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Jessop TS, Kairinos N. Hypervitaminosis D and hard-to-heal wounds: a case report. J Wound Care 2025; 34:368-371. [PMID: 40358220 DOI: 10.12968/jowc.2023.0177] [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: 05/15/2025]
Abstract
Vitamin D is thought to be safe due to its wide therapeutic index and concentrations are rarely raised to toxic levels in the blood. However, excessive vitamin D supplementation can lead to hypervitaminosis D, causing hypercalcaemia and hyperphosphataemia. Due to its lipid solubility, vitamin D can be stored in adipose tissue, leading to persistent hypercalcaemia, even after supplementation has been discontinued. This case reports an 81-year-old female patient who developed hypervitaminosis D after taking excessive vitamin D supplementation for 30 years. The patient presented with complex bilateral leg wounds and tissue calcification. This case highlights the importance of monitoring vitamin D supplementation and the risks associated with hypervitaminosis D, including soft tissue calcification.
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Affiliation(s)
- Thomas Steve Jessop
- MBChB Student, Division of Plastic Reconstructive Surgery, University of Stellenbosch, South Africa
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Lee SYC, Bayan L, Sato A, Vankayalapati DK, Antoniou V, Shami MZ, Sulaiman HO, Yap N, Nakanishi H, Than CA, Wong KY. Benefits of negative pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomised controlled trials. J Plast Reconstr Aesthet Surg 2025; 102:204-217. [PMID: 39932531 DOI: 10.1016/j.bjps.2025.01.036] [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: 08/18/2024] [Revised: 11/04/2024] [Accepted: 01/24/2025] [Indexed: 03/09/2025]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is a widely used adjunct for wound healing and an alternative to conventional dressings for skin grafts. This meta-analysis aimed to quantify the effectiveness of NPWT versus conventional dressings in this population through randomised control trials (RCTs). METHODS A literature search in several databases was conducted from inception to October 2023. Eligible studies were RCTs reporting the efficacy and post-operative outcomes of NPWT and non-NPWT (control) in patients ≥18 years with skin grafts. Pooled proportions were analysed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42023471105). RESULTS Overall, 16 RCTs met the criteria for inclusion in the meta-analysis. This included 411 patients and 401 controls. Compared to conventional dressings, NPWT demonstrated 8.3% higher overall graft take (95% CI: 2.97, 13.63, I2 = 85%), 10.0% higher graft take at -80 mmHg (95% CI: 5.69, 14.34, I2 = 0%), higher graft success rates (OR = 1.86, 95% CI: 1.05, 3.30, I2 = 0%), lower graft loss rates (OR = 0.44, 95% CI: 0.23, 0.85, I2 = 0%), lower complication rates (OR = 0.36, 95% CI: 0.13, 0.99, I2 = 76%) and lower reoperation rates (OR = 0.31, 95% CI: 0.13, 0.72, I2 = 0%). CONCLUSION NPWT is a safe and effective approach for dressing skin grafts in adult patients compared to conventional wound dressings. NPWT improved graft take and graft success while reducing graft failure, reoperations and overall complications.
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Affiliation(s)
- Sum-Yu Christina Lee
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus.
| | - Laith Bayan
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Alma Sato
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Dilip K Vankayalapati
- Oxford Thames Valley Foundation School, Buckinghamshire NHS Trust, Oxford Thames Valley, UK
| | - Valeria Antoniou
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - M Zaid Shami
- HCA Florida Aventura Hospital, Aventura Hospital and Medical Center, Miami, FL, USA
| | - Hafsa Omer Sulaiman
- Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, Cleveland, OH, USA
| | - Nathanael Yap
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus; St George's University of London, London SW17 0RE, UK
| | | | - Christian A Than
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus; St George's University of London, London SW17 0RE, UK; School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Kai Yuen Wong
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Ylli K, AlQahtani J, Hraishawi I, Murphy T. VACStent closure of oesophageal defects by covered stent and endoscopic vacuum therapy: initial use and clinical outcomes. J Surg Case Rep 2025; 2025:rjae804. [PMID: 39717413 PMCID: PMC11663413 DOI: 10.1093/jscr/rjae804] [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: 09/15/2024] [Accepted: 12/05/2024] [Indexed: 12/25/2024] Open
Abstract
Endoscopic management of transmural oesophageal defects following esophagectomy or spontaneous perforations, such as Boerhaave's syndrome, is often complicated by stent migration and luminal occlusion [1]. The Vacuum-Assisted Closure (VAC) stent, which integrates a covered stent with endoscopic vacuum therapy, aims to address these issues by providing functional drainage and promoting wound healing [2]. This case series presents our initial experience with VACStent therapy in four patients treated between February 2023 and April 2024. Two patients had staple line defects post-esophagectomy, and two had Boerhaave's syndrome. Treatment involved stent placement under general anaesthesia, followed by evaluations and scheduled stent exchanges every 6 days. All patients achieved successful defect closure, with no procedural complications noted. Three patients required one stent application, while one needed two applications. VACStent therapy appears to be a safe and effective treatment for transmural oesophageal defects, potentially establishing a new standard of care.
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Affiliation(s)
- Kristali Ylli
- Department of Surgery, Mercy University Hospital, Grenville Place, Cork, T12 WE28, Ireland
| | - Jowhara AlQahtani
- Department of Surgery, Mercy University Hospital, Grenville Place, Cork, T12 WE28, Ireland
| | - Ihab Hraishawi
- Department of Surgery, Mercy University Hospital, Grenville Place, Cork, T12 WE28, Ireland
| | - Thomas Murphy
- Department of Surgery, Mercy University Hospital, Grenville Place, Cork, T12 WE28, Ireland
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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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Biermann N, Eigenberger A, Felthaus O, Brébant V, Heine N, Brix E, Spoerl S, Prantl L, Gurtner G, Anker AM. Breast Lipofilling: Is the Bra Really Full? Clinical Bra Pressure Measurement and In Vitro Testing of Processed and Unprocessed Fat Cells. Aesthetic Plast Surg 2024; 48:5018-5025. [PMID: 38814346 DOI: 10.1007/s00266-024-04116-9] [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: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Breast lipofilling, a popular cosmetic and reconstructive procedure, involves the transplantation of autologous fat to enhance breast volume and contour. Despite its widespread use, cell processing and the aftertreatment remain controversial. This study investigates the pressure applied by a compression bra and reports in vitro stress tests of processed and unprocessed fat cells. METHODS Clinical bra pressure measurements were conducted on a cohort of 45 patients following lipofilling, reduction mammoplasties and DIEP flaps. Laboratory analysis included cell vitality testing using Resazurin assays of processed and unprocessed fat cells after exposure to mechanical or hyperbaric pressure. RESULTS Our findings show a mean overall pressure value of the compression bra for all patients of 6.7 ± 5.7 mmHg (range 0-35). Cell processing is superior to sedimentation only regarding fat cell vitality. However, neither mechanical pressure within the specified range nor hyperbaric oxygen exposure significantly affected fat graft survival as measured by Resazurin assays. CONCLUSION The in vitro measurements showed that it was impossible to harm fat cells with external pressure during lipofilling procedures, regardless of their processing. In the clinical context, the compression bra applied pressure values deceeding the perfusion pressure and may therefore not diminish oxygen supply nor harm the transplanted cells. Therefore, we recommend the use of a compression bra for all lipofilling procedures around the breast. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany.
| | - Andreas Eigenberger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
- Medical Device Lab, Regensburg Center of Biomedical Engineering (RCBE), Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053, Regensburg, Germany
| | - Oliver Felthaus
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Norbert Heine
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Eva Brix
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Steffen Spoerl
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Geoffrey Gurtner
- Department of Plastic and Reconstructive Surgery, Stanford University School Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Alexandra M Anker
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
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Cuthbert C, Zaghloul T, Bhatia S, Mothi SS, Davis E, Heavens HG, Bishop MW, Talbot LJ, Neel MD, Abdelhafeez AH. Use of Vacuum-Assisted Closure to Reduce the Likelihood of Wound Complications After Limb-Sparing Resection of Pediatric Primary Bone Sarcomas of the Femur. J Pediatr Surg 2024; 59:1735-1739. [PMID: 38548494 DOI: 10.1016/j.jpedsurg.2024.02.028] [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: 11/21/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Limb-sparing surgery is the standard of care for primary bone tumors. However, such procedures are associated with high rates of wound complications, specifically in lower-extremity surgeries. Therefore, identifying and implementing interventions to minimize the likelihood of wound complications after limb-sparing resection of the lower extremity is crucial. METHODS Patients who underwent limb-sparing osteosarcoma or Ewing sarcoma resection during a 7-year period at a single institution were retrospectively reviewed. Data were collected on 39 patients who underwent limb-sparing resection of the femur. Patient demographics, tumor characteristics, and perioperative and postoperative data were extracted and analyzed. Patients who underwent resection before April 2017 received conventional postoperative incision dressings. Starting in April 2017, patients received vacuum-assisted closure (VAC) with the 3 M™ Prevena VAC system after surgical closure. Eighteen patients received conventional postoperative incision dressing, and 21 received incisional wound VAC. A wound complication was defined as any Clavien-Dindo classification greater than 0 within a 28-day postoperative period. RESULTS Patients who received postoperative incisional wound VAC had lower rates of wound complications than those who received conventional incision dressings (14% vs. 50%; p = 0.035). Additionally, patients in whom wound complications developed had a longer average hospital stay than those without wound complications (5 days vs. 4 days; p = 0.029). CONCLUSIONS Wound complications prolong the hospital stay and can delay adjuvant chemotherapy for bone tumors. The use of postoperative incisional wound VAC is associated with less likelihood of wound complications and should be considered in any high-risk surgical closure. LEVEL OF EVIDENCE Level III Treatment Study.
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Affiliation(s)
- Chance Cuthbert
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tarek Zaghloul
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt
| | - Shalini Bhatia
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Erma Davis
- Center for Advanced Practice, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Heather G Heavens
- Center for Advanced Practice, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Lindsay J Talbot
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Michael D Neel
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA.
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Lumsden EJ, Kimble RM, Ware RS, Griffin B. Tissue Pressure Changes and Implications on Dressing Selection when utilising Negative Pressure Wound Therapy on an Ex Vivo Porcine Model. Burns 2024; 50:1241-1246. [PMID: 38378389 DOI: 10.1016/j.burns.2024.01.023] [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: 10/20/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/22/2024]
Abstract
Negative Pressure Wound Therapy (NPWT) is broadly used in surgical wound management and more recently burn care; however, the tissue pressure changes and best dressing application technique remains unknown. This study was done to help understand the tissue pressure changes beneath negative pressure when varying the delivered pressures, dressing thickness and distribution of dressings. This study was done in 2021 at a quaternary paediatric burns hospital. Utilising a cadaveric porcine model, an intracranial pressure monitor and transducer were used to assess pressure. The transducer was placed on the epidermis or inserted under ultrasound guidance via cannulation to the dermis, subcutaneous or muscular layer. Mepitel™, ACTICOAT™, varying layers of Kerlix™ (10, 20 or 30 layers) and NPWT were then applied either circumferentially or non-circumferentially. Each set of results is indicative of the intracranial pressure probe reading when NPWT was delivered at -40, -60, -80, -100 and -120 mmHg. The median and interquartile pressure recordings were epidermis: -42 (-42.5 - -41), -60.5 (-62.5 - -60), -80.5 (-82 - -80), - 99 (-99 - -98)mmHg (p < 0.001); dermis: 1 (0 - 2), 2 (1 - 3.5), 3 (2 - 5.5), 4 (3 - 7), 5.5 (4 - 7.5)mmHg (p < 0.001) (the increase in pressure was less when circumferential dressings (p < 0.001) or more layers of Kerlix were applied (p < 0.001)); subcutis: 1.5 (-4.5-1), -2.5 (-7.5 - 1.5), -3.5 (-11 - 1.5), -5 (-14 - 1.5) and -6 (-16 - 2)mmHg (p = 006) (the decrease in pressure was less with increased layers of Kerlix (0.047) and muscular: 0 (-0.5 - 0), 0 (-1 - 0.5), 0 (-1 - 1), 0 0 (-1 - 1), 00 (-1.5 - 1)mmHg (p = 0.55). These data suggest negative pressure paradoxically exerts a positive pressure on the dermis. Circumferential and multi-layer dressings reduce this positive pressure. This knowledge has impacted our burn negative pressure wound therapy dressing selection. The limitation of this study is the cadaveric model, a live model is suggested for future studies.
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Affiliation(s)
- Emma J Lumsden
- Griffith University, Faculty of Health, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia; Department of Paediatric Surgery, Urology, Burns and Trauma; Queensland Children's Hospital, Stanley St, South Brisbane, QLD 4101, Australia; Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD 4101, Australia.
| | - Roy M Kimble
- Griffith University, Faculty of Health, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia; Department of Paediatric Surgery, Urology, Burns and Trauma; Queensland Children's Hospital, Stanley St, South Brisbane, QLD 4101, Australia; Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD 4101, Australia
| | - Robert S Ware
- Griffith University, Menzies Health Institute Queensland, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia
| | - Bronwyn Griffin
- Griffith University, Faculty of Health, Gold Coast Campus, Parklands Dr, Southport, QLD 4222, Australia; Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD 4101, Australia
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Vaddavalli VV, Girdhani B, Savlania A, Behera A, Rastogi A, Kaman L, Abuji K. Effectiveness of incisional negative pressure wound therapy after major lower extremity amputation: a randomised controlled trial. Ann R Coll Surg Engl 2024; 106:418-424. [PMID: 37435705 PMCID: PMC11060853 DOI: 10.1308/rcsann.2023.0011] [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] [Accepted: 02/16/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD). METHODS This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement. RESULTS It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group (p = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant (p > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, p = 0.002). CONCLUSIONS iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.
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Affiliation(s)
- VV Vaddavalli
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Girdhani
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Savlania
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Behera
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Rastogi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - L Kaman
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Abuji
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Taeger CD, Muehle C, Kruppa P, Prantl L, Biermann N. Negative Pressure Wound Therapy-A Vacuum-Mediated Positive Pressure Wound Therapy and a Closer Look at the Role of the Laser Doppler. J Clin Med 2024; 13:2351. [PMID: 38673623 PMCID: PMC11051509 DOI: 10.3390/jcm13082351] [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: 03/15/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Negative pressure wound therapy (NPWT) is an intensely investigated topic, but its mechanism of action accounts for one of the least understood ones in the area of wound healing. Apart from a misleading nomenclature, by far the most used diagnostic tool to investigate NPWT, the laser Doppler, also has its weaknesses regarding the detection of changes in blood flow and velocity. The aim of the present study is to explain laser Doppler readings within the context of NPWT influence. Methods: The cutaneous microcirculation beneath an NPWT system of 10 healthy volunteers was assessed using two different laser Dopplers (O2C/Rad-97®). This was combined with an in vitro experiment simulating the compressing and displacing forces of NPWT on the arterial and venous system. Results: Using the O2C, a baseline value of 194 and 70 arbitrary units was measured for the flow and relative hemoglobin, respectively. There was an increase in flow to 230 arbitrary units (p = 0.09) when the NPWT device was switched on. No change was seen in the relative hemoglobin (p = 0.77). With the Rad-97®, a baseline of 92.91% and 0.17% was measured for the saturation and perfusion index, respectively. No significant change in saturation was noted during the NPWT treatment phase, but the perfusion index increased to 0.32% (p = 0.04). Applying NPWT compared to the arteriovenous-vessel model resulted in a 28 mm and 10 mm increase in the venous and arterial water column, respectively. Conclusions: We suspect the vacuum-mediated positive pressure of the NPWT results in a differential displacement of the venous and arterial blood column, with stronger displacement of the venous side. This ratio may explain the increased perfusion index of the laser Doppler. Our in vitro setup supports this finding as compressive forces on the bottom of two water columns within a manometer with different resistances results in unequal displacement.
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Affiliation(s)
- Christian D. Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
| | - Clemens Muehle
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
| | - Philipp Kruppa
- Department of Plastic, Hand and Reconstructive Surgery, Ernst von Bergmann Klinikum, 14467 Potsdam, Germany;
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
| | - Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (C.M.); (L.P.); (N.B.)
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Biermann N, Taeger CD, Schatz V, Eigenberger A, Prantl L, Felthaus O. The influence of negative pressure wound therapy on bacterial and fungal growth. J Tissue Viability 2023; 32:613-617. [PMID: 37414709 DOI: 10.1016/j.jtv.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/21/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The use of negative pressure wound therapy (NPWT) in superinfected wounds is controversial. The mechanism of action is unclear, but recent studies have shown lower atmospheric oxygen levels within the dressing. Therefore, different oxygen-favoring bacteria and fungi might benefit or face impaired thriving conditions. The aim of this in vitro study is to investigate the influence of NPWT on bacterial and fungal growth. METHODS Salmonella enterica subsp. enterica serovar Typhimurium, Pseudomonas aeruginosa and Candida albicans strains were cultured on concentrated agars and attached to a standard NPWT-device. After 48 hours, colonies were separately harvested from the agar and foam. Optical density (OD) was obtained in order to estimate bacterial loads. RESULTS For all tested microorganisms, no overall significant differences were found compared to controls. Subanalysis showed lower OD levels from the agar beneath the foam in the NPWT-group. CONCLUSION NPWT removed bacteria and fungi from the wound surface but accumulation is found within the foam. The use of NPWT showed no influence on bacterial or fungal growth selection. With superinfected wounds, the use of NPWT should thoroughly be evaluated as toxins and virulence factors may not fully be evacuated.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany.
| | - Christian D Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Valentin Schatz
- Department of Medical Microbiology and Hygiene, University Hospital Regensburg, Germany
| | - Andreas Eigenberger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Oliver Felthaus
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
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Szilagyi J, Kuester V, Reznicek J. Pediatric Necrotizing Fasciitis. JOURNAL OF THE PEDIATRIC ORTHOPAEDIC SOCIETY OF NORTH AMERICA 2023; 5:728. [PMID: 40432944 PMCID: PMC12088141 DOI: 10.55275/jposna-2023-728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 05/29/2025]
Abstract
Necrotizing fasciitis (NF) is a rapidly progressing bacterial infection of the subcutaneous tissue that can be lifethreatening. Without prompt diagnosis and treatment, it can lead to septic shock, organ failure, and death. Due to the rarity of this disease in the pediatric population and the fact that initial symptoms are frequently nonspecific, NF in children is often misdiagnosed as cellulitis, which delays the correct treatment. Physicians must maintain a high index of suspicion and keep NF in mind because rapid surgical debridement is necessary to reduce morbidity and mortality. The purpose of this article is to better characterize what is currently known about NF within the pediatric population. In this article, the microbiology, pathophysiology, clinical manifestations, diagnosis, and treatment of pediatric NF are reviewed, and key differences between adult and pediatric NF are highlighted. Key Concepts•One must keep Necrotizing Fasciitis in mind when dealing with soft tissue infections.•A common symptom is a disproportionate level of pain for what can appear to be cellulitis.•Prompt treatment must include early, thorough, and frequently multiple debridements.•As a result of low incidences, collaborative multiple-center studies are needed to improve our level of understanding.
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Affiliation(s)
- Jacqueline Szilagyi
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA
| | - Victoria Kuester
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Julie Reznicek
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
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Lumsden E, Kimble R, McMillan C, Storey K, Ware RS, Griffin B. The feasibility of negative pressure wound therapy versus standard dressings in paediatric hand and foot burns protocol: a pilot, single-centre, randomised control trial. Pilot Feasibility Stud 2023; 9:90. [PMID: 37237316 DOI: 10.1186/s40814-023-01308-z] [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: 12/06/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The goal of paediatric hand and foot burn management is hypertrophic scar and/or contracture prevention. The risk of scar formation may be minimised by integrating negative pressure wound therapy (NPWT) as an acute care adjunct as it decreases the time to re-epithelialisation. NPWT has known associated therapeutic burden; however, this burden is hypothesised to be outweighed by an increased likelihood of hypertrophic scar prevention. This study will assess the feasibility, acceptability and safety of NPWT in paediatric hand and foot burns with secondary outcomes of time to re-epithelialisation, pain, itch, cost and scar formation. METHODS AND ANALYSIS This is a single-site, pilot randomised control trial. Participants must be aged ≤ 16 years, otherwise well and managed within 24 h of sustaining either a hand or foot burn. Thirty participants will be randomised to either standard care (Mepitel®-a silicone wound interface contact dressing-and ACTICOAT™-a nanocrystalline silver-impregnated dressing) or standard care plus NPWT. Patients will be reviewed until 3 months post-burn wound re-epithelialisation, with measurements taken at dressing changes to assess primary and secondary outcomes. Surveys, randomisation and data storage will be done via online platforms and physical data storage collated at the Centre for Children's Health Research, Brisbane, Australia. Analysis will be performed using the Stata statistical software. ETHICS AND DISSEMINATION Queensland Health and Griffith University Human Research ethics approval including a site-specific assessment was obtained. The findings of this study will be disseminated through clinical meetings, conference presentations and peer reviewed journals. TRIAL REGISTRATION Registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622000044729, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381890&isReview=true , registered 17/01/2022).
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Affiliation(s)
- Emma Lumsden
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia.
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia.
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Roy Kimble
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Catherine McMillan
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Kristen Storey
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
| | - Bronwyn Griffin
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
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Lumsden EJ, Kimble RM, McMillan C, Storey K, Ware RS, Griffin B. Protocol for a feasibility, acceptability and safety study of the PICO device (negative pressure wound therapy) in acute paediatric burns. BMJ Open 2023; 13:e068499. [PMID: 37137557 PMCID: PMC10163492 DOI: 10.1136/bmjopen-2022-068499] [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: 09/21/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Negative pressure wound therapy (NPWT) in acute burn care may decrease the time to re-epithelialisation by more than 20%. Despite this, the perceived burden of use; including therapeutic, physical and financial, have limited the use of NPWT in acute burn care. This might be minimised by using the small, ultraportable, single-use NPWT device PICO as opposed to larger devices, which to date has never been studied in acute burn care. This research will; therefore, primarily assess the feasibility, acceptability and safety of PICO in paediatric burns. Secondary outcomes include time to re-epithelialisation, pain, itch, cost and scar formation. METHODS AND ANALYSIS This protocol details a clinical trial methodology and is pre-results. This single site, prospective, pilot randomised controlled trial will be conducted in an Australian quaternary paediatric burns centre. Participants must be aged ≤16 years, otherwise well and managed within 24 hours of sustaining a burn that fits beneath a PICO dressing. Thirty participants will be randomised to one of three groups: group A: Mepitel and ACTICOAT, group B: Mepitel, ACTICOAT and PICO and group C: Mepitel, ACTICOAT Flex and PICO. Patient outcomes will be recorded at each dressing change to assess efficacy and safety outcomes until 3 months postburn wound re-epithelialisation. Surveys, randomisation and data storage will be undertaken via online platforms and physical data storage collated at the Centre for Children's Health Research, Brisbane, Australia. Analysis will be done by using StataSE 17.0 statistical software. ETHICS AND DISSEMINATION Ethics has been obtained from Queensland Health and Griffith Human Research Ethics committees including a site-specific approval. These data will be disseminated via clinical meetings, conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000009718.
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Affiliation(s)
- Emma Joan Lumsden
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Burns and Trauma Research Group, Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Burns and Trauma Research Group, Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Catherine McMillan
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kristen Storey
- Burns Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Bronwyn Griffin
- Faculty of Health, Griffith University, Southport, Queensland, Australia
- Burns and Trauma Research Group, Centre for Children's Health Research, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Lange J, Eisenberger CF, Knievel J, Linderer A, Heiss MM. Preemptive endoluminal vacuum therapy with the VACStent—A pilot study to reduce anastomotic leakage after Ivor Lewis hybrid esophagectomy. Front Surg 2023; 10:1133083. [PMID: 37066006 PMCID: PMC10097441 DOI: 10.3389/fsurg.2023.1133083] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionEndoscopic treatment by vacuum therapy (EVT) or covered stents has emerged as an improved treatment option for upper gastrointestinal wall defects and is regarded as an improved treatment option for anastomotic leakage (AL) after esophagectomy. However, endoluminal EVT devices may lead to obstruction of the GI tract; and a high rate of migration and missing functional drainage has been shown for covered stents. The recently developed VACStent, a combination of a fully covered stent within a polyurethane sponge cylinder may overcome these issues allowing EVT while stent passage is still open. Initial clinical applications have demonstrated efficacy, practicability and safety in the treatment of esophageal leaks (AL).MethodsIn this pilot study, 9 patients with high-risk anastomosis after neoadjuvant therapy undergoing hybrid esophagectomy received the VACStent in a preemptive setting for the assessment of the reduction of the AL rate, postoperative morbidity and mortality.ResultsTechnical success of the application of the VACStent® was achieved in all interventions. One patient experienced anastomotic leakage 10 days after esophagectomy and was successfully treated with two consecutive VACStents and a VAC Sponge. In summary, mortality in-hospital was 0% and anastomotic healing was uneventful without septic episodes. No severe device-related adverse events (SADE) nor significant local bleeding or erosion could be observed. Oral intake of liquids or food was documented in all patients. The device handling was regarded uncomplicated.DiscussionThe preemptive application of the VACStent offers a promising new option for improved clinical treatment avoiding of critical situations in hybrid esophagectomy, which should be validated in a large clinical study.
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Biermann N, Wallner S, Martini T, Spoerl S, Prantl L, Taeger CD. Negative Pressure Wound Therapy with Instillation: Analysis of the Rinsing Fluid as a Monitoring Tool and Approach to the Inflammatory Process: A Pilot Study. J Clin Med 2023; 12:jcm12020711. [PMID: 36675638 PMCID: PMC9864079 DOI: 10.3390/jcm12020711] [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] [Received: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Negative pressure wound therapy with instillation (NPWTi) is an established wound conditioning tool. Previous investigations discovered that the rinsing fluid is a suitable monitoring tool containing various cells and cytokines. METHODS The aim of this pilot study was to analyze rinsing fluid samples from patients treated with NPWTi and link them to the clinical course, including microbiological contamination. In 31 consecutive patients with acute and chronic wounds, laboratory analysis was performed to evaluate IL-6, IL-8, bFGF, Tnf-a, and VEGF. RESULTS IL-6 showed a significant increase to 1540 pg/mL on day two and 860 pg/mL on day four (p = 0.01 and p = 0.04, resp.). IL-8 steadily increased from a median of 2370 pg/mL to a maximum of 19,400 pg/mL on day three (p = 0.01). The median bFGF showed a steady decline from 22 pg/mL to 10 pg/m (p = 0.35) on day three. The median Tnf-a increased from 11 pg/mL to 44 pg/mL (p = 001). The median VEGF values fluctuated but showed an overall increase from 35 pg/mL to 250 pg/mL (p = 0.07). Regarding IL-8, diabetic and non-diabetic patients both showed a gradual increase with non-significant higher median values for the diabetics. The subgroup analysis of IL-6 showed increasing and higher values in cases with bacterial superinfections (p = 0.07). CONCLUSION We were able to use an established wound conditioning tool to gather important information about the inflammatory response during NPWTi treatment. Cytokine and cell courses were mostly consistent with the literature, especially in diabetic patients, and should be further investigated.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Stefan Wallner
- Department of Clinical Chemistry, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Teresa Martini
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Steffen Spoerl
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christian D. Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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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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17
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Accelerated Angiogenesis of Human Umbilical Vein Endothelial Cells Under Negative Pressure Was Associated With the Regulation of Gene Expression Involved in the Proliferation and Migration. Ann Plast Surg 2022; 89:e51-e59. [DOI: 10.1097/sap.0000000000003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Aslan-Horch EC, Horch RE, Arkudas A, Müller-Seubert W, Ludolph I. Effects of Different Pressure Levels in Topical Negative Pressure Application—Analysis of Perfusion Parameters in a Clinical Skin Model Using Multimodal Imaging Techniques. J Clin Med 2022; 11:jcm11175133. [PMID: 36079063 PMCID: PMC9457425 DOI: 10.3390/jcm11175133] [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: 06/13/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
The effects of topical negative pressure therapy (TNP) have been a subject of research for many years. In this study, we investigated new imaging devices to detect clinical changes that TNP causes on healthy tissue and identified differences in microcirculation created by different pressure levels. We used near-infrared spectroscopy (NIS), thermography, and a vein illuminator to measure the differences in oxygen saturation, tissue temperature, and vein pattern. A control group (−125 mmHg) and three comparison groups with only TNP dressing (Group 1), −25 mmHg (Group 2), and −175 mmHg (Group 3) were established. Thirty minutes of TNP on intact skin was followed by 30 min of resting. A total of 24 participants were measured by all imaging devices at predetermined time points. Oxygen saturation and skin temperature increased by 8.07% and 1.67 °C for the control group, 4.00% and 1.65 °C for Group 2, and 8.45% and 1.68 °C for Group 3. Group 1 showed a slight increase in oxygen saturation and a 2.7 °C increase in skin temperature. Over the 30 min following removal of TNP, oxygen saturation and temperature decreased gradually for all groups. The vein illuminator did not show significant differences in the venous pattern or flow. Our study showed that higher negative pressure values resulted in higher oxygen saturation and higher tissue temperature.
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Priyadharsini Prabakaran P, Totty JP, Carradice D, Chetter IC, Smith GE. The local physiological effects of a single-use topical negative pressure device in healthy volunteers: the PICO-1 study. J Wound Care 2022; 31:624-632. [PMID: 36001706 DOI: 10.12968/jowc.2022.31.8.624] [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: 11/11/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of a single-use negative pressure wound therapy (sNPWT) device on tissue perfusion, oxygenation and pressure in the intact skin of healthy volunteers. METHOD Healthy volunteers wore a PICO sNPWT device (Smith+Nephew, UK) on their right medial calf for one week. Perfusion, tissue oxygenation and tissue pressure were recorded in superficial and deep tissues over a period of seven days. At the baseline visit, measurements were recorded before and after dressing application without activation. Macrovascular flow and transduced needle pressure measures were recorded at 0 minutes, 30 minutes and 60 minutes after device activation. Superficial tissue perfusion and both oxygenation measures were recorded continuously over the hour following activation. All outcome measures were repeated at 24 hours and again after seven days, both with the dressing and following dressing removal. RESULTS The device was associated with a measurable increase in perfusion of the limb in 12 healthy volunteers. Superficial tissue oxygenation adjacent to the dressing was reduced during wear, while deeper tissue demonstrated an increase in oxygenation levels. Superficial skin perfusion was observed to differ between skin overlying muscle and that overlying bone. Pressure in tissue underneath the dressing pad was increased throughout dressing wear and returned to baseline levels on dressing removal. CONCLUSION sNPWT produced measurable changes in local physiology in healthy volunteers with intact skin, despite the absence of a wound. Effects may differ according to anatomical site and the composition of underlying tissues. Other factors that promote healing were not explored in this study. DECLARATION OF INTEREST This study was funded by Smith+Nephew investigator-initiated grant IIS 684. The funder had no input into study design, conduct, analysis, manuscript preparation or dissemination. The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Joshua P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK.,Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals, Cottingham, UK
| | - Dan Carradice
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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Closed-Incision Negative-Pressure Wound Therapy after Resection of Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized Trial. Plast Reconstr Surg 2022; 149:972e-980e. [PMID: 35311753 DOI: 10.1097/prs.0000000000009023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wound healing after resection of large soft-tissue tumors is often impaired by large dead space and fluid collection. Recently, the authors were able to show an association of wound complications with worse oncologic outcome in soft-tissue sarcomas. The aim of the study was to examine the value of closed-incision negative pressure wound therapy on postoperative wound drainage and wound complications after soft-tissue tumor resection. METHODS Patients for whom resection is planned of a soft-tissue tumor larger than 10 cm in diameter of the extremities or the trunk were allocated randomly to one of two groups. After wound closure, patients in the study group received closed-incision negative-pressure wound therapy for a duration of 5 days, whereas those in the control group received regular dressings. The amount of drainage fluid, course of wound healing, length of hospital stay, and wound edge perfusion at postoperative day 5 measured by white-light infrared spectroscopy were compared. RESULTS Sixty patients could be included in the study with even distribution to both study arms, meeting the goal. The postoperative course of wound drainage volume was significantly lower in the study group, and hospital stay was significantly shorter, with 9.1 ± 3.8 days versus 13.9 ± 11.8 days. The occurrence of wound complications was significantly lower in the study group on time-to-event analysis (one versus six). Tissue spectroscopy revealed a significantly higher oxygen saturation increase in the wound edge for the study group versus the control group. CONCLUSION Closed-incision negative-pressure wound therapy should be considered for patients undergoing resection of large soft-tissue tumors. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Gutschow CA, Schlag C, Vetter D. Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it. Langenbecks Arch Surg 2022; 407:957-964. [PMID: 35041047 PMCID: PMC9151563 DOI: 10.1007/s00423-022-02436-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic vacuum therapy (EVT) has emerged as a novel treatment option for upper gastrointestinal wall defects. The basic principle of action of EVT entails evacuation of secretions, removal of wound debris, and containment of the defect. Furthermore, there is increasing evidence that EVT reduces interstitial edema, increases oxygen saturation, and promotes tissue granulation and microcirculation. Various devices, such as macroporous polyurethane sponge systems or open-pore film drains, have been developed for specific indications. Depending on the individual situation, EVT devices can be placed in- or outside the intestinal lumen, as a stand-alone procedure, or in combination with surgical, radiological, and other endoscopic interventions. PURPOSE The aim of this narrative review is to describe the current spectrum of EVT in the upper gastrointestinal tract and to assess and summarize the related scientific literature. CONCLUSIONS There is growing evidence that the efficacy of EVT for upper GI leakages exceeds that of other interventional treatment modalities such as self-expanding metal stents, clips, or simple drainages. Owing to the promising results and the excellent risk profile, EVT has become the therapy of choice for perforations and anastomotic leakages of the upper gastrointestinal tract in many centers of expertise. In addition, recent clinical research suggests that preemptive use of EVT after high-risk upper gastrointestinal resections may play an important role in reducing postoperative morbidity.
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Affiliation(s)
- Christian A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Diana Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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22
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Nangole FW, Agak G. The effects of negative pressure wound therapy on wounds with cerebrospinal fluid leakages. J Wound Care 2022; 31:348-351. [DOI: 10.12968/jowc.2022.31.4.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Negative pressure wound therapy (NPWT) has been widely used for a variety of wounds with good outcomes. However, it is contraindicated in the management of wounds with cerebrospinal fluid (CSF) leakages. The reason is the fear of a sudden shift of CSF fluid as a result of suction leading to brain herniation or coning. There is a paucity of data to either support or negate such claims. We aimed to determine the effect of NPWT in the management of patients with wounds with CSF leakages. Method: This was a longitudinal prospective study of patients having wounds with CSF leakages managed with NPWT in our institute. Outcome measures evaluated were changes in the level of consciousness, Glasgow Coma Scale (GCS) score, length of hospital stay, mean effluent collected, time taken for the wounds to heal/close and complications related to NPWT. Results: A total of 12 patients with wounds that had CSF leakage were managed with NPWT over two years. Of the patients, nine had wounds in communication with the brain, with three patients having spinal cord wounds. The average effluent collected on the first day of applying NPWT was 510ml, and by the third day this had fallen to approximately 200ml. The mean time taken for wounds to close was 12.3 days. There was no evidence of herniation nor any other morbidities or mortalities reported in any of our patients. Conclusion: NPWT, as indicated in this series, had a beneficial effect in the management of wounds with CSF leakage. NPWT, once applied to the wound, caused a tamponade effect that resulted in stoppage of the leakage of the CSF and did not lead to suction of the fluid, as previously thought. The dressings ensured an airtight system, preventing communication between the wound and the external environment, thus reducing sepsis while awaiting definitive wound closure.
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Affiliation(s)
| | - George Agak
- Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, CA, US
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Topical negative pressure wound therapy enhances the local tissue perfusion - A pilot study. Microvasc Res 2021; 140:104301. [PMID: 34971695 DOI: 10.1016/j.mvr.2021.104301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Topical negative pressure wound therapy (TNPWT) is a regularly used method in modern wound treatment with a growing and diverse potential for clinical use. So far positive effects on microcirculation have been observed and examined, although precise statements on the underlying mechanism appear unsatisfying. OBJECTIVE The aim of our study was to extend the understanding of the effect of TNPWT on tissue perfusion and determine the time frame and the extent to which the tissue perfusion changes due to TNPWT. MATERIAL AND METHODS TNPWT was applied to the anterior thighs of 40 healthy individuals for 30 min, respectively. Before and up to 90 min after the application, measurements of the amount of regional haemoglobin (rHb), capillary venous oxygen saturation (sO2), blood flow (flow) and velocity were conducted with spectrophotometry (combining white light spectrometry and laser Doppler spectroscopy) within two different depths/skin layers. A superficial measuring probe for depths up to 3 mm and a deep measuring probe for up to 7 mm were used. RESULTS All parameters show significant changes after the intervention compared to baseline measurements. The greater effect was seen superficially. The superficially measured rHb, sO2 and flow showed a significant increase and stayed above the baseline at the end of the protocol. Whereas deeply measured, the rHb initially showed a decrease. The flow and sO2 showed a significant increase up to 60 min after the intervention. CONCLUSION The application of TNPWT on healthy tissue shows an increase in capillary-venous oxygen saturation and haemoglobin concentration of at least 90 min after intervention. A possible use in clinical practice for preconditioning to enhance wound healing for high-risk patients to develop wound healing disorder, requires further studies to investigate the actual duration of the effect.
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Kairinos N. Mechanism of Origin of Positive Tissue Pressure During Negative-Pressure Wound Therapy. INT J LOW EXTR WOUND 2021; 21:342-343. [PMID: 34955069 DOI: 10.1177/15347346211069815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Singh D, Livingstone JP, Lautze J, Murray PC. Measuring In-Vivo Foot Perfusion Distal to a Near-Circumferential Negative Pressure Wound Therapy Dressing via Thermal Imaging. Cureus 2021; 13:e17720. [PMID: 34650894 PMCID: PMC8489966 DOI: 10.7759/cureus.17720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background Negative pressure wound therapy (NPWT) has been shown to promote the healing of acute and chronic wounds. In our previous study, we demonstrated that a near-circumferential NPWT dressing provided "lift-off" on an in-vitro extremity model resulting in decreased pressure. We hypothesized that this decrease in pressure may increase perfusion distal to the NPWT dressing by increasing lymphatic drainage and venous flow. Methods In this study, we tested if a near-circumferential NPWT dressing caused any appreciable skin movement around the dressing. We then used a thermal imaging camera to test if there was an increase in perfusion to the foot when a near-circumferential NPWT dressing was placed around the lower leg and tested at various negative pressures. Finally, we wanted to see if an artificial "lift-off" mechanism would lead to an increase in perfusion. Results The skin was noted to stretch between the short ends of the NPWT dressing, consistent with our previously described "lift-off" mechanism. However, there was no correlation between negative pressure and perfusion to the foot in the other experiments. Conclusion This study demonstrated that a near-circumferential NPWT dressing may not have any appreciable effects on perfusion when applied on a healthy patient, however, future studies are needed to determine if similar results would be seen on a traumatized or otherwise compromised extremity.
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Affiliation(s)
- Dylan Singh
- Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | | | - Jacob Lautze
- Medicine, Homer Stryker School of Medicine, Western Michigan University, Kalamazoo, USA
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Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM, Davison PG. Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications. Semin Plast Surg 2021; 35:164-170. [PMID: 34526864 DOI: 10.1055/s-0041-1731792] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Negative pressure wound therapy (NPWT) promotes healing by evenly applying negative pressure on the surface of the wound. The system consists of a sponge, a semiocclusive barrier, and a fluid collection system. Its effectiveness is explained by four main mechanisms of action, including macrodeformation of the tissues, drainage of extracellular inflammatory fluids, stabilization of the environment of the wound, and microdeformation. Rarely will complications linked to NPWT occur, but special care must be taken to prevent events such as toxic shock syndrome, fistulization, bleeding, and pain. New NPWT modalities have been recently developed to make NPWT suitable for a wider variety of wounds. These include NPWT with instillation therapy (NPWTi-d), different cleansing options, and application of NPWT on primarily closed incisions. Finally, vacuum-assisted wound closure therapy has been demonstrated to be efficient for various clinical settings, such as the management of diabetic foot ulcers, pressure ulcerations, chronic wounds, and skin grafts.
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Affiliation(s)
- Shanel Normandin
- Faculty of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Tyler Safran
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Sebastian Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Carrie K Chu
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, Texas
| | | | - Amanda M Murphy
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Peter G Davison
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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Kairinos N, Hudson DA, Solomons MW. Comment on "Novel imaging methods reveal positive impact of topical negative pressure application on tissue perfusion in an in vivo skin model". Int Wound J 2021; 18:940-941. [PMID: 34498372 PMCID: PMC8613382 DOI: 10.1111/iwj.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nicolas Kairinos
- Department of Plastic and Reconstructive Surgery, University of Cape Town, Cape Town, South Africa
| | - Donald Anthony Hudson
- Department of Plastic and Reconstructive Surgery, University of Cape Town, Cape Town, South Africa
| | - Michael Wayne Solomons
- Department of Plastic and Reconstructive Surgery, University of Cape Town, Cape Town, South Africa
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Li Y, Sun Y, Liu Z, Li Y, Gou S. Active drain system with reticulated open-pore foam-surface dressing for postoperative pancreatic fistula in a rat model. Ann Med Surg (Lond) 2021; 68:102559. [PMID: 34386219 PMCID: PMC8346361 DOI: 10.1016/j.amsu.2021.102559] [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: 05/31/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Postoperative pancreatic fistula (POPF) is one of the most harmful complications after pancreatic resection. Efficient drainage affects the clinical outcome of POPF. Inefficient drain of the fluid collection should contribute greatly to the need of additional interventional drainage, secondary morbid complications, and death. Methods A rat model of POPF was established by distal pancreatosplenectomy. A novel active drain system (ADS) for POPF was developed by wrapping polyvinyl alcohol sponges (PVA) to an end of the drainage tube. Passive drain system (PDS), ADS and ADS with PVA were used for POPF in rat models. The volume and amylase of ascites were measured. CT scan was applied to assess abdominal fluid collection. Rats pancreatic transection stumps were stained by hematoxylin and eosin (H&E). Results The volume of drainage of ADS with PVA group was less than that of PDS group and ADS group at late stage. CT scan showed obvious abdominal fluid collections in 2/8, 2/8 and 0/8 rats in PDS, ADS and ADS with PVA group separately. Macrofindings showed significant intra-abdominal adhesions and inflammation in PDS and ADS group but not in ADS with PVA group. H&E staining showed less inflammatory cells and destroyed pancreatic glands in ADS with PVA group. Conclusion ADS with PVA drained ascites effectively in the rat model of POPF. The effective drainage of pancreatic juice reduced the inflammation of abdominal organs and pancreatic resection stumps, and might promote the healing of POPF.
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Affiliation(s)
- Yang Li
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ying Sun
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhiqiang Liu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yongfeng Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shanmiao Gou
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Rother U, Theune M, Lang W, Meyer A. Pilot assessment of the effect of negative pressure wound therapy on microperfusion of chronic and acute wounds. Clin Hemorheol Microcirc 2021; 79:455-462. [PMID: 34057141 DOI: 10.3233/ch-211189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) has been established over years for treatment of chronic and complex wounds. OBJECTIVE Aim of this study was to investigate the effect NPWT on the microperfusion. METHODS Prospective single centre analysis of patients treated with NPWT due to acute (ACUTE) wounds after fasciotomy or patients with chronic wounds (CHRONIC) due to a chronic limb threatening ischemia was performed. NPWT was conducted through a three days sequence with a negative pressure of -120 mmHg. Before after and during the entire period of therapy the microperfusion was assessed (O2C™, LEA Medizintechnik). RESULTS Comparison of the perfusion values of 28 patients (CHRONIC/ACUTE 5/23, women/men 8/20) before and after the NPWT sequence showed a non-significant improvement in the CHRONIC group (supine position: p = 0.144, elevated position p = 0.068) and a significant decrease in the ACUTE group (supine position p = 0.012, elevated position p = 0.034). This effect could also been demonstrated during the NPWT over time (CHRONIC: supine position: p = 0.320, elevated position: p = 0.053, ACUTE: supine position: p = 0.021, elevated position: p = 0.012). CONCLUSION Microperfusion measurements showed alterations and differences in wound bed perfusion of acute and chronic wounds; acute wounds tended to a decrease of blood flow, whereas this effect was not seen in chronic wounds in peripheral artery disease.
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Affiliation(s)
- Ulrich Rother
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mona Theune
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Study Comparing Platform Wound Dressing, a Negative-Pressure Device without a Filler, with Three Conventional Negative-Pressure Wound Therapy Systems in the Treatment of Excisional and Incisional Wounds. Plast Reconstr Surg 2021; 147:76-86. [PMID: 33370053 DOI: 10.1097/prs.0000000000007450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND All common negative-pressure wound therapy systems include a material, usually foam or gauze, at the wound/device interface. In this preclinical study, the authors have compared the effects on different wound healing parameters in the three most common negative-pressure wound therapy systems (i.e., V.A.C.VIA, PREVENA, and PICO) with a new device without foam or gauze (i.e., Platform Wound Dressing). A strong effort was made to avoid bias. The study was conducted under good laboratory practice conditions, with the presence of an independent observer. METHODS In pigs, three types of wounds were studied: full-thickness excisions, open incisions, and sutured closed incisions. Several macroscopic and microscopic parameters were studied. The pigs were euthanized on day 9 and all wounds were processed for histology and excisions for immunohistochemistry. RESULTS In general, the devices produced similar results, with only a few significant differences. In the excisions, the Platform Wound Dressing reduced wound area more than the V.A.C.VIA and the PICO. In the excisional wounds, reepithelialization was the same. In open incisions, PREVENA was better than the Platform Wound Dressing. Histologic examination showed that, in open incisions, there was less inflammation in the PREVENA-treated in comparison with the Platform Wound Dressing- and the PICO-treated wounds. Immunohistochemical analyses showed that the Platform Wound Dressing-treated excisions had significantly more blood vessels (von Willebrand factor) than the V.A.C.VIA-treated ones and that the PICO caused less T-cell activation (CD3) than the other two. CONCLUSION The devices-with foam, with gauze, or without either and just an embossed membrane-performed equally in general.
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Livingstone JP, Singh D, Murray PC. An In Vitro Study Measuring the Effects of Circumferential and Near-Circumferential Closed Incisional Negative Pressure Wound Therapy Dressings. Cureus 2021; 13:e14389. [PMID: 33981509 PMCID: PMC8106949 DOI: 10.7759/cureus.14389] [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] [Indexed: 01/05/2023] Open
Abstract
Background Negative pressure wound therapy (NPWT) and closed incisional negative pressure wound therapy (ciNPWT) have been shown to promote the healing of acute and chronic wounds. Despite the growth in their usage, the mechanism by which they promote healing is not fully understood. Several studies have shown that NPWT results in a combination of microdeformation and macrodeformation, which may promote wound recovery. The macrodeformation forces have raised concerns about circumferential NPWT compressing the extremity and decreasing perfusion distal to the NPWT. The literature on circumferential NPWT is mixed, with some studies showing increased perfusion, while others have shown decreased perfusion. We hypothesized that a near-circumferential ciNPWT dressing applied over intact skin would provide a “lift-off” force rather than a compressive force. We also theorized that as the sponge contracts under negative pressure while in a near-circumferential setting, the dressing will pull on the surrounding skin and tissue, leading to a decrease in the pressure of the extremity. This could potentially translate to improved venous and lymphatic return, increasing perfusion to the tissue beneath the sponge as well as distal to the sponge. Methods This study consisted of three separate experiments. The first experiment measured the width and length of a ciNPWT dressing at various negative pressures. The second experiment utilized an in vitro model consisting of an elastic ball and tubing to examine the effects that circumferential and near-circumferential ciNPWT dressings may have on extremity pressure. Varying lengths of ciNPWT dressings were applied to the ball, ranging from 25% circumferential to 100% circumferential. The pressure within the ball was monitored as varying lengths of circumferential dressings were applied at various negative pressures. The third experiment utilized the same model as the second experiment but with a 66% circumferential dressing and various baseline ball pressures to see how extremity pressure may impact the ability of the ciNPWT dressing to alter extremity pressure. Results The first experiment demonstrated that a ciNPWT dressing decreased in length and width in a linear fashion as negative pressure was applied. The second experiment revealed that both fully circumferential and near-circumferential dressings resulted in a decrease in the pressure of the elastic ball at lower levels of suction. The greatest decrease in ball pressure was noted with the 66% near-circumferential dressing. With greater suction, however, the pressure within the ball was noted to increase above baseline. The third experiment illustrated that as the baseline pressure of a ball was increased, the dressing had less of an ability to change the pressure of the ball. Conclusions These results suggest that near-circumferential and circumferential ciNPWT systems may decrease the pressure of an extremity at certain negative pressures and that compression may be less likely to occur when used on a higher-pressure extremity.
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Affiliation(s)
| | - Dylan Singh
- John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
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Taeger CD, Wallner S, Martini T, Schiltz D, Kehrer A, Prantl L, Biermann N. Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study. Cells 2021; 10:cells10040732. [PMID: 33810232 PMCID: PMC8065450 DOI: 10.3390/cells10040732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: During negative pressure wound therapy (NPWT), open wounds are draped with a nontransparent sponge, making daily wound evaluation impossible. Sometimes, late or undetected bacterial infections and postoperative bleeding result in repetitive surgery, thus prolonging inpatient time. With the introduction of additional fluid instillation (NPWTi), the wound surface is rinsed, and bacteria, proteins and biomarkers are flushed into a collecting canister, which is later discarded. Methods: The aim of this pilot study was to analyze rinsing fluid samples (0.9% sodium chloride) from the NPWTi device in patients with acute and chronic wounds. In 31 consecutive patients a standardized laboratory analysis was performed to evaluate cellular composition and potassium, phosphate, lactate dehydrooxygenase, pH and total protein levels. Results: While there was an increase in the total cellular amount and the number of polymorphonuclear cells, the number of red blood cells (RBC) decreased after surgery. Potassium and pH showed no significant changes in the first three postoperative days, whereas total protein showed an undulant and partially significant course. Conclusion: We were able to quantify cellular metabolites by analyzing the rinsing fluid of NPWTi. We propose the analysis of this material as a novel and potentially promising tool to monitor wound status without removal of the dressing. The establishment of reference values might help to improve the NPWTi therapy.
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Affiliation(s)
- Christian D. Taeger
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
- Correspondence: ; Tel.: +49-941-944-6763
| | - Stefan Wallner
- Institute for Clinical Chemistry, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany;
| | - Teresa Martini
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Daniel Schiltz
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Andreas Kehrer
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Lukas Prantl
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
| | - Niklas Biermann
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; (T.M.); (D.S.); (A.K.); (L.P.); (N.B.)
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Circumferential Negative Intermittent Pressure to the Midarm Does Not Impair Digital O2 Saturation: A Randomized Controlled Study. Ann Plast Surg 2021; 84:e7-e9. [PMID: 31490239 DOI: 10.1097/sap.0000000000001966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Circumferential negative pressure wound therapy is commonly used to manage wounds and enhance the healing process. A theoretical concern was recently raised that circumferential negative pressure wound therapy may have a negative effect on perfusion distally. METHODS In a randomized study, we applied circumferential negative pressure (125 mm Hg) to the midarm of 13 healthy volunteers through InfoV.A.C. Therapy Unit device. The pressure was applied intermittently (5 minutes on and 2 minutes off) for 9 hours. The same device without negative pressure was applied to the contralateral midarm as control. Bilateral index finger O2 saturation (SpO2) was measured every 30 minutes using digital pulse oximetry. RESULTS Mean (SD) age of the volunteers was 32.2 (9.5) years, and 61.5% were male. Mean (SD) area under the curve from time 0 to 9 hours of SpO2 was 890.56 (6.69) and 889.71 (6.23) %xh in the intervention and control arms, respectively (P = 0.35). O2 saturation was ≥94% at all observation times in both arms, and no adverse events were identified. CONCLUSIONS Circumferential negative intermittent pressure of 125 mm Hg applied to the midarm of healthy volunteers for 9 hours does not adversely affect digital SpO2.
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Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2739. [PMID: 32983749 PMCID: PMC7489611 DOI: 10.1097/gox.0000000000002739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/31/2020] [Indexed: 12/16/2022]
Abstract
Foam-mediated external suction (FMES) has previously shown to improve tissue microcirculation. We hypothesized that preconditioning fasciocutaneous perforator flaps with FMES would augment perfusion and demonstrate greater capillary recruitment.
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Chu H, Maklad M, Cobley T, Sen S. The use of negative pressure wound therapy (NPWT), as an adjunct for primary wound healing, in deep partial-thickness paediatric foot burns: A case report. BURNS OPEN 2020. [DOI: 10.1016/j.burnso.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kunze KN, Hamid KS, Lee S, Halvorson JJ, Earhart JS, Bohl DD. Negative-Pressure Wound Therapy in Foot and Ankle Surgery. Foot Ankle Int 2020; 41:364-372. [PMID: 31833393 DOI: 10.1177/1071100719892962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Negative Pressure Wound Therapy (NPWT) is frequently utilized to manage complex wounds, however its mechanisms of healing remain poorly understood. Changes in growth factor expression, micro- and macro-deformation, blood flow, exudate removal, and bacterial concentration within the wound bed are thought to play a role. NPWT is gaining widespread usage in foot and ankle surgery, including the management of traumatic wounds; diabetic and neuropathic ulcers; wounds left open after debridement for infection or dehiscence; high-risk, closed incisions; tissue grafts and free flaps. This article reviews the rationale for NPWT, its proposed mechanisms of action, and the evidence regarding its clinical applications within the field of foot and ankle surgery. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jason J Halvorson
- Department of Orthopaedic Surgery, Wake Forest Baptist Health Center, Winston Salem, NC, USA
| | | | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Biermann N, Geissler EK, Brix E, Schiltz D, Muehle C, Prantl L, Taeger CD. Pressure distribution and flow characteristics during negative pressure wound therapy. J Tissue Viability 2020; 29:32-36. [DOI: 10.1016/j.jtv.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 01/13/2023]
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Cagney D, Simmons L, O’Leary DP, Corrigan M, Kelly L, O’Sullivan MJ, Liew A, Redmond HP. The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis. World J Surg 2020; 44:1526-1537. [DOI: 10.1007/s00268-019-05335-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Biermann N, Geissler EK, Brix E, Schiltz D, Prantl L, Kehrer A, Taeger CD. Oxygen levels during negative pressure wound therapy. J Tissue Viability 2019; 28:223-226. [PMID: 31500929 DOI: 10.1016/j.jtv.2019.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY Negative pressure wound therapy (NPWT) has become an established treatment modality when dealing with chronic and infected wounds. The underlying mechanism of action is still under discussion and remains controversial. Evidence exists showing rather hypoxic conditions as the main reason for the positive results and bacterial clearance. In an attempt to further explain the mechanism of action, we investigated oxygen levels within the foam interface of a NPWT device. MATERIALS AND METHODS We used an optical sensor based on the principle of dynamic fluorescence quenching and tested five different commonly available NPWT systems used during our daily clinical routine. All measurements were done in an in vitro experimental design for at least 24 h and multiple vacuum intensities were investigated. RESULTS Oxygen levels decreased as much as 22.8% and the amount of vacuum applied inversely correlated with the oxygen reduction. A stepwise increase in vacuum of 25 mmHg showed a linear mean drop of 2.75% per setting. All devices were able to maintain a constant level of negative pressure, and no significant difference between the various dressings was found (p > 0.05). CONCLUSION Therefore, oxygen levels are decreased within the foam of NPWT dressings, likely leading to oxygen deprivation effects in the underlying wound tissue.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | | | - Eva Brix
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany.
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Li Z, Yu Q, Wang S, Wang G, Li T, Tang PF, Liu D. Impact of negative-pressure wound therapy on bacterial behaviour and bioburden in a contaminated full-thickness wound. Int Wound J 2019; 16:1214-1221. [PMID: 31483575 DOI: 10.1111/iwj.13197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/25/2022] Open
Abstract
The use of negative-pressure wound therapy (NPWT) has displayed significant clinical benefits in the healing of infected wounds. However, the effects of NPWT on bacterial colonisation and infection of traumatic wounds has been controversial. The aim of this study is to evaluate the impact of NPWT treatment in rabbits with a contaminated full-thickness wound on bacterial behaviour, including colony morphology, spatial distribution, fissional proliferation, and bacterial bioburden. Full-thickness wounds were created on the back of rabbits, and were inoculated with bioluminescent Staphylococcus aureus. The wounds were treated with sterile gauze dressings and NPWT with continuous negative pressure (-125 mm Hg). Wound samples were harvested on days 0 (6 hours after bacterial inoculation), 2, 4, 6, and 8 at the centre of wound beds before irrigation. Scanning electron microscopy and transmission electron microscopy (TEM) analyses were performed to determine the characteristic bacteriology. Laser scanning confocal microscopy was performed to obtain bioluminescent images, which were used to observe spatial distribution of the GFP-labelled S. aureus within the tissue and quantify the bacterial bioburden. NPWT resulted in sparse amounts of scattered bacteria on the wound surface or as sparsely spaced single colonies within the tissue. Wound bioburden on day 8 in the NPWT and gauze groups was 34.6 ± 5.5% and 141.9 ± 15.4% of the baseline values (N = 6), respectively (P < .0001). TEM showed a lack of S. aureus active fission within NPWT-treated tissue. NPWT can impact S. aureus colony morphology and spatial distribution both on the surface and within wound tissue, and reduce S. aureus as early as 48 hours after therapy initiation. Additionally, NPWT inhibits bacterial fissional proliferation in microcolonies.
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Affiliation(s)
- Zhirui Li
- Department of Orthopedics, The General Hospital of People's Liberation Army, Beijing, China.,Department of Orthopedics, Chinese PLA General Hospital and Hainan Branch, Sanya, China
| | - Qingwen Yu
- Department of Orthopedics, Beijing, China
| | - Song Wang
- Medical College, Nankai University, Tianjin, China
| | - Guoqi Wang
- Department of Orthopedics, The General Hospital of People's Liberation Army, Beijing, China
| | - Tongtong Li
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Pei-Fu Tang
- Department of Orthopedics, The General Hospital of People's Liberation Army, Beijing, China
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Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: Negative Pressure Wound Therapy. J Wound Care 2019; 26:S1-S154. [PMID: 28345371 DOI: 10.12968/jowc.2017.26.sup3.s1] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14 The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19 with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
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Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden
| | - Christian Willy
- Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden
| | - Marco Fraccalvieri
- Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy
| | - Astrid Probst
- Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany
| | - Peter Vowden
- Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
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Ali E, Raghuvanshi M. Treatment of open upper limb injuries with infection prevention and negative pressure wound therapy: a systematic review. J Wound Care 2019; 26:712-719. [PMID: 29244969 DOI: 10.12968/jowc.2017.26.12.712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Open upper limb injuries requiring soft reconstruction can pose a dilemma for trauma surgeons when considering the treatment options. The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons Standard for Trauma (BOAST) have addressed the management of severe open lower limb fractures with the creation of the BOAST 4 guidelines. However, no such gold standard exists for the treatment of open injuries of the upper limb. Furthermore, treatment of these injuries is often more difficult and requires complicated strategies. Since the advent of negative pressure wound therapy (NPWT), there has been an improvement in wound care, though a focused review of its use in wound closure and infection prevention in the upper limb has not been published. We examine wound care management for open upper limb injuries with regard to the dressings applied, NPWT, wound closure and infection prevention. METHOD A systematic search of Medline, Cochrane and Google Scholar was performed using the key words. The key word searches were performed by two independent reviewers and 8,792 papers were found. Manuscripts between 1990 and 2010 were included, with the addition of key manuscripts before this date. Each manuscript was assessed by the two authors independently for methodology and validity Results: Approximately 120 manuscripts fulfilled selection criteria examining the influence of NPWT on open upper and lower limb injuries, and those examining infection risk in the same injuries. Of these 120 manuscripts, 28 were suitable for inclusion in the review. The systematic review is presented, allied to the BOAST 4 principles, examining the use of NPWT and the tools available for infection prevention for wounds of the upper and lower limb. The use of NPWT in conjunction with antibiotic-bead therapy improved the way in which open fractures of both the upper and lower limb are treated. CONCLUSION Production of guidelines is warranted for the treatment of upper limb injuries. The treatment options available for wound closure and infection prevention that are used in the treatment of open injuries of the lower limb could be adopted to open injuries of the upper limb.
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Affiliation(s)
- E Ali
- Doctoral Student, Clinical School, Magdalene College, University of Cambridge, Cambridge, UK
| | - M Raghuvanshi
- Trauma and Orthopaedic Consultant, Broomfield Hospital, Chelmsford, UK
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Beidas OE, Garwe T, Wicks RF, Jalla A, Bryant C, Sarwar Z, Albrecht RM. Equivalent outcomes with once versus thrice weekly dressing changes in midline laparotomy wounds treated with negative pressure wound therapy. Am J Surg 2019; 217:1065-1071. [DOI: 10.1016/j.amjsurg.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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de Moura DTH, de Moura BFBH, Manfredi MA, Hathorn KE, Bazarbashi AN, Ribeiro IB, de Moura EGH, Thompson CC. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc 2019; 11:329-344. [PMID: 31205594 PMCID: PMC6556487 DOI: 10.4253/wjge.v11.i5.329] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023] Open
Abstract
A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a first-line approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
- Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | | | - Michael A Manfredi
- Esophageal and Airway Atresia Treatment Center, Boston Children's Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Ahmad N Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Igor Braga Ribeiro
- Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | | | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
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Sirisena R, Bellot GL, Puhaindran ME. The Role of Negative-Pressure Wound Therapy in Lower-Limb Reconstruction. Indian J Plast Surg 2019; 52:73-80. [PMID: 31456615 PMCID: PMC6664838 DOI: 10.1055/s-0039-1687922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Negative-pressure wound therapy (NPWT) has gained increasing popularity among clinicians since its introduction in 1997 as a potential aid to wound healing. Multiple benefits of NPWT have since been proven in studies, including increase in granulation tissue formation, decrease in bacterial load, and the improved survival of flaps. With our increasing use and greater understanding of the tissue and cellular changes that occur in a wound treated with NPWT, our lower-limb reconstructive practice has also evolved. Although controversial, the definite timing for lower-limb reconstruction has stretched from 72 hours to longer than 2 weeks as NPWT contains the wound within a sterile, closed system. It has also shown to decrease the rate of infection in open tibia fractures. Previously, a large number of critical defects of the lower limb would require free tissue transfer for definitive reconstruction. NPWT has reduced this rate by more than 50% and has allowed for less complicated resurfacing procedures to be performed instead.
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Affiliation(s)
- Renita Sirisena
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Gregory Lucien Bellot
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Mark Edward Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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Does Vacuum-assisted Closure Reduce the Risk of Wound Complications in Patients With Lower Extremity Sarcomas Treated With Preoperative Radiation? Clin Orthop Relat Res 2019; 477:768-774. [PMID: 30811365 PMCID: PMC6437357 DOI: 10.1097/corr.0000000000000371] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although preoperative radiation followed by wide local excision yields excellent local control in soft tissue sarcomas, the risk of wound complications is reported to be higher compared with the incidence in patients who were administered postoperative radiation therapy. Vacuum (vac)-assisted closure may improve wound healing, but it is unknown whether vac-assisted closure during soft tissue sarcoma resection may reduce the risk of wound complications or impair local disease control. QUESTIONS/PURPOSES (1) Does the use of a wound vac application at the time of soft tissue sarcoma resection reduce the risk of developing wound complications after lower extremity sarcoma resection? (2) Is vac-assisted closure associated with an increased risk of local relapse? METHODS From 2000 to 2016, 312 patients with stage I to III soft tissue sarcomas were treated. Of these, 123 were treated with preoperative radiation ± chemotherapy followed by limb-sparing resection based on tumor location, size, grade, histology, and patient age. There was a minimum followup of 12 months. Radiation was delivered generally based on tumor size, grade, superficial versus deep nature, and proximity to neurovascular structures. Chemotherapy was administered in patients < 70 years old with high-grade tumors and tumors > 5 cm. Patient, demographic, and treatment variables, including incisional vac application and wound outcomes, were retrospectively evaluated. Incisional vac-assisted closure took place at the time of primary resection in 32% (46 of 123) of patients. Vac-assisted closure was considered when there was a concern for risk of external contamination such as instances in which fixation of adhesives would be difficult or regions where there was a high risk of contamination. Vac-assisted closure may have also been used in instances with increased wound tension at closure or with heightened concern for shearing on the wound such as buttock wounds. Ten patients were lost to followup, two in the vac group and eight in the non-vac group. Potential factors associated with wound complications were evaluated using Fisher's exact test for univariate analysis and logistic regression for multivariate analysis. Local recurrence-free survival was evaluated using the Kaplan-Meier estimate. RESULTS After taking into consideration factors such as tumor size, location, age, and patient comorbidities, it was shown that patients who underwent vac-assisted closure were less likely to experience wound complications compared with patients who did not undergo vac-assisted closure (odds ratio, 0.129; 95% confidence interval [CI], 0.041-0.398; p = 0.004). The local control incidence in the entire cohort was 98%. With the numbers available, Kaplan-Meier survivorship free from local recurrence did not differ between patients treated with or without the vac (100% [95% CI, 154.09-154.09] versus 96% [95% CI, 152.21-169.16]; p = 0.211), respectively. CONCLUSIONS Vac-assisted closure at the time of resection of proximal lower extremity soft tissue sarcomas is associated with a lower risk of wound complications, and its use apparently did not compromise local control. We show that the use of vac-assisted closure may be worth considering in surgeons' attempts to reduce the risk of wound complications among patients with soft tissue sarcomas of the proximal lower extremities. LEVEL OF EVIDENCE Level III, therapeutic study.
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Ahtzaz S, Sher Waris T, Shahzadi L, Anwar Chaudhry A, Ur Rehman I, Yar M. Boron for tissue regeneration-it’s loading into chitosan/collagen hydrogels and testing on chorioallantoic membrane to study the effect on angiogenesis. INT J POLYM MATER PO 2019. [DOI: 10.1080/00914037.2019.1581202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Samreen Ahtzaz
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University, Lahore, Pakistan
| | - Tayyaba Sher Waris
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University, Lahore, Pakistan
| | - Lubna Shahzadi
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University, Lahore, Pakistan
| | - Aqif Anwar Chaudhry
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University, Lahore, Pakistan
| | - Ihtesham Ur Rehman
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University, Lahore, Pakistan
- Engineering Department, Lancaster University, Lancaster, UK
| | - Muhammad Yar
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University, Lahore, Pakistan
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Frear CC, Griffin B, Cuttle L, McPhail SM, Kimble R. Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial. Trials 2019; 20:130. [PMID: 30760332 PMCID: PMC6374905 DOI: 10.1186/s13063-019-3223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone. METHODS/DESIGN A total of 104 children will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present to the participating children's hospital within 7 days of their injury with a thermal burn covering <5% of their total body surface area. Facial and trivial burns will be excluded. Following a randomised controlled parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™. The intervention arm will be treated with silver-impregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants' dressings will be changed every 3 to 5 days until their wounds are fully re-epithelialised. Time to re-epithelialisation will be studied as the primary outcome. Secondary outcomes will include pain, pruritus, wound progression, health-care-resource use (and costs), ease of management, treatment satisfaction and adverse events. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. DISCUSSION The study will be the first randomised controlled trial to explore the clinical effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618000256279 . Registered on 16 February 2018.
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Affiliation(s)
- Cody C. Frear
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
| | - Leila Cuttle
- Institute of Health and Biomedical Innovation, Centre for Children’s Burns and Trauma Research, Lvl 8, Children’s Health Research Centre, Queensland University of Technology, South Brisbane, QLD 4101 Australia
| | - Steven M. McPhail
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, QLD 4102 Australia
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059 Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
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Biomechanical Effects of Incisional Negative Wound Pressure Dressing: An Ex Vivo Model Using Human and Porcine Abdominal Walls. BIOMED RESEARCH INTERNATIONAL 2019; 2018:7058461. [PMID: 30687756 PMCID: PMC6330824 DOI: 10.1155/2018/7058461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022]
Abstract
Introduction Incisional negative pressure wound therapy (iNPWT) has been of recent interest in different surgical fields as beneficial outcomes on high-risk wounds have been reported. Nevertheless, its mechanisms of function are not widely studied to date. Methods We established two ex vivo setups of iNPWT in porcine and human abdominal wall for measuring pressures within the wound which result from iNPWT application. For pressure measurements, a high-resolution manometry catheter and a balloon catheter probe were used in a wound sealed with either a commercially available PREVENA VAC kit or a self-made iNPWT kit. Furthermore, we evaluated seroma evacuation by iNPWT. Results Both setups showed similar characteristics of pressure curves within the wound when applying increasing negative pressures. Application of high pressures did not result in a similar increase in wound pressure. Only subtotal evacuation of seroma by iNPWT application (about 75% of volume) could be detected. Conclusion Our ex vivo model of iNPWT in porcine and human abdominal wall could show reproducible measurements of pressures within the wounds in both types of tissue. As intrawound pressures did not increase in the same way as the applied negative pressure, we suggest that our results do not advocate the idea of using iNPWT for wound care especially as seroma evacuation remains insufficient.
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Negative-pressure Wound Therapy for Periocular Necrotizing Fasciitis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e1921. [PMID: 30656092 PMCID: PMC6326626 DOI: 10.1097/gox.0000000000001921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/11/2018] [Indexed: 11/25/2022]
Abstract
Periocular necrotizing fasciitis is a rare, but potentially blinding, or even fatal disease. The authors report a case of a 44-year-old man who presented with quiescent bilateral periocular and facial necrotizing fasciitis. The patient was treated with antibiotics and surgical debridement, followed by negative-pressure wound therapy (NPWT), until the wound bed was thought to be healthy enough to support bilateral upper eyelid full-thickness skin grafts. NPWT appeared to decrease local edema; speed reperfusion and granulation tissue formation; and served to stabilize the skin grafts against the wound bed, while not causing any ocular complications. NPWT can be a safe and effective adjunct treatment for periocular necrotizing fasciitis.
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