Combination Of Negative Pressure Wound Therapy Research Articles

Negative Pressure Wound Therapy for Gas Gangrene of the Fingertip with Prolonged Infection.

We encountered a case of infected soft tissue defect of the fingertip treated using negative pressure wound therapy (NPWT). The development of NPWT was started in the early 1990s, and it is a relatively new treatment method included in insurance coverage in Japan in 2010. NPWT is used for intractable wounds; some reports have examined its use on infected wounds. However, to the best of our knowledge, no study has examined its use on infected fingertip wounds. A patient with an infected soft tissue defect in the fingertip whose epithelialization period was prolonged despite continued antibiotic therapy was treated using NPWT in combination. After NPWT was started, signs of infection and wound granulation were good. Additionally, completion of epithelialization was confirmed 7 weeks after NPWT started. Conventionally, skin flap or graft by hand surgeons have been performed on fingertip soft tissue defects with infection. NPWT does not require specialized and advanced surgical techniques; treatment for infected soft tissue defects can be administered by anyone if they have the required skills. In conclusion, NPWT may be considered a suitable alternative when treatment options such as flaps and skin grafts are not feasible.

A case series describing combined negative pressure wound therapy and split-thickness skin graft as a method of sterilizing and closing midline laparotomy wounds near ostomies.

Negative pressure wound therapy (NPWT) promotes wound sterilization, improves tissue granulation, and ensures appropriate wound healing. Its potential in contaminated abdominal procedures is still under study, but the results are promising. This research provides insight into the use of NPWT for the effective preparation of laparotomy wounds in close proximity to ostomies. It also demonstrates the application of NPWT systems for successful skin graft take under these conditions. The authors describe 3 cases in the burn unit of an academic hospital in the northeastern United States treated successfully with a combination of NPWT and skin grafting to manage open abdominal laparotomy wounds in close proximity to ostomies. NPWT improved skin graft survival by promoting the creation of a clean base, which is important for ensuring appropriate skin graft take, and strengthening the bond between the graft and the recipient wound bed. Despite these successful results, evidence in this area is still mixed and would benefit from further studies in the field.

Investigating the joint application of negative pressure wound treatment and tissue therapy for chronic wounds in patients with diabetes.

This study aimed to investigate the effectiveness of combined negative pressure wound therapy (NPWT) and human amniotic membrane in patients with chronic wounds associated with diabetes. A total of five patients with type 2 diabetes, including ischemic and mixed forms of diabetic foot syndrome, presenting with ischemic wounds of the lower extremities were included in this study. Patients with uncorrected limb ischemia were excluded. The treatment protocol included diabetes compensation (treatment with fractional insulin therapy), anticoagulant, metabolic therapy and angiotropic therapy, physical treatment methods, osteoporosis therapy with calcium preparations, and wound-specific interventions. The primary treatment approach involved the application of a vacuum bandage to the transplanted human amniotic membrane, which improved the adaptation of the flap to the wound surface, allowed the removal of excess wound exudate, and stimulated angiogenesis and reparative properties. The combined approach of NPWT and biotherapy was a safe and effective cure for diabetic wounds, promoting faster wound healing, reducing the need for autodermoplasty, and possibly reducing the necessity for high-level amputations.

Combined negative pressure wound therapy with irrigation and dwell time and artificial dermis prevents infection and promotes granulation formation in a ruptured giant omphalocele: a case report

BackgroundOmphalocele is a congenital abdominal wall defect of the umbilical cord insertion site. A giant omphalocele, with a fascial defect > 5 cm in diameter and/or containing > 50% of the liver within the hernia sac, can be challenging for pediatric surgeons. Recently, negative pressure wound therapy has been reported as an effective management for giant omphaloceles; however, it is not recommended for an infected wound with necrotic tissue as it may exacerbate infection. We adopted negative pressure wound therapy with irrigation and dwell time (NPWTi-d) for a case of a ruptured giant omphalocele. Artificial membranes, followed by artificial dermis, were used to promote fibrous capsule formation, and then NPWTi-d was used to promote granulation while controlling infection. However, studies have not been conducted regarding NPWTi-d for ruptured giant omphaloceles; hence, we present our treatment experience with NPWTi-d for a giant omphalocele.Case presentationThe patient was a boy born at 38 weeks and 3 days of gestation, weighing 1896 g. He was diagnosed with a ruptured giant omphalocele with a total liver and intestine defect hole of 10 cm × 10 cm. The patient underwent silo placement using an artificial mesh, followed by plicating the artificial mesh at 4 days of age. The herniated viscera were gradually reduced into the abdominal cavity; however, the defect size was still large. Hence, a collagen-based artificial dermis was patched on the defect hole. After creating a fresh and smooth granulated tissue, NPWTi-d was applied at 33 days of age to promote granulation and control infection. We used the 3 M™ V.A.C.® Ulta Therapy Unit with 3 M™ VeraFlo™ therapy. NPWTi-d was stopped at 60 days of age when the granulation tissue was well formed including at the artificial dermis site. The wound was managed with prostandin ointment and appropriate debridement, resulting in complete epithelialization at 5 months of age.ConclusionsArtificial membranes followed by artificial dermis were used to promote a fibrous capsule and artificial dermis granulation, which protects against organ damage. NPWTi-d achieved better control of infection and promoted wound healing. NPWTi-d combined with artificial dermis can effectively treat ruptured giant omphaloceles.

Application of combined negative pressure wound therapy and shoelace technique to the treatment of widespread femoral gas gangrene stemming from multiple open wounds in retroperitoneal perforations in ascending colon cancer

Application of combined negative pressure wound therapy and shoelace technique to the treatment of widespread femoral gas gangrene stemming from multiple open wounds in retroperitoneal perforations in ascending colon cancer

Experimental study of negative pressure wound therapy combined with platelet-rich fibrin for bone-exposed wounds.

Aim: To evaluate the efficacy of negative pressure wound therapy (NPWT) combined with platelet-rich fibrin (PRF) in treating bone-exposed wounds and explore its possible mechanism. Materials & methods: Abone-exposed wound was created in a total of 32healthy Sprague-Dawley rats, which were divided into either control group, NPWT group, PRF groupor both (N+P group). The bone-exposed area, skin contraction rateand granulation coverage and the level of growth factors in granulation tissue were determined on days 4, 7and 10. Results: The N+P group showed significantly higher wound closure rate than that achieved with others respectively. Four factors were significantly higher in N+P group than in the other three groups. Conclusion: Combination of NPWT and PRF can repair bone-exposed wounds effectively and accelerate wound healing.

Dermal Matrices: Game Changers in Leg and Foot Soft Tissue Reconstruction? A Case Series.

The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes.

Negative-pressure wound therapy in combination with bronchial occlusion to treat bronchopleural fistula: a case report

BackgroundBronchopleural fistula, which usually accompanies bronchial fistula and empyema, is a severe complication of lung cancer surgery. Negative-pressure wound therapy can enhance drainage and reduce the empyema cavity, potentially leading to early recovery. This therapy is not currently indicated for bronchopleural fistulas because of the risk of insufficient respiration due to air loss from the fistula.Case presentationA 73-year-old man, who was malnourished because of peritoneal dialysis, was referred to our hospital for the treatment of lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed via posterolateral thoracotomy, and the bronchial stump was covered with the intercostal muscle flap. His postoperative course was uneventful and he was discharged. However, he was readmitted to our hospital because of respiratory failure and diagnosed as having bronchopleural fistula on the basis of the bronchoscopic finding of a 10-mm hole at the membranous portion of the inlet of the remnant lower lobe bronchus. Thus, thoracotomy debridement and open window thoracostomy were immediately performed. After achieving infection control, bronchial occlusion was performed using fibrin glue and a polyglycolic acid sheet was inserted through a fenestrated wound. Bronchial fistula closure was observed on bronchoscopy; therefore, a negative-pressure wound therapy system was applied to close the fenestrated wound. The collapsed lung was re-expanded and the granulation tissue around the wound increased; therefore, thoracic cavity size decreased and thoracoplasty using the latissimus dorsi was performed.ConclusionsThis bronchopleural fistula was treated successfully after a right lower lobectomy using an extra-pleural bronchial occlusion and negative-pressure wound therapy.

Associating Insulin Instillation with Negative Pressure Wound Therapy Reduces Insulin Resistance in Diabetic Patients with Infected Foot Wounds

In this work we investigated whether a joint treatment with insulin instillation and negative pressure wound therapy (NPWT) would reduce insulin resistance (IR) in diabetic patients with infected diabetic foot ulcers (DFUs) and improve their healing. We also studied the effects of insulin+NPWT treatment on the inflammatory response coupled with wound healing. Seventy-five diabetic patients with infected DFUs were recruited and randomly divided into equal (n=25) groups treated respectively with NPWT alone, NPWT+insulin, and conventional dressings (controls). Thereafter, the ulcers’ healing progress was assessed. The serum levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2), and Interleukin-6 (IL-6) were measured at 1 day before and at 7, 14, and 21 days after each treatment using specific double-antibody sandwich enzyme-linked immunosorbent assays (ELISA). Serum glucose was measured via a glucose-oxidase method, and serum insulin via radioimmunoassay. In each patient, IR was appraised via the Homeostasis Model Assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Our results showed that at 7, 14 and 21 days post-treatment, with respect to the control group the two NPWT-treated groups had (i) significantly (p < 0.05) lower serum levels of TNF-α, IL-2 and IL-6; (ii) a significantly (p < 0.01) greater reduction in IR; and (iii) significantly (p < 0.05) higher wound healing rates. Moreover, at 14- and 21-days post-treatment, the NPWT+insulin-treated group had a significantly (p < 0.05) higher wound healing rate than the NPWT alone-treated group. In conclusion, the combined NPWT+insulin instillation treatment gave superior results by improving wound healing, decreasing inflammation at the wounds surface, and reducing IR in diabetic patients with infected DFUs.

Effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area

Objective: To investigate the effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area. Methods: From January 2015 to June 2019, 20 patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area were admitted to Department of Burns and Plastic Surgery and Cosmetology of Linyi People's Hospital. Among them, there were 11 males and 9 females, aged 48 to 88 years. The wounds of 13 patients were located in the sacrococcygeal region, and 8 of them had exposed sacrococcyx. The wounds of 4 patients were located in the greater trochanter area of femur, and the wounds of 3 patients were located in the ischial tuberosity area. All the patients had fever in different degree, bacterial infection, hypoproteinemia, and electrolyte imbalance, etc. at admission. After thorough debridement and dressing change, routine negative-pressure wound therapy with negative pressure value of -16.6 kPa was performed according to the scope of lesions in period Ⅰ. When granulation tissue was fresh with less exudate and without residual necrotic tissue, modified double negative-pressure wound therapy in combination with debridement and tension-reduced suture was performed immediately in period Ⅱ. Modified double negative-pressure wound therapy were persistently performed through negative pressure drainage tube inserted into deep part of wounds and negative pressure drainage tube on surface at the same time, with superficial negative pressure value of -19.9 kPa. Meanwhile, systemic anti-infection and nutritional supports were given. The wounds were monitored for the grade of wound healing and whether skin necrosis, split, or fluid accumulation develop at the suture site. The patients were followed up for 1 to 6 months after discharge to monitor wound healing. Length of hospital stay, infection condition before and after the debridement and tension-reduced suture, and complications during treatment were recorded. Results: All wounds achieved first grade healing, with the skin at the suture site healed without split, fluid accumulation, or necrosis. The patients were followed up for 1 to 6 months after discharge, with good shape of surgical incision, little pigmentation on the skin, no hypertrophic scar or contracture, and no recurrence of pressure sores. Length of hospital stay of patients was 24 to 33 d, with an average of 28.5 d. Before debridement and tension-reduced suture, 2 cases were infected with Pseudomonas aeruginosa, 1 case was infected with Escherichia coli and Staphylococcus aureus, and 1 case was infected with Proteus mirabilis. The results of bacterial culture were all negative after debridement and tension-reduced suture. During the treatment, all patients were not complicated with bone or joint infection, necrotizing fasciitis, septicemia, etc. Conclusions: Modified double negative-pressure wound therapy combined with debridement and tension-reduced suture for treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area is easy to operate with minimal injury, easy for patients to accept with a very high level of satisfaction, and is suitable to popularize and applicate for primary hospitals.

Clinical usefulness of acellular dermal matrix combined negative pressure wound therapy in diabetic foot amputee

Category: Diabetes Introduction/Purpose: Negative pressure wound therapies (NPWT) have been useful to prevent further amputation by filling defect with granulation in diabetic foot amputee. However the hospitalized period have been prolonged to complete filling defect with NPWT. There were many efforts to accelerate rate of granulation filling using dermal matrix in NPWT. We hypothesized outcomes of acellular dermal matrix combined negative pressure wound therapy (NPWT) can be useful in comparison of exclusive usage of NPWT. The aim of this study was to investigate clinical outcomes of acellular dermal matrix of combined negative pressure wound therapy in DM foot amputee. Methods: This study included 40 patients of 40 ischemic diabetic feet. We divide these diabetic feet into two groups: 20 cases of acellular dermal matrix combined NPWT and 20 cases of exclusive usage of NPWT. We performed the amputation and combined NPWT at a mean age of 50.7 years (26 to 75) with the mean 12 months follow-up between June, 2014, and January, 2017. FTSG was performed after sufficient granulation healing of DM foot amputee in case of need. We evaluated multiple risk factors preoperatively and postoperatively. The wound healing after FTSG was evaluated during the followup. Number of NPWT was checked during the hospitalized period. Necessity of further amputation was decided as failed cases. Success rate of NPWT was evaluated in two groups. Multiple risk factors were evaluated. Results: Failed case was 3 cases (exclusive usage of NPWT) and 2 cases (acellular dermal matrix usage combined NPWT). Other feet showed complete healing of wound. Mean NPWT number of times to complete filling of granulation were significantly lesser in acellular dermal matrix combined NPWT group. Decreasing rate of wound defect was significantly shorter in acellular dermal matrix combined NPWT group. There were no significant correlations between wound healing and risk factors (CRP, HbA1C) (p=0.223, p=0.175). Conclusion: Acellular dermal matrix usage combined negative pressure wound therapy in DM foot amputee can be helpful to improve filling granulation filling rate with NPWT than exclusive usage of NPWT.

Clinical outcomes of full thickness skin graft combined with negative pressure wound therapy in diabetes mellitus foot amputee after infection

Category: Diabetes Introduction/Purpose: Infected diabetes mellitus (DM) foot has been controlled with amputation. After performing the amputation with preserving enough length of the foot due to functional and cosmetic advantages, remaining wounds have been covered with split thickness skin graft (STSG) despite of sacrifice of donor site with pain and scar. We hypothesized outcomes of full thickness skin graft (FTSG) combined with negative pressure wound therapy (NPWT) can be an alternative STSG. The aim of this study was to investigate clinical outcomes of FTSG combined with negative pressure wound therapy in DM foot infection. Methods: This study included 21 patients of infected DM foot (21 feet). There were 20 cases of midfoot and 1 case of hindfoot. We performed the amputation and combined NPWT at a mean age of 51.7 years (37 to 81) with the mean 12 months follow-up between June, 2014, and January, 2016. FTSG was performed after sufficient granulation healing of DM foot amputee. We measured multiple risk factors preoperatively and postoperatively. The wound healing after FTSG was evaluated during the followup. The relationship between outcomes of FTSG and multiple risk factors were evaluated. Results: 20 feet showed complete healing of wound. One foot showed failed wound healing. Mean NPWT number of times before the FTSG were 11. Mean C-reactive protein (CRP) values and Hemoglobin A1C (HbA1C) were 1.24 and 9.21 just before FTSG, respectively. There were no significant correlations between wound healing and risk factors (CRP, HbA1C) (p=0.223, p=0.175). Conclusion: Full thickness skin graft combined with negative pressure wound therapy (NPWT) can be the treatment of choice for the diabetes mellitus foot amputee as an alternative STSG.

Abstract: The Efficacy of Negative Pressure Wound Therapy and Antibiotic Beads as Infection Prophylaxis in Post-Traumatic Lower Extremity Salvage

INTRODUCTION: This study compares outcomes in trauma patients receiving negative pressure wound therapy (NPWT), antibiotic beads, or both treatments prior to soft tissue reconstruction of the lower extremity. METHODS: This is retrospective review of patients requiring soft tissue reconstruction following traumatic lower extremity open fractures in an urban Level 1 trauma center between August 2007 and March 2015. Patients with infection prior to NPWT and/or antibiotic bead application were excluded. RESULTS: In 72 trauma patients with 73 extremities having open fractures and subsequent lower limb vascularized soft tissue reconstruction, 26 received only NPWT, 24 only antibiotic beads, 2 neither treatment and 23 both treatments. There was no significant difference in time from injury to definitive soft tissue coverage, time from injury to NPWT/bead placement, or length of NPWT/beads use between groups. Infection rate was 26.9% with NPWT only, 0.0% with antibiotic beads only, 50.0% with neither treatment, and 8.7% with antibiotic beads and NPWT in combination. Patients receiving antibiotic beads alone were significantly less likely to develop an infection or complication as those receiving NPWT alone (p<0.01, p<0.01) or combined NPWT/beads (p<0.01, p<0.01). Development of infection was associated with longer periods from initiation of NPWT use to definitive soft tissue coverage (p<0.01); this finding was independent of time from injury to soft tissue coverage but correlated with number of operations. Limb salvage rate was 95.9% and 50.0% of patient could ambulate without an assistance device 3 or more months out of surgery. CONCLUSION: Antibiotic beads may be more effective than negative pressure wound therapy in preventing infections in patients awaiting soft tissue coverage of wounds. Utilizing these treatments together does not improve infection rates. Limb salvage was successful in most cases regardless of treatment.

Combined negative pressure wound therapy with open bone graft for infected wounds with bone defects: An experimental study.

Background:Bone and soft-tissue defects in infected wound have been an intractable problem to many surgical consultations. Infected wounds with bone defects are physical and financial burden to society. Nowadays, infected wounds with compound defect of bone and soft tissues are common in orthopedics department. Currently, no simple and efficient treatment has been found to solve this problem. This study investigates the effects of combining negative pressure wound therapy (NPWT) with open bone graft on this focus.Materials and Methods:Twenty four rabbits with bone and soft tissue defects accompanied infected wounds were randomized into experimental (combined NPWT with open bone graft) and contrast group (only open bone graft). Treatment efficacy was assessed by the wound condition; wound healing time, bacterial bioburden, and bony callus were evaluated by X-ray. Furthermore, samples of granulation tissue from wounds on the 3rd, 7th, and 14th days of healing were evaluated for blood vessels and expression of vascular endothelial growth factor.Results:Wounds in the experimental group tended to have shorter healing time, healthier wound conditions, lower bacterial bioburden, better bony callus, and more blood supply than those in the controlled group.Conclusions:In conclusion, NPWT combined open bone graft can act as a feasible and valuable method to treat combined infected bone and soft-tissue defects.

Accelerated wound healing with combined NPWT and IPC: a case series.

Negative pressure wound therapy (NPWT) and intermittent pneumatic compression (IPC) have traditionally been used in patients with chronic complicated non-healing wounds. The aim of this study (retrospective case series) was to describe the use of NPWT in combination with IPC in patients with a relatively short history (2-6 months) of ulcers. All wounds showed improved healing during the treatment period with marked or moderate reduction in ulcer size, and granulation tissue formation was markedly stimulated. Oedema was markedly reduced due to IPC. Treatment was generally well tolerated. The results of this study indicate that combined NPWT and IPC can accelerate wound healing and reduce oedema, thus shortening the treatment period. Therefore, patients may have a shorter healing period and may avoid entering a chronic wound phase. However, controlled studies of longer duration are needed in order to show the long-term effect of a more accelerated treatment course.

On the significance of negative-pressure wound therapy with instillation in dermatology.

Methods used in the treatment of acute and chronic wounds undergo constant evolution, reevaluation, and innovation. While negative-pressure wound therapy (NPWT) is an established treatment modality, the combination of NPWT and instillation of normal saline as well as solutions with active antiseptic components for topical treatment of the wound bed represents a novel approach. The well-known effects of NPWT may thus be combined with those of local antisepsis. They include a decrease in wound area, induction of granulation tissue, and reduction in bacterial colonization. To date, studies have focused on NPWT with instillation for orthopedic/surgical indications, whereas clinical data in dermatosurgery is limited to case reports or small case series. There are as yet no randomized prospective studies investigating NPWT with instillation in the treatment of skin disorders. The goal of this review is to present the method of NPWT with instillation, to highlight its mode of action as well as possible complications and contraindications, and to review the recent literature. In summary, there is increasing evidence that both simple and complicated wounds may be effectively treated with NPWT with instillation, resulting in markedly accelerated tissue granulation and thus earlier defect closure.

Randomized controlled trial comparing the combination of a polymeric membrane dressing plus negative pressure wound therapy against negative pressure wound therapy alone: The WICVAC study.

Negative pressure wound therapy (NPWT) is the treatment of choice for chronic wounds; yet, it is associated with considerable workload. Prompted by its nonadhesive and wound-healing properties, this study investigated the effect of an additional polymeric membrane interface dressing (PMD; PolyMem WIC) in NPWT. From October 2011 to April 2013, 60 consecutive patients with chronic leg wounds or surgical site infections after revascularization of lower extremities were randomly allocated to either treatment with conventional NPWT (control arm) or NPWT with an additional PMD (intervention arm). The primary outcome was wound healing achieved within 30 days, the secondary endpoints included: number of days between dressing changes, wound-related pain, cost efficiency, and occurrence of adverse events (ClinTrials.gov Identifier: NCT02399722). Forty-seven patients completed follow-up. No difference in wound healing was observed (p > 0.05) between both study arms. The additional PMD allowed significantly longer wearing times (days) between dressing changes (intervention: 8.8 ± 0.5, control: 4.8 ± 0.2; p < 0.001). Pain was slightly higher in patients randomized to NPWT alone (VAS score: 4.8 ± 2.9) compared to NPWT + PMD (VAS score: 3.0 ± 2.9, p = 0.063). No wound infections were observed. Costs were reduced by 34% per patient in the intervention arm. These results suggest that the combination of NPWT and an additional interface PMD is a safe and economic method for the treatment of chronic wounds, which requires significantly fewer dressing changes for a comparable wound healing.

Negative pressure and nanocrystalline silver dressings for nonhealing ulcer: A randomized pilot study.

Chronic wounds have a high prevalence and wound care, treatment, and prevention consume large quantities of resources. Chronic wounds are a growing challenge for clinicians. A prospective randomized pilot study was conducted to assess the effectiveness in terms of reduction in area and safety of the combined use of negative-pressure wound therapy and nanocrystalline silver dressings as compared to negative pressure wound therapy (NPWT) alone in the management of outpatients with chronic wounds. A total of 17 patients were included in the study, 10 were treated with the combined method and 7 with NPWT. Patients were followed for 6 weeks, with a final assessment at 3 months. Clinical improvement, microbiologic data, and toxicity of silver were evaluated. The antibacterial effects of ionic silver together with the development of granulation tissue promoted by NPWT reduced significantly the median extension of the wound between weeks 3 and 6 of treatment. The combination with silver also reduced bacterial colonization with Pseudomonas aeruginosa and the bacterial load on the surface of the wound. The silver levels correlated positively with the extension of the wound, although in none of the patients' toxic levels were reached. The combination of NPWT with nanocrystalline silver dressings was safe and as effective as NPWT alone.

Negative pressure wound therapy in the treatment of ulcerated infantile haemangioma.

Infantile haemangioma is a common benign tumour of infancy. Ulceration is the most common complication and is often painful and difficult to treat. Propranolol therapy is widely used to induce involution in rapidly growing or ulcerated lesions, or those in anatomically awkward locations. The ideal dressing regimen for these lesions would provide effective analgesia, act as a wound dressing, and aid involution of the primary lesion. To date, no ideal regimen has been established. Negative pressure wound therapy (NPWT) has been used in adult and paediatric populations to help improve wound healing in a variety of settings. It may provide a useful alternative to traditional dressing regimens in ulcerated infantile haemangioma. Six consecutive patients with ulcerating infantile haemangioma presenting to the Royal Children's Hospital vascular anomalies clinic were included in the study. Each patient was treated with a combination of NPWT and propranolol. Outcomes including time to wound healing, perceived ease of dressing management, and analgesia were recorded. Complete wound healing was obtained in all cases. Patient outcomes in terms of analgesia, comfort, and ease of wound dressing were improved following application of NPWT. We propose that this regimen represents a novel therapy for management of ulcerated infantile haemangioma. Possible mechanisms for healing effect, and improved analgesia are discussed. Further investigation is required to determine if negative pressure wound therapy results in faster healing times compared to traditional dressing regimens.

Efficacy and safety of negative pressure wound therapy for Szilagyi grade III peripheral vascular graft infection.

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether it is safe and effective to use negative pressure wound therapy (NPWT) for Szilagyi grade III (i.e. the arterial implant proper involved in the infection) peripheral vascular graft infection. Altogether, 69 papers were found using the reported search. From the search results, reference lists of potentially eligible studies and related citations in PubMed, seven papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In the only randomized, controlled trial that compared NPWT (n = 10) and alginate dressing change (n = 10), the NPWT group demonstrated shorter time to full skin epithelialization (median 57 vs 104 days; P = 0.026). In the other six case series, the recruited case number ranged from 12 to 72. The mode of NPWT varied among the included studies, with the majority using a continuous negative pressure of 125 mmHg. One study combined NPWT and sartorius myoplasty, another used sartorius myoplasty in selected cases and others did not. The mean duration of using NPWT ranged from 14.2 to 43 days. The mean duration to achieve complete wound healing ranged from 24 (the study with sartorius myoplasty) to 51 days. The NPWT treatment failure rate ranged from 0 (the study with sartorius myoplasty) to 25%. The major complication of NPWT was bleeding and the incidence rate was reported to be <10%. We conclude that the amount of evidence for recommending NPWT alone as the first-line treatment for Szilagyi grade III peripheral vascular graft infection is small with only one small-sized randomized controlled trial demonstrating that NPWT alone is superior to alginate dressing change in shortening the time to complete wound healing by 2 months. Limited evidence (case series with >1 year of follow-up) showed that NPWT with a continuous negative pressure of 125 mmHg, or combined NPWT and sartorius myoplasty, may shorten the time to complete wound healing by 2 months, have a >70% success rate, and have a <10% NPWT-related complication rate.