Closure Therapy In Patients Research Articles

The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers.

In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum-assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.

Endoscopic Vacuum-Assisted Closure Therapy in Patients with Anastomotic Leakage after Esophagectomy: A Single-Center Experience.

Aim To study the efficacy of E-VAC therapy for patients with anastomotic leakage after esophagectomy. Methods Between January 2013 and April 2017, 12 patients underwent E-VAC therapy for the management of postoperative leakage. Their clinical features and endoscopic procedure details, therapy results, adverse events, and survival were investigated. Results All 12 patients were male and the median age was 57 years (interquartile range 51.5–62.8 years). The reasons for esophageal surgery were esophageal cancer (83.3%), gastrointestinal stromal tumor (8.3%), and esophageal diverticulum (8.3%). Prior to E-VAC therapy, 6 patients had undergone failed primary surgical repair and the median duration from esophagectomy to leakage discovery was 13.5 days (IQR 6–207 days). The median duration of E-VAC therapy was 25 days (IQR 13.5–34.8 days) and the average sponge exchange rate was 2.7 times during the treatment period. After E-VAC therapy, 8 patients (66.7%) had complete leakage closure, 3 (25%) had a decreased leakage size, and 1 (8.3%) was unchanged. The three patients with a decreased leakage size after E-VAC therapy were treated with endoscopic and conservative management without further surgery. Conclusion With proper patient selection, E-VAC therapy is a feasible and safe method for the treatment of anastomotic leakage after esophagectomy.

Outcome analysis of vacuum assisted closure therapy in patients with open wounds

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Vacuum assisted Closure (VAC) of wound is a recent trend and proven method of fast and better healing of wounds. The basic concept is the removal of blood and serous collection from the wound site with negative pressure and promoting the healing process rapidly by altering the local microcellular environment.</span><span lang="EN-IN">The objective of the study was to show the efficacy of healing process in open wounds treated by VAC method of dressing.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In this prospective study, total of 50 patients with </span><span lang="EN-IN">upper and lower limbs non-healing open wounds were recruited. Before the application of VAC, surgical debridement was performed to remove all the devitalized necrotic tissues and the wound was packed with povodine iodine. Prior to and at the end of VAC dressing, wound dimensions were noted</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Patients mean age was 46.72±7.63 years and out of which 42 patients (84%) were males and 8 patients (16%) were females. All patients had suffered an acute trauma. VAC therapy was applied through continuous or intermittent suction on wounds and dressing were changed every second or third day. After application of VAC therapy all wounds showed improvement, which were indicated by presence of healthy granulation tissue, absence of necrotic tissue and subsequent wound closure. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">VAC dressing in an open wound is an efficient and safe adjunct to treat severe infections and may be a good alternative to treat the open wounds in selected patients. Short time intervals between VAC changes and short course of therapy result in good patient acceptance. This method is recommended for all the types of non-healing wounds management.</span></p>

High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis.

The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation. The hospital OPS-database (time period 2005-2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients' characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation. Forty-three patients (19 male, 24 female) with a median age of 65years (range 24-90years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12days (range 3-88days). Twenty of 43 (47%) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47%). Overall 16 of 43 (37%) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p < 0.001). ROC curve analysis determined the optimal duration of VAC therapy to reduce the risk of fistula formation at 13days. Long-term VAC treatment of patients with an open abdomen due to secondary peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.

Vacuum-Assisted Closure Therapy in Patients Undergoing Liver Transplantation With Necessity to Maintain Open Abdomen

BackgroundNegative-pressure wound therapy (NPWT) has been recognized as a valid method of temporary abdominal closure. The role of open abdomen (OA) in the management of abdominal sepsis has been a controversial issue. Recent experimental and clinical studies have indicated that vacuum-assisted closure (VAC) is associated with superior outcomes in the treatment of OA conditions, but sufficient proof of efficacy and effectiveness is lacking. MethodsWe enrolled in this observational study all patients who had undergone liver transplantation (LT) for all causes between 2007 and 2014 in whom we needed to use VAC therapy, describing the pathology that led to the complication, length of hospitalization, graft survival, microbial identifications, and causes of death. ResultsWe enrolled 11 patients—6 men (55%) and 5 women (45%), from 41.92 to 64.96 years old (mean, 57.62 ± 6.56 years) —who went to LT for different pathologies. The mean hospital stay was 56.72 ± 36.40 days (range, 8–133 days). Graft survival was 35.65 ± 31.61 months (range, 1.51–89.19 months). Six of 11 patients died (55%) of different causes; in particular, 4 patients died 1 to 3 months after the procedures that led to the condition of OA for septic shock and subsequent multi-organ failure. ConclusionsComplications related to the use of NPWT, such as painful management and bleeding, are rare and mild when the device is used properly. Although studies are needed to verify the real cost/benefit ratio in this application of VAC therapy, we consider it a useful means to treat the OA condition.

Vacuum-assisted closure therapy in patients with large postoperative wounds complicated by multiple fistulas.

Vacuum-assisted closure (VAC) therapy is a widely acknowledged method for chronic and traumatic wound healing. The feasibility of VAC therapy used for the treatment of intestinal fistulas is still a subject of debate. Complex postoperative wounds pose significant therapeutic problems, especially when there are several fistula openings in the wound area and other sites, usually at the site of previous drains. This paper describes the treatment of three patients in a critical condition, with complex postoperative wounds complicated by multiple fistulas. Vacuum-assisted closure therapy was based on effective drainage of the biggest fistula opening and ensuring conditions promoting the healing process of other fistulas and the wound. A considerable improvement in general condition and wound healing was noted within 2-4 weeks and both the number of fistulas and the volume of excreted contents decreased. After 5-7 weeks a significant improvement in wound healing was observed in all patients. Once the general condition of all patients was considered satisfactory (2-6 months), they underwent surgery aimed at restoration of the digestive tract continuity.In our opinion, VAC therapy used for the treatment of postoperative wounds with multiple fistulas in the wound area and other sites should aim mainly at the improvement of patients’ general condition, limitation of the number of fistulas as well as accelerated wound healing. This may lead to formation of one stoma-type fistula, which can be dressed and cared for by patients until the continuity of the digestive tract has been surgically restored.