Negative Pressure Wound Dressings Research Articles

EP568 - A rare case of necrotizing fasciitis caused by Streptococcus Anginosus and Staphylococcus Lugdunensis

Abstract Necrotizing fasciitis (NF) is a rare soft tissue infection involving the fascial planes, causing rapid and extensive tissue destruction. We present a unique case of NF in a patient with poor glycemic control caused by atypical pathogens. A 66-year-old female with a recent biopsy for a wart-like lesion developed a wound infection, with greenish-black exudate. Initial observations were: temperature: 39.4 degrees, heart rate: 105, GCS: 15/15. Physical examination revealed a grossly filiform lesion below her abdominal apron measuring 7cm in diameter. The patient was empirically treated with IV Co-Amoxiclav. Abnormal biochemistry results are shown below. Microbiological analysis revealed Streptococcus Anginosus, anaerobes and Staphylococcus Lugdunensis. CT abdomen revealed extensive inflammatory changes with gas and fluid collection and enlarged pelvic and inguinal lymph nodes. Two urgent surgical explorations and debridements, with meticulous wound care using negative pressure wound dressings (Prevena) were done. Intravenous Gentamicin, Benzylpenicillin, Clindamycin, Metronidazole and Flucloxacillin were administered for six weeks. The patient's clinical status gradually improved. Streptococcus Anginosus, that is part of the Streptococcus Milleri group and Staphylococcus Lugdunensis, a coagulase-negative Staphylococci (CoNS) are commensal organisms of the oral and gastrointestinal tracts. These organisms possess virulence factors that facilitate tissue invasion and destruction, causing an aggressive course of NF. This case highlights the importance of considering atypical pathogens, especially in patients with predisposing factors such as diabetes and obesity. Early recognition, prompt surgical intervention and a multidisciplinary approach are essential for improving outcomes in these cases.TestResultWhite Blood Cells (WBC)22,200 [WBCs per microliter]Sodium123 [mmol/L]Chloride88 [mmol/L]C-reactive protein (CRP)318 [mg/L]Blood Glucose19.3 [mmol/L]

Construction and Performance Study of a Dual-Network Hydrogel Dressing Mimicking Skin Pore Drainage for Photothermal Exudate Removal and On-Demand Dissolution.

In recent years, negative pressure wound dressings have garnered widespread attentions. However, it is challenging to drain the accumulated fluid under negative pressures for hydrogel dressings. To address this issue, this study prepared a chemical/physical duel-network PEG-CMCS/AG/MXene hydrogel composed by chemical disulfide crosslinked network of four-arm polyethylene glycol/carboxymethyl chitosan (4-Arm-PEG-SH/CMCS), and the physical network of hydrogen bond of agar (AG). Under near-infrared light (NIR) irradiation, the PEG-CMCS/AG/MXene hydrogel undergoes photothermal heating due to integrate of MXene, which destructs the hydrogen bond network and allows the removal of exudate through a mechanism mimicking the sweat gland-like effect of skin pores. The photothermal heating effect also enables the antimicrobial activity to prevent wound infections. The excellent electrical conductivity of PEG-CMCS/AG/MXene can promote cell proliferation under the external electrical stimulation (ES) in vitro. The animal experiments of full-thickness skin defect model further demonstrate its ability to accelerate wound healing. The conversion between thioester and thiol achieved with L-cysteine methyl ester hydrochloride (L-CME) can provides the on-demand dissolution of the dressing in situ. This study holds promises to provide a novel solution to the issue of fluid accumulations under hydrogel dressings and offers new approaches to alleviating or avoiding the significant secondary injuries caused by frequent dressing changes.

1091 Comparing the Incidence of Superficial Surgical Site Infections Following Emergency Laparotomies with the Use of Negative Pressure Wound Dressings Versus Standard Wound Dressings

1091 Comparing the Incidence of Superficial Surgical Site Infections Following Emergency Laparotomies with the Use of Negative Pressure Wound Dressings Versus Standard Wound Dressings

(183) Radial Artery Free Flap Urethroplasty

Abstract Introduction Urethroplasty is an essential component of gender-affirming phalloplasty for transgender individuals who desire the ability to stand to void through a neophallus. Objective We demonstrate the creation of a neourethra using a radial artery free flap for transmasculine individuals with an existing neophallus using live surgical footage. Methods The patient was a 36 year old transmasculine individual who had undergone abdominal phalloplasty 6 months prior, and desired the ability to stand to void. Two teams may simultaneously work; one will harvest a radial forearm flap from the non-dominant upper extremity following a preoperative Allen's test. The flap is tubularized over a catheter. The other team will open the existing neophallus and groin site to prepare the flap recipient site. Following microvascular anastomosis, a micro-Doppler is used to confirm perfusion. The donor site is covered with a skin graft and negative pressure wound dressing. Results The patient had an uneventful recovery after 48 hours of bedrest with head of bed maintained at 30 degrees, and scheduled flap checks. They were discharged on postoperative day 5 after removal of the negative pressure forearm dressing. He has recovered well and has satisfactory orthotopic voiding on follow-up visits. Conclusions This technique of radial artery flap urethroplasty is a safe and effective option for patients who desire a neourethra with their neophallus. Disclosure No.

Hydrogels and Wound Healing: Current and Future Prospects.

The care and rehabilitation of acute and chronic wounds have a significant social and economic impact on patients and global health. This burden is primarily due to the adverse effects of infections, prolonged recovery, and the associated treatment costs. Chronic wounds can be treated with a variety of approaches, which include surgery, negative pressure wound therapy, wound dressings, and hyperbaric oxygen therapy. However, each of these strategies has an array of limitations. The existing dry wound dressings lack functionality in promoting wound healing and exacerbating pain by adhering to the wound. Hydrogels, which are commonly polymer-based and swell in water, have been proposed as potential remedies due to their ability to provide a moist environment that facilitates wound healing. Their unique composition enables them to absorb wound exudates, exhibit shape adaptability, and be modified to incorporate active compounds such as growth factors and antibacterial compounds. This review provides an updated discussion of the leading natural and synthetic hydrogels utilized in wound healing, details the latest advancements in hydrogel technology, and explores alternate approaches in this field. Search engines Scopus, PubMed, Science Direct, and Web of Science were utilized to review the advances in hydrogel applications over the last fifteen years.

Portable Negative Pressure Wound Dressing in Oncoplastic Conservative Surgery for Breast Cancer: A Valid Ally.

Background and Objectives: The use of oncoplastic techniques has spread widely in the last decade, with an expansion of the indications and demonstration of excellent oncological safety profiles. A potential downside may be the increased complication rates, which could influence the timing of adjuvant therapy. To date, there is increasing evidence that negative pressure therapy on closed wounds can reduce complication rates after surgery. From this perspective, we tested the use of portable negative pressure wound dressings (NPWDs) in oncoplastic surgery to minimize early post-operative admissions to the outpatient clinic and prevent surgical complications. Materials and Methods: An observational prospective cohort study was conducted on a population of patients who underwent quadrantectomy and wise-pattern reduction mammoplasty for breast cancer. The primary objective of the study is represented by the evaluation of the impact of NPWD on post-operative outcomes in an oncoplastic surgery setting. Patients enrolled between January 2021 and January 2023 were divided into two groups, the conventional dressing (CD) group and the NPWD group, by a simple randomization list. Results: A total of 100 patients were enrolled, with 52 in the CD group and 48 in the NPWD group. The use of NPWD significantly reduced the wound dehiscence rate (2.0% vs. 7.7% p = 0.002) and the number of one-month postoperative admissions to our clinic (3.8 ± 1.1 vs. 5.7 ± 1.3 p = 0.0009). Although not significant, it is possible to note a trend of reduction of clinically relevant postoperative total complications in patients treated with NPWDs. Conclusions: NPWDs may represent a useful tool in the post-surgical management of complex oncoplastic procedures, ensuring less wound dehiscence. Furthermore, the use of these dressings led to a significant reduction in admissions to the clinic, promoting a lower use of resources by hospitals and effective prevention of possible complications.

A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin.

For 9 months (April-December 2022), we performed 32 vacuum wound dressings with the newly developed technique using the 3M ActiV.A.C. Therapy Unit and accessories, and Convatec's VARIHESIVE, avoiding skin contact with the adhesive films. Seven patients with 11 wounds who had sensitive skin or allergy to the conventionally used adhesive films were successfully treated with the new technique. The negative pressure wound dressings remained intact and functioned properly for up to 168 hours without compromising patients' daily activities and therapy. The novel "no foil-to-skin contact" technique for vacuum-assisted wound closure can successfully be incorporated in the treatment of patients in whom conventional negative pressure dressings are otherwise not applicable.

Training assessment of clinical knowledge and skills in the use of negative pressure wound dressings in cardiac patients

Funding AcknowledgementsType of funding sources: None.ObjectiveAn assessment was conducted to analyse the level of improvement impact one can have on clinical knowledge and skills in the use of a novel negative pressure wound dressings in high-risk cardiac patients along with their years of experience following a training program conducted among our cardiac staff.MethodsIn a prospective study involving twenty cardiac nursing staff from December 2020 to June 2021 who voluntarily participated in the study. Their pre and post training assessment of clinical knowledge and skills were assessed using twenty questionnaires. The pre and post training educational knowledge and skills scores were analysed along with their years of clinical experience.ResultsIn the six-month period n=20 (100 %) were compliant to the training despite the covid-19 pandemic.The study group showed an average pre-training score of 10.5% (Knowledge 5.25% and Skills 5.25%)The average post-training score of84.75% (Knowledge 42.25% and Skills 42.25%)While comparing the years of clinical experience against the pre and post training scoresSeventeen (n=17/20, 85%) had five to ten years experience compared to three (n-3/20, 15%) with more than 20 years of experience.ConclusionBoth clinical knowledge and skills can be augmented through regular training members with more than ten years of clinical experience might have an added benefit and their experience could be important to train younger staff members with less clinical experience.

Impact of closed-incision negative pressure wound dressings on surgical site infection following groin incisions in vascular surgery; a single-centre experience.

Surgical site infection (SSI) is a common complication in vascular surgery, and is associated with increased patient morbidity, readmission and reintervention. The aim of this study was to assess the impact of closed-incision negative pressure wound therapy (CiNPWT) upon rate of SSI and length of hospital stay. This study was reported in line with the STROBE guidelines. We assessed the baseline incidence of SSI from a 12-month retrospective cohort and, following a change in practice intervention with CiNPWT, compared to a 6-month prospective cohort. The primary endpoint was incidence of SSI (according to CDC-NHSN guidelines) while secondary endpoints included length of hospital stay, readmission, reintervention and Days Alive and Out of Hospital (DAOH) to 90-days. A total of 127 groin incisions were performed: 76 (65 patients) within the retrospective analysis and 51 (42 patients) within the prospective analysis (of whom 69% received CiNPWT). The primary endpoint of SSI was seen in 21.1% of the retrospective cohort and 9.8% of the prospective cohort (p = .099). Readmission was found to be significantly associated with the retrospective cohort (p = .016) while total admission (inclusive of re-admission) was significantly longer in those in the retrospective cohort (p = .013). DAOH-90 was 83days (77-85) following introduction of the CiNPWT protocol as compared to the retrospective cohort (77days (64-83), p = .04). Introduction of CiNPWT was associated with a reduced length of hospital stay and improved DAOH-90. Further trials on CINPWT should include patient-centred outcomes and healthcare cost analysis.

Botulinum Toxin A infiltration in conjunction with negative-pressure wound dressing and mesh-mediated traction in management of the open abdomen.

Botulinum Toxin A infiltration in conjunction with negative-pressure wound dressing and mesh-mediated traction in management of the open abdomen.

PD29-09 PRIMARY CLOSURE IS SUPERIOR TO SECONDARY INTENTION FOR TREATING FOURNIER GANGRENE

You have accessJournal of UrologyCME1 May 2022PD29-09 PRIMARY CLOSURE IS SUPERIOR TO SECONDARY INTENTION FOR TREATING FOURNIER GANGRENE Peter Sam, Andrew Zilavy, Carolyn Ice, and Maxx Gallegos Peter SamPeter Sam More articles by this author , Andrew ZilavyAndrew Zilavy More articles by this author , Carolyn IceCarolyn Ice More articles by this author , and Maxx GallegosMaxx Gallegos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Initial management of Fournier Gangrene (FG) is well-established. However, the optimal management post-debridement is still unclear. In general, most post-debridement FG wounds are allowed to heal by secondary intention (SI) with negative pressure wound dressings or treated with delayed primary closure (DPC) using flaps and/or grafts. We hypothesize that DPC is superior to closure by SI in terms of days in the hospital (LOS) and time until return to normal daily activity. Additionally, we hypothesize that DPC is not inferior to SI in terms of infection control. METHODS: At our single tertiary care center, we retrospectively assessed all cases of FG that underwent wound healing by SI vs DPC from 2016 to 2021. A transition to DPC began when our institution hired a GU reconstructive surgeon. Patients who died from their disease, those who were lost to follow up, or those whose closure deviated from our standardized protocol were excluded. Primarily, we collected data regarding LOS and time until return to normal daily activity. Secondarily, we evaluated if DPC or SI resulted in any further need for additional debridement for lack of infection control. T-tests were used to compare our two groups. RESULTS: 18 cases of DPC and 19 cases of SI met inclusion criteria. Patients who underwent DPC spent an average of 14.3 days in the hospital compared to 21.1 days in SI group, CI (-13.23 to -0.37) p <0.05. Time until return to normal daily activity was 43.6 days for the DPC group compared to 103.1 days for SI group CI (-92.14 to -26.86) p <0.005. None of the DPC or SI cases required any debridement beyond the initial 48 hours from presentation. CONCLUSIONS: At our institution, DPC was superior to closure by SI in regards to LOS and time until return to normal daily activity. Patients that underwent DPC enjoyed about 7 less LOS and returned to normal activity about 60 days earlier than patients in the SI group. DPC was non-inferior to SI for infection control. Multi-institutional prospective data is needed to confirm these findings. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e507 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Sam More articles by this author Andrew Zilavy More articles by this author Carolyn Ice More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF DownloadLoading ...

Indigenously Prepared Intermittent Negative Pressure Wound Dressing: Effective and Economic in Indian Scenario

Introduction: Intermittent negative pressure wound treatment (INPWT) is a proven way to accelerate wound healing by increasing blood flow, promoting angiogenesis and suction removal of matrix metalloproteinases. The purpose of the study was to evaluate the use of INPWT in pressure sores. In our study, we have used very low-cost locally available material for INPWT in place of commercially available costly vacuum-assisted closure (VAC) machine and dressing. Materials and Methods: This was a prospective study conducted in the department of plastic and reconstruction surgery and physical medicine and rehabilitation at a tertiary level facility. Eighty patients of spinal cord injury with 70% of ASIA Grade A and B with pressure ulcer most commonly at sacral and ischial regions with National Pressure Ulcer Advisory Panel Grade 3 and Grade 4 pressure sore were treated. Patients enrolled included 57 males and 23 females. The study employed locally manufactured low-cost materials such as foam, Ioban tape, Room Vac drain and suction machine (easily and locally available at any primary, secondary as well as tertiary healthcare centre) for INPWT in patients with pressure sores. Dressing was changed every 4th day till desired granulation tissue was formed. Results: Out of patients who were treated with INPWT, 30% achieved direct closure, 49% required split skin grafting and 21% required reconstruction by local flaps. Commercial available VAC machines available in the market cost around 300,000–500,000 INR, and the cost of single dressing is around 7000–15,000 INR. This may not be economically feasible, especially in patients having large wounds which require multiple applications of these dressings with our indigenous dressing; there is a 95%–98% decrease in pricing of dressing. Conclusion: The study concluded that low-cost indigenously prepared INPWT dressing produced effective results at minimum cost that were at par with commercially available costly VAC dressing. This low-cost indigenously prepared INPWT can be groundbreaking in treatment of patients with pressure ulcer in developing country like India in both rural and urban settings.

Closed-Incision Negative Pressure Wound management Following Midline Laparotomy in Gynecological Oncology Operations: A Feasibility Pilot Study.

IntroductionSurgical site infections (SSIs) are a cause of considerable morbidity and mortality in healthcare. Increasingly, closed-incision negative pressure wound therapy (ciNPWT) is being studied as a potential method of reducing incidence of SSI with conflicting results in the literature. Few studies however have looked at its use in the field of gynecological oncology.ObjectivesWe aimed to compare the incidence of SSI when using ciNPWT dressings versus conventional dressings in gynecological oncology patients undergoing midline laparotomies.MethodsThis was a pilot study involving 14 patients receiving the ciNPWT dressing and 26 control patients. All patients were followed up for a period of 30 days. We used the American College of Surgeons (ACS) risk calculator to estimate each patient’s risk of SSI in order to risk stratify the groups.ResultsThe incidence of wound infection was 21% (3/14) in the ciNPWT group and 23% (6/26) in the control group (p=0.886). The ciNPWT group was found to be at significantly higher risk for SSI as calculated by the ACS tool (8.8% ciNPWT, 6% control, p=0.004). After stratifying for this difference in risk, still no significant difference in incidence of SSI was found between the two groups (27% (3/11) ciNPWT, 29% (2/7) control p=0.929).ConclusionThe incidence of SSI does not appear to decrease by the prophylactic use of the closed-incision negative pressure wound dressing.

TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy?

Abstract Aims Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change. Methods In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019. Results We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates. Conclusion While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient.

Sterile peri-graft abscess formation following aortic replacement: A word of caution for usage of BioGlue®

We report sterile peri-graft abscess formation following an ascending aortic and hemiarch replacement for acute type A aortic dissection, possibly caused as a reaction to BioGlue®. The patient was successfully treated by drainage, cleaning, removal of BioGlue® remnants, three sessions of negative-pressure wound dressing, and secondary chest closure.

A guide to caesarean wound healing

A guide to caesarean wound healing

Recurrent Subcutaneous Abscess Due to Nocardia farcinica in an Immunocompetent Patient: A Case Report

Nocardia farcinica differs from other species of Nocardia due to its multi-drug resistance and propensity to disseminate hematogenously. Cutaneous nocardiosis in immunocompetent patients is rare. To describe the treatment and clinical trajectory of a 37-year-old male patient who was not immunocompromised and presented with a history of minor trauma from a canister and palpable subcutaneous draining nodules in the forearm. Purulent drainage was present. The injury had occurred 3 months before presentation. Magnetic resonance imaging revealed multiple abscess foci up to 3 cm in diameter in the forearm muscles. The wound culture obtained after debridment indicated Nocardia farcinica as the cause. The case was difficult to manage despite serial debridements, negative pressure wound dressings, and culture-specific antibiotic treatments. The entire treatment process took approximately 7 months. The patient had 5 surgical interventions and more than 6 months of antibiotic treatment. Healing was eventually achieved but with a painful scar. Although nocardiosis has been documented to occur primarily in immunocompromised patients, it should be considered in the differential diagnosis of immunocompetent patients if there is a history of skin injury and a late-onset subcutaneous draining abscess resistant to common treatment regimens.

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.

Does Negative Pressure Wound Dressing Improve Healing in Obese Women After Cesarean Delivery

Women with body-mass index ≥30 kg/m2 are at greater risk for major postoperative wound complications. Investigators compared two approaches to wound

An Application of a Negative-Pressure Wound Dressing for Partial- or Full-Thickness Burn Wounds.

Negative-pressure wound therapy is widely used in burn populations. Traditionally, negative-pressure devices use persistent vacuum suction, requiring a longer hospital stay. In this study, we applied a novel negative-pressure wound dressing for burn wounds, which eliminates the hospital stay. The medical records of 39 patients with partial-/full-thickness burns treated by negative-pressure wound dressing were retrospectively analyzed. The average burn area, burn degree, healing duration, cost, and incidents during treatment were determined and compared with previous data for conventional therapies. In conclusion, for patients diagnosed with partial-thickness or full-thickness burns and a burn area <34.6 ± 2.21 cm2, the negative-pressure wound dressing is a reliable option, especially for burnt children. Moreover, the negative-pressure wound dressing treatment was not only much cheaper than conventional therapies, but also eliminated hospital stay in patients with small-area deep burn wounds.