Negative Pressure Wound Therapy Group Research Articles

Roles of Oxidative Stress and Raftlin in Wound Healing Under Negative-Pressure Wound Therapy.

BackgroundNegative-pressure wound therapy (NPWT) is an effective way to promote wound healing. However, its mechanisms have not been investigated thoroughly. Growing evidence suggests that oxidative stress and Raftlin levels play important roles in wound healing. However, whether NPWT promotes wound healing through this mechanism remains unclear.PurposeOur study focuses on the different levels of oxidative stress and antioxidant response between wounds treated by NPWT and routine dressing change. The objective of this study was to measure the differences in Raftlin levels between the two groups, which is a new biomarker related to wound healing.MethodsWe divided 48 male Sprague-Dawley rats with identical full-thickness skin defects into two groups. At specific times (0, 3, 5, 7, 9, 11, and 13 days after surgery), wound tissue samples were obtained for immunohistochemistry and biochemical analysis. The expression of Raftlin and levels of oxidative stress, including malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) levels were measured by biochemical analysis. Wound-healing times were also compared.ResultsIn the NPWT group, MDA levels were significantly decreased on days 3, 5, and 7. Furthermore, the expressions of SOD and CAT were significantly reduced on days 3 and 5. Our data also revealed that Raftlin was significantly upregulated across the whole period of wound healing. Moreover, wound healing in the NPWT group was significantly more rapid (16 days on average) than in the control group (24 days on average). On day 13 post surgery, the wound-healing percentage in the NPWT group was 91%, while that in the control group was 48%.ConclusionNPWT may promote wound healing by upregulating Raftlin and inhibiting oxidative stress levels.

SP5.2.3 Comparison of Open Abdomen Management Techniques in a cohort of patients with Encapsulating Peritoneal Sclerosis – A large single centre retrospective review

Abstract Aims Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement and obstruction of the bowel by thickened peritoneum. In our centre, EPS laparotomies are typically managed with open abdomen (OA) and planned relook at 24-48 hours. The aim of the study was to compare ABTHERATM open abdomen negative pressure wound therapy (NPWT) with packing (betadine-soaked gauze) as temporary abdominal closure (TAC) techniques in OA management. Methods We performed retrospective analysis of a contemporaneously maintained database of all patients who underwent surgery for EPS between 2010-2020. A variety of variables were included with the primary endpoint being time to definitive fascial closure. Patient demographics, surgical complications, subsequent method of closure (including mesh usage) and outcomes were recorded. Results 99/122 patients underwent open abdomen management. 43/99 were managed with NPWT and 56/99 were managed with packing. The NPWT group had significantly higher fascial closure rates without need for subsequent bridged (mesh) closure when compared to the packed abdomen [62.8% vs 12.5%, (p < 0.001, c2 test)]. In the NPWT group, there were also fewer failed closures [4.7% vs 19.6%, (p = 0.03, c2 test)] along with shorter time to definitive closure and reduced theatre episodes. No incidence of intestinal fistulation was associated with NPWT. Conclusion This study provides definitive guidance as to the benefit of ABTHERATM open abdomen NPWT for fascial closure following open abdominal management. ABTHERATM open abdomen NPWT provides significant advantages over traditional methods of TAC and may provide benefit in OA management in other patient groups (sepsis and trauma) as well.

Retrospective Analysis of Flap Based Management in Deep Sternal Wound Infection in a Tertiary Care Centre –A Single Centre Study

Aims: In this retrospective study we analyzed the outcomes of flap based management in deep sternal wound infection (DSWI). Materials & Methods: Patients, who had undergone open heart surgery through median sternotomy between September 2017 and March 2020 and had developed deep sternal infections, were retrospectively analyzed in this study. Few patients found to have DSWI were managed only by Negative Pressure Wound Therapy (NPWT) and few were managed by NPWT and Bipectoral musculo fascial flap cover. The outcomes in terms of mortality and readmission in the postoperative course were obtained from the records during subsequent follow ups in OPD for six months. Results: Out of 925 patients 11 patients (1.2%) had deep sternal wound infection There were six patients (n=6, 54.55%) who received NPWT where as five patients (n=5, 45.45 %) received flap surgery following NPWT. The patient who underwent Flap surgery had a longer postoperative stay than NPWT group (46.2+/- 22.21, C.I 95%) days Vs (25.5+/- 14.41, C.I 95%) days. However, the readmission due to recurrence of infection was seen only in NPWT group (n=3, 50%) with in the period of six months following discharge. One patient out of the three readmitted patients expired due to sepsis. Conclusion: NPWT followed by bipectoral muscle flap closure has a better surgical outcome than NPW alone in deep sternal wound infection in early postoperative period

A Randomized Controlled Trial of Negative Pressure Wound Therapy to Reduce Colorectal Surgical Site Infection

Background: The rate of surgical site infection (SSI) in clean-contaminated wounds resulting from elective colorectal procedures ranges from 15 to 30%. Within the region considered in the study, the SSI rate is 20% despite the adoption of preventative measures. Objective: The objective of this study was to determine the effectiveness of prophylactic negative pressure wound therapy (NPWT) in reducing superficial SSIs in clean-contaminated wounds resulting from elective colorectal surgery to below 10%. Design: An unblinded randomized controlled trial was conducted. Settings: The study was conducted at two Canadian tertiary academic hospitals. Patients and Methods: Patients undergoing elective, non-emergent, clean-contaminated colorectal resection by both laparoscopic and open procedures were included. Participants were randomized to either standard surgical dressing (SSD) or NPWT over a closed incision. Main Outcome Measures: Incidence of superficial SSI on postoperative day 30. Results: The study closed early due to lack of accrual. From the planned group of 398 patients, 126 were randomly assigned to SSD (n = 61) or NPWT (n = 61). The analysis included 55 patients from the SSD group and 47 from the NPWT group. The mean age for the groups was 64.9 years (SSD) and 65.1 years (NPWT) with males comprising 52.7% (n = 29) and 44.7% (n = 21) of the populations, respectively. The results showed a clinically important but statistically non-significant difference between the two groups. The overall rate of SSI in the as-treated analysis was 14.7%, while it was slightly lower at 13.5% in the intent-to-treat (ITT) analysis. In both cases, there was a trend toward higher rates of SSI in the SSD, with the ITT analysis showing somewhat larger differences; however, in both the logistic regression models, the trends were non-significant. Conclusion: We present a randomized controlled trial of prophylactic NPWT following elective colorectal resection. The results indicated a clinically important reduction in the superficial SSI rate compared with standard surgical dressing. A more extensive randomized study is needed to clarify the effectiveness of NPWT to reduce wound infections in this patient population. Limitations: Neither patients nor clinicians were blinded to the treatment. The lack of recruitment introduced a type two statistical error, which led to a non-significant difference between the cases and controls. Conflict of Interest: None.

A systematic review and meta-analysis of efficacy and safety of negative pressure wound therapy in the treatment of diabetic foot ulcer.

Negative pressure wound therapy (NPWT) is one of the new modality for the treatment of diabetic foot ulcers. In this article we will investigate the efficacy and safety of it by literature search and meta-analysis. The databases of PubMed, Embase, Ovid, and Cochrane library were selected as search platforms. Randomized controlled trials (RCTs) published after 2010 were searched with the keyword "vacuum-assisted closure therapy" OR "negative pressure wound therapy" OR "diabetic foot". The Cochrane Review Handbook was used to assess the bias of the literatures. The software RevMan 5.4 was used for analysis to obtain a forest plot and funnel plot. In this study, 363 articles were initially screened, and 9 literatures were finally included, involving a total of 943 patients. Combined analysis using the fixed effects model showed that the healing rate of the NPWT group was significantly lower than the standard group [odds ratio (OR) =3.60, 95% confidence interval (CI): 2.38 to 5.45, P<0.001]. The granulation tissue formation time of the NPWT group was significantly less than the standard group [mean difference (MD) =-8.95, 95% CI: -10.26 to -7.64, P<0.001]. The rate of adverse events of both groups showed no significant difference (OR =0.49, 95% CI: 0.10 to 2.42, P=0.38). The amputation rate of both groups showed no statistically significant (OR =0.33, 95% CI: 0.09 to 1.26, P=0.10) too. Negative pressure wound therapy can effectively accelerate wound healing, it is equally safe with general routine treatment. However, the negative pressure value should be appropriately maintained and adjusted to avoid bleeding tendency of the wound when applying this new modality.

Use of a Negative-Pressure Wound Dressing to Prevent Surgical Site Complications after Revision Knee Arthroplasty—A Randomized Controlled Trial

The aim of this study was to determine if a negative pressure wound therapy (NPWT) system can facilitate wound healing and withstand mechanical stress owing to the high range of motion of the knee joint in total knee arthroplasty. The benefits of NPWT include aiding wound granulation and a reduction in wound edema and secretion; our goal is to investigate its benefits in primary wound closure. Within an eight-day duration of treatment, we compared standard wound dressing (gauze and compression) with the disposable NPWT system (PICO)TM. A total of 79 patients were recruited in a controlled, randomized, prospective, single-institution clinical trial. A total of 40 patients were allocated to the study group and 39 to the control group. In terms of blood loss and infection parameters, there was no significant difference between both groups. In the NPWT group, we determined a significant reduction in wound edema but none in wound secretion. While the NPWT dressings survived the mechanical effects of movement during postoperative physiotherapy, conventional compressive dressings were often renewed. Even though the risk factors that could lead to delayed wound healing were reduced in the test group, we could not identify any significant difference pertaining to delayed wound healing that required surgical treatment.

Algorithmic Approach Using Negative Pressure Wound Therapy Improved Survival for Patients with Synchronous Hypopharyngeal and Esophageal Cancer Undergoing Pharyngolaryngoesophagectomy with Gastric Tube Reconstruction

This study retrospectively analyzed the feasibility and surgical outcome of an algorithmic approach using negative pressure wound therapy for patients with synchronous hypopharyngeal and esophageal cancer undergoing pharyngolaryngoesophagectomy with gastric tube reconstruction. Patients undergoing pharyngolaryngoesophagectomy and gastric tube reconstruction for hypopharyngeal cancer between 2011 and 2019 were candidates for this study. Data were collected on patient demographics, comorbidities, performance status, cancer stage, treatment, complication, and survival. Survival analysis was performed using the Kaplan-Meier method. The Cox proportional hazards model was used for prognostic factors. The study enrolled 43 patients. Anastomotic leakage was found in 21 of the patients with a conventional surgical drain (61.9%) and in 10 of the 22 patients with negative pressure wound therapy (45.5%) (p = 0.280). Nine patients in the conventional drain group (42.9%) and two patients in the negative pressure wound therapy group (9.1%) had leakage-associated complications (p = 0.011). The incidence of pulmonary complications was higher in the conventional surgical drain group (9 vs 2; p = 0.011). The number of complications requiring surgery was higher in the conventional drain group (7 vs 0; p = 0.004). The overall survival in the negative pressure wound therapy group was better (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.15-0.76; p = 0.009). Negative pressure wound therapy was independently associated with overall survival (HR, 0.31; 95% CI, 0.13-0.77; p = 0.011). Negative pressure wound therapy with an algorithmic approach improved the overall survival for the patients undergoing gastric tube reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal and esophageal cancer by preventing deadly complications secondary to anastomotic leakage.

Comprehensive analysis of lncRNA and miRNA expression profiles and ceRNA network construction in negative pressure wound therapy.

BackgroundThis study aims to explore the molecular mechanism of negative pressure wound therapy (NPWT) at the transcriptome level through whole transcriptome sequencing and biometric analysis.MethodsA rat skin defect model was constructed and randomly divided into a NPWT group and a gauze group. The tissue in the center of the wound was used for whole transcriptome sequencing, and differentially expressed messenger RNAs (DEmRNAs), long noncoding RNAs (DElncRNAs), and microRNAs (DEmiRNAs) were identified between the two groups. Quantitative real time-polymerase chain reaction (qRT-PCR) analysis was used to verify the sequencing results. Functional enrichment analysis, pathway analysis, and protein-protein interaction (PPI) network analysis of DEmRNAs were conducted. Through bioinformatics analysis, a lncRNA-associated competing endogenous RNA (ceRNA) network was identified and constructed.ResultsWe detected 896 DEmRNAs, 1,471 DElncRNAs, and 20 DEmiRNAs between the two groups. qRT-PCR verified the sequencing results. Functional analysis showed that DEmRNAs were mainly enriched in immune system processes and the Notch signaling pathway. Protein tyrosine phosphatase receptor type C (PTPRC) and signal transducer and activator of transcription 1 (STAT1) were the central hub nodes in the PPI analysis. The ceRNA network contained 11 mRNAs, 15 lncRNAs, and 4 miRNAs.ConclusionsWe identified several DEmRNAs, DElncRNAs, and DEmiRNAs between the NPWT treatment group and the control group. These findings may provide new insights into the pathophysiological mechanism of NPWT and wound healing.

Cost-effectiveness of adjunctive negative pressure wound therapy in paediatric burn care: evidence from the SONATA in C randomised controlled trial

Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound re-epithelialisation. Its effects on healthcare costs, however, remain poorly understood. The aim of this study was to evaluate the cost-effectiveness of NPWT from a healthcare provider perspective using evidence from the SONATA in C randomised controlled trial, in which 101 children with small-area burns were allocated to either standard care (silver-impregnated dressings) or standard care in combination with adjunctive NPWT. The primary outcome, time to re-epithelialisation, was assessed through a blinded photographic review. Resource usage and costs were prospectively recorded for each participant for up to 6 months. Incremental cost-effectiveness ratios and dominance probabilities were estimated and uncertainty quantified using bootstrap resampling. Mean costs per participant—including dressings, labour, medication, scar management, and theatre operations—were lower in the NPWT group (AUD $903.69) relative to the control group (AUD $1669.01). There was an 89% probability that NPWT was dominant, yielding both faster re-epithelialisation and lower overall costs. Findings remained robust to sensitivity analyses employing alternative theatre costs and time-to-re-epithelialisation estimates for grafted patients. In conclusion, adjunctive NPWT is likely to be a cost-effective and dominant treatment for small-area paediatric burns (ANZCTR.org.au:ACTRN12618000256279).

Efficiency of Hyperbaric Oxygen Therapy Combined with Negative-Pressure Wound Therapy in the Treatment Strategy of Fournier's Gangrene -A Retrospective Study.

Fournier's gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment's strategies of FG. This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient's age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1-5. The study group consisted of all men (n=35) aged 24-85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier's syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2.The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23days) than in group 1 (mean, 26days). HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury.

Negative pressure wound therapy in the treatment of deep sternal wound infections – a critical appraisal

Introduction. Negative pressure wound therapy (NPWT) has widely become the first-line option in the treatment of deep sternal wound infections. After several positive reports in comparison with conventional treatment, very recent studies comparing NPWT with early reconstruction have favored the latter. Our aim was to evaluate the effectiveness and safety of NPWT in comparison with early flap reconstruction. Materials and methods. We concluded a retrospective analysis of 125 patients with deep sternal wound infection treated in a single institution between the years 2006 and 2018. NPWT became the first-line treatment in our hospital in 2011. The study group consisted of 55 patients treated primarily with NPWT with or without subsequent flap reconstruction. The control group consisted of 60 patients treated with flap reconstruction without prior NPWT. Ten patients with an immediate re-fixation and direct wound closure were excluded. Results. There were no significant differences between the two groups concerning the type or urgency of the original open-heart surgery, age, gender, or co-morbidities. In the NPWT group there was significantly higher mortality (p = .002), longer stay in the intensive care unit (p = .028), and in the university hospital (p < .001) as well as higher number of operations (p < .001). However, there were somewhat more surgical complications in the control group as well as a higher number of distant flap reconstructions. Overall, five patients suffered from NPWT associated bleeding. Conclusion. Our results raise concerns about the wide use of NPWT as a first-line treatment of deep sternal wound infections. Further evaluative studies are warranted to confirm the results.

Effects of negative pressure wound therapy on an axial congested rabbit skin flap model without any bare surface

One of the most important problems encountered in reconstructive surgery is partial or total flap loss, and venous congestion is the most common reason. It should be solved as early as possible. The purpose of this study is to investigate the effects of Negative pressure wound therapy (NPWT) on an ideal congested rabbit skin flap model without any open wound. The current study included 28 female, adult, New Zealand albino rabbits. Animals were divided into four groups according to the duration of NPWT to be applied. An axial pattern ideal congested skin flap was designed on the posterior surface of the ear. After surgical intervention on the right ears, we applied NPWT treatment for 2, 4, 6 and 8 days. The left ears were followed without any treatment. Samples were taken for edema, congestion and neo-angiogenesis examination. There was no significant difference between the NPWT applied group and control group in the 2nd, 4th, 6th, and 8th days for edema and neo-angiogenesis and no differences in the 2nd, 6th, and 8th days for congestion. NPWT group had a higher flap survival rate than the control group but without a significant difference. This study used an ideal congested rabbit skin flap model imitating venous congestion. Our findings illustrate that NPWT treatment does not have a significant effect on the congested skin flap model we utilized where a closed system was created maintaining a skin barrier without a bare surface of the flap. Level of Evidence: Level I, experimental study

Randomized controlled trial of single-use negative-pressure wound therapy dressings in morbidly obese patients undergoing cesarean delivery

The single-use negative-pressure wound therapy dressings are designed to use over a closed surgical wound. Early prospective studies suggested that these dressings may be of potential benefit in reducing cesarean wound complications. This study aimed to test the hypothesis that incisional negative-pressure wound therapy decreases postoperative wound morbidity compared with standard surgical dressing in patients with class III obesity undergoing cesarean delivery. In a single-site, parallel, randomized controlled trial, participants with class III obesity (body mass index ≥40 kg/m2) were recruited to participate in the study. Patients were consented in the ambulatory obstetrical units, on admission to the antepartum service, and on labor and delivery before active labor. Patients who had a cesarean delivery were randomized to either the standard surgical dressing or a prophylactic negative-pressure wound therapy device. The randomization was achieved using permuted blocks of 4, 6, and 8 in a 1:1 allocation ratio. The primary outcome was a composite outcome of wound complications. The planned enrollment of 242 subjects was based on the power to detect a 50% decrease in the composite wound outcome, assuming a 30% baseline wound morbidity rate for this population. The outcomes were assessed by study staff blinded to the patient's treatment arm. An unplanned interim analysis was performed because of the slow enrollment and publication of larger trials showing no benefit of the negative-pressure wound therapy. Of 411 eligible patients during the study period, 212 participants with class III obesity were enrolled. Of these, 110 underwent cesarean delivery and were subsequently randomized (55 to standard dressing and 55 to prophylactic negative-pressure wound therapy device). The primary outcome occurred in 29.1% in the standard surgical dressing compared with 20% in the negative-pressure wound therapy group (risk difference, 9.1%; 95% confidence interval, -8.3 to 25.8%; P=.38). The study was stopped early because of a low enrollment rate and lower likelihood of seeing a clinically significant benefit. The trial was stopped after an unplanned, interim analysis showed the use of a prophylactic negative-pressure wound therapy device used for cesarean delivery did not reduce wound complications compared with a standard surgical dressing.

Negative pressure wound therapy does not decrease postoperative wound complications in patients undergoing mastectomy and flap fixation

Patients and breast cancer surgeons are frequently confronted with wound complications after mastectomy. Negative pressure wound therapy (NPWT) is a promising technique for preventing wound complications after skin closure in elective surgery. However, a clinical study evaluating postoperative complications following the use of NPWT, focusing solely on closed incisions in patients undergoing mastectomy, has yet to be performed. Between June 2019 and February 2020, 50 consecutive patients underwent mastectomy with NPWT during the first seven postoperative days. This group was compared to a cohort of patients taking part in a randomized controlled trial between June 2014 and July 2018. Primary outcome was the rate of postoperative wound complications, i.e. surgical site infections, wound necrosis or wound dehiscence during the first three postoperative months. Secondary outcomes were the number of patients requiring unplanned visits to the hospital and developing clinically significant seroma (CSS). In total, 161 patients were analyzed, of whom 111 patients in the control group (CON) and 50 patients in the NPWT group (NPWT). Twenty-eight percent of the patients in the NPWT group developed postoperative wound complications, compared to 18.9% in the control group (OR = 1.67 (95% CI 0.77–3.63), p = 0.199). The number of patients requiring unplanned visits or developing CSS was not statistically significant between the groups. This study suggests that Avelle negative pressure wound therapy in mastectomy wounds does not lead to fewer postoperative wound complications. Additionally, it does not lead to fewer patients requiring unplanned visits or fewer patients developing clinically significant seromas.Trial registration: ClinicalTrials.gov number, NCT03942575. Date of registration: 08/05/2019.

Ready-to-Use Micronized Human Acellular Dermal Matrix to Accelerate Wound Healing in Diabetic Foot Ulcers: A Prospective Randomized Pilot Study.

To examine and report clinical outcomes of a ready-to-use micronized dermal matrix for diabetic foot ulcers (DFUs) and compare it to treatment with conventional negative-pressure wound therapy (NPWT) only. The researchers randomly allocated 30 DFUs Wagner grade 2 or higher from 30 adult patients into two groups. The control group (n = 15) was treated with conventional NPWT, and the experimental group (n = 15) was treated with micronized dermal matrix and NPWT. The researchers evaluated the following outcomes: granulation tissue formation, proportion of patients with closed or granulated wounds at 42 and 120 days, achievement of complete wound healing in the 6 months of follow-up, and intervals from enrollment to final surgical procedures. All 15 wounds treated with the micronized matrix showed healthy granulation tissue without noticeable complications during follow-up. At 42 days, 46.7% of wounds in the experimental group had closed compared with 28.6% in the conventional NPWT group (P = .007). At 120 days, 86.7% of the experimental group had completely closed wounds, compared with 57.1% in the conventional therapy group (P = .040). During the 6-month follow-up period, 93.3% of the experimental group achieved complete wound healing compared with 85.7% of the conventional therapy group (P = .468). The healing outcomes for DFUs in the experimental group were superior when micronized matrix treatment was combined with NPWT.

Use of a negative pressure wound therapy system over closed incisions option in preventing post-sternotomy wound complications.

Post-sternotomy surgical site infections may be serious complications responsible for increased morbidity, mortality and length of hospital stay. A variety of wound-healing strategies can be used over closed surgical incisions, including negative pressure wound therapy (NPWT). The aim of the study is to assess sternal wound complications after heart surgery using NPWT in patients at risk for surgical site complication. Considered risk factors affecting wound healing were type 2 diabetes, Body Mass Index (BMI) >30, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF) and myocardial revascularization by double mammary artery harvesting. With these premises, 90 patients were selected: 30 patients received traditional gauze dressings, 30 advanced dressings (hydrocolloid and carboxymethyl cellulose) and 30 patients NPWT. Thirty-four patients (37.7%) had two risk factors, 41 patients (45.5%) were affected by three risk factors and 15 patients (16.6%) by four risk factors. The NPWT group had lower rates of diabetes and CRF and only one patient presented four risk factors. With regard to surgical times and types of surgical procedure, no significant differences were observed within the three groups. The patients who received NPWT over closed incision experimented a significantly lower rate of deep sternal complication over traditional gauze and hydrocolloid and carboxymethyl cellulose dressings.

Closed Incisional Negative Pressure Wound Therapy (ciNPWT) in Oncological Orthopedic Surgery: Preliminary Report

This report presents the authors’ experience with surgical wound-healing using a negative-pressure wound therapy (NPWT) device in a population of oncological orthopedic patients. Two groups of 26 oncological patients each underwent surgical excision. After surgery, the control group received standard dressings and the closed incisional NPWT (ciNPWT) group was treated with a ciNPWT system on the sutured wound area for 14 days. As a primary endpoint, the percentage of post-surgery wound-site complications using ciNPWT devices was compared to that with standard patch dressings. Overall, 30.7% of the control group and 7.7% of the ciNPWT group manifested wound-site complications within 2 weeks after surgery. As a secondary endpoint, final wound healing was compared between the groups: delayed wound healing was observed in 4 (15.4%) patients in the control group and in none (0%) of those in the ciNPWT group. Finally, the length of stay (LOS) was 6.3 days in the control group and 5.1 days in the ciNPWT group. These results suggest that the ciNPWT device could be beneficial in minimizing the incidence of short-term surgical-site complications and decreasing length of stay in high-risk patients, such as those undergoing oncological orthopedic surgery.

The Pressure is on: Single Center's Experience with Negative Pressure Wound Therapy and Driveline Infection

PurposeDelay or complete lack of integration with the HeartMate 3 (HM3) driveline has led to an increased incidence of driveline infection (DLI). Negative pressure wound therapy (NPWT) may be helpful in decreasing the rate of infection by facilitating integration, therefore we evaluated the possible benefits of a single use NPWT system (Prevena) on DLI outcomes (Figure 1).MethodsRetrospective chart review of primary HM3 patients implanted from January 2019 through October 2020. The INTERMACS 2016 definition of DLI was utilized. DLI outcomes were analyzed using Fisher's exact test. Freedom from DLI for the NPWT and non NPWT groups were analyzed using the Kaplan-Meier method.ResultsWithin the study period there was a total of 40 primary implants. Twenty- two patients were implanted between January 2019 and October 2019 (non NPWT group) and 18 patients were implanted between November 2019 and October 2020 (NPWT group). In the non NPWT group, 3 patients developed DLI in the first six months (14 %). In the NPWT group, 1 patient developed DLI in the first six months (6 %) (p = 0.512, Figure 2).Average length of time to infection in the NPWT group was 146 days vs 69.3 days in the non NPWT group. Although exit site diameter tended to be smaller with the NPWT approach, overall integration and mobility of the driveline in its transcutaneous track was similar.ConclusionIn a moderate size single center experience, use of a NPWT approach led to a decrease in DLI rate. Larger studies are needed to validate this finding. Delay or complete lack of integration with the HeartMate 3 (HM3) driveline has led to an increased incidence of driveline infection (DLI). Negative pressure wound therapy (NPWT) may be helpful in decreasing the rate of infection by facilitating integration, therefore we evaluated the possible benefits of a single use NPWT system (Prevena) on DLI outcomes (Figure 1). Retrospective chart review of primary HM3 patients implanted from January 2019 through October 2020. The INTERMACS 2016 definition of DLI was utilized. DLI outcomes were analyzed using Fisher's exact test. Freedom from DLI for the NPWT and non NPWT groups were analyzed using the Kaplan-Meier method. Within the study period there was a total of 40 primary implants. Twenty- two patients were implanted between January 2019 and October 2019 (non NPWT group) and 18 patients were implanted between November 2019 and October 2020 (NPWT group). In the non NPWT group, 3 patients developed DLI in the first six months (14 %). In the NPWT group, 1 patient developed DLI in the first six months (6 %) (p = 0.512, Figure 2).Average length of time to infection in the NPWT group was 146 days vs 69.3 days in the non NPWT group. Although exit site diameter tended to be smaller with the NPWT approach, overall integration and mobility of the driveline in its transcutaneous track was similar. In a moderate size single center experience, use of a NPWT approach led to a decrease in DLI rate. Larger studies are needed to validate this finding.

Negative pressure wound therapy enhances bone regeneration compared with conventional therapy in a rabbit radius gap-healing model.

Negative pressure wound therapy (NPWT) has been recognized as an effective method for the treatment of intractable wounds. However, its effects on bone healing remain to be elucidated. Our previous study demonstrated that NPWT induced cell proliferation and osteoblastic differentiation of rat periosteum-derived mesenchymal stem cells (P-MSCs). It was reported that following NPWT treatment, the expression of the mechanotransduction molecule integrin β5 is increased, indicating that NPWT may serve an active role in fracture healing by enhancing bone formation and reducing bone resorption. The present study sought to further investigate the efficacy of NPWT on the bone regeneration process in a rabbit radial gap-healing model. All rabbits with radial defects were randomly divided into two groups: NPWT and control groups. Continuous negative pressure at -125 mmHg was applied to all rabbits. Furthermore, X-ray imaging and scoring on day 7, 14, 21 and 28 postoperatively were performed to evaluate new bone formation. Histological changes were determined via hematoxylin and eosin and Masson's trichrome staining at 2- and 4-weeks following surgery. In addition, vimentin-positive cells located in the periosteum were detected via immunohistochemical examination on day 3 post operation. Finally, protein expression levels of vascular endothelial growth factor (VEGF), bone morphogenetic protein (BMP)-2 and osteopontin (OPN) were evaluated using western blot analysis on the 2nd and 4th week following NPWT. X-ray and histological examination revealed that the bone-healing processes in the NPWT group were faster compared with the control group. Additionally, compared with the control group, the NPWT group exhibited higher X-ray scores, increased percentage of positive vimentin-stained cells and upregulated expression of VEGF, BMP-2 and OPN proteins. The aforementioned findings suggest that NPWT, under a continuous negative pressure of -125 mmHg, may accelerate bone regeneration by enhancing MSC proliferation, osteoblastic differentiation and VEGF, BMP-2 and OPN expression.

Short- and long-term efficacy of negative-pressure wound therapy in split-thickness skin grafts: a retrospective study.

Graft fixation is essential for the successful survival of skin grafts. Negative-pressure wound therapy (NPWT) can be utilized for fixing a skin graft, ensuring adhesion of the graft with continuous and uniform pressure. However, the reported short- and long-term efficacy of NPWT in split-thickness skin grafts (STSGs) is inconsistent, with few studies on the long-term efficacy (scar quality). To clarify the appropriate methods of skin graft fixation, we conducted a single-center retrospective study on the shortand long-term effects of skin grafting using different fixation methods. This study retrospectively analyzed patients who underwent STSG from December 2010 to June 2019. The patients were divided into two groups based on the skin graft-fixing method: an NPWT group and a conventional mechanical fixation group. Medical data including age, sex, underlying diseases, wound etiology, recipient site, surgical methods, surgical outcomes, postoperative complications, and follow-up data (Vancouver Scar Scale score and Patient and Observer Scar Assessment Scale score) were analyzed. A total of 392 cases were ultimately included in the analysis. Among them, 218 cases were fixed with NPWT for skin grafting and 174 with conventional mechanical fixation. No significant differences in baseline data were noted between the two groups. The total graft survival rate in the NPWT group was higher than that in the conventional mechanical fixation group (86.7% vs. 74.1%, P=0.002). Moreover, the infection rate in the NPWT group was lower than that in the conventional mechanical fixation group (5.5% vs. 13.2%, P=0.008). In terms of scar quality, no significant difference was observed, except for in the hand. Overall, the scar surface regularity was better in the NPWT group than in the control group. (P=0.019 for Patient Scar Assessment Scale, P=0.025 for Observer Scar Assessment Scale). NPWT is an effective approach for fixing skin grafts. Compared with conventional mechanical fixation, NPWT can significantly improve the survival rate and reduce the infection rate of STSG. In the long-term, NPWT can also improve scar surface regularity in the hand, with an esthetic effect that is more satisfactory to clinicians and patients.