Negative Pressure Therapy Research Articles

Results of negative pressure wound therapy for deep sternal wound infections after cardiac surgery

Objectives: The aim of this study was to present the outcomes of negative pressure wound therapy (NPWT) for deep sternal wound infection (DSWI) after cardiac surgery. Patients and methods: Sixty-eight patients (35 males, 33 females; mean age: 60.1±10.1 years; range, 18 to 80 years) who underwent coronary artery bypass surgery or valvular heart surgery between January 2017 and December 2021 were retrospectively reviewed. Patients who underwent NPWT for DSWI after cardiac surgery were included in the study. Baseline and postoperative characteristics of the patients were presented. Previously claimed risk factors for mortality were investigated. Results: The time interval between cardiac surgery and diagnosis of DSWI was 35.8±30.2 days. The mean duration of NPWT was 21.1±11.8 days. In-hospital mortality was 14.7%. Coagulase-negative staphylococci were the most frequently isolated microorganism (n=26, 38.2%), followed by Klebsiella spp. (n=10, 14.7%). The only factor associated with higher mortality was the female sex in our DSWI patients. Conclusion: Negative pressure therapy is a safe and reliable treatment option in patients with DSWI with or without sternal dehiscence.

P-110 SURGICAL MESH INFECTION SECONDARY TO SKIN NECROSIS MANAGED WITH NEGATIVE PRESSURE THERAPY IN A PATIENT UNDERGOING TAR (TRANSVERSUS ABDOMINIS MUSCLE RELEASE)

Abstract Aim To Show the management of skin necrosis, wound dehiscence and mesh infection in a patient undergoing TAR (Transversus Abdominis Muscle Release) through NPT (Negative Pressure Therapy) Material and Methods A 55-year-old man underwent elective surgery in 2017 for a giant hydatid cyst with portal rupture during the intervention, making a subcostal incision and subsequently midline laparotomy. Subsequently, he developed portal cavernomatosis and portal hypertension. In 2018, he underwent surgery for incisional hernia in a patient with a complex abdominal wall (extended subcostal incision + median laparotomy) performing a RIVES-type hernia repair. Develops chronic wall infection, mesh rejection and hernia recurrence that required reoperation with TAR (polypropylene mesh). One month after the intervention, he presents skin necrosis, wound infection and mesh infection in the upper third of the wound, which was managed through TPN cures for a year and a half. Results Given the dehiscence in the upper third of about 15×7 cm, conservative management was decided with cures and debridement of non-viable tissue. In contact with the polypropylene mesh, a silver dressing was applied, as well as treatment with negative pressure therapy. This cure was carried out for a year and a half every 3–4 days, being able to cover the mesh with granulation tissue and close it by secondary intention, thus avoiding a reintervention with mesh explant. Conclusions TPN is a useful tool in the management of mesh infections in patients with complex abdominal wall, thus avoiding reintervention and mesh explantation.

P-108 MARJOLIN'S ULCER AS A COMPLICATION OF UNRESOLVED OPEN ABDOMEN

Abstract Introduction Marjolin's ulcer (MU) is a rare cutaneous tumour, commonly associated with chronic wounds with difficult healing. We present a case of UM diagnosed on a persistent unresolved open abdominal closure wound. Materials and Methods 80-year-old male with a history of ruptured infrarenal aortic aneurysm (2010) that required aorto-unifemoral repair. Postoperative period requiring decompressive laparotomy for abdominal compartment syndrome and treated with negative pressure therapy, and impossibility of definitive abdominal closure due to abdominal muscle retraction. Loss of outpatient follow-up for 10 years. Consultation for worsening of the surgical wound with abdominal pain. Examination revealed abdominal incisional hernia M2–4W3 and large abdominal ulcer. Biopsies positive results for squamous cell carcinoma with infiltrative pattern. A computed tomography describes an abdominal wall mass of 14×6×11cm and space-occupying lesion in the left hepatic lobe. Liver biopsy showed a moderately differentiated hepatocarcinoma. Surgical management consist in intramuscular injection of botulinum toxin and en bloc resection of granulation and ulcerated tissue and ileal loop attached to the lesion. Wall reconstruction with anterior separation of components and supraponeurotic mesh. Conclusions Marjolin's ulcer is associated with squamous cell carcinoma with a high rate of metastasis and mortality. This tumour is considered infrequent, of long-term duration and associated with developing societies. In our environment, this neoplasia can develop in patients with open abdomen treated partially or with closure by second intention, so we consider it necessary to have a high index of diagnostic suspicion in these cases and to perform biopsies for its detection.

OC-059 TEMPORARY ABDOMINAL CLOSURE NEGATIVE THERAPY IMPROVES DEFINITIVE FASCIAL CLOSURE RATES IN PATIENTS WITH OPEN ABDOMEN MANAGEMENT

Abstract Aims Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement of the bowel by a thickened peritoneum due to prolonged peritoneal dialysis exposure. We are an international referral centre, typically managing cases with a planned open abdomen (OAM) and scheduled relook after 24–48 hours. We compare outcomes for those patients whose OAM was with simple packing (betadine-soaked-gauze) with negative pressure therapy providing temporary abdominal closure (TAC). Methods A retrospective review of a contemporaneous database of patients who underwent surgery for EPS between 2010–2020 was performed. Primary endpoints were time to definitive closure and closure method (primary fascial closure vs. bridged biologic mesh closure vs. failure to close fascia). Secondary endpoints included comparison of stoma formation, bowel resection, fistulation rate, enterotomy formation, re-operation post closure, and wound infection. Results 99 patients had OAM (56 static packing; 43 TAC.) Patients with TAC were significantly more likely to undergo primary closure of fascia when compared to those patients managed with static packing, (63% vs 13%, p<0.0001, Chi Sq). The TAC group required fewer theatre episodes (n=2.27 vs. 4.78, p<0.0001, t-test) and time in days to achieve closure (n=2.78 vs n=4.68, p<0.005, Chi Sq), with less failure to close episodes and returns to theatre 30 days post closure. Conclusion This study provides definitive evidence of TAC efficacy for fascial closure following OAM. This provides definitive benefit over traditional open abdominal methods. It may provide benefit in definitive open abdominal management in other areas (sepsis and trauma) and requires further study.

Management of the Diabetic Foot in People with Diabetes Mellitus Older than 65 Years

Introduction: Diabetic foot is the infection, ulceration or destruction of the deep tissues of the foot in patients with diabetes mellitus. This pathology occurs when there are high levels of glucose in the blood, as well as other factors such as high blood pressure and hypercholesterolemia. These factors cause damage to the vessels and nerves, producing medium and long-term complications. This is a health problem that affects diabetic patients throughout their lives. Objective: To know the different techniques and strategies that allow to carry out an appropriate management of the diabetic foot. Methodology: A narrative review was carried out between November 2021 and July 2022 in the different databases of Pubmed (Medline), Scielo, Scopus and Web of Science (WOS), with a search string that combined the keywords derived from thesauri, namely Descriptors of Health Sciences (DeCS) and Medical Subject Headings (MeSH), combined with the Boolean operators “AND”, “NOT” and “NOT”. Results: After applying the article selection criteria and evaluating the quality of the methodology, a total of 22 articles were obtained. The results affirm the existence of promising therapies for the treatment of diabetic foot ulcers such as negative-pressure therapy and hyperbaric oxygen therapy. It is highlighted that the use of therapeutic footwear and health education are deficient aspects that must be reinforced. Conclusions: After comparing the different articles, it was possible to determine that negative-pressure therapy and hyperbaric oxygen therapy should be promoted as they are suitable for the treatment of diabetic foot ulcers. In addition, therapeutic footwear is a baseline in the diabetic foot approach. On the other hand, it is necessary to reinforce interdisciplinary work in this area and health education for patients suffering from this disease.

Simple suture whipstitch closure is a reasonable option for many patients requiring temporary abdominal closure for blunt or penetrating trauma

ObjectivesMultiple temporary abdominal closure (TAC) techniques are currently used to manage the open abdomen (OA) in severely injured trauma patients, with variability in efficacy and cost. We evaluated the clinical...

Implementation of closed incision negative pressure therapy in Enhanced Recovery After Surgery for immediate breast reconstruction with deep inferior epigastric artery perforator flap

Objectives: To compare the number of abdominal dehiscences in patients undergoing immediate breast reconstruction with Deep Inferior Epigastric artery Perforator flap (DIEP) before and after implementation of the Enhanced Recovery After Surgery (ERAS) protocol that adds postoperative Closed Incision Negative Pressure Therapy (ciNPT) to conventional abdominal binder compression therapy.

Construction and application of standard nursing procedures for treating infection after spinal internal fixation by pulse combined with closed negative pressure

Application of standardized nursing procedures in pulse combined with closed negative pressure therapy for patients with infection after spinal internal fixation, discuss its scientificity and operability. From July 2018 to December 2021, 54 patients with postoperative infection after spinal internal fixation were treated with pulse combined with vacuum sealing in our department. 42 patients in usual care were used as the control group, Among them, 12 patients in the observation group were nursed using standardized operating procedures, the VAS scores of the two groups were compared at 6h, 12h and 24h after operation,Patient and family satisfaction and quality of care. After application of standardized nursing procedures, the VAS scores of the patients decreased significantly at 6h, 12h and 24h after operation; hospital days, days of antibiotic used, the incidence of ineffective negative pressure was significantly reduced; the satisfaction of patients and their families was significantly improved. The difference was statistically significant (P<0.05). Implementing standardized nursing procedures can significantly reduce the incidence of ineffective negative pressure, reduce postoperative VAS score of patients, shorten the days of hospitalization and antibiotic use, improve patient and doctor satisfaction. At the same time, it can provide homogenization guidance for clinical nursing practice.

Construction and application of standard nursing procedures for treating infection after spinal internal fixation by pulse combined with closed negative pressure

Application of standardized nursing procedures in pulse combined with closed negative pressure therapy for patients with infection after spinal internal fixation, discuss its scientificity and operability. From July 2018 to December 2021, 54 patients with postoperative infection after spinal internal fixation were treated with pulse combined with vacuum sealing in our department. 42 patients in usual care were used as the control group, Among them, 12 patients in the observation group were nursed using standardized operating procedures, the VAS scores of the two groups were compared at 6h, 12h and 24h after operation,Patient and family satisfaction and quality of care. After application of standardized nursing procedures, the VAS scores of the patients decreased significantly at 6h, 12h and 24h after operation; hospital days, days of antibiotic used, the incidence of ineffective negative pressure was significantly reduced; the satisfaction of patients and their families was significantly improved. The difference was statistically significant (P<0.05). Implementing standardized nursing procedures can significantly reduce the incidence of ineffective negative pressure, reduce postoperative VAS score of patients, shorten the days of hospitalization and antibiotic use, improve patient and doctor satisfaction. At the same time, it can provide homogenization guidance for clinical nursing practice.

Role of Closed Incision Negative Pressure Therapy in Scar Management

In recent years, there has been a greater emphasis on providing high-quality medical treatment to ensure patients’ safety through improving recovery after surgery (ERAS), reducing postoperative stress, and restoring normal function quickly. Negative pressure wound care has revolutionized the way acute and chronic wounds are treated. The incision site is usually covered with an occlusive or semiocclusive covering after primary wound closure. It is thought that using closed incisional negative pressure therapy on surgical wounds improves wound healing by better distributing shear stresses on wound edges and promoting the evacuation of wound fluids such subcutaneous seroma and hematoma.

Device for Negative Pressure Wound Therapy in Low-Resource Regions: Open-Source Description and Bench Test Evaluation.

Background: Negative (vacuum) pressure therapy promotes wound healing. However, commercially available devices are unaffordable to most potential users in low- and middle-income countries (LMICs), limiting access to many patients who could benefit from this treatment. This study aimed to design and test a cheap and easy-to-build negative pressure device and provide its detailed open-source description, thereby enabling free replication. Methods: the negative pressure device was built using off-the-shelf materials available via e-commerce and was based on a small pump, a pressure transducer, and the simplest Arduino controller with a digital display (total retail cost ≤ 75 US$). The device allows the user to set any therapeutic range of intermittent negative pressure and has two independent safety mechanisms. The performance of the low-cost device was carefully tested on the bench using a phantom wound, producing a realistic exudate flow rate. Results: the device generates the pressure patterns set by the user (25–175 mmHg of vacuum pressure, 0–60 min periods) and can drain exudate flows within the clinical range (up to 1 L/h). Conclusions: a novel, low-cost, easy-to-build negative pressure device for wound healing displays excellent technical performance. The open-source hardware description provided here, which allows for free replication and use in LMICs, will facilitate the application and wider utilization of this therapy to patients.

Closed-Incision Negative Pressure Therapy Prevents Major Abdominal Donor-Site Complications in Autologous Breast Reconstruction.

Outcomes in autologous breast reconstruction continue to improve with refinements in microsurgical techniques; however, donor-site morbidity remains a concern. Closed-incision negative pressure therapy (ciNPT) has been shown to reduce wound complications. Limited evaluation in abdominal donor sites has shown promising results. We hypothesize that ciNPT will reduce abdominal donor-site complications. A retrospective chart review was performed of patients who underwent abdominally based autologous free tissue transfer for breast reconstruction by 4 microsurgeons at an academic institution from 2015 to 2020. The application of a commercial ciNPT for donor-site management was at the discretion of the operating surgeon. Demographics, operative details, and management of donor-site complications were analyzed. Four hundred thirty-three patients underwent autologous breast reconstruction; 212 abdominal donor sites were managed with ciNPT and 219 with standard dressings. Demographics were statistically similar between groups. Abdominal wound healing complications were noted in 30.2% of ciNPT patients (64/212) and 22.8% of control patients (50/219, P = 0.08); however, overall wound complications were attributed to obesity on multivariable analysis. Closed-incision negative pressure therapy significantly decreased complications requiring reoperation (ciNPT 6.2%, 4/64; control 26.5%, 13/51; P = 0.004). There were no significant differences in surgical site infection rates (P = 0.73) and rates of abdominal scar revisions (ciNPT 11.8%, 25/212; control 9.1%, 20/219; P = 0.37). Use of ciNPT in abdominal donor-site management significantly decreases the incidence of delayed wound healing requiring surgical intervention, with one major wound healing complication prevented for every 6 donor sites managed with ciNPT.

Incisional and Surrounding Periarticular Soft Tissue Management With Negative Pressure Therapy.

Periarticular injuries of the lower extremity are known for wound healing and infection complications. The role for incisional negative pressure wound therapy for lower extremity periarticular fractures has expanded over the last 10 years in hopes of minimizing complications. To date, there is no standardized published protocol of how negative pressure wound therapy is best used in lower extremity periarticular fractures. A review of strategies to decrease complications associated with the operative management of lower extremity periarticular fractures to include the use of incisional negative pressure wound therapy is presented.

Effects of Different Pressure Levels in Topical Negative Pressure Application-Analysis of Perfusion Parameters in a Clinical Skin Model Using Multimodal Imaging Techniques.

The effects of topical negative pressure therapy (TNP) have been a subject of research for many years. In this study, we investigated new imaging devices to detect clinical changes that TNP causes on healthy tissue and identified differences in microcirculation created by different pressure levels. We used near-infrared spectroscopy (NIS), thermography, and a vein illuminator to measure the differences in oxygen saturation, tissue temperature, and vein pattern. A control group (−125 mmHg) and three comparison groups with only TNP dressing (Group 1), −25 mmHg (Group 2), and −175 mmHg (Group 3) were established. Thirty minutes of TNP on intact skin was followed by 30 min of resting. A total of 24 participants were measured by all imaging devices at predetermined time points. Oxygen saturation and skin temperature increased by 8.07% and 1.67 °C for the control group, 4.00% and 1.65 °C for Group 2, and 8.45% and 1.68 °C for Group 3. Group 1 showed a slight increase in oxygen saturation and a 2.7 °C increase in skin temperature. Over the 30 min following removal of TNP, oxygen saturation and temperature decreased gradually for all groups. The vein illuminator did not show significant differences in the venous pattern or flow. Our study showed that higher negative pressure values resulted in higher oxygen saturation and higher tissue temperature.

Knowledge of Using Vacuums in the Treatment of Resistance Diabetic Foot Ulcers among Medical Students at King Faisal University, Saudi Arabia

Negative pressure therapy is used in diabetic foot cases to be healing of diabetic foot wounds by suctioning and vacuuming negative partial air from the wound, which helps in the formation and promotion of new tissues that are healthy and rich in capillaries. The aim of the study is to assess medical students’ knowledge about using negative pressure therapy in healing resistance diabetic foot wounds and ulcers. This is a cross-sectional study, depending on the online questionnaire that was used for data collection using social media platforms. 63.2% of participants answered “for 1-3 weeks” or “for 3-6 weeks” when they asked what is the duration of negative pressure wound therapy, while those who answered “for 6-9 weeks” were 29.4%, and about 7.5% answered “for 9-12 weeks.” About 43.5% of the participants only heard about the vacuum treatment. Also, only 23.6% of the participants had seen the negative pressure wound therapy instrument, and the remaining 76.4% did not see it. when asked about thinking that negative pressure wound therapy impacted the quality of patient care, about 54.5% of the participants indicated that it impacted the better quality of care, and only 9.5% indicated that it is the same quality of care, while about 30.8% of them indicated that it impacted relative better but highly expensive, and only 5.2% indicated that it is the worse quality of care. Medical students need to be aware of negative pressure therapy to take care of the well-being of resistance wounds of diabetic patients.

The Use of Negative Pressure Wound Therapy After Arterial Vascular Reconstructions

The Use of Negative Pressure Wound Therapy After Arterial Vascular Reconstructions

Open abdominal management after ruptured abdominal aortic aneurysm repair: from a single-center study in Japan

PurposeWe investigated the utility of the open abdominal management (OA) technique for ruptured abdominal aortic aneurysm (rAAA).MethodsBetween January 2016 and August 2021, 33 patients underwent open surgery for rAAA at our institution. The patients were divided into OA (n = 12) and non-OA (n = 21) groups. We compared preoperative characteristics, operative data, and postoperative outcomes between the two groups. The intensive care unit management and abdominal wall closure statuses of the OA group were evaluated.ResultsThe OA group included significantly more cases of a preoperative shock than the non-OA group. The operation time was also significantly longer in the OA group than in the non-OA group. The need for intraoperative fluids, amount of bleeding, and need for blood transfusion were significantly higher in the OA group than in the non-OA group. Negative pressure therapy (NPT) systems are useful in OA. In five of the six survivors in the OA group, abdominal closure was able to be achieved using components separation (CS) technique.ConclusionsNPT and the CS technique may increase the abdominal wall closure rate in rAAA surgery using OA and are expected to improve outcomes.

Principles of Fasciotomy Closure After Compartment Syndrome Release.

Acute compartment syndrome is a surgical emergency in the extremities resulting from increased compartmental pressure, requiring immediate fasciotomy to resolve muscular compromise. As the mainstay treatment, fasciotomies involve substantial skin incisions and are thus prone to complications such as skin necrosis, wound infection, and permanent disability. Multidisciplinary care instituted at the time of fasciotomy can facilitate timely closure and minimize the complication profile. Several approaches are available to enhance outcomes of fasciotomy wounds, and a comprehensive knowledge of these options affords the treating surgeon greater flexibility and confidence in optimal management. Common techniques include early primary closure, gradual approximation, skin grafting, and negative pressure therapy. There is currently no consensus on the best method of closure. The purpose of this study was to review fasciotomy wound management from the time of initial release to final closure. Highlights include preparation for closing these wounds; the various techniques for fasciotomy closure, including adjunct options; evaluation of timing and staging; and injury-specific features, such as fracture management, limited subcutaneous tissues, and hand fasciotomies. Combining the perspectives of orthopaedic and plastic surgery, this review evaluates the benefits of multiple closure methods and highlights the importance of planning closure at the time of release.

Differences in fluid removal of different open-pore elements for endoscopic negative pressure therapy in the upper gastrointestinal tract

Endoscopic negative pressure therapy is an effective treatment strategy for various defects of the gastrointestinal tract. The functional principle is based on an open-pore element, which is placed around a perforated drainage tube and connected to a vacuum source. The resulting open-pore suction device can undergo endoluminal or intracavitary placement. Different open-pore suction devices are used for endoscopic negative pressure therapy of upper gastrointestinal tract defects. Comparative analyses for features and properties of these devices are still lacking. Eight different (six hand-made devices and two commercial devices) open-pore suction devices for endoscopic negative pressure therapy of the upper gastrointestinal tract were used, amount fluid removed was evaluated. The evaluation parameters included the time to reach the target pressure, the time required to remove 100 ml of water, and the material resistance of the device. All open-pore suction devices are able to aspirate the target volume of fluids. The time to reach the target volume varied considerably. Target negative pressure was not achieved with all open-pore suction devices during the aspiration of fluids; however, there was no negative effect on suction efficiency. Of the measurement data, material resistance could be calculated for six open-pore elements. We present a simple experimental, nonphysiologically setup for open-pore suction devices used for endoscopic negative pressure therapy. The expected quantity of fluids secreted into the treated organs should affect open-pore suction device for endoscopic negative pressure therapy.

Closed-Incision Negative-Pressure Therapy Reduces Donor-Site Surgical Wound Dehiscence in DIEP Flap Breast Reconstructions: A Randomized Clinical Trial.

In breast reconstruction operations, surgical wound dehiscence is a serious complication that generates a significant burden on patients and health care systems. There are indications that postoperative treatment with closed-incision negative-pressure therapy has been associated with reduced wound dehiscence rates. This randomized clinical trial examines the effect of closed-incision negative-pressure application on abdominal donor-site surgical wound dehiscence in low- and high-risk patients undergoing breast reconstruction with a deep inferior epigastric perforator flap. Eighty eligible women, stratified as low- or high-risk patients, were included and were randomized for treatment with either closed-incision negative-pressure or adhesive strips by drawing sealed, opaque envelopes. All surgeons were kept blinded for allocation. Primary outcomes were surgical wound dehiscence and surgical-site infection at the abdominal donor site on follow-up after 12 weeks. Secondary outcomes were seroma and hematoma formation. Five patients were excluded from the study because of insufficient exposure to the study treatment ( n = 4) or major protocol deviation ( n = 1). A total of 75 women, low-risk ( n = 38) and high-risk ( n = 37), received either closed-incision negative-pressure ( n = 36) or adhesive strips ( n = 39). Patients' demographics did not differ significantly. Donor-site surgical wound dehiscence occurred in 23 patients; the absolute risk reduction was statistically significant (21.6 percent; 95 percent CI, 1.5 to 41.7 percent). No statistically significant differences were found in surgical-site infection or secondary outcomes. In this randomized clinical trial, postoperative treatment with closed-incision negative-pressure therapy decreased the incidence of surgical wound dehiscence at the abdominal donor site in low- and high-risk deep inferior epigastric perforator flap breast reconstruction patients. Therapeutic, I.