Negative Pressure Wound Therapy Research Articles

Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

Comparative analysis of negative pressure wound therapy (PICO) and standard dressing application after arterial vascular reconstructions.

Surgical site infections following arterial reconstructions with femoral exposures are common and potentially preventable. Negative pressure wound therapy has emerged as a potential solution to minimize groin wound complications. Our study evaluates efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions. A retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and June 2023. Patients were divided into two groups: patients treated with PICO device and patients who received standard dressing (non-PICO). Patient demographics, comorbidities, vascular evaluation, and procedure indications were compared. Previous interventions, incision orientation and procedure types were noted. The wound complication categories were graded according to the Szilagyi classification: grade 1 (superficial infection/minor dehiscence), grade 2 (deep infection/major dehiscence), and grade 3 (artery or prosthetic involvement). Statistical significance level was determined at p < .05 for all analyses. A total of 217 groin dissections in 184 patients were analyzed with 132 and 85 groin dissections in the PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups in terms of age, sex, BMI, and procedure indications. Prior endovascular procedures and re-operative groin surgeries were more prevalent in the PICO group. The use of antibiotics post-operatively for groin wound complication was greater in the non-PICO group. The incidence of wound complications was higher in the non-PICO group (29.4% vs 10.6%, p < .001). Multivariate logistic regression analysis determined that PICO dressing as well as hybrid and endovascular index procedures were associated with lower risks of groin complications. PICO dressing decreased the incidence of groin wound complications in patients undergoing open vascular reconstructions. This study highlights the value of adjunctive negative pressure therapy in reduction of wound complications after arterial reconstructions in the inguinal region.

A Comprehensive Approach for Diabetic Foot Ulcer Management

Objectives: This study aims to evaluate the efficacy of a comprehensive management plan in the treatment of diabetic foot ulcers (DFUs). Evaluating the effects of wound debridement on the outcomes of diabetic foot ulcers, advanced dressings, blood sugar control, and offloading strategies are the main objectives. The study also intends to investigate the function of surgery in managing chronic ulcers and preventing recurrences. The goal is to offer advice for managing DFUs optimally and lowering related morbidity based on evidence. Method: The intervention program includes techniques like wound debridement, advanced dressings, unloading modalities, blood sugar level control, and, where necessary, surgical treatments. Growth factors, electrical stimulation, negative pressure wound therapy, bio-engineered skin, and hyperbaric oxygen therapy are among the many treatments that are included. Regression models are among the statistical analyses used to assess the efficacy of the overall management strategy. Results: Significant findings are presented in the results section, which shows how the holistic management strategy improves DFU outcomes. Improved wound healing rates, reduced infection incidents, and enhanced patient-reported outcomes are highlighted. The results underscore the significance of maintaining blood sugar levels, wound debridement, and incorporating various therapeutic modalities in DFU management. Conclusion: This study concludes by recommending a thorough and interdisciplinary approach to DFU management. Maintaining blood sugar levels, debridement of the wound, sophisticated dressings, unloading techniques, and surgical procedures are among the effective strategies that help reduce morbidity and prevent serious complications related to diabetic foot ulcers. Additional investigation is necessary to enhance and broaden these results for ongoing progress in the management of diabetic foot ulcers.

Primary delayed sternal closure in adult cardiac surgery: a systematic review of protocols.

Primary delayed sternal closure (DSC) is a useful tool in the management of certain critically unstable patients after cardiac surgery, but there is a paucity of consensus management guidelines. This review aimed to identify critical key areas in DSC management. Systematic literature search was conducted in January 2023 and performed using Embase and PubMed. For original research articles were included that described outcomes and/or protocols for primary adult DSC patients, excluding articles on pediatric patients and secondary DSC. Eleven retrospective review original articles examined protocols for adult patients undergoing DSC. Hemodynamic instability and uncontrolled bleeding/coagulopathy were the two most common indications. Time to chest closure ranged 22 hours - 8.7 days. A range of dressings were employed, including Esmark and VAC dressings, with about half of authors not disclosing details. VAC was endorsed by several authors specifically for management of uncontrolled hemorrhage/coagulopathy. There was no consensus regarding irrigation solution for mediastinal prepping, with or without antibiotic solution. There was a lack of consensus on antibiotic selection and duration, varying from 2 and 3 multidrug regimens of broad-spectrum antibiotics, with/without antifungals. Mediastinal re-exploration varied from undefined intervals to regimented 24-48-hour interval re-explorations, with final closures in the OR or ICU. The optimum care for the patient with an open chest is evolving, and although there is a lack of a consensus DSC protocol, this review identifies mediastinal management, antimicrobial prophylaxis, and mediastinal re-exploration schedules/protocols as key areas for study to determine optimal care for DSC patients.

Incisional Negative Pressure Wound Therapy Versus Primary Wound Suturing after Intestinal Ostomy Closure: A Systematic Review and Meta-Analysis.

Objective: Wound infection after intestinal ostomy closure is a very common postoperative complication. An alternative to primary wound suturing by single sutures or purse string sutures (PSS) is applying incisional negative pressure wound therapy (iNPWT). The aim of the following systematic review and meta-analysis was to assess and compare clinical outcomes in patients after PSS and iNPWT use. Approach: The aim of the study was to find relevant clinical data comparing outcomes of iNPWT and primary wound closure after intestinal ostomy closure. The search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases and took place up to November 12, 2022. The authors did not use date or language filters. Statistical analysis was performed using Review Manager 5.4 (The Cochrane Collaboration, 2020, London, UK). The authors conducted a meta-analysis of the following four parameters: wound healing time (WHT), surgical site infections (SSIs), complications, and length of hospital stay (LOS). Odds ratios (OR) and inverse variance (IV) were generated with 95% confidence intervals (CI). The meta-analysis was registered in the International Prospective Register of Systematic Reviews database under registration number CRD42023391640. Results: The analysis revealed that the iNPWT group and the control group did not differ significantly with regard to the WHT parameter (Z = 2,73; p = 0.006; χ2 = 0.37, df = 1, p = 0.54, I2 = 0%). Meta-analysis of SSI incidence revealed a significant difference favoring the iNPWT group over the observational group (OR = 0.42; 95% CI = 0.25-0.72; p = 0.002; I2 = 14%). Patients included in the iNPWT group had a significantly lower pooled incidence of overall complications than the observational group (OR = 0.52; 95% CI = 0.35-0.77; p = 0.001, I2 = 71%). Subgroup analysis limited to randomized studies also presented significant differences favoring the iNPWT group over the observational group (OR = 0.27; 95% CI = 0.14-0.52; p < 0.001, I2 = 67%). Our analysis showed that LOS did not differ significantly between the groups treated with and without iNPWT (IV = 0.19; 95% CI = -0.66 -1,04; p = 0.76, I2 = 0%). In addition, subgroup analysis of randomized studies also did not present a significant difference (IV = 0.25; 95% CI = -0.80 -1,30; p = 0.33, I2 = 10%). Innovation: This study shows that the use of iNPWT can reduce the risk of SSIs with other complications, such as wound hematomas, wound seromas, wound dehiscence, fistulas, and ileus, in patients undergoing intestinal ostomy closure without extended hospital stay. Conclusions: Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complications after ostomy closure.

Prevention of vascular surgical site infections in the groin with negative pressure wound therapy

Bevezetés: A negatív nyomású sebkezelés egyre nagyobb szereppel bír a krónikus, nehezen gyógyuló sebek, sebfertőzések kezelésében. Az érsebészeti műtéteket követően kialakuló sebfertőzések predilekciós helye a femoralis háromszög műtéti bemetszései. A sebfertőzés kialakulásában szerepet játszó tényezők: diabetes, elhízás, korábbi műtétek ugyanebben a régióban, azonos oldali alsó végtagi gangraenák, fekélyek. Célkitűzés: Hipotézisünk, hogy a femoralis hajlat sebfertőzéseit csökkentheti a negatív nyomású sebkezelés zárt seben való alkalmazása a nagy rizikójú csoportokban, ezzel együtt csökkenthető a rettegett érsebészeti szövődmény, a szeptikus graft kialakulása. Módszer: Vizsgálatunkba 38 beteget vontunk be, akiknél legalább egy kritérium teljesült a következők közül: testtömegindex &gt;30; korábbi műtét ugyanebben a régióban; azonos oldali végtagon jelen lévő szövetelhalás, seb. A kontrollcsoportba kerülő betegeknél (n = 19) hagyományos sebfedést (Cosmopor E) alkalmaztunk. Az incisionalis negatív nyomású sebkezelésben részesülő csoportban (n = 19) a műtőben a varratokkal egyeztetett sebet fehér szivaccsal (VivanoMed White Foam) fedtük, fóliával légmentesen lezártuk, és ide csatlakoztattuk a vákuumgép portját, amelyen keresztül azonnal megkezdődött a seb szívása (folyamatos üzemmód, 100 Hgmm). A kezelés időtartamát átlagosan 7 napig terveztük. A betegeket a posztoperatív 10., 30., 60. napon, ambulanciánkon ellenőriztük. Eredmények: A kontrollcsoportban a betegek 42,1%-ában (n = 8) sebgyógyulási zavar, 36,8%-ában (n = 7) sebfertőzés alakult ki. Egy esetben szeptikus graft miatt reoperációt végeztünk. Az incisionalis negatív nyomású sebkezelésen átesett csoportban 31,6%-ban (n = 6) jelentkezett sebgyógyulási zavar, 26,3%-ban (n = 5) sebfertőzés, egy esetben szeptikus graft. Következtetés: Bár a vizsgált csoportok között nem találtunk szignifikáns különbséget a primer végpont tekintetében, kimutattuk, hogy az elhízott, valamint a korábban lágyékfeltárásból végzett műtéten átesett betegek esetén az incisionalis vákuumkezelés előnyös lehet a hagyományos sebkezeléssel szemben. Orv Hetil. 2024; 165(42): 1652–1658.

Enteroatmospheric fistulas in open abdomen in trauma associated with abdominal reintervention and VAC therapy

Enteroatmospheric fistulas in open abdomen in trauma associated with abdominal reintervention and VAC therapy

Preoperative, Intraoperative & Postoperative Concepts to Prevent Infection for Unicompartmental Knee Arthroplasty

Periprosthetic joint infection (PJI) is a complication that occurs in less than 1% of patients after unicompartmental knee arthroplasty (UKA). Though infrequent, it may potentially lead to revision while placing a significant financial burden on the healthcare system. Pre-operative, intra-operative, and postoperative strategies should be implemented to minimize the risk of PJI. Patient optimization prior to surgery can help to identify patients at risk for PJI and also maximize the health of the patient prior to surgery. Intraoperative and postoperative strategies can also mitigate the risk of postoperative infection. This article will summarize the evidence for preoperative, intra-operative, and postoperative strategies to prevent PJI in UKA. This will include topics on malnutrition and obesity, staphylococcus aureus, smoking, human immunodeficiency virus, rheumatoid arthritis, as well as skin preparation, laminar air flow, preoperative antibiotic administration anti-microbial incision drapes, pulsatile lavage, vancomycin powder, wound closure method, thromboprophylactic agents, and closed incisional negative pressure wound therapy dressings.

The Negative Pressure Wound Therapy for Flap Salvage

Negative Pressure Wound Therapy (NPWT) effectively manages complex wounds by promoting fluid drainage, stabilizing the wound environment, and reducing bacterial load. It aids in granulation tissue formation and modulation of inflammatory reactions. NPWT is increasingly used in reconstructive surgery, particularly in flap procedures, enhancing wound healing and cosmetic outcomes while reducing flap complications. Despite concerns about flap compromise, clinical trials demonstrate low flap loss rates with NPWT. Strategies like observation windows and implantable Doppler devices help overcome monitoring challenges. However, conclusive evidence regarding NPWT's safety and impact on flap vascularity is limited due to scarce studies. The study involved 40 healthy adult patients, mostly male, with soft tissue defects primarily caused by road traffic accidents. They were split into two groups: NPWT (25 patients) and conventional dressing (15 patients). The NPWT group was further categorized into high pressure (8 patients) and low pressure (17 patients) subgroups. Results showed lower flap edema in NPWT groups compared to controls, but high pressure NPWT led to higher flap ischemia and infection rates. Overall, low pressure NPWT yielded the best clinical and aesthetic outcomes with fewer complications. The study suggests a delayed NPWT approach and low-pressure settings for optimal vascular perfusion in Fasciocutaneous flaps, emphasizing the need for further trials to establish its efficacy and determine ideal pressure settings for different flap types.

Combined local flap placement and negative-pressure wound therapy for the management of critical peritracheostomal pharyngocutaneous fistula

ObjectivePeritracheostomal pharyngocutaneous fistula (PCF), a direct connection between the PCF and tracheal stoma due to a skin defect, is among the most problematic complications after total laryngectomy or pharyngolaryngectomy. Peritracheostomal PCFs can cause lethal complications, including severe pneumonia or carotid blowout, secondary to salivary leakage directly into the tracheal stoma, and their management is challenging without early invasive surgical closure. We aimed to evaluate the utility of our novel and minimally invasive combined local skin flap placement and negative-pressure wound therapy (NPWT) method for the management and conservative closure of peritracheostomal PCFs. MethodsWe retrospectively enrolled patients who developed a peritracheostomal PCF from July 2015 to September 2021 at our institution and affiliated hospitals. Postoperative PCFs were all initially managed with appropriate wound bed preparation. Subsequently, a small local flap of healthy, lower neck skin was elevated and transferred anterior to the PCF to replace the peritracheostomal skin defect. The flap served to provide a sufficient surface for film dressing attachment and facilitated airtight sealing during NPWT. We initiated NPWT after confirming the local skin flap was firmly sutured to the tracheal mucosa. A flexible hydrocolloid dressing was applied to the peritracheostomal skin flap, and a film dressing was placed on the flexible hydrocolloid dressing and surrounding cervical skin. We inserted the NPWT foam shallowly into the fistula tract and applied negative pressure (73.5–125 mmHg). NPWT was continued until the PCF was closed or became so small that salivary leakage was minimal and could be managed by conventional compression dressings. ResultsWe enrolled six patients [male, n = 6; mean age, 66.5 years (range, 57–80 years)]. NPWT was applied for an average of 18.2 days (range, 2–28 days). During NPWT, air leakage occurred once (2 cases), only a few times (2 cases), or not at all (2 cases). In all patients, complete fistula closure was achieved in an average of 28.2 days (range, 15–55 days) after the start of NPWT, and no patient required further surgical intervention. There were no lethal complications (e.g., severe pneumonia) during treatment. ConclusionOur method of combined local flap placement and NPWT enabled effective management of salivary aspiration and accelerated wound healing, which allowed conservative fistula closure in all patients. We believe combined local flap placement and NPWT should be considered a first-line treatment for intractable peritracheostomal PCF.

Closed-incision negative-pressure wound therapy after Bascom's cleft lift surgery for pilonidal sinus disease: A randomized study comparing healing.

Despite favourable outcomes in recurrence after off-midline closure techniques in pilonidal surgery, between 18% and 40% of patients suffer from prolonged postoperative wound healing. The aim of this work was to investigate if closed-incision negative-pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery for complicated pilonidal sinus disease compared with conventional drainage and dressing. Patients were randomized to either NPWT for 4-7 days or loop-vessel drain for 24 h and a dry dressing postoperatively. Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint). Healing was defined as one or no closing defects of ≤5 mm and with no undermining. Although we had wanted to recruit 200 patients, the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58) after interim analysis. Patients were comparable by age, sex, body mass index, previous smoking status and indication for BCL surgery. At 2 weeks 12% of patients were healed in both the NPWT and control groups [risk difference = 0.00(95% CI -0.12 to 0.11), p = 1.00]. After 12 weeks, 68% of patients were healed in the NPWT group and 72% in the control group [risk difference = -0.03 (95% CI 0.19 to 0.13), p = 0.82]. There was no significant difference in pain experienced postsurgery. In a symptom-based questionnaire, the control group reported self-esteem to be less affected (p = 0.015). Closed-incision negative-pressure wound therapy did not significantly improve healing after BCL surgery for complicated pilonidal sinus disease.

The efficacy of antimicrobial solutions against multispecies bacterial biofilm with or without negative pressure wound therapy in an in vitro wound model.

Biofilm is the major challenge in chronic wound management. Instilling a wound cleansing solution aids in wound bed cleaning and infectious pathogen elimination. Negative pressure wound therapy (NPWT) improves the wound-healing process. This study investigated the efficacy of two antimicrobials (Vashe Wound Cleanser and Prontosan Wound Irrigation Solution) against a multispecies bacterial biofilm with or without NPWT in an in vitro wound model. A mixed multispecies biofilm containing Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, and Acinetobacter baumannii was developed and verified by scanning electron microscopy and fluorescent in situ hybridization. The efficacy of Vashe and Prontosan against multispecies biofilm with or without NPWT was evaluated by colony-forming unit (cfu) of each species and total bacterial number, and visually confirmed by live/dead stain and confocal microscopy. Prontosan reduced biofilm cell numbers significantly: 6 instils over 24 h resulting in 3.86 ± 0.14 cfu log10 reduction without NPWT and 4.75 ± 0.13 cfu log10 reduction combined with NPWT (P < 0.01) and 12 instils over 48 h resulting in 5.24 ± 0.11 cfu log10 reduction without NPWT and biofilm eradication with NPWT (P < 0.001). NPWT alone or combined with Vashe failed to reduce multispecies biofilm numbers significantly over 24 or 48 h. Prontosan significantly reduced biofilm cell numbers, with better efficacy over 48 than 24 h, emphasizing the necessity for persistent and robust treatment. NPWT enhanced the effectiveness of Prontosan instillation. However, NPWT alone or combined with Vashe showed limited efficacy and difficulty when combating the multispecies biofilm in vitro.

Investigating the Association Between Pre-Flap Negative Pressure Wound Therapy and Surgical Outcomes in Extremity Free Flap Reconstruction: A Systematic Review.

While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction. A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID Databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 301 identified articles, 161 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups. A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received pre-flap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared to the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69% vs. 9.80%) and partial flap failure (2.24% vs. 6.54%). Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.

The Efficacy of Negative Pressure Wound Therapy (NPWT) on Healing of Diabetic Foot Ulcers: A Literature Review.

Diabetes mellitus is a complex disorder that requires continuous management to control blood sugar levels and prevent complications. Diabetic foot ulcers (DFU) are the most common complication in diabetic patients. A popular therapy modality with considerable advantages in the management of diabetic foot ulcers today is negative pressure wound therapy (NPWT). This study aimed to review related articles about the efficacy as well as the complications or adverse effects of using NPWT on the healing of DFUs. Searching English databases from PubMed, Ebscohost, Proquest and Science Direct was done to identify relevant citations published between January 2017 and January 2022. A combination of terms was used with the boolean formulation of "negative pressure wound therapy OR NPWT" OR "vacuum-assisted closure or VAC" AND "diabetic foot ulcers OR diabetic foot wound" AND "wound healing" AND "Conventional dressings" and map terms were also used for the subject heading. Some potentially relevant citations of articles from the bibliographies are also reviewed. This study included 8 related articles consisting of 6 RCTs, 1 cohort study and 1 Quasy experimental study. There were various methodological techniques for using NPWT and outcome measures among studies. The results of this literature review showed that NPWT was more efficacious than the other conventional or advanced moist dressings. This therapy revealed a faster healing time with complete wound healing and formation of granulation tissue and reduction in wound size. The complications or adverse effects of NPWT, such as amputation rate, bleeding and pain, were not different from conventional or advanced moist dressings, though. NPWT was more efficacious than other conventional or advanced moist dressings for the healing of DFUs. However, complications or adverse effects of using this therapy showed no significant difference with other conventional or advanced moist dressings.

Combination therapy of negative pressure wound therapy and antibiotic-loaded bone cement for accelerating diabetic foot ulcer healing: A prospective randomised controlled trial.

Negative pressure wound therapy (NPWT) and antibiotic-loaded bone cement (ALBC) are commonly used treatments for diabetic foot ulcers (DFUs). However, the combined efficacy of these two modalities remains unclear. This clinical study aimed to assess the effectiveness and underlying mechanisms of NPWT&ALBC in the management of DFUs. A total of 28 patients were recruited, 16 of whom served as controls and received only NPWT, whilst 12 received NPWT&ALBC. Both groups underwent wound repair surgery following the treatments. Blood samples were obtained to detect infections and inflammation. Wound tissue samples were also collected before and after the intervention to observe changes in inflammation, vascular structure and collagen through tissue staining. Compared with the NPWT group, the NPWT&ALBC group exhibited a superior wound bed, which was characterised by reduced inflammation infiltration and enhanced collagen expression. Immunostaining revealed a decrease in IL-6 levels and an increase in α-SMA, CD68, CD206 and collagen I expression. Western blot analysis demonstrated that NPWT&ALBC led to a decrease in inflammation levels and an increase in vascularization and collagen content. NPWT&ALBC therapy tends to form a wound bed with increased vascularization and M2 macrophage polarisation, which may contribute to DFUs wound healing.

Management of Pediatric Type III Tibial Shaft Fractures: A Cohort Study Utilizing the Trauma Quality Improvement Program Database.

Pediatric open tibial fractures represent a challenging subset of injuries with limited literature to guide management. For children, the epidemiology, management, and outcomes of tibial-shaft fractures have not been fully described. A retrospective analysis of the Trauma Quality Improvement Program Data Bank from 2017-2020 was used to query demographics, injury patterns, and management strategies in pediatric open tibial fractures. Fractures were compared by age group (0-5, 6-12, 13-17 years) and type (I/II vs type III). A subgroup analysis was performed on patients with type III open fractures. A total of 3480 open tibial fractures were identified, 3049 were type I/II, and 431 were type III. Motor vehicle accidents (48%) were the most common mechanism of injury (P < 0.001). Subanalysis of 128 type IIIb/c tibial fractures revealed local flap reconstruction (25%) skin graft (25%), and free tissue transfer were the most common management strategies and soft-tissue coverage was achieved after 162 hours (interquartile range = 109-231). Negative pressure wound therapy was utilized in 63% of cases but used in isolation in only 23% of cases. Immediate fixation with intramedullary nailing was more frequently used in the 13-17 age group while plate fixation was more commonly used in younger age groups. Soft-tissue management patterns following open tibial shaft fractures mirror those seen in adult cohorts. The median time to achieve soft-tissue coverage exceeds the traditional 72-hour target advocated by Godina. Age-based variation is seen in orthopedic management of these fractures based on growth maintenance concerns.

Negative pressure wound therapy for the management of deep brain stimulation‐related surgical site infections: A retrospective case series

AbstractThe management of deep brain stimulation (DBS)‐related surgical site infection (SSI) is challenging. This article aimed to report the efficacy of negative pressure wound therapy (NPWT) in treating DBS‐related SSI while preserving all DBS devices. As a retrospective case series in a single center, localized DBS‐related SSI was treated with complete debridement and NPWT, with preserving all DBS devices. Successful infection control was defined as no clinical or microbiological evidence of recurrent infection 3 months after NPWT. Five patients (three females, two males, median age: 64 years) received NPWT for their DBS‐related SSI. The infection was located in the chest, parietal, and retroauricular areas. Only one patient had the extension wires removed due to the heavy contamination, while no DBS devices were removed in the other patients. All patients showed successful infection control without any remarkable side effects 3 months after debridement and NPWT. These findings suggest that NPWT may effectively promote wound healing with a high probability of preserving all DBS devices in DBS‐related SSI.

Effects of different treatment measures on the efficacy of diabetic foot ulcers: a network meta-analysis.

Through a network meta-analysis, we compared different treatment measures for patients with diabetic foot ulcers (DFU), assessing their impact on the healing of DFU and ranking them accordingly. We searched the PubMed, the China National Knowledge Infrastructure (CNKI), Embase, the WanFang and the WeiPu database. The retrieval time was from database establishment to January 2024, and retrieval entailed subject and free words. Randomized controlled trials (RCTs) with different treatment measures for DFU were included. Data extraction and evaluation were based on the PRISMA guidelines. Meta-analyses using pairwise and network methods were employed to compare and rank the effectiveness of different treatments for DFU. Ultimately, we included 57 RCTs involving a total of 4,826 patients with DFU. When it comes to ulcer healing rates, compared to standard of care(SOC),platelet-rich plasma(PRP), hyperbaric oxygen therapy(HBOT), topical oxygen therapy(TOT), acellular dermal matrix(ADM), and stem cells(SCs) in both direct meta-analysis(DMA) and network meta-analysis(NMA) can effectively increase the complete healing rate. For Scs+PRP, a statistically significant improvement was only observed in the NMA. Moreover, when compared to the negative pressure wound therapy(NPWT) group, the PRP+NPWT group was more effective in promoting the complete healing of ulcers. In terms of promoting the reduction of ulcer area, no statistical differences were observed among various treatment measures. When it comes to ulcer healing time, both PRP and NPWT can effectively shorten the healing time compared to SOC. Furthermore, when compared to the NPWT group, the combined treatment of PRP and ultrasonic debridement(UD) with NPWT is more effective in reducing healing time. In terms of amputation rates and adverse reactions, the PRP group effectively reduced the amputation rate and adverse reactions for patients with DFU. Additionally, compared to the NPWT group, the combined treatment of PRP and UD with NPWT reduced the incidence of adverse reactions. However, no significant differences were observed among other treatment measures in terms of amputation rates and adverse reactions. The ranking results showed that the efficacy of PRP+NPWT and UD+NPWT in promoting ulcer healing, reducing ulcer area, shortening healing time, decreasing amputation rates and adverse reactions is superior to that of the alone PRP group, NPWT group, and UD group. Conversely, the SOC group demonstrates the least effective performance in all aspects. Due to the particularity of the wound of DFU, the standard of care is not effective, but the new treatment scheme has a remarkable effect in many aspects. And the treatment of DFU is not a single choice, combined with a variety of methods often achieve better efficacy, and will not bring more adverse reactions.

Application of Closed Incision Negative Pressure Wound Therapy in Ventral Hernia Repair Surgery Using a Polypropylene Mesh: A Randomized Clinical Trial.

Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group (n=50), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group (n=50), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.

Staged surgical treatment of wounds of the extra-abdominal rectum

AIM: to improve the algorithm and results of surgical treatment of combat wounds of the rectum. PATIENTS AND METHODS: thirty-one patients with combat injuries of the rectum were included in the cohort. RESULTS: twenty-seven (87.1 %) patients were discharged in satisfactory condition, 4 (12,9 %) patients died. Sepsis developed in all four patients: in two of them sepsis was on the background of necrotising fasciitis and one had peritonitis. Endoscopic control revealed 10 wounds of the extraperitoneal part of the rectum undiagnosed at the 1st and 2nd stages of medical care. Surgical care included all four main components: diverting stoma, distal washout (mechanical cleansing of the rectum to clear water), suturing of the lesion through perineal access, drainage or tamponisation of the presacral space was done in 20 (64.5 %) patients. Endoluminal VAC therapy was used in 12 patients. In 11 of them, VAC treatment was successful with complete healing of rectal wall wounds. CONCLUSION: the four-component treatment approach is the optimal option for wounds of the extraperitoneal part of the rectum. Diverting stoma and distal bowel washout prevents severe infection. Endoluminal VAC therapy, in some cases, can be used as an alternative to presacral drainage and suturing of the rectal wall lesion.