wirohadidjojo
- Department of Dermatovenerology, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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Bloom JA, Tian T, Homsy C, Singhal D, Salehi P, Chatterjee A. A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions. Am Surg 2022:31348221087395. [PMID: 35392664 DOI: 10.1177/00031348221087395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Closed-incision negative pressure therapy (CINPT) with the Prevena system has been used and clinically evaluated in high-risk groin incisions to reduce the risk of postoperative complications. We performed a cost-effectiveness analysis evaluating CINPT in femoral-popliteal bypass with prosthetic graft. METHODS A literature review looking at prospective randomized trials determined the probabilities and outcomes for femoral-popliteal bypass with and without CINPT. Reported utility scores were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure and postoperative complications. Medicare current procedure terminology and diagnosis-related group codes were used to assess the costs for a successful surgery and associated complications. A decision analysis tree was constructed with rollback analysis to highlight the more cost-effective strategy. An incremental cost-effectiveness ratio (ICER) analysis was performed with a willingness to pay at $50,000. Deterministic and probabilistic sensitivity analyses were performed to validate the robustness of the results, and to accommodate for the uncertainty in the literature. RESULTS Femoral-popliteal bypass with CINPT is less costly ($40,138 vs $41,774) and more effective (6.14 vs 6.13) compared to without CINPT. This resulted in a negative ICER of -234,764.03, which favored CINPT, indicating a dominant strategy. In one-way sensitivity analysis, surgery without CINPT was more cost-effective if the probability of successful surgery falls below 84.9% or if the cost of CINPT exceeds $3139. Monte Carlo analysis showed a confidence of 99.07% that CINPT is more cost-effective. CONCLUSIONS Despite the added device cost of CINPT, it is cost-effective in vascular surgical operations using groin incisions.
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Affiliation(s)
- Joshua A Bloom
- Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
| | - Tina Tian
- Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
| | - Christopher Homsy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
| | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Payam Salehi
- Division of Vascular Surgery, Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA
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Orlov A, Gefen A. The potential of a canister‐based single‐use negative‐pressure wound therapy system delivering a greater and continuous absolute pressure level to facilitate better surgical wound care. Int Wound J 2022; 19:1471-1493. [PMID: 35048527 PMCID: PMC9493241 DOI: 10.1111/iwj.13744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University Tel Aviv Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University Tel Aviv Israel
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Zhang H, Wang S, Lei C, Li G, Wang B. Experimental study of negative pressure wound therapy combined with platelet-rich fibrin for bone-exposed wounds. Regen Med 2021; 17:23-35. [PMID: 34905932 DOI: 10.2217/rme-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the efficacy of negative pressure wound therapy (NPWT) combined with platelet-rich fibrin (PRF) in treating bone-exposed wounds and explore its possible mechanism. Materials & methods: A bone-exposed wound was created in a total of 32 healthy Sprague-Dawley rats, which were divided into either control group, NPWT group, PRF group or both (N + P group). The bone-exposed area, skin contraction rate and granulation coverage and the level of growth factors in granulation tissue were determined on days 4, 7 and 10. Results: The N + P group showed significantly higher wound closure rate than that achieved with others respectively. Four factors were significantly higher in N + P group than in the other three groups. Conclusion: Combination of NPWT and PRF can repair bone-exposed wounds effectively and accelerate wound healing.
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Affiliation(s)
- Hong Zhang
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China.,Department of Pediatric Surgery, Fujian Children's Hospital, Fuzhou Fujian, 350000, PR China.,Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou Fujian, 350000, PR China.,Fujian Maternity & Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Songyu Wang
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Chen Lei
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Guanmin Li
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
| | - Biao Wang
- Department of Plastic & Cosmetic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, PR China
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Zeybek B, Li S, Silberschmidt VV, Liu Y. Wound contraction under negative pressure therapy measured with digital image correlation and finite-element analysis in tissue phantoms and wound models. Med Eng Phys 2021; 98:104-114. [PMID: 34848029 DOI: 10.1016/j.medengphy.2021.11.003] [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: 03/23/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to demonstrate the capabilities of finite-element (FE) models to predict contraction of wounds managed with negative pressure wound therapy (NPWT). The features of wounds and surrounding tissues were analysed to gain insights into the mechanical effects of NPWT on them. 3D digital image correlation (DIC) measurement of soft tissue phantoms was used to investigate the effect of wound thickness, size, and shape, which were further compared with results of FE simulations. It was noticed that with an increased NP level the difference between DIC and FE in wound contraction became more pronounced, particularly for the thick wounds. In addition, the locations of the wounds were evaluated to predict their contraction characteristics, based on surrounding tissue structures, in 3D using the developed FE models. It was demonstrated that features and location of wounds influenced their deformations differently for the same pressure levels. Overall, this study, involving a combined experimental and computational approach, allowed the important insights into mechanical effects of NPWT.
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Affiliation(s)
- Begum Zeybek
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom
| | - Simin Li
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom
| | - Vadim V Silberschmidt
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom
| | - Yang Liu
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom; Centre of Biological Engineering, Loughborough University, United Kingdom.
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One-Stage Perifascial Areolar Tissue and Skin Grafting Combined with Negative Pressure Wound Therapy for a Refractory Wound with an Exposed Elbow Joint and Extensive Skin Defect. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kim TH, Park JH. A novel negative pressure wound therapy (NPWT) monitoring system for postoperative flap management. Medicine (Baltimore) 2021; 100:e27671. [PMID: 34871244 PMCID: PMC8568380 DOI: 10.1097/md.0000000000027671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Various types of flaps are widely utilized as reconstructive options for patients with soft tissue defects. However, the postoperative monitoring of the flap requires a large amount of time and effort. The aim of this study was to evaluate the efficacy and safety of this novel monitoring procedure using negative pressure wound therapy (NPWT) immediately after the flap operations.A retrospective analysis was performed on patients who underwent free flaps and perforator flaps from March 2019 to December 2020. The flaps were managed by either novel NPWT method or conventional dressing. Among NPWT group, computed tomography angiography was performed in randomly selected 5 flaps on the third postoperative day for evaluation of pedicle compression. Statistical analysis was performed between the 2 groups.A total of 54 flaps were included in this study. Twenty seven flaps were managed using novel NPWT method and 27 flaps were managed using conventional dressing. There was no statistically significant difference in flap survival rates between the 2 groups (P = .91). The patency of flap pedicles in the NPWT group was confirmed by comparing the computed tomography angiography findings. The estimated total flap monitoring time and cost for 5 days was significantly decreased by the application of the novel NPWT monitoring system.Through the application of the novel postoperative monitoring system using NPWT, there is efficient evaluation of the flap. Furthermore, safe flap monitoring is possible with the reduced risk of infection by the avoidance of multiple manual dressing performed in the conventional method.
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Immediate application of negative pressure wound therapy following lower extremity flap reconstruction in sixteen patients. Sci Rep 2021; 11:21158. [PMID: 34707109 PMCID: PMC8551315 DOI: 10.1038/s41598-021-00369-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
Negative pressure wound therapy (NPWT) is usually applied in wound management and soft-tissue salvage after the development of complications. However, immediate postoperative application of NPWT over the flap coverage is seldom reported. We evaluate the effectiveness of immediate postoperative application of NPWT following fasciocutaneous or muscle flap coverage for lower leg reconstruction. A retrospective review of patients who underwent either fasciocutaneous or muscle flap coverage of lower leg soft-tissue defects applied with NPWT immediately after surgery was conducted in a level I trauma center. Sixteen patients, with an average age of 51.2 years, were included in the study. Nine patients had trauma-related soft-tissue loss, six had subsequent soft-tissue defects after debridement, and one had burn injury. Two patients had been treated with free anterolateral thigh flaps, 11 with pedicle flaps, and three with muscle flaps. All flaps survived except for those in two patients with venous congestion on postoperative day 1, which needed further debridement and skin grafting. Therefore, the use of immediate incisional NPWT is an alternative for wound care following flap coverage. The U-shaped design allows easy flap observation and temperature check. Furthermore, this method eliminates any concerns of vascular pedicle compression under negative pressure.
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