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Reese MW, Hogge RL, Roess BJ, Hepner JM, Luke RD, Rendel RE, Kabir IK, Nguyen TM, Snyder KN, Heaton JA, Martyak MT. The Implementation of Incisional Negative Pressure Therapy in Trauma Laparotomies Leads to Fewer Open Wounds at Discharge. Am Surg 2025:31348251339700. [PMID: 40401823 DOI: 10.1177/00031348251339700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2025]
Abstract
Background: Surgical site infections (SSIs) tend to be higher in emergent trauma cases. To combat this increased risk, the skin is often left open and allowed to heal by secondary intention. We sought to investigate the effect of the implementation of incisional negative pressure wound therapy (iNPWT) in trauma laparotomies. Methods: A single-institution retrospective chart review was performed of trauma patients receiving an emergent exploratory laparotomy between 2015 and 2022. Patients with class II and III wounds were included. The primary outcome was open wound at discharge between the pre-iNPWT and post-iNPWT implementation. The secondary outcome was development of superficial SSI in closed wounds. Results: 260 patients, 111 pre-iNPWT and 149 post-iNPWT implementation, were included. The proportion of patients who were discharged with an open wound in the pre-iNPWT group was 52.3% vs 18.8% in the post-iNPWT group, P = <.001. The proportion of patients with closed wounds who developed a superficial SSI in the pre-iNPWT group was 12.1%, 8 of 66, vs 5.9%, 8 of 135, in the post-iNPWT group, P = .13. The proportion of patients with closed class III wounds who developed a superficial SSI was 14.0%, 7 of 50, vs 5.0%, 6 of 119, in the post-iNPWT group, P = .046. Conclusion: Our study identified a decrease in the number of patients who were discharged with an open wound after the implementation of iNPWT without an increase in SSIs. A decrease in SSIs in class III wounds closed with iNPWT was also observed.
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Affiliation(s)
- Miles W Reese
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Raymond L Hogge
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Brendan J Roess
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - John M Hepner
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Robert D Luke
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Ricardo E Rendel
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Ishraq K Kabir
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Tuan M Nguyen
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Kristen N Snyder
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Julia A Heaton
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
| | - Michael T Martyak
- Department of Surgery, Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Old Dominion University, Norfolk, VA, USA
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Herold JM, Selkridge I, Nocon AA, Bornes TD, Sculco TP, Carli AV, Sculco PK. Closed-Incision Negative Pressure Wound Therapy Improves Outcomes in Obese Aseptic Revision Total Hip and Knee Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00215-3. [PMID: 40074094 DOI: 10.1016/j.arth.2025.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/01/2025] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND The burden of revision total joint arthroplasty (rTJA) is increasing. Revision procedures are associated with an increased risk of perioperative complications. Obese patients undergoing rTJA may have a higher risk of wound complications due to their soft-tissue envelope. Closed-incision negative pressure wound therapy (ciNPWT) has been rigorously investigated for its effect on reducing wound complications; however, the literature is limited to primary total joint arthroplasty. The purpose of the current study was to investigate the association between ciNPWT and clinical outcomes for obese patients undergoing aseptic revision total hip and knee arthroplasty. METHODS This was a retrospective study examining aseptic rTJA procedures from January 2017 to December 2021 at a high-volume institution. Patients were included if their body mass index was > 35 and had a minimum follow-up of 2 years. The cohorts were rTJA procedures that used ciNPWT versus procedures without ciNPWT use. A total of 214 rTJA (Hip, n = 61; Knee, n = 153) patients qualified for analysis. After surgery, ciNPWT was applied on 130 (60.7%) patients (92 knees and 38 hips), and standard dressing was used on 84 (39.3%) patients (61 knees and 23 hips). There were no significant baseline differences between the groups. Outcomes evaluated were as follows: (1) revision for infection; (2) superficial wound complications; (3) overall complications; (4) all-cause revision; and (5) all-cause readmissions. The association between ciNPWT use and outcomes was evaluated using Chi-square tests. RESULTS When controlling for all variables, ciNPWT use was associated with significantly fewer revisions for infection (0.8 versus 8.3%), overall complications (3.8 versus 11.9%), all-cause revisions (3.1 versus 13.1%), and readmissions (10.8 versus 21.7%) compared to those who did not use ciNPWT. Secondary superficial wound complication-specific outcomes did not show significant differences. CONCLUSIONS To our knowledge, this study is the largest retrospective study to date examining the effect of ciNPWT on outcomes in obese aseptic revision rTJA patients. Our results demonstrated major benefits associated with the use of ciNPWT in obese patients undergoing aseptic rTJA in reference to infection-related revision, overall complications, all-cause revisions, and early readmission for any reason.
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Affiliation(s)
- Johannes M Herold
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York
| | - Isaiah Selkridge
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York
| | - Allina A Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Troy D Bornes
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York; Division of Orthopaedic Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | - Thomas P Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Alberto V Carli
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital For Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Blasberg T, Meiborg M, Richl J, Weber M, Hiebel L, Mekolli A, Seif Amir Hosseini A, Amanzada A, Ellenrieder V, Hochberger J, Wedi E. Prophylactic endoscopic vacuum therapy for stricture prevention after wide-field endoscopic submucosal dissection of superficial esophageal cancer. Gastrointest Endosc 2025; 101:650-654. [PMID: 39265744 DOI: 10.1016/j.gie.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND AND AIMS Esophageal stricture is a severe adverse event after wide-field endoscopic submucosal dissection (ESD) of superficial esophageal carcinoma. This study evaluated the efficacy and safety of combining endoscopic vacuum therapy (EVT) and a budesonide orodispersible tablet (BOT) in preventing post-ESD strictures. METHODS This prospective case series included patients with superficial esophageal squamous cell carcinoma and adenocarcinoma who had wide-field ESD (≥75% circumference, resection length ≥50 mm). After ESD, EVT was applied immediately followed by 8 weeks of BOTs. The main outcome measurement was the incidence of post-ESD stricture. RESULTS Eleven patients underwent ESD. Of these, 81.8% had 75% to 99% circumference resected and 18.2% had a circumferential resection. EVT remained in situ for a mean of 3.5 days. No esophageal strictures were observed by the final follow-up, and no major adverse events occurred related to EVT or the BOT. CONCLUSIONS The prophylactic combination of EVT and BOT is a novel and promising strategy for reducing post-ESD strictures.
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Affiliation(s)
- Tobias Blasberg
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Moritz Meiborg
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Johannes Richl
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Marie Weber
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Lukas Hiebel
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
| | - Ardian Mekolli
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ahmad Amanzada
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
| | - Jürgen Hochberger
- Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany
| | - Edris Wedi
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
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Kim Y, Cui CL, Shafique HS, Weissler EH, Johnson AP, Coleman DM, Southerland KW. Effectiveness of Negative Pressure Wound Therapy on Groin Surgical Site Infection After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2025; 111:143-150. [PMID: 39581325 DOI: 10.1016/j.avsg.2024.10.020] [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: 06/17/2024] [Revised: 10/04/2024] [Accepted: 10/22/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Surgical site infections (SSIs) are a common cause of patient morbidity, hospital readmission, and reoperation after lower extremity bypass (LEBs) surgery for chronic limb-threatening ischemia (CLTI). Recent studies on the use of incisional negative pressure wound therapy (NPWT) in LEB surgery have reported conflicting results. In this single-center study, we examined our experience on the impact of NPWT on groin SSI rates after LEB surgery. METHODS We retrospectively queried electronic medical records for all LEB operations performed for CLTI. Multivariate logistic regression analysis was used to identify risk factors associated with postoperative SSI. Using these risk factors, subset analysis was performed to determine whether NPWT was associated with reduced SSI in high-risk patients. RESULTS From 2018 to 2022, a total of 367 patients underwent LEB surgery for CLTI. Mean patient age was 66 years. Postoperative groin SSI was diagnosed in 22.9% (n = 84) of patients. Patients suffering SSI were more frequently morbidly obese (6.0% vs 1.8%, P = 0.03) and had higher rates of chronic obstructive pulmonary disease (35.7% vs 23.3%, P = 0.02). Other comorbidities and demographic data were similar between groups. NPWT was utilized in 19.6% (n = 72) of patients, with no baseline differences between SSI and no SSI cohorts (15.5% vs 20.9%, P = 0.28). On multivariate analysis, female sex (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.06-3.35, P = 0.03), white race (OR 2.17, 95% CI 1.23-3.82, P = 0.007), morbid obesity (OR 3.67, 95% CI 0.93-14.4, P = 0.05), and active smoking (OR 4.07, 95% CI 1.20-13.8, P = 0.02) were independently associated with postoperative SSI. Subset analysis among patients at increased risk of SSI did not reveal any differences in wound infection with NPWT usage. CONCLUSIONS In our experience, NPWT does not appear to be more effective than standard dressings in preventing groin SSI after LEB surgery for CLTI, even among populations at heightened risk for wound infection.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC.
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
| | - Hana S Shafique
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
| | - E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
| | - Adam P Johnson
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC
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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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Kramer DE, Bharthi R, Myers D, Chang P, Dabecco R, Xu C, Yu A. Prophylactic closed-incisional negative pressure wound therapy following posterior instrumented spinal fusion: a single surgeon's experience and cost-benefit analysis. Neurosurg Rev 2024; 47:847. [PMID: 39542937 PMCID: PMC11564409 DOI: 10.1007/s10143-024-03083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 10/15/2024] [Accepted: 10/30/2024] [Indexed: 11/17/2024]
Abstract
PURPOSE Surgical site infections (SSIs) following spine surgery are associated with morbidity and resource utilization. Applying prophylactic closed-incisional negative pressure wound therapy (ciNPWT) during posterior instrumented fusion has mixed results in reducing rates of wound complications and SSI. We evaluated the clinical efficacy and potential cost-savings associated with ciNPWT in high-risk patients receiving posterior instrumented spinal fusion. METHODS We retrospectively reviewed patients receiving posterior instrumented spinal fusion for any surgical indication between July 1, 2017 and December 31, 2019, and compared rates of wound dehiscence, SSI, and reoperation for wound complications between standard surgical dressings and ciNPWT. Surgical dressing selection was based on the senior author's assessment of infection risk factors. RESULTS A total of 229 patients (n = 85 standard surgical dressings, n = 144 ciNPWT) were included. The ciNPWT group had significantly more risk factors for wound-related complications, including older age (61.8 vs. 58.5 years, p = 0.042), diabetes mellitus (36.8% vs. 23.5%, p = 0.037), more instrumented levels (5.6 vs. 3.9, p < 0.0001), estimated blood loss (1298 vs. 998 mL, p = 0.036), and deformity was the predominant operative indication (29.9% vs. 17.7%, p = 0.040). Prophylactic ciNPWT was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI (8.3% vs. 21.2%, p = 0.005). Number needed to treat with ciNPWT to prevent one SSI was 8 patients. The cost of preventing one SSI was $4,560. Cost-benefit analysis demonstrated a potential mean savings of $21,662 per operative SSI prevented and $270,775 per 100 patients undergoing posterior instrumented fusion with ciNPWT. CONCLUSIONS Prophylactic ciNPWT use is a cost-effective means of reducing rates of wound dehiscence and SSI following posterior instrumented fusion.
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Affiliation(s)
- Dallas E Kramer
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | - Rosh Bharthi
- Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA
| | - Daniel Myers
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | - Patrick Chang
- Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Rocco Dabecco
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | - Chen Xu
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | - Alexander Yu
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, 15212, USA.
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Jeong JW, Lee S, Park JH. Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction. BMC Geriatr 2024; 24:906. [PMID: 39497041 PMCID: PMC11533407 DOI: 10.1186/s12877-024-05526-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/29/2024] [Indexed: 11/06/2024] Open
Abstract
BACKGROUND Pressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps. METHODS A retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics. RESULTS In this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate. CONCLUSION Closed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care. TRIAL REGISTRATION The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20-2023-25, Date: Mar. 24 2023).
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Affiliation(s)
- Ji Won Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Seungkeun Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Jomaru-ro 170, Bucheon, 14584, Republic of Korea
| | - Jun Ho Park
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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Campbell A, Bae J, Hein M, Hillis SL, Rebeck ON, Rakel BA, Grice E, Gardner SE. The heterogeneous wound microbiome varies with wound care pain, dressing type, and inflammatory gene expression. Wound Repair Regen 2024; 32:811-825. [PMID: 38666460 PMCID: PMC11511792 DOI: 10.1111/wrr.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 09/28/2024]
Abstract
Wound dressing changes are essential procedures for wound management. However, ~50% of patients experience severe pain during these procedures despite the availability of analgesic medications, indicating a need for novel therapeutics that address underlying causes of pain. Along with other clinical factors, wound pathogens and inflammatory immune responses have previously been implicated in wound pain. To test whether these factors could contribute to severe pain during wound dressing changes, we conducted an exploratory, cross-sectional analysis of patient-reported pain, inflammatory immune responses, and wound microbiome composition in 445 wounds at the time of a study dressing change. We profiled the bacterial composition of 406 wounds using 16S ribosomal RNA amplicon sequencing and quantified gene expression of 13 inflammatory markers in wound fluid using quantitative real-time polymerase chain reaction (qPCR). Neither inflammatory gene expression nor clinically observed inflammation were associated with severe pain, but Corynebacterium and Streptococcus were of lower relative abundance in wounds of patients reporting severe pain than those reporting little or no pain. Wound microbiome composition differed by wound location, and correlated with six of the inflammatory markers, including complement receptor C5AR1, pro-inflammatory cytokine interleukin (IL)1β, chemokine IL-8, matrix metalloproteinase MMP2, and the antimicrobial peptide encoding cathelicidin antimicrobial peptide. Interestingly, we found a relationship between the wound microbiome and vacuum-assisted wound closure (VAC). These findings identify preliminary, associative relationships between wound microbiota and host factors which motivate future investigation into the directional relationships between wound care pain, wound closure technologies, and the wound microbiome.
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Affiliation(s)
- Amy Campbell
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Jaewon Bae
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Maria Hein
- The University of Iowa College of NursingIowa CityIowaUSA
| | | | | | | | | | - Sue E. Gardner
- The University of Iowa College of NursingIowa CityIowaUSA
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Miller-Mikolajczyk C, Beach K, Silverman R, Cooper M. The Evolution of Commercial Negative Pressure Wound Therapy Systems over the Past Three Decades. Adv Wound Care (New Rochelle) 2024; 13:375-390. [PMID: 38666695 DOI: 10.1089/wound.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Significance: Since the introduction of the first commercial negative pressure wound therapy (NPWT) system nearly three decades ago, several key technological innovations have led to the wide adoption of the therapy. This is a review of the history and innovation of commercial NPWT systems for adjunctive management of open wounds. Recent Advances: Technical modifications have broadened NPWT options to include innovative dressing interfaces, tubing configurations, power sources, capability of topical wound solution instillation or irrigation, canister versus canister-free configurations, smart technology, and disposable versus larger reusable therapy units. While these options complicate product selection, they have greatly expanded the potential to manage a wide variety of wounds in patients who previously may not have been candidates for NPWT. Critical Issues: Basic yet mandatory requirements of NPWT include delivering an accurate level of negative pressure to the wound bed, maintaining a seal, removing wound surface exudate through the dressing interface, and patient adherence to prescribed therapy. Meeting these requirements is challenging in the face of variable wound types, wound locations, exudate levels, and exudate viscosity. While there are a growing number of marketed NPWT systems, each may have different characteristics and performance. Evaluating the functionality of each system and relevant accessories is complicated, especially as additional manufacturers enter the market. Understanding the key innovations and specific challenges they are intended to solve may aid health care providers in selecting appropriate NPWT technologies for patients. Future Directions: Evolving technology, including artificial intelligence, will likely play a major role in redefining NPWT safety, simplicity, and reliability.
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Affiliation(s)
| | | | - Ronald Silverman
- Becton Dickinson and Company, Franklin, New Jersey, USA
- University of Maryland Medical System, Baltimore, Maryland, USA
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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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Bobkiewicz A, Francuzik W, Martinkosky A, Borejsza-Wysocki M, Ledwosinski W, Szmyt K, Banasiewicz T, Krokowicz L. Negative Pressure Level and Effects on Bacterial Growth Kinetics in an in vitro Wound Model. Pol J Microbiol 2024; 73:199-206. [PMID: 38905277 PMCID: PMC11192228 DOI: 10.33073/pjm-2024-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/20/2024] [Indexed: 06/23/2024] Open
Abstract
Negative Pressure Wound Therapy (NPWT) has been widely adopted in wound healing strategies due to its multimodal mechanism of action. While NPWT's positive impression on wound healing is well-established, its effect on bacterial load reduction remains equivocal. This study investigates NPWT's efficacy in reducing bioburden using an in vitro porcine skin model, focusing on the impact of Staphylococcus aureus and Staphylococcus epidermidis. Custom-made negative pressure chambers were employed to apply varying negative pressures. Porcine skin was cut into 5 × 5 cm squares and three standardized wounds of 6 mm each were created using a biopsy punch. Then, wounds were infected with S. aureus and S. epidermidis bacterial suspensions diluted 1:10,000 to obtain a final concentration of 1.5 × 104 CFU/ml and were placed in negative pressure chambers. After incubation, bacterial counts were expressed as colony-forming units (CFU) per ml. For S. aureus at 120 hours, the median CFU, mean area per colony, and total growth area were notably lower at -80 mmHg when compared to -250 mmHg and -50 mmHg, suggesting an optimal negative pressure for the pressure-dependent inhibition of the bacterial proliferation. While analyzing S. epidermidis at 120 hours, the response to the negative pressure was similar but less clear, with the minor CFU at -100 mmHg. The influence of intermittent negative pressure on the S. epidermidis growth showed notably lower median CFU with the interval therapy every hour compared to the S. aureus control group. This study contributes valuable insights into NPWT's influence on the bacterial load, emphasizing the need for further research to reformulate its role in managing contaminated wounds.
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Affiliation(s)
- Adam Bobkiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Wojciech Francuzik
- Department of Dermatology, Venerology and Allergology. Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Amy Martinkosky
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Maciej Borejsza-Wysocki
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Witold Ledwosinski
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
| | - Lukasz Krokowicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan, University of Medical Sciences, Poznan, Poland
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12
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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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13
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Mamun AA, Shao C, Geng P, Wang S, Xiao J. Recent advances in molecular mechanisms of skin wound healing and its treatments. Front Immunol 2024; 15:1395479. [PMID: 38835782 PMCID: PMC11148235 DOI: 10.3389/fimmu.2024.1395479] [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: 03/04/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
The skin, being a multifaceted organ, performs a pivotal function in the complicated wound-healing procedure, which encompasses the triggering of several cellular entities and signaling cascades. Aberrations in the typical healing process of wounds may result in atypical scar development and the establishment of a persistent condition, rendering patients more vulnerable to infections. Chronic burns and wounds have a detrimental effect on the overall quality of life of patients, resulting in higher levels of physical discomfort and socio-economic complexities. The occurrence and frequency of prolonged wounds are on the rise as a result of aging people, hence contributing to escalated expenditures within the healthcare system. The clinical evaluation and treatment of chronic wounds continue to pose challenges despite the advancement of different therapeutic approaches. This is mainly owing to the prolonged treatment duration and intricate processes involved in wound healing. Many conventional methods, such as the administration of growth factors, the use of wound dressings, and the application of skin grafts, are used to ease the process of wound healing across diverse wound types. Nevertheless, these therapeutic approaches may only be practical for some wounds, highlighting the need to advance alternative treatment modalities. Novel wound care technologies, such as nanotherapeutics, stem cell treatment, and 3D bioprinting, aim to improve therapeutic efficacy, prioritize skin regeneration, and minimize adverse effects. This review provides an updated overview of recent advancements in chronic wound healing and therapeutic management using innovative approaches.
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Affiliation(s)
- Abdullah Al Mamun
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Chuxiao Shao
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Peiwu Geng
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Shuanghu Wang
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
| | - Jian Xiao
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, Zhejiang, China
- Molecular Pharmacology Research Center, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
- Department of Wound Healing, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Alves AS, Martineau J, Scampa M, Kalbermatten DF, Oranges CM. Negative Pressure Wound Therapy versus Conventional Dressing in Lower Limb Fractures: Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5806. [PMID: 38752221 PMCID: PMC11095958 DOI: 10.1097/gox.0000000000005806] [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: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 05/18/2024]
Abstract
Gustilo 3 lower limb fractures represent a significant challenge because of high complication risk. Two management strategies are commonly used for wound coverage until final closure: negative pressure wound therapy (NPWT) and conventional wound dressing (CWD), also described as standard wound coverage without subatmospheric pressure. Understanding their relative effectiveness is essential to improve patient outcomes. The aim of this systematic review and meta-analysis was to compare the efficacy of NPWT and CWD in Gustilo 3 lower limb fracture management, with a focus on overall rates, superficial infection, and deep infection rates. A systematic review of medical research databases was conducted in accordance with PRISMA guidelines. Studies comparing NPWT with CWD for Gustilo 3 fractures were included. Data extraction and quality assessment were performed. Treatment with CWD was associated with significantly higher rates of overall infection [pooled risk ratio (RR): 0.33; 95% confidence interval (CI): 0.14-0.51] and pooled risk difference (RD: 0.27; 95% CI: 0.15-0.38), superficial infection (pooled RR: 0.35; 95% CI: 0.04-0.66), and deep infection (pooled RR: 0.20; 95% CI: 0.02-0.38) compared with NPWT treatment. Overall infection rate remained significantly higher in the CWD group after analyzing only open tibia fractures (pooled RR: 0.35; 95% CI: 0.21-0.48). Nonunion rate was significant higher in the CWD group (pooled RR: 0.30; 95% CI: 0.00-0.59). Flap failure rate was similar in both groups (pooled RR: 0.09; 95% CI: -0.05 to 0.23). NPWT appears to be a reasonable option for wound management in Gustilo 3 lower limb fractures in terms of infection rates.
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Affiliation(s)
- André S. Alves
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jérôme Martineau
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Matteo Scampa
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Daniel F. Kalbermatten
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Carlo M. Oranges
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Meirizal M, Magetsari R, Anwar SL, Chaidir MR, Muhammad H, Baskara AANN, Pradipta MFW, Huwaidi AF. Utilizing Low-cost Vacuum-assisted Closure as Adjuvant Therapy in Soft Tissue Reconstruction for a Mangled Upper Extremity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5826. [PMID: 38798936 PMCID: PMC11124598 DOI: 10.1097/gox.0000000000005826] [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: 12/27/2023] [Accepted: 03/25/2024] [Indexed: 05/29/2024]
Abstract
Soft tissue reconstruction using flaps in managing mangled injuries is occasionally insufficient due to large defects and low flap viability. Conversely, delaying the closure of the defect can elevate the risk of infection. Adjuvant therapy becomes essential in the management of mangled injuries. We aim to present the use of low-cost vacuum-assisted closure (VAC) as an adjuvant therapy for mangled injuries. We reported the case of a 20-year-old man who sustained a mangled injury to his left forearm in a traffic accident 4 hours before admission. The mangled extremity severity score was 9; however, the patient declined amputation. Although the initial reconstruction was done, the flap could only cover vital structures. VAC was utilized to address the uncovered portion of the defect, to promote optimal granulation and prevent infection. The reconstruction proceeded with a skin graft and wrist arthrodesis. At 1-year follow-up, viable tissue was obtained but contracture occurred at the metacarpophalangeal and proximal interphalangeal joints. We intend to perform functional reconstruction at a later stage. Although the benefits of VAC in wound management are well established, reports regarding its advantages in mangled injury management remain relatively scarce. The high cost of VAC is a limiting factor, particularly in developing countries. This prompts the need for an affordable VAC innovation with comparable efficiency to the commercial model. Reverse Aqua Pump VAC, our innovative low-cost VAC, shows satisfactory outcomes in managing patients with mangled injuries with mangled extremity severity score indicating amputation.
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Affiliation(s)
- Meirizal Meirizal
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sumadi Lukman Anwar
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Oncology Surgery Division, Surgery Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mohammad Rizal Chaidir
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Hand and Microsurgery Division, Orthopedics, and Traumatology Department, Dr. Hasan Sadikin Hospital–Faculty of Medicine Padjajaran University, Bandung, Indonesia
| | - Hilmi Muhammad
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - A Faiz Huwaidi
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
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16
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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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17
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Chen H, Xu T, Yu H, Zhu J, Liu Y, Yang L. Effect of platelet-rich plasma combined with negative pressure wound therapy in treating patients with chronic wounds: A meta-analysis. Int Wound J 2024; 21:e14758. [PMID: 38629618 PMCID: PMC11022301 DOI: 10.1111/iwj.14758] [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: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 04/19/2024] Open
Abstract
A meta-analysis was conducted to comprehensively explore the effects of platelet-rich plasma (PRP) combined with negative pressure wound therapy (NPWT) in treating patients with chronic wounds. Computer searches were conducted, from database infection to November 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the use of PRP combined with NPWT technology for treating chronic wounds. Two researchers independently screened the literature, extracted data and conducted quality assessments according to the inclusion and exclusion criteria. Stata 17.0 software was employed for data analysis. Overall, 18 RCTs involving 1294 patients with chronic wounds were included. The analysis revealed that, compared with NPWT alone, the use of PRP combined with NPWT technology significantly improved the healing rate (odds ratios [OR] = 1.92, 95% confidence intervals [CIs]: 1.43-2.58, p < 0.001) and total effective rate (OR = 1.31, 95% CI: 1.23-1.39, p < 0.001), and also significantly shortened the healing time of the wound (standardized mean difference = -2.01, 95% CI: -2.58 to -1.45, p < 0.001). This study indicates that the treatment of chronic wounds with PRP combined with NPWT technology can significantly enhance clinical repair effectiveness and accelerate wound healing, with a high healing rate, and is worth further promotion and practice.
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Affiliation(s)
- Hao Chen
- Department of Vascular SurgeryAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Tong‐Jie Xu
- Department of Vascular SurgeryAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Hao Yu
- Department of Vascular SurgeryAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Jun‐Long Zhu
- Department of Vascular SurgeryAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yong Liu
- Department of Vascular SurgeryAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Lu‐Pin Yang
- Department of Interventional MedicineAffiliated Hospital of Southwest Medical UniversityLuzhouChina
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Sexton FC, Soh V, Yahya MS, Healy DA. Effectiveness of negative-pressure wound therapy to standard therapy in the prevention of complications after vascular surgery. Minerva Surg 2024; 79:48-58. [PMID: 37930087 DOI: 10.23736/s2724-5691.23.10096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Wound complications are common after vascular surgery and many may be preventable. Negative pressure wound therapy (NPWT) dressings may be able to reduce wound complications relating to closed incisions following vascular surgery and several devices are currently available along with a large body of literature. This review article will describe the use of NPWT dressings in vascular surgery. We will summarize the currently available systems, the likely mechanism of action of NWPT, the published studies to date and we will give our recommendations regarding the priorities for future research on this topic.
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Affiliation(s)
- Fiona C Sexton
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Vernie Soh
- Department of Vascular Surgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Muhammad S Yahya
- Department of Vascular Surgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Donagh A Healy
- Department of Vascular Surgery, Belfast Health and Social Care Trust, Belfast, UK -
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Wang C, Li R, Su X, Zhang J, Liu Z. Effect of hydrocolloid dressings on preventing air leakage when applying negative pressure wound therapy to the perineum, buttocks, and sacrococcygeal region. Wound Repair Regen 2024; 32:74-79. [PMID: 38127338 DOI: 10.1111/wrr.13136] [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: 04/23/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Maintaining a vacuum when applying negative pressure wound therapy (NPWT) is the key to its function, which is a challenge in the perineum, buttocks, and sacrococcygeal region. A retrospective cohort study was conducted to assess the effect of hydrocolloid dressings on preventing air leakage when applying NPWT in these regions. There were 61 patients in Group A (without the aid of hydrocolloid dressings) and 65 patients in Group B (with the aid of hydrocolloid dressings). The hydrocolloid dressing-assisted NPWT significantly reduced the incidence of air leakage compared with conventional NPWT placement (24.6% vs. 7.7%; risk ratio, 3.20; 95% confidence interval, 1.24-8.27; p = 0.009), while decreasing the number of open NPWT applications (2.2 vs. 1.7; difference, 0.43; 95% confidence interval, 0.19-0.66; p < 0.001), shortening hospital stays (20.1 vs. 16.1; difference, 4.07; 95% confidence interval, 1.68-6.46; p = 0.01), and reducing the incidence of adverse skin events (18.0% vs. 4.6%; risk ratio, 3.91; 95% confidence interval, 1.14-13.34; p = 0.017). These findings support the routine use of hydrocolloid dressing-assisted NPWT placement in the perineum, buttocks, and sacrococcygeal region.
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Affiliation(s)
- Chao Wang
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Rui Li
- Department of Emergency, The Second Hospital of Shandong University, Jinan, China
| | - Xiangpeng Su
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jixun Zhang
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Zhenzhong Liu
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, China
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Pan Y, Hao S, Qin Q, Dong Q, Yin L, Wang C. Bascom II combined with VSD treatment involving the preservation of tissue bridges for recurrent complex pilonidal sinuses with a literature review. Int J Surg Case Rep 2024; 114:109108. [PMID: 38064859 PMCID: PMC10757027 DOI: 10.1016/j.ijscr.2023.109108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 01/02/2024] Open
Abstract
INTRODUCTION For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high surgical difficulty, significant local damage, numerous complications, slow healing, and a high risk of recurrence. This article reports a case of recurrent complex pilonidal sinus and discusses the advantages of Bascom II combined with VSD treatment involving the preservation of tissue bridges. CASE PRESENTATION The patient, a 31-year-old male, presented with recurrent swelling, pain, and purulent discharge from the sacrococcygeal region for over a year. Upon physical examination, extensive lumps and sinus tracts were observed in the lumbosacral tail area, with the lesion extending from L4 to the tip of the coccyx. Under general anesthesia, a segmental resection was performed, and the lumbosacral mass lesion was excised, preserving normal tissue bridges. The mature sinus tract at the upper part of the coccyx was removed, and Bascom II reconstruction surgery was performed. In the late stage at the site of lumbar sacral lesion excision, VSD was applied to promote wound healing. DISCUSSION The combination of Bascom II with lesion tunnel-like removal can reduce the damage, elevate gluteal cleft, and lower the recurrence rate. Subsequently, with the addition of VSD, it can accelerate the elimination of necrotic tissue, reduce infection risk, and expedite wound healing. CONCLUSION This case explores the advantages and characteristics of combining various techniques in the treatment of recurrent complex pilonidal sinuses, emphasizes the utility of VSD as an adjunctive therapy for large lesions.
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Affiliation(s)
- Yan Pan
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Shuang Hao
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Qin Qin
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Qingjun Dong
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Lixin Yin
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Chen Wang
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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21
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Wang H, Sun S, Wang G, Huang Q, Zhang Z. Analysis of Vacuum-Assisted Closure-Assisted Antibiotic Irrigation in Treatment of Severe Neurosurgical Central Nervous System Infections. Surg Infect (Larchmt) 2023; 24:803-810. [PMID: 37910866 DOI: 10.1089/sur.2023.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Objective: Severe neurosurgical central nervous system infections (sNCNSIs) are among the most serious complications of neurosurgical disease. Conventional methods have shown a poor prognosis. This study aims to analyze the clinical characteristics of vacuum-assisted closure (VAC) in sNCNSIs with the help of antibiotic irrigation treatment. Patients and Methods: A retrospective study was performed for patients diagnosed with sNCNSIs. A VAC device was placed on the incision after debridement and the surgical cavity was rinsed with antibiotic agents in the VAC group. Meanwhile the surgical cavity was drained after debridement in the control group. Medical data were reviewed and analyzed. Results: Twenty-eight patients met the inclusion criteria, including 18 cases in the VAC group and 10 cases in the control group. The basic medical data showed no differences. Bacteria was isolated from 24 (85.7%) patients. The cure rate was significantly higher in the VAC group (p < 0.05). The cure rate in patients with multi-drug-resistant (MDR) infections was significantly higher in patients treated with VAC therapy (p < 0.05). The prognosis evaluated by Glasgow Outcome Score (GOS) between the two groups showed significant difference (p < 0.05). No re-infection in the VAC group occurred in the follow-up period. Conclusions: It is suggested that VAC-assisted antibiotic irrigation is safe and effective for patients with severe NCNSIs and can improve the prognosis dramatically. The results can provide a new effective and reasonable therapeutic strategy for patients with sNCNSIs.
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Affiliation(s)
- Huaqing Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Shengnan Sun
- Department of Nursing, Shandong Medical College, Jinan, Shandong Province, P.R. China
| | - Guanghui Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Qibing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
| | - Zeli Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, Shandong Province, P.R. China
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22
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AlJoaib NA, Alghamdi FA, AlEdwani BN, AlNaimi AK, AlGhamdi ZM. Negative Pressure Wound Therapy in Closed Colorectal Surgical Incisions: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49621. [PMID: 38161866 PMCID: PMC10755622 DOI: 10.7759/cureus.49621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
The utilization of negative pressure wound therapy (NPWT) in lowering the incidence of infections in closed colorectal surgical incisions has not been thoroughly established, and recent trials have had conflicting results. This meta-analysis was conducted to synthesize the findings of available trial data and carefully evaluate the effectiveness of this intervention in colorectal surgery. The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were combed for randomized controlled trials (RCTs) that compared negative pressure wound therapy to standard dressing in closed wounds of patients undergoing colorectal surgery. The incidence of surgical site infections (SSIs) was the primary outcome. Secondary outcomes included the occurrence of seroma and hematoma. The trial results were represented as odds ratios (OR) with a 95% confidence interval (CI), and a fixed-effects model was used. Nine studies found eligible were included, and the pooled results revealed that negative pressure wound therapy significantly reduced the incidence of surgical site infections (OR: 0.70; 95% CI: 0.53, 0.93; P= 0.02). Furthermore, there was a significant reduction in seroma (OR: 0.27; 95% CI: 0.08, 0.95; P = 0.04) and hematoma (OR: 0.20; 95% CI: 0.04, 0.96; P = 0.04). The use of negative pressure wound therapy for primarily closed incisions has been increasing, and our results indicate that it is superior to standard surgical dressings in preventing surgical site infections and other wound complications in colorectal surgeries.
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Affiliation(s)
- Nasser A AlJoaib
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Faisal A Alghamdi
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Batoul N AlEdwani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Zeead M AlGhamdi
- Department of Thoracic Surgery, Imam Abdulrahman Bin Faisal University, Khobar, SAU
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23
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Ravindhran B, Schafer N, Howitt A, Carradice D, Smith G, Chetter I. Molecular mechanisms of action of negative pressure wound therapy: a systematic review. Expert Rev Mol Med 2023; 25:e29. [PMID: 37853784 DOI: 10.1017/erm.2023.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Negative pressure wound therapy (NPWT) has significantly advanced wound care and continues to find new applications. Its effects at a molecular level however, remain a subject of debate. The aim of this systematic review is to summarize the current evidence regarding the molecular mechanisms of action of NPWT. Medline, Embase, EBSCO databases and clinical trial registries were searched from inception to January 2023. Clinical studies, animal models or in-vitro studies that quantitatively or semi-quantitatively evaluated the influence of NPWT on growth factors, cytokine or gene-expression in the circulation or wound-bed were included. Risk of Bias assessment was performed using the RoBANS tool for non-randomized studies, the COCHRANE's Risk of Bias 2(ROB-2) tool for randomized clinical studies, OHAT tool for in-vitro studies or the SYRCLE tool for animal model studies. A descriptive summary was collated and the aggregated data is presented as a narrative synthesis. This review included 19 clinical studies, 11 animal studies and 3 in-vitro studies. The effects of NPWT on 43 biomarkers and 17 gene expressions were studied across included studies. NPWT stimulates modulation of numerous local and circulating cytokines and growth factor expressions to promote an anti-inflammatory profile. This is most likely achieved by downregulation of TNFα, upregulation of VEGF, TGF-β and fibronectin.
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Affiliation(s)
- Bharadhwaj Ravindhran
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
- Department of Health Sciences, University of York, York, UK
| | - Nicole Schafer
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Annabel Howitt
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | | | - George Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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24
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Groenen H, Jalalzadeh H, Buis DR, Dreissen YE, Goosen JH, Griekspoor M, Harmsen WJ, IJpma FF, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, de Jonge SW, Orsini RG, Eskes AM, Wolfhagen N, Boermeester MA. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine 2023; 62:102105. [PMID: 37538540 PMCID: PMC10393772 DOI: 10.1016/j.eclinm.2023.102105] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Background The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA). Methods PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995. Findings We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. Interpretation In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence. Funding Dutch Association for Quality Funds Medical Specialists.
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Affiliation(s)
- Hannah Groenen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Hasti Jalalzadeh
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Dennis R. Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Yasmine E.M. Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jon H.M. Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Wouter J. Harmsen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Frank F.A. IJpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Division of Trauma Surgery, Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Maarten J. van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Roald R. Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, Netherlands
- Dutch Association of Anesthesiology (NVA), Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wil C. van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, Maastricht, Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Ricardo G. Orsini
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
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25
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Iliev IE, Koutny-Adensamer AM, Herbst F, Dauser B. A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5160. [PMID: 37547350 PMCID: PMC10400055 DOI: 10.1097/gox.0000000000005160] [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: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023]
Abstract
In some patients with chronic wounds, the surrounding skin is so injured due to various underlying conditions that negative pressure dressing cannot be applied or cannot function properly. Having faced this problem in our everyday practice, we developed a new skin-sparing technique for vacuum-assisted wound closure, which ensures that the peri-wound skin does not come into contact with the transparent adhesive films. Methods For 9 months (April-December 2022), we performed 32 vacuum wound dressings with the newly developed technique using the 3M ActiV.A.C. Therapy Unit and accessories, and Convatec's VARIHESIVE, avoiding skin contact with the adhesive films. Results Seven patients with 11 wounds who had sensitive skin or allergy to the conventionally used adhesive films were successfully treated with the new technique. The negative pressure wound dressings remained intact and functioned properly for up to 168 hours without compromising patients' daily activities and therapy. Conclusion The novel "no foil-to-skin contact" technique for vacuum-assisted wound closure can successfully be incorporated in the treatment of patients in whom conventional negative pressure dressings are otherwise not applicable.
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Affiliation(s)
- Iliyan Emilov Iliev
- From the Department of Surgery, St. John of God’s Hospital Vienna, Vienna, Austria
| | | | - Friedrich Herbst
- From the Department of Surgery, St. John of God’s Hospital Vienna, Vienna, Austria
| | - Bernhard Dauser
- From the Department of Surgery, St. John of God’s Hospital Vienna, Vienna, Austria
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26
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Quacinella MA, Yong TM, Obremskey WT, Stinner DJ. Negative pressure wound therapy: Where are we in 2022? OTA Int 2023; 6:e247. [PMID: 37448565 PMCID: PMC10337842 DOI: 10.1097/oi9.0000000000000247] [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: 11/23/2022] [Accepted: 12/22/2022] [Indexed: 07/15/2023]
Abstract
The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures. Many adjuvants have been engineered into newer generations of NPWT devices such as wound instillation of fluid or antibiotics allowing surgeons to further optimize the wound healing environment or aid in the eradication of infection. This review discusses the recent relevant literature on the proposed mechanisms of action, available adjuvants, and the required components needed to safely apply NPWT. The supporting evidence for the use of NPWT in traumatic extremity injuries, infection control, and wound care is also reviewed. Although NPWT has a low rate of complication, the surgeon should be aware of the potential risks associated with its use. Furthermore, the expanding indications for the use of NPWT are explored, and areas for future innovation and research are discussed.
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27
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Matar DY, Ng B, Darwish O, Wu M, Orgill DP, Panayi AC. Skin Inflammation with a Focus on Wound Healing. Adv Wound Care (New Rochelle) 2023; 12:269-287. [PMID: 35287486 PMCID: PMC9969897 DOI: 10.1089/wound.2021.0126] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Significance: The skin is the crucial first-line barrier against foreign pathogens. Compromise of this barrier presents in the context of inflammatory skin conditions and in chronic wounds. Skin conditions arising from dysfunctional inflammatory pathways severely compromise the quality of life of patients and have a high economic impact on the U.S. health care system. The development of a thorough understanding of the mechanisms that can disrupt skin inflammation is imperative to successfully modulate this inflammation with therapies. Recent Advances: Many advances in the understanding of skin inflammation have occurred during the past decade, including the development of multiple new pharmaceuticals. Mechanical force application has been greatly advanced clinically. Bioscaffolds also promote healing, while reducing scarring. Critical Issues: Various skin inflammatory conditions provide a framework for analysis of our understanding of the phases of successful wound healing. The large burden of chronic wounds on our society continues to focus attention on the chronic inflammatory state induced in many of these skin conditions. Future Directions: Better preclinical models of disease states such as chronic wounds, coupled with enhanced diagnostic abilities of human skin, will allow a better understanding of the mechanism of action. This will lead to improved treatments with biologics and other modalities such as the strategic application of mechanical forces and scaffolds, which ultimately results in better outcomes for our patients.
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Affiliation(s)
- Dany Y. Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brian Ng
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Oliver Darwish
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, California Northstate University College of Medicine, Elk Grove, California, USA
| | - Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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28
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Wen Y, Wang C, Jia H, Liu T, Yu J, Zhang M. Comparison of diagnosis and treatment of MSSA and MRSA osteomyelitis in children: a case-control study of 64 patients. J Orthop Surg Res 2023; 18:197. [PMID: 36915118 PMCID: PMC10012508 DOI: 10.1186/s13018-023-03670-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND We aimed to compare the clinical characteristics of acute osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) in children. METHODS We retrospectively analyzed the data of 64 children treated between September 2017 and June 2021. Based on the bacterial culture results, they were divided into MRSA and MSSA infection groups. Both groups were treated with debridement and vacuum-assisted closure for negative pressure drainage. Parameters including clinical manifestations, number of operations, length of hospital stay, inflammatory indicators, and concurrent arthritis were compared between the two groups. RESULTS In the MRSA infection group, there was one case each of residual joint stiffness and pathological fracture. Conversely, the MSSA group had two cases of residual joint stiffness. The MRSA infection group was more prone to high fever (t = 3.61, P = 0.001), white blood cell count elevation (t = 2.41, P = 0.022), arthritis (X2 = 7.48, P = 0.013), metastatic abscess (X2 = 4.78, P = 0.042), and a shorter length of progression from onset to admission (t = - 2.04, P = 0.046); however, it required more surgeries (t = 2.68, P = 0.009) and longer hospital stay (t = 2.04, P = 0.045). CONCLUSIONS Pediatric acute osteomyelitis caused by MRSA is more prone to cause high fever and markedly elevated of white blood cell count, and is often accompanied with suppurative infection of adjacent joints and metastatic abscesses, thus requiring more surgeries and longer hospital stay.
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Affiliation(s)
- Yuwei Wen
- Department of Orthopaedics, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56, Nalishi Road, Beijing, 100045, China
| | - Chunhua Wang
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China.
| | - Haiting Jia
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China
| | - Tao Liu
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China
| | - Jiazhi Yu
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China
| | - Mengyuan Zhang
- Department of Peking Union Medical College, Class of 2025, Beijing, 100730, China
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29
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Bueno-Lledó J, Martinez-Hoed J, Bonafe-Diana S, Pous-Serrano S. Mesh Infection After Hernia Repair and Negative Pressure Wound Therapy. A Systematic Review. World J Surg 2023; 47:1495-1502. [PMID: 36802233 DOI: 10.1007/s00268-023-06943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Surgical mesh infection (SMI) after abdominal wall hernia repair (AWHR) is a challenging and highly debated clinical problem with no current consensus. The purpose of this review was to analyze the literature about the use of negative pressure wound therapy (NPWT) in the management of the conservative treatment of SMI and report results about infected mesh salvage. METHODS A systematic review of EMBASE and PUBMED was performed describing the use of NPWT in patients with SMI following AWHR. Reviewed articles evaluating data about the association between clinical, demographic, analytic and surgical characteristics about SMI after AWHR were analyzed. The high heterogeneity of these studies did not allow a meta-analysis of outcomes. RESULTS The search strategy yielded 33 studies from PubMed, and 16 studies from EMBASE. NPWT was performed in 230 patients across 9 studies being achieved the mesh salvage in 196 (85.2%). Of these 230 cases, 46% were polypropylene (PPL), 9.9% polyester (PE), 16.8% polytetrafluoroethylene (PTFE), 4% biologic and 10.2% composite mesh (PPL and PTFE). Infected mesh location was onlay (43%), retromuscular (22%), preperitoneal (19%), intraperitoneal (10%) and between the oblique muscles (5%). The better option on salvageability with the use of NPWT was the combination of macroporous PPL mesh in an extraperitoneal position (19.2% onlay, 23.3% preperitoneal, 48.8% retromuscular). CONCLUSION NPWT is a sufficient approach to treat SMI following AWHR. In most cases, infected prostheses can be salvaged with this management. Further studies with a larger sample size are needed to confirm our analysis results.
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Affiliation(s)
- Jose Bueno-Lledó
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain.
| | | | - Santiago Bonafe-Diana
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain
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30
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Wu M, Matar DY, Yu Z, Chen Z, Knoedler S, Ng B, Darwish O, Haug V, Friedman L, Orgill DP, Panayi AC. Modulation of Lymphangiogenesis in Incisional Murine Diabetic Wound Healing Using Negative Pressure Wound Therapy. Adv Wound Care (New Rochelle) 2023. [PMID: 36424821 DOI: 10.1089/wound.2022.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: Despite the significant function of lymphatics in wound healing, and frequent clinical use of Negative Pressure Wound Therapy (NPWT), the effect of mechanical force application on lymphangiogenesis remains to be elucidated. We utilize a murine incisional wound healing model to assess the mechanisms of lymphangiogenesis following NPWT. Approach: Dorsal incisional skin wounds were created on diabetic mice (genetically obese leptin receptor-deficient mice [db/db]; n = 30) and covered with an occlusive dressing (Control, n = 15) or NPWT (-125 mmHg, continuous, 24 h for 7 days; NPWT, n = 15). The wounds were macroscopically assessed for 28 days. Tissue was harvested on day 10 for analysis. Qualitative functional analysis of lymphatic drainage was performed on day 28 using Evans Blue staining (n = 2). Results: NPWT increased lymphatic vessel density (40 ± 20 vs. 12 ± 6 podoplanin [PDPN]+ and 25 ± 9 vs. 14 ± 8 lymphatic vessel endothelial receptor 1 [LYVE-1]+) and vessel diameter (28 ± 9 vs. 12 ± 2 μm). Western blotting verified the upregulation of LYVE-1 with NPWT. Leukocyte presence was higher with NPWT (22% ± 3.7% vs. 9.1% ± 4.1% lymphocyte common antigen [CD45]+) and the leukocytes were predominately B cells clustered within vessels (8.8% ± 2.5% vs. 18% ± 3.6% B-lymphocyte antigen CD20 [CD20]+). Macrophage presence was lower in the NPWT group. Lymphatic drainage was increased in the NPWT group, which exhibited greater Evans Blue positivity. Innovation: The lymphangiogenic effects take place independent of macrophage infiltration, appearing to correlate with B cell presence. Conclusion: NPWT promotes lymphangiogenesis in incisional wounds, significantly increasing the lymph vessel density and diameter. This study highlights the potential of NPWT to stimulate lymphatic drainage and wound healing of surgical incisions.
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Affiliation(s)
- Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dany Y Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Zhen Yu
- Opthalmology Department, Shenzhen Eye Hospital, Shenzhen Key Ophthalmic Laboratory, Jinan University, Shenzhen, China.,Angiogenesis Laboratory, Ophthalmology Department, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ziyu Chen
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Brian Ng
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Oliver Darwish
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, California Northstate University College of Medicine, Elk Grove, California, USA
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Leigh Friedman
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Lehigh University, Bethlehem, Pennsylvania, USA.,Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Tingting S, Xinyue F, Tiantian Y, xiao A, Rui L, Feng L, Daohong L, Zhirui L, Guoqi W. Comparison of the effects of negative pressure wound therapy and negative pressure wound therapy with instillation on wound healing in a porcine model. Front Surg 2023; 10:1080838. [PMID: 37139193 PMCID: PMC10149976 DOI: 10.3389/fsurg.2023.1080838] [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: 10/26/2022] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
Background Negative pressure wound therapy with instillation (NPWTi) is a novel method based on standard negative pressure wound therapy (NPWT). This study aimed to compare the effects of standard NPWT and NPWTi on bioburden and wound healing in a Staphylococcus aureus (S.aureus) infected porcine model. Methods Green fluorescent protein-labeled S.aureus infected wounds were created on the back of porcine. Wounds were treated with NPWT or NPWT with instillation (saline). The tissue specimens were harvested on days 0 (12 h after bacterial inoculation), 2, 4, 6, and 8 at the center of wound beds. Viable bacterial counts, laser scanning confocal microscopy, PCR, western blot, and histological analysis were performed to assess virulence and wound healing. Results The bacterial count in the NPWTi group was lower than that of the NPWT group and the difference was statistically significant on day 2, day 4, day 6, and day 8 (P < 0.05). The expression levels of agrA, Eap, Spa, and Hla genes of the NPWTi group were significantly lower than that of the NPWT group on day 8 (P < 0.05). The bacterial invasion depth of the NPWTi group was significantly lower than that of the NPWT group on day 2, day 4, day 6, and day 8 (P < 0.05). Though the NPWTi group showed a significantly increased expression of bFGF and VEGF than that of the NPWT group in the early time (P < 0.05), NPWTi cannot lead to better histologic parameters than the NPWT group (P > 0.05). Conclusion Our results demonstrated that NPWTi induced a better decrease in bacterial burden and virulence compared with standard NPWT. These advantages did not result in better histologic parameters on the porcine wound model.
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Affiliation(s)
- Sun Tingting
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Feng Xinyue
- Department of Dermatology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yang Tiantian
- Department of Anesthesiology, Wenchang People’s Hospital, Wenchang, China
| | - An xiao
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Li Rui
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Lin Feng
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- Correspondence: Wang Guoqi Li Zhirui Liu Daohong Lin Feng
| | - Liu Daohong
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, The Eighth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing, China
- Correspondence: Wang Guoqi Li Zhirui Liu Daohong Lin Feng
| | - Li Zhirui
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing, China
- Correspondence: Wang Guoqi Li Zhirui Liu Daohong Lin Feng
| | - Wang Guoqi
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing, China
- Department of Pediatric, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Senior Department of Pediatric, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- Correspondence: Wang Guoqi Li Zhirui Liu Daohong Lin Feng
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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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Wang G, Xu H, Xu G, Zhang H, Li Z, Liu D. Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta‐analysis of randomised controlled trials. Int Wound J 2022; 20:1739-1749. [PMID: 36519410 PMCID: PMC10088847 DOI: 10.1111/iwj.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.
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Affiliation(s)
- Guoqi Wang
- Department of Pediatric The First Medical Center of Chinese PLA General Hospital Beijing China
- Senior Department of Pediatric The Seventh Medical Center of Chinese PLA General Hospital Beijing China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation Beijing China
| | - Haiyan Xu
- Department of Pharmacy Medical Supplies Center of Chinese PLA General Hospital Beijing China
| | - Gaoxiang Xu
- Department of Orthopedics The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Hao Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation Beijing China
| | - Zhirui Li
- Department of Orthopedics Hainan Hospital of Chinese PLA General Hospital Sanya China
| | - Daohong Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation Beijing China
- Senior Department of Orthopedics The Fourth Medical Center of PLA General Hospital Beijing China
- Department of Orthopedics The Eighth Medical Center of PLA General Hospital Beijing China
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Yang L, Rong GC, Wu QN. Diabetic foot ulcer: Challenges and future. World J Diabetes 2022; 13:1014-1034. [PMID: 36578870 PMCID: PMC9791573 DOI: 10.4239/wjd.v13.i12.1014] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/07/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulcers (DFUs) have become one of the important causes of mortality and morbidity in patients with diabetes, and they are also a common cause of hospitalization, which places a heavy burden on patients and society. The prevention and treatment of DFUs requires multidisciplinary management. By controlling various risk factors, such as blood glucose levels, blood pressure, lipid levels and smoking cessation, local management of DFUs should be strengthened, such as debridement, dressing, revascularization, stem cell decompression and oxygen therapy. If necessary, systemic anti-infection treatment should be administered. We reviewed the progress in the clinical practice of treating DFUs in recent years, such as revascularization, wound repair, offloading, stem cell transplantation, and anti-infection treatment. We also summarized and prospectively analyzed some new technologies and measurements used in the treatment of DFUs and noted the future challenges and directions for the development of DFU treatments.
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Affiliation(s)
- Li Yang
- Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
| | - Gui-Chuan Rong
- Department of Gynaecology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
| | - Qi-Nan Wu
- Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
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Souza SCD, Mendes CMC, Meneses JVL, Dias RM. Simplified vacuum dressing system: effectiveness and safety in wounds management. Acta Cir Bras 2022; 37:e370906. [PMID: 36515315 DOI: 10.1590/acb370906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Negative pressure wound therapy (NPWT) has revolutionized wound care, but its high cost reduces the procedure's availability. To solve the problem, streamlined vacuum dressings systems have been proposed, but the utility of these devices has been poorly studied. The objective of this study was to evaluate a simplified vacuum dressing system model (SVDM). METHODS Randomized clinical trial in which wounds were treated with SVDM compared to a complex occlusive dressing (silver hydrofiber, SHF). The analyzed outcomes were cleaning, presence of granulation tissue, clinical appearance, and indication for surgical closure of wounds. RESULTS Fifty injuries were treated (25 in each group), most located on lower limbs. SVDM proved to be more effective than SHF in the evaluated outcomes. Wound recalcitrance reduced the effectiveness of the equipment used. Despite its efficacy, complications occurred, the most frequent related to dressing changes: minor bleeding, foam adherence to a wound bed, and pain. Only for bleeding no favorable risk-benefit ratio was found. There were no severe complications, worsening conditions of injuries, or deaths. CONCLUSIONS SVDM proved to be an effective and acceptably safe device for managing studied wounds.
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Affiliation(s)
- Sandro Cilindro de Souza
- Ph.D. Universidade Federal da Bahia - Instituto de Ciências de Saúde - Programa de Pós-Graduação - Salvador (BA), Brazil
| | - Carlos Maurício Cardeal Mendes
- Ph.D. Universidade Federal da Bahia - Instituto de Ciências de Saúde - Programa de Pós-Graduação - Salvador (BA), Brazil
| | - José Valber Lima Meneses
- Ph.D. Universidade Federal da Bahia - Faculdade de Medicina - Departamento de Cirurgia Plástica - Salvador (BA), Brazil
| | - Rosana Menezes Dias
- Nurse. Secretaria da Saúde do Estado da Bahia - Hospital Carvalho Luz - Salvador (BA), Brazil
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36
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The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: A systematic review and meta-analysis. HPB (Oxford) 2022; 24:2035-2044. [PMID: 36244906 DOI: 10.1016/j.hpb.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Surgical site infections (SSI) cause significant morbidity. Prophylactic negative pressure wound therapy (NPWT) may promote wound healing and decrease SSI. The objective is to evaluate the effect of prophylactic NPWT on SSI in patients undergoing pancreatectomy. METHODS Electronic databases were searched from inception until April 2022. Randomized controlled trials (RCTs) comparing prophylactic NPWT to standard dressings in patients undergoing pancreatectomy were included. The primary outcome was the risk of SSI. Secondary outcomes included the risk of superficial and deep SSI and organ space infection (OSI). Random effects models were used for meta-analysis. RESULTS Four single-centre RCTs including 309 patients were identified. Three studies were industry-sponsored, and two were at high risk of bias. There was no significant difference in the risk of SSI in patients receiving NPWT vs. control (14% vs. 21%, RR = 0.72, 95%CI = 0.32-1.60, p = 0.42, I2 = 53%). Likewise, there was no significant difference in the risk of superficial and deep SSI or OSI. No significant difference was found on subgroup analysis of patients at high risk of wound infection or on sensitivity analysis of studies at low risk of bias. CONCLUSION Prophylactic NPWT does not significantly decrease the risk of SSI among patients undergoing pancreatectomy. Insufficient evidence exists to justify the routine use of NPWT.
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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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38
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Park JH, Park JU. Flap monitoring with incisional negative pressure wound therapy (NPWT) in diabetic foot patients. Sci Rep 2022; 12:15684. [PMID: 36127377 PMCID: PMC9489718 DOI: 10.1038/s41598-022-20088-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer. However, flap reconstruction for diabetic foot ulcer treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperative monitoring procedure implemented in conjunction with negative pressure wound therapy immediately after flap operations for treating diabetic foot. A retrospective analysis was performed on diabetic foot patients who underwent free flaps and perforator flaps from March 2019 through August 2021. The surgical outcomes of interest were the rates of survival and complications. On the third postoperative day, patients underwent computed tomography angiography to check for pedicle compression or fluid collection in the sub-flap plane. Monitoring time, as well as comparisons between NPWT and conventional methods, were analyzed. Statistical analysis was performed between the two groups. This study included 26 patients. Among patients, the negative pressure wound Therapy treated group included 14 flaps and the conventional monitoring group included 12 flaps. There was no significant intergroup difference in flap survival rate (p = 0.83). In addition, there was no significant intergroup difference in the diameters of perforators or anastomosed vessels before and after negative pressure wound therapy (p = 0.97). Compared with conventional monitoring, flap monitoring with incisional negative pressure wound therapy was associated with a significantly lower mean monitoring time per flap up to postoperative day 5. Although conventional monitoring is widely recommended, especially for diabetic foot ulcer management, the novel incisional negative pressure wound therapy investigated in this study enabled effortless serial flap monitoring without increasing complication risks. The novel flap monitoring technique is efficient and safe for diabetic foot patients and is a promising candidate for future recognition as the gold standard for flap monitoring.
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Affiliation(s)
- Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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The Utility of Closed Incision Negative Pressure Wound Therapy following Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 168:258-267.e1. [PMID: 36116727 DOI: 10.1016/j.wneu.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine if closed incision negative pressure wound therapy (ciNPWT) decreases surgical site infection (SSI) or wound dehiscence following spinal fusion. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic review and meta-analysis was conducted to identify studies utilizing ciNPWT following spinal fusion. Funnel plots and quality scores of the articles were performed to determine if the articles were at risk of bias. Forest plots were conducted to identify the treatment effect of ciNPWT following spinal fusion. RESULTS A total of 8 studies comprising 1,061 patients who received ciNPWT or a standard postoperative dressing following spinal fusion were included. The rate of SSI [ciNPWT: 4.49% (95% CI: 2.48, 8.00) vs. control: 11.32% (95% CI: 7.51, 16.70), p=0.0103] was significantly lower for patients treated with ciNPWT. A fixed-effects model showed no significant difference between patients who received ciNWPT or a standard postoperative dressing with respect to requiring reoperations for wound debridement (OR: 1.25, 95% CI: 0.64, 2.41). Additionally, wound dehiscence was not significantly different between the two groups although it was non-significantly lower in ciNWPT-treated patients [ciNPWT: 4.59% (95% CI: 2.49, 8.31) vs control: 7.48% (95% CI: 4.38, 12.47), p=0.23]. CONCLUSION Closed incision NPWT may reduce the rates of SSI following spinal fusion. The use of ciNWPT may also significantly reduce the burden associated with postoperative wound complications, but the meta-analysis was insufficiently powered to make this association. Additional, studies may identify a subset of patients who benefit from ciNPWT for other wound-related complications.
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40
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Agarwal A. Evolution of Negative Pressure Wound Therapy in Orthopaedic Trauma. J Orthop Trauma 2022; 36:S1-S5. [PMID: 35994301 DOI: 10.1097/bot.0000000000002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
Negative Pressure Wound Therapy (NPWT) has evolved from open wound management to now include closed incision management. It has been a major advance in the management of open wounds and closed incisional wounds especially in orthopaedic trauma surgery. Because of the success of NPWT in the late 1990s and early 2000s, surgeons began using NPWT with adjuncts on closed incisions as a way to help prevent surgical wound dehiscence especially in at-risk patients for wound problems. It has been well established that obesity, diabetes, and smoking in addition to other comorbidities increase the risk of wound dehiscence and surgical site infections in orthopaedic patients. It is widely used for open wound management, often associated with open fractures, and in the mitigation of risk of surgical site infections over closed incisions (incisional negative pressure wound therapy). Newer systems allow the use of various topical wound solutions to be instilled in conjunction with NPWT, termed NPWTi-d. This has shown promising results in difficult wounds that may be resistant to standard NPWT. This article reviews the evolution and use of NPWT in orthopaedic trauma.
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Affiliation(s)
- Animesh Agarwal
- Division of Orthopaedic Trauma, University of Texas Health Science Center at San Antonio, Department of Orthopaedics, San Antonio, TX
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41
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Bueno-Lledó J, Martínez-Hoed J, Pous-Serrano S. Negative pressure therapy in abdominal wall surgery. Cir Esp 2022; 100:464-471. [PMID: 35584763 DOI: 10.1016/j.cireng.2022.05.017] [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: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 06/15/2023]
Abstract
Negative pressure wound therapy (NPWT) is widely known in surgical practice. The initial indications for NPWT were chronic wounds, especially diabetic foot, vascular and decubitus ulcers, and infected traumatic wounds. Nowadays, the use has been widely increased. Although in the field of abdominal wall surgery, it has mainly been used in the treatment of surgical wound complications after hernia repair, other indications have been added after years of experience in the management of NPWT. Therefore, the aim of this article is to analyze and review the main indications of NPWT in abdominal wall surgery, as well as the advantages obtained with its application.
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Affiliation(s)
- José Bueno-Lledó
- Unidad de Cirugía de Pared Abdominal, Hospital Universitari i Politècnic La Fe, Universidad de Valencia, Valencia, Spain.
| | | | - Salvador Pous-Serrano
- Unidad de Cirugía de Pared Abdominal, Hospital Universitari i Politècnic La Fe, Universidad de Valencia, Valencia, Spain
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42
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Negative Pressure Wound Therapy Prevents Hernia Recurrence in Simultaneous Ventral Hernia Repair and Panniculectomy. Plast Reconstr Surg Glob Open 2022; 10:e4171. [PMID: 35265446 PMCID: PMC8901215 DOI: 10.1097/gox.0000000000004171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN.
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43
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Putri IL, Adzalika LB, Pramanasari R, Wungu CDK. Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta-analysis of observational studies and randomised controlled trials. Int Wound J 2022; 19:1578-1593. [PMID: 35112467 PMCID: PMC9493220 DOI: 10.1111/iwj.13756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/08/2022] [Indexed: 12/01/2022] Open
Abstract
The application of negative pressure wound therapy (NPWT) in cancer surgical wounds is still controversial, despite its promising usage, because of the risks of increased tumorigenesis and metastasis. This study aimed to review the risks and benefits of NPWT in surgical wounds with the underlying malignant disease compared with conventional wound care (CWC). The first outcome was wound complications, divided into surgical site infection (SSI), seroma, hematoma, and wound dehiscence. The secondary outcome was hospital readmission. We performed a separate meta‐analysis of observational studies and randomised controlled trials (RCTs) with CI 95%. Thirteen observational studies with 1923 patients and seven RCTs with 1091 patients were included. NPWT group showed significant decrease in the risk of SSI (RR = 0.45) and seroma (RR = 0.61) in observational studies with P value <0.05, as well as RCTs but were not significant (RR = 0.88 and RR = 0.68). Wound dehiscence (RR = 0.74 and RR = 1.15) and hospital readmission (RR = 0.90 and RR = 0.62) showed lower risks in NPWT group but were not significant. Hematoma (RR = 1.08 and RR = 0.87) showed no significant difference. NPWT is not contraindicated in cancer surgical wounds and can be considered a beneficial palliative treatment to promote wound healing.
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Affiliation(s)
- Indri Lakhsmi Putri
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, Indonesia
| | - Lavonia Berlina Adzalika
- Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, Indonesia
| | - Rachmaniar Pramanasari
- Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Wolfsberger CH, Maitz E, Schmachtl P, Winkler S, Luschnig D, Sigl E, Heinzle A, Gamerith C, Tuca AC, Schintler MV. Feasibility of collecting wound fluid during ongoing negative pressure wound therapy by the use of an additional container - A prospective observational study. Int Wound J 2021; 19:1133-1140. [PMID: 34939308 PMCID: PMC9284636 DOI: 10.1111/iwj.13709] [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: 08/19/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Negative‐pressure‐wound‐therapy is commonly used in clinical routine for wound management. Aim of the present study was to assess the feasibility and safety of using an additional container to collect wound fluid during ongoing negative‐pressure‐wound‐therapy. In this present prospective observational study, patients with negative‐pressure‐wound‐therapy were included. An additional container was inserted in the connecting tube between the wound and the vacuum generating device. The following 3 days, the container was changed daily and replaced by a new one. Further safety outcome parameters were assessed. A questionnaire was answered by the responsible surgeon. Twenty‐two patients with negative‐pressure‐wound‐therapy with a median (IQR) age of 58.5 (53.0‐70.0) years were included in the present study. In median, the duration of negative‐pressure‐wound‐therapy was 5.0 (4.6‐5.5) days. In mean ± SD the collected volume of the wound fluid in millilitres (mL) was on day one 7 ± 4 on day two 8 ± 7 and 10 ± 11 on day three. In one patient, there was <0.1 mL of clear water in the additional container. No safety concerns due to the additional container were observed. This study demonstrates that collecting wound fluid during ongoing negative‐pressure‐wound‐therapy over a time period of 3 days is feasible and safe. No safety concerns were observed.
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Affiliation(s)
- Christina Helene Wolfsberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Plastic, Aesthetic and Reconstructive Medicine, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Emanuel Maitz
- Division of General Otorhinolaryngology, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Philipp Schmachtl
- Division of Plastic, Aesthetic and Reconstructive Medicine, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | | | - Eva Sigl
- Qualizyme Diagnostics GmbH & Co KG, Graz, Austria
| | | | | | - Alexandru-Cristian Tuca
- Division of Plastic, Aesthetic and Reconstructive Medicine, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Michael V Schintler
- Division of Plastic, Aesthetic and Reconstructive Medicine, Department of Surgery, Medical University of Graz, Graz, Austria
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Borejsza-Wysocki M, Bobkiewicz A, Francuzik W, Krokowicz L, Walczak D, Szmeja J, Banasiewicz T. Effect of closed incision negative pressure wound therapy on incidence rate of surgical site infection after stoma reversal: a pilot study. Wideochir Inne Tech Maloinwazyjne 2021; 16:686-696. [PMID: 34950263 PMCID: PMC8669980 DOI: 10.5114/wiitm.2021.106426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The stoma reversal (SR) procedure is associated with a relatively high risk of perioperative complications with surgical site infection (SSI) as the most common. Recently closed incision negative pressure wound therapy (ciNPWT) was applied widely to prevent SSI. AIM To investigate the efficiency of ciNPWT in terms of the incidence rate of SSI after SR surgery. MATERIAL AND METHODS As an exploratory observational cohort study patients were treated either with ciNPWT (n = 15) or standard sterile dressing (SSD) (n = 15). CiNPWT was applied every 3 days whereas SSD was changed every day. Clinical evaluation for SSI signs, C-reactive protein level and pain assessment using the visual analogue scale (VAS) were analyzed. RESULTS The incidence rate of SSI was in 13% (2/15) in the ciNPWT group and 26% (4/15) in the SSD group (p = 0.651, OR = 0.44, 95% CI: 0.03-3.73). All patients in the SSD group who developed SSI presented both local and generalized signs of infection. Pain-VAS levels assessed on the 1st (MdnciNPWT = 4, MdnSSD = 5, p = 0.027, W = 51.5) and 3rd postoperative day (MdnciNPWT = 2, MdnSSD = 4, p = 0.014, W = 45.5) were significantly lower in the ciNPWT group than in the SSD group. CONCLUSIONS CiNPWT seems not to have a benefit to reduce SSI after the SR procedure. Further investigation is needed to establish firmly the benefit of using ciNPWT in this group of patients.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Francuzik
- Department of Dermatology, Venerology and Allergology Charité – Universitätsmedizin, Berlin, Germany
| | - Lukasz Krokowicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Dominik Walczak
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Gliwice, Poland
| | - Jacek Szmeja
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Kim TH, Park JH. A novel negative pressure wound therapy (NPWT) monitoring system for postoperative flap management. Medicine (Baltimore) 2021; 100:e27671. [PMID: 34871244 PMCID: PMC8568380 DOI: 10.1097/md.0000000000027671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Various types of flaps are widely utilized as reconstructive options for patients with soft tissue defects. However, the postoperative monitoring of the flap requires a large amount of time and effort. The aim of this study was to evaluate the efficacy and safety of this novel monitoring procedure using negative pressure wound therapy (NPWT) immediately after the flap operations.A retrospective analysis was performed on patients who underwent free flaps and perforator flaps from March 2019 to December 2020. The flaps were managed by either novel NPWT method or conventional dressing. Among NPWT group, computed tomography angiography was performed in randomly selected 5 flaps on the third postoperative day for evaluation of pedicle compression. Statistical analysis was performed between the 2 groups.A total of 54 flaps were included in this study. Twenty seven flaps were managed using novel NPWT method and 27 flaps were managed using conventional dressing. There was no statistically significant difference in flap survival rates between the 2 groups (P = .91). The patency of flap pedicles in the NPWT group was confirmed by comparing the computed tomography angiography findings. The estimated total flap monitoring time and cost for 5 days was significantly decreased by the application of the novel NPWT monitoring system.Through the application of the novel postoperative monitoring system using NPWT, there is efficient evaluation of the flap. Furthermore, safe flap monitoring is possible with the reduced risk of infection by the avoidance of multiple manual dressing performed in the conventional method.
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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: 1] [Impact Index Per Article: 0.3] [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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Moog P, Jensch M, Betzl J, Bauer AT, Cerny MK, Schmauss D, Kükrek H, Erne H, Machens HG, Megerle K. Bacterial bioburden of wounds: influence of debridement and negative-pressure wound therapy (NPWT). J Wound Care 2021; 30:604-611. [PMID: 34382852 DOI: 10.12968/jowc.2021.30.8.604] [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: 11/11/2022]
Abstract
OBJECTIVE To clarify the role of microbiological swabs in surgical decision-making, we investigated the effect of negative-pressure wound therapy (NPWT) and serial surgical debridement on bacterial bioburden in hard-to-heal wounds and ultimately correlated them with the success of surgical closure. METHOD All patients were treated with surgical debridement, jet lavage and NPWT before their wounds were finally closed. The treatment effect was assessed by correlating microbiological swabs obtained immediately after intervention with those obtained after removal of the dressings during the following surgical procedures. The result of the last microbiological swab taken before definitive surgical closure was correlated with the requirement for revision surgery. RESULTS We included the results of 704 microbiological swabs from 97 patients in 110 wound localisations in this monocentric, retrospective study. NPWT did not improve bacterial bioburden in 77% of cases and the duration of NPWT did not affect the result. Furthermore, no significant effect of NPWT could be found for either anaerobic (p=0.96) or aerobic bacteria (p=0.43). In contrast, surgical debridement decreased bacterial load in approximately 60% of cases. If sterile wound swabs could be obtained at all, it was during the first four surgical debridements in 60% of patients; after that only 10% became sterile. CONCLUSIONS Sterile microbiological wound swabs before surgical closure were associated with lower rates of revision surgery, while low or medium bacterial loads did not increase revision rates.
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Affiliation(s)
- Philipp Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Maryna Jensch
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Julia Betzl
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Anna-Theresa Bauer
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Michael K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Daniel Schmauss
- Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Haydar Kükrek
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Holger Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Hans-Günther Machens
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
| | - Kai Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, D-81675, Munich, Germany
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