Enhanced wound healing of deep wound dehiscence and fistula in abdominal tuberculosis, with negative pressure wound therapy and split-thickness skin graft: an evidence-based case report

要旨皮膚欠損を伴う創傷においては，創傷治癒を促進するために局所陰圧閉鎖療法（NPWT）が一般的に行われているが感染創に対しては使用できない。今回，下肢の救済が困難と思われた壊死性筋膜炎に対し創内持続陰圧洗浄療法（IW–CONPIT）とNPWTを用いて治療を行い，最終的に植皮術で治癒し下肢を救済し得た1例を経験した。患者は67歳男性で糖尿病を指摘されるも未治療であった。8日前より右下腿の発赤・腫脹が出現し，近医で抗菌薬内服による加療を行うも右下腿の発赤部より排膿を認め，当院紹介となった。血液検査で著明な炎症所見およびCTにて右下腿筋膜に沿って液体貯溜の所見を認め，壊死性筋膜炎の診断であった。入院3日目にデブリードマン施行し，連日創部の洗浄処置を行った。10日目より，まずIW–CONPITを導入し，以後，感染が沈静化したため34日目にNPWTに変更した。その後，肉芽形成が良好であったため入院55日目に全身麻酔下で分層植皮術を施行した。術後14日目には最終的に創部は完全に上皮化し歩行可能となった。感染創に対してNPWTにIW–CONPITを併用することは，感染コントロールしつつ創管理を行うことが可能であり，非常に有用な治療法であると考えられる。

NPWT combined with porcine ADM dressing can effectively remove wound bacteria, reduce wound exudation, and promote wound healing in repairing deep partial-thickness burn wounds and full-thickness burn wounds. Its clinical effect is better than NPWT or porcine ADM dressing alone, and this method may be suitable for patients with non-surgical treatment.

Background: Chronic ulcer is a type of wound, which persists for at least 3 months. One of the causes of chronic ulcer is deep vein thrombosis (DVT). Chronic ulcers require very high maintenance costs and can negatively impact the patient’s quality of life and mental health. Case Illustration: A 40-year-old man came to the hospital with a history of chronic ulcer on both legs, which first appeared 3 years ago. The Patient had undergone treatment at a public outpatient clinic and hospital, unfortunately the wound did not heal. The patient continued to change the bandage independently and did not go to the doctor for wound control. Upon doppler ultrasound, a sign of deep vein thrombosis (DVT) was observed. Negative Pressure Wound therapy (NPWT) was used for wound bed preparation, Split Thickness Skin Graft (STSG) on the left foot was used as a dressing, while conventional dressing was chosen for the right foot. The graft take on the left foot with NPWT was 95%, while the one on the right foot with conventional dressing was 90%. Discussion: Negative pressure wound therapy (NPWT) is a closed system that applies negative pressure through continuous or intermittent suction. NPWT can be used in wound bed preparation to reduce biofilm. NNPWT helps in the removal of exudates from the wound, thus preventing the build-up of serous fluids and blood, reducing the growth of bacteria at the base of the wound, which helps tissue growth after split thickness skin graft (STSG). Conclusion: NPWT stimulates better healing after surgery. The left leg, which used NPWT after STSG had faster healing time and better aesthetic result by promoting graft take. The graft take on the left leg (with NPWT) was higher compared to the right leg.

Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds

Introduction: Negative pressure wound therapy (NPWT) alone or with the addition of a split-thickness skin graft (STSG) are 2 reconstructive options available after surgical excision of axillary hidradenitis suppurativa (HS). The aim of this study was to retrospectively examine patients undergoing these treatments and to assess clinical and patient-related outcome measures. Methods: A single-centre, retrospective analysis was conducted, evaluating surgical excision of axillary HS, with STSG and NPWT, or NPWT alone. Data collected included No. of post-operative clinic visits, time to heal, size of wound, disease recurrence, follow-up time, Dermatology Life Quality Index (DLQI), the Generalised Anxiety Disorder Assessment (GAD-7), the Patient Health Questionnaire Depression Scale (PHQ-9), Pain Visual Analogue Scale (PAINVAS2), the Brief Illness Perception Questionnaire (BIPQ), and Dermatology Visual Analogue Scale (DERMVAS). Two-tailed t-test and Mann-Whitney Wilcoxon U-tests were used to assess for significant relationships. Results: One hundred five patients were included in the study, 44 who received NPWT alone, and 61 who received NPWT + STSG. There was no significant difference in follow-up time (P = .934) or No. of follow-up appointments between groups (P = .287). There was a significant difference in time to heal between groups, with STSG + NPWT observing a mean time of 2.77 months and NPWT alone observing a mean time of 4.40 months (P = .0006). There was no difference in patient-reported outcomes between the 2 groups. Conclusion: There is no difference in patient-reported outcomes with the addition of an STSG to NPWT after surgical excision of HS. Wide excision and use of NPWT alone is an effective procedure for the treatment of axillary HS.

The fibula free flap (FFF) is a mainstay in maxillofacial reconstruction, yet donor site morbidity remains a significant clinical concern. Closure technique is a key factor influencing complication rates, but comparative data remain heterogeneous. This study provides a technique-dependent analysis of 60-day donor site wound healing in FFF with skin paddles and reports a two-stage closure approach. A retrospective review of 211 patients undergoing FFF between 2017 and 2024 was conducted. Donor site complications within the first 60 postoperative days were assessed and stratified by closure technique: one-stage split-thickness skin grafting (STSG) with or without negative pressure wound therapy (NPWT), and a two-stage closure consisting of one-week NPWT followed by STSG. Multivariate logistic regression was applied to identify independent predictors for complications. Overall, 50.2% of patients experienced donor site complications, with wound healing disorders (31.8%) and (partial) skin necrosis (23.7%) most prevalent. Regarding wound closure, STSG coverage without NPWT was associated with the highest morbidity and a complication rate of 91.0%. Despite being limited in sample size, the two-stage closure, despite larger skin defects, showed complication rates comparable to one-stage closure with NPWT. Multivariate analysis identified STSG with NPWT (OR 0.1 [0.01; 0.4], p = 0.002) and two-stage closure (OR 0.1 [0.01; 0.5], p = 0.01) as protective factors for wound healing complications. Donor site morbidity following FFF harvest with skin paddles is significantly impacted by closure technique. Wound management using one- or two-stage STSG with NPWT is preferred. Initial results of the two-stage closure indicate potentially beneficial outcomes for extensive defects and warrant further prospective validation.

OBJECTIVES: This study aimed to evaluate wound outcomes following the application of negative pressure wound therapy to vulvar wounds resulting from surgical treatment of hidradenitis suppurativa (HS) or Necrotizing Fasciitis MATERIALS AND METHODS: Four patients treated at Thomas Jefferson University Hospital in Philadelphia, PA who underwent radical vulvectomies for HS or Necrotizing Fasciitis with subsequent application of negative pressure wound therapy were identified. Retrospective chart reviews of these four patients were conducted and data was collected regarding their postoperative course. These patients required extensive surgical debridement of the vulvar, perirectal, and buttock area. Following debridement, negative pressure wound therapy was placed. Patients continued to have negative pressure wound therapy dressing changes three times a week for a variable amount of time. Degree of granulation and details of wound healing were documented in patient charts. At Thomas Jefferson University Hospital negative pressure wound therapy was achieved using the Vacuum Assisted Closure Device (VAC) (KCI Inc.; San Antonio, TX). RESULTS: Most case reports on this topic have used the VAC device initially to aid in wound healing; however, complete wound closure was typically achieved using split-thickness skin grafts. Very few case reports have used the VAC device alone to achieve complete closure. Three of the four patients in our series achieved complete closure of their vulvar wounds with the VAC device alone. One patient required closure with a split thickness skin graft after the VAC device was removed. CONCLUSION: Patients with severe Hidradenitis Suppurativa and Necrotizing Fasciitis often require extensive surgical debridement. Data conflict over the optimal methods of management of post-surgical vulvar wounds. Our experience supports good outcome for complete closure of vulvar wounds with negative pressure wound therapy.

A retrospective review was done for each wound (n = 223) in all patients (n = 191) who underwent Split Thickness Skin Graft (STSG) placement in the Wound Division at Georgetown University Hospital from January 2014 to March 2017 in order to determine the factors that significantly affect STSG take. In doing so, these factors that prove to significantly affect STSG take can be used to predict the possibility of graft failure, and, thus, determine if additional measures must be taken in order to improve the success of the skin graft. Patient medical records were examined for patient demographics, comorbidities, wound parameters, wound bed prep, post-operative dressing, 30 day graft outcomes, and 60 day graft outcomes. Statistical analysis was performed to determine the significance of each factor, and further analysis was done to determine the association and risk of the statistically significant factors. Statistical analysis showed a significant association between Negative Pressure Wound Therapy (NPWT) for wound bed dressing after STSG placement and successful STSG outcome compared to use of bolster only for the post-surgical wound (χ<sup>2</sup> = 4.66, p=0.0308). The odds of STSG failure in patients who underwent NPWT were approximately 80% less than those who had bolster dressing used for their post-surgical dressing (OR = 0.203). These results indicate that NPWT after skin graft placement yields a greater success rate for split-thickness skin grafts than conventional bolster dressing. In terms of comorbidities, there was also a significant association between congestive heart failure (CHF) and STSG failure (χ<sup>2</sup> = 4.12, p=0.0422). Patients with CHF were approximately 2.55 times more likely to have their STSG fail (OR = 2.55), indicating that CHF is a good predictor of split-thickness skin graft failure. It was also found that bacterial presence and STSG failure also showed an association (χ<sup>2</sup> = 4.66, p=0.0308), in which patients with bacterial presence on the wound prior to debridement were approximately 2.89 times more likely to have STSG failure (OR = 2.89). Although bacterial presence prior to debridement showed an association with STSG failure, bacterial presence after debridement just prior to STSG placement did not show a significant correlation with STSG failure [n<sub>f</sub> = 52 (73.2%) versus n<sub>s</sub> = 95 (62.5%), (p = 0.1150)]. These results suggest that bacterial presence may also be a good predictor of graft failure, however it is possibly the strain of bacteria, not the presence of bacteria that predominantly affects skin graft take. In order to elucidate the role that bacteria plays in the success of STSG take, further experimental analysis is warranted.

A split-thickness skin graft (STSG) is one of the main tools used in the reconstruction of skin defects. Negative-pressure wound therapy (NPWT) has been widely used as adjunct therapy for wound healing for decades. Few studies have conducted the outcomes of NPWT use as a postoperative dressing for STSGs. This study aimed to compare the outcomes of the application of NPWT versus conventional dressing on STSGs after soft-tissue reconstruction. A prospective observational study was performed at the King Abdullah Medical City. A total of 18 patients with STSGs for acute or chronic skin defects were recruited. Patients from the two groups—10 patients in the NPWT group and 8 in the No-NPWT group—were postoperatively evaluated for three weeks. Assessment included the STSG take rate, wound healing, pain, infection, hematoma formation, and the need to re-graft the same recipient area. Our data demonstrated a higher mean skin graft take rate in the second and third weeks of the No-NPWT group compared to the NPWT group, but it was not statistically significant (p > 0.05). No significant differences between the two groups in terms of wound healing, pain, infection, hematoma formation, and the need to re-graft (p > 0.05) were found. Our study showed that the conventional dressing of STSGs is not inferior to NPWT. In addition, conventional dressing was shown to be easier to use and less expensive to apply, as well as having a higher skin graft take rate and lower infection rate.

Negative-pressure wound therapy (NPWT) has been used for to treat wounds for more than 15 years and, more recently, has been used to secure split-thickness skin grafts. There are some data to support this use of NPWT, but the actual mechanism by which NPWT speeds healing or improves skin graft take is not entirely known. The purpose of this project was to assess whether NPWT improved angiogenesis, wound healing, or graft survival when compared with traditional bolster dressings securing split-thickness skin grafts in a porcine model. We performed two split-thickness skin grafts on each of eight 30 kg Yorkshire pigs. We took graft biopsies on postoperative days 2, 4, 6, 8, and 10 and submitted the samples for immunohistochemical staining, as well as standard hematoxylin and eosin staining. We measured the degree of vascular ingrowth via immunohistochemical staining for von Willenbrand's factor to better identify blood vessel epithelium. We determined the mean cross-sectional area of blood vessels present for each representative specimen, and then compared the bolster and NPWT samples. We also assessed each graft for incorporation and survival at postoperative day 10. Our analysis of the data revealed that there was no statistically significant difference in the degree of vascular ingrowth as measured by mean cross-sectional capillary area (p = 0.23). We did not note any difference in graft survival or apparent incorporation on a macroscopic level, although standard hematoxylin and eosin staining indicated that microscopically, there seemed to be better subjective graft incorporation in the NPWT samples and a nonsignificant trend toward improved graft survival in the NPWT group. We were unable to demonstrate a significant difference in vessel ingrowth when comparing NPWT and traditional bolster methods for split-thickness skin graft fixation. More studies are needed to elucidate the manner by which NPWT exerts its effects and the true clinical magnitude of these effects.

Objectives: Negative pressure wound therapy (NPWT) is a useful therapy in the preparation of wounds prior to application of a split-thickness skin graft (STSG) both “pregraft” and “postgraft” on top of the STSG. Customarily, a foam-based NPWT has been used, but gauze-based therapy is finding an increasing use. Gauze is easy to apply and forgiving of complicated wound geometries so it can be an ideal material in this indication. The aim of this study was to quantitatively assess the clinical efficacy of gauze-based NPWT as an adjunctive therapy to STSG procedures. Methods: A prospective, noncomparative, multicenter evaluation was carried out to assess the performance of gauze-based NPWT. Twenty-one patients had NPWT applied prior to definitive closure by STSG or flap techniques (pregraft group). A further 21 patients underwent an STSG procedure and had gauze-based NPWT placed immediately on top of the STSG (postgraft group). Negative pressure was applied at −80 mm Hg. Results: In the pregraft group, NPWT was used for a median of 12 days. Improvement in quality of wound bed with decreased nonviable tissue (from 20% to 0% median wound area) and increased granulation tissue (from 20% to 90% median wound area) was observed. In the postgraft group, median duration of therapy was 5 days at which point median percentage skin graft-take was 96%. Conclusions: Gauze-based NPWT appears to be an effective addition to the care and management of wounds intended for definitive closure by STSG.

Objective: To compare the clinical effects of continuous negative-pressure wound therapy (NPWT) and conventional pressure dressing at at hard-to-fix sites after split-thickness skin grafting. Methods: From September 2017 to August 2019, 129 patients who met the inclusion criteria and had spilt-thickness skin grafting at hard-to-fix sites were admitted to the First Affiliated Hospital of Air Force Medical University and included in this retrospective cohort study. The patients were divided into NPWT group (67 patients, 41 males and 26 females, aged (32±6) years) and conventional pressure dressing group (62 patients, 37 males and 25 females, aged (30±5) years) according to whether the hard-to-fix sites were applied with NPWT after spilt-thickness skin grafting. After debridement and spilt-thickness skin grafting at hard-to-fix sites in patients of 2 groups, the wounds of patients in conventional pressure dressing group were applied with conventional pressure bandaging after being filled with dry gauze; for the wounds of patients in NPWT group, the semi-permeable membrane was pasted and sealed for continuous negative pressure suction after filled with dry gauze and placed the drainage foam or drainage tube, with the negative pressure ranging from -16.6 to -9.9 kPa. The bandage was opened during the first dressing change on the 5th day after surgery in NPWT group and on the 7th day after surgery in conventional pressure dressing group. The skin graft surviving area and proportion, the area and proportion of hematoma, the incidence of common complications of skin graft were observed and calculated. The times of postoperative dressing change and the length of hospital stay were counted. Data were statistically analyzed with two independent sample t test, Cochran & Cox approximate t test, chi-square test, and Fisher's exact probability test. Results: (1) At the first dressing change, the skin graft surviving area of patients in NPWT group was (420±94) cm(2), which was significantly larger than (322±97) cm(2) in conventional pressure dressing group (t'=12.33, P<0.01); the skin graft surviving area proportion of patients in NPWT group was (97.0±2.3)%, which was significantly higher than (74.4±4.8)% in conventional pressure dressing group (t'=50.11, P<0.01). (2) At the first dressing change, the skin hematoma area of patients in conventional pressure dressing group was (31.7±10.1) cm(2), which was significantly larger than (3.2±0.7) cm(2) in NPWT group (t'=23.04, P<0.01); the skin hematoma area proportion of patients in conventional pressure dressing group was (7.3±2.3)%, which was significantly higher than (0.7±0.3)% in NPWT group (t'=76.21, P<0.01). (3) At the first dressing change, there was 1 case of skin movement and no case of skin graft edge tear in NPWT group with an incidence of 1.5% (1/67). In the conventional pressure dressing group, there were 4 cases of skin movement and 2 cases of skin graft edge tear with an incidence of 9.7% (6/62), P<0.05. The incidence of complication of skin graft of patients in NPWT group was significantly lower than that in conventional pressure dressing group (P<0.05). (4) The times of postoperative dressing change of patients in NPWT group was significantly less than that in conventional pressure dressing group (t=7.93, P<0.01). The postoperative length of hospital stay in NPWT group was significantly less than that in conventional pressure dressing group (t=11.71, P<0.01). Conclusions: Continuous NPWT can effectively promote wound healing, improve the survival rate of skin graft, reduce the incidence of complications after skin grafting, and shorten the length of hospital stay in split-thickness skin grafting at hard-to-fix sites.

Reconstruction of complex injuries of the extremities with full-thickness wounds is a challenging but important task. If primary closure is not feasible, more complex procedures are required, such as split-thickness skin graft or flap surgery. Recently, several studies have shown good results when combined with negative pressure wound therapy (NPWT) and artificial dermal replacement therapy after extensive surgical debridement and NPWT administration for severe complex wounds accompanied by tendon or bone exposure. However, flap surgery remains the only treatment for wounds in which the hardware is exposed after fracture fixation. Therefore, in this study, we attempted to prove the usefulness of the combined treatment using artificial dermal substitutes (MatriDerm) and NPWT by focusing on hardware-exposed wounds, which have not been studied before. From 2019 to 2021, we treated with our wound management procedure 14 patients with hardware-exposing wounds after internal fixation using plates, out of 48 patients with full-thickness posttraumatic skin defect. Before skin grafting, after surgical debridement and thorough washouts, MatriDerm was placed and NPWT was applied over it. This staged approach aimed at conditioning even the most complex wounds so that closure with MatriDerm-augmented skin grafting would become possible in a one-step approach. We stratified the duration of treatment and number of replacements in NPWT according to the type of injury. Cases with open fractures required significantly longer NPWT than those with closed fractures (P = 0.01); however, there was no significant difference between the Gustilo-Anderson classification within open fractures (P > 0.05). Patients with open fractures underwent a mean of 6.6 changes while those with closed fractures underwent 2.5 (P = 0.002) until the final wound closure with MatriDerm-augmented skin grafting was performed. There was no significant difference in the treatment period based on the location and size of the wound, and there was no significant difference in the number of NPWT replacements. Skin grafting was successful in all 14 patients. This study revealed that NPWT and artificial dermis-augmented skin grafting after combined treatment with NPWT and artificial dermis were sufficiently useful for hardware-exposed wounds, where flap surgery has been considered the only treatment to date.

Background: Evidence for postoperative management of split-thickness skin grafts (SSGs) to lower leg wounds has shown early mobilisation has no adverse effects on graft take, while improving patient outcomes and significantly reducing hospitalisation costs. The development of negative-pressure wound therapy (NPWT) for SSGs led to new options for bolster dressings. This study aimed to determine the current postoperative mobilisation and dressing choices of Australian plastic surgeons. Methods: Australian plastic surgeons were invited electronically to participate in a questionnaire regarding their postoperative regimens for lower limb SSG in 2013, and again in 2018. A literature review was performed to establish whether surgeon-reported practice was in line with current evidence for early mobilisation of lower limb SSGs and also for NPWT on SSGs. Results: In 2013, 119 responses were received and in 2018, 110 responses were received. Survey responses showed significant reductions in the numbers of patients kept immobilised for more than five days (30% to 9%, p = 0.001) between 2013 and 2018. Surgeons reported immobilising their patients longer with standard dressings than with NPWT dressings (p = 0.003 by multinomial logistic regression). More than two-thirds of surgeons reported NPWT use in both 2013 (66%) and 2018 (70%). Conclusion: Between 2013 and 2018, NPWT use increased slightly and the percentage of surgeons mobilising their patients early significantly increased, in accordance with evidence in the literature. A link was noted between NPWT use and an increased tendency to early mobilisation. However, a large proportion of surgeons continued to prescribe bed rest postoperatively.

Negative pressure wound therapy as an accelerator and stabilizer for incorporation of artificial dermal skin substitutes – A retrospective, non-blinded, and non-randomized comparative study