Negative Pressure Wound Therapy Research Articles

Negative Pressure Wound Therapy-A Vacuum-Mediated Positive Pressure Wound Therapy and a Closer Look at the Role of the Laser Doppler.

Background: Negative pressure wound therapy (NPWT) is an intensely investigated topic, but its mechanism of action accounts for one of the least understood ones in the area of wound healing. Apart from a misleading nomenclature, by far the most used diagnostic tool to investigate NPWT, the laser Doppler, also has its weaknesses regarding the detection of changes in blood flow and velocity. The aim of the present study is to explain laser Doppler readings within the context of NPWT influence. Methods: The cutaneous microcirculation beneath an NPWT system of 10 healthy volunteers was assessed using two different laser Dopplers (O2C/Rad-97®). This was combined with an in vitro experiment simulating the compressing and displacing forces of NPWT on the arterial and venous system. Results: Using the O2C, a baseline value of 194 and 70 arbitrary units was measured for the flow and relative hemoglobin, respectively. There was an increase in flow to 230 arbitrary units (p = 0.09) when the NPWT device was switched on. No change was seen in the relative hemoglobin (p = 0.77). With the Rad-97®, a baseline of 92.91% and 0.17% was measured for the saturation and perfusion index, respectively. No significant change in saturation was noted during the NPWT treatment phase, but the perfusion index increased to 0.32% (p = 0.04). Applying NPWT compared to the arteriovenous-vessel model resulted in a 28 mm and 10 mm increase in the venous and arterial water column, respectively. Conclusions: We suspect the vacuum-mediated positive pressure of the NPWT results in a differential displacement of the venous and arterial blood column, with stronger displacement of the venous side. This ratio may explain the increased perfusion index of the laser Doppler. Our in vitro setup supports this finding as compressive forces on the bottom of two water columns within a manometer with different resistances results in unequal displacement.

783 Understanding Barriers to the Implementation of Negative Pressure Wound Therapy in Acute Pediatric Burn Care

783 Understanding Barriers to the Implementation of Negative Pressure Wound Therapy in Acute Pediatric Burn Care

Managing incisional wounds with Prevena VAC therapy in lower-extremity vascular surgery: A comparative study.

Vascular surgical site infections have been reported with an overall incidence of 5-10% for patients undergoing arterial interventions and as high as 10-20% for lower-limb bypass grafting procedures. Given that vascular surgery patients are known to be at a higher risk of postoperative wound infections and other complications, our objective was to evaluate a potential method to reduce such complications. This study compares the rate of wound healing complications between incisional negative pressure wound therapy (NPWT) and conventional dressings in vascular surgery patients with infra-inguinal incisions. The primary endpoint is complete closure of the wound at the 2-week follow-up appointment. Secondary endpoints include frequency infections requiring antibiotics, need for wound revision, and wound dehiscence. A prospective cohort study with retrospective control group was performed following infra-inguinal vascular surgeries for peripheral arterial disease at the Mount Carmel Health System. The patients included in this study were those who underwent a lower-extremity vascular procedure with primary closure of an incision distal to the groin between January 2014 and July 2018. Patients that had received an infra-inguinal incision with primary closure were included. Patients in the experimental group who had a Prevena Wound VAC were compared with a retrospectively obtained control arm treated with conventional dressings. Data regarding wound healing and complications, specifically infections and wound dehiscence, were obtained. A total of 201 patients were recruited in our study: 64 in the Prevena group and 137 in the control group. There was a significant reduction in the number of open wounds in the Prevena group compared to the control group at the 2-week follow-up (10.9% Prevena vs 33.6% control; p = .0005). When evaluated in aggregate, there was a statistically significant reduction in the number of patients who succumbed to any complication in the Prevena arm compared with traditional dressings (13 (20.3%) Prevena vs 72 (52.6%) control; p < .0001). The results of our study suggest there should be a significant consideration for the use of NPWT as a prophylactic measure to reduce the risk of wound complications of primarily closed infra-inguinal incisions in vascular surgery patients following common vascular procedures. Its use is particularly effective for patients at enhanced risk of infection, especially those with poor vascularization from BMI, smoking, and diabetes. This leads to decreased trends in antibiotic use, ED visits, readmissions, and surgical revisions, which translates to decreased utilization of hospital resources and economic burden.

Improvement in community wound management: why simple changes in clinical practice matter

Background/Aims Wounds continue to be an increasing burden to society, healthcare systems and patients. Wound care is an urgent challenge that requires new management strategies to help facilitate wound healing. This study aimed to evaluate an early intervention wound project facilitated by the COMPASS programme in a Swedish community setting in terms of treatment outcomes and health economic benefits. Methods An evaluation of wound care practice was completed using data collected on all wounds treated in 1 week in March 2021 (n=97). Single-use negative pressure wound therapy (sNPWT) was then introduced, alongside specialist education for all nurses. A post-intervention evaluation was carried out the following year with data on all wounds treated in 1 week in October 2022 (n=36). The samples were compared in terms of proportion of static and deteriorating wounds, wound characteristics, average number of dressing changes per wound and proportion of wounds requiring the patient to be admitted to hospital or referred to a specialist. Costs of care were calculated and compared for the two samples. Results Wounds in the post-intervention dataset were in a better overall condition (size and depth), with a lower proportion being classified as static or deteriorating (58.8% vs 44.4%). There was a non-significant difference in the average number of dressing changes required per week, with post-intervention wounds requiring fewer changes. A significantly lower proportion of patients required a referral to a specialist in the post-intervention sample compared to the pre-intervention sample (43.3% vs 16.7%; P&lt;0.01). Conclusions Implementing a sNPWT pathway, alongside nurse education and increased involvement of nurses with specialist knowledge, can help to improve wound care outcomes and reduce the burden of wounds on nursing time and healthcare resources.

Is barbed better? Evaluation of triclosan-coated barbed suture on wound complications following emergency laparotomy.

Emergent laparotomy is associated with significant wound complications including surgical site infections (SSIs) and fascial dehiscence. Triclosan-coated barbed (TCB) suture for fascial closure has been shown to reduce local complications but primarily in elective settings. We sought to evaluate the effect of TCB emergency laparotomy fascial closure on major wound complications. Adult patients undergoing emergency laparotomy were prospectively evaluated over 1 year. Patients were grouped into TCB versus polydioxanone (PDS) for fascial closure. Subanalysis was performed on patients undergoing single-stage laparotomy. Primary outcomes were SSI and fascial dehiscence. Multivariate analysis identified independent factors associated with SSI and fascial dehiscence. Of the 206 laparotomies, 73 (35%) were closed with TCB, and 133 (65%) were closed with PDS. Trauma was the reason for laparotomy in 73% of cases; damage-control laparotomy was performed in 27% of cases. The overall rate of SSI and fascial dehiscence was 18% and 10%, respectively. Operative strategy was similar between groups, including damage-control laparotomy, wound vac use, skin closure, and blood products. Surgical site infection events trended lower with TCB versus PDS closure (11% vs. 21%, p = 0.07), and fascial dehiscence was significantly lower with TCB versus PDS (4% vs. 14%, p < 0.05). Subanalysis of trauma and nontrauma cases showed no difference in SSI or fascial dehiscence. Multivariable analysis found that TCB decreased the likelihood of fascial dehiscence (odds ratio, 0.07; p < 0.05) following emergency laparotomy. Increased odds of fascial dehiscence were seen in damage-control laparotomy (odds ratio, 3.1; p < 0.05). Emergency laparotomy fascial closure with TCB showed significantly decreased rates of fascial dehiscence compared with closure with PDS and a strong trend toward lower SSI events. Triclosan-coated barbed suture was independently associated with decreased fascial dehiscence rates after emergency laparotomy. Therapeutic/Care Management; Level III.

Use of negative pressure wound therapy with instillation to salvage infected breast reconstruction implant pockets: a retrospective review of cases

"Introduction: Periprosthetic breast implant infections are a well-known but devastating complication of breast reconstruction, occurring in up to 35 per cent of patients postoperatively. Historically, surgical washout and explantation was common practice to control infection, often sacrificing the reconstruction. Methods: After successfully using negative-pressure wound therapy with instillation (Veraflo, Intermed, Auckland) on lower leg wounds, we transferred the use of this technology to infected breast pockets. Results: In the first year using NPWTi, our department managed seven patients (8 breast reconstructions) presenting with breast device infection at an average of 15.3 days postoperatively. The average length of stay for treatment was 7.4 days with 2.5 operations over this period. Four patients had attempted salvage of their reconstructive pocket and all were discharged with a breast expander in situ. Conclusion: Attempted salvage using negative-pressure wound therapy with instillation may improve rates of reconstruction salvage after periprosthetic infection. We present our current management algorithm for periprosthetic infections."

A Diagnostic-Driven Prospective Clinical Study Evaluating the Combination of an Antibiofilm Agent and Negative Pressure Wound Therapy.

Each year, millions of Americans develop truncal pressure ulcers (PUs) which can persist for months, years, or until the end of life. Despite the negative impact on quality of life and escalating costs associated with PUs, there is sparse evidence supporting validated and efficacious treatment options. As a result, treatment is based on opinion and extrapolation from other wound etiologies. The ideal reconstructive plan maximizes the patient's nutritional status, incorporates the basic tenets of wound bed preparation (debridement, offloading, proper moisture balance, reduction of bacterial burden), and employs diagnostics to guide therapeutic intervention. The use of combination therapies can potentially overcome several of the barriers to wound healing. Negative pressure wound therapy (NPWT), a commonly used modality in the management of PUs, facilitates healing by stimulating the formation of granulation tissue and promoting wound contraction; however, NPWT alone is not always effective. Clinical studies examining microbial bioburden in PUs determined that most ulcers contain bacteria at levels that impede wound healing (>104 CFU/g). Thus, we hypothesized that adding an anti-microbial agent to decrease both planktonic and biofilm bacteria in the wound would increase the efficacy of NPWT. In this prospective study, twenty patients with recalcitrant PUs that previously failed NPWT were treated with a biofilm-disrupting agent (Blast-X, Next Science, Jacksonville, FL, USA) in combination with NPWT. Fluorescence imaging was used to follow bacterial burden and guide therapy. In total, 45% of the PUs reduced in size over the course of the four-week study, with a resolution of bacterial fluorescence in the NPWT dressing and wound bed seen in an average of three weeks. The combination of an antibiofilm agent and NPWT reduced bacterial levels and improved wound healing in recalcitrant PUs.

The Use of Negative Pressure Wound Therapy (NPWT) as a Dressing for Split Thickness Skin Graft for Bilateral Chronic Venous Leg Ulcer

Background: Chronic ulcer is a type of wound, which persists for at least 3 months. One of the causes of chronic ulcer is deep vein thrombosis (DVT). Chronic ulcers require very high maintenance costs and can negatively impact the patient’s quality of life and mental health. Case Illustration: A 40-year-old man came to the hospital with a history of chronic ulcer on both legs, which first appeared 3 years ago. The Patient had undergone treatment at a public outpatient clinic and hospital, unfortunately the wound did not heal. The patient continued to change the bandage independently and did not go to the doctor for wound control. Upon doppler ultrasound, a sign of deep vein thrombosis (DVT) was observed. Negative Pressure Wound therapy (NPWT) was used for wound bed preparation, Split Thickness Skin Graft (STSG) on the left foot was used as a dressing, while conventional dressing was chosen for the right foot. The graft take on the left foot with NPWT was 95%, while the one on the right foot with conventional dressing was 90%. Discussion: Negative pressure wound therapy (NPWT) is a closed system that applies negative pressure through continuous or intermittent suction. NPWT can be used in wound bed preparation to reduce biofilm. NNPWT helps in the removal of exudates from the wound, thus preventing the build-up of serous fluids and blood, reducing the growth of bacteria at the base of the wound, which helps tissue growth after split thickness skin graft (STSG). Conclusion: NPWT stimulates better healing after surgery. The left leg, which used NPWT after STSG had faster healing time and better aesthetic result by promoting graft take. The graft take on the left leg (with NPWT) was higher compared to the right leg.

The effect of negative pressure wound therapy on the outcome of diabetic foot ulcers: A meta-analysis.

Negative pressure injury is one of the auxiliary methods of treating diabetes foot ulcers. It has been shown to be superior to conventional techniques in randomized controlled trials (RCTs). Nevertheless, the results of observational research are still scarce. A systematic review of RCTs and observations was carried out to evaluate the effectiveness and security of negative pressure wound therapy (NPWT) treatment for diabetes foot ulcers. Three English e-databases have been found for NPWT research. The meta-analyses of the comparative studies provided point estimates of results. Intermediate results were given as median and binary values were given in the form of odds ratios (OR). Seventeen trials, 13 RCTs and four randomized, controlled trials were found in the survey. Of these, 831 were treated with NPWT, 834 were treated with standard therapy. A total of 14 studies have been conducted to investigate the influence of NPWT on the healing of diabetic foot ulcers(DFU). In the study, NPWT was shown to speed up the healing of the wound in DFU patients(OR, 2.57; 95% CI, 1.72, 3.85 p < 0.0001). A subgroup analysis showed that NPWT was associated with an acceleration of the wound healing rate in 10 RCT trials (OR, 2.48; 95% CI, 1.58, 3.89 p < 0.001). In the four nRCT trials, NPWT was also shown to speed up the healing of the wound(OR, 2.95; 95% CI, 1.03, 8.42 p = 0.04). In 11 studies, the influence of NPWT on amputations of diabetes mellitus (DM) foot ulcers was investigated. The results showed that NPWT was associated with a reduction in amputations (OR, 0.53; 95% CI, 0.37, 0.74 p = 0.0002).In a subgroup of RCT trials, nine RCT trials showed a reduction in amputations(OR, 0.61; 95% CI, 0.43, 0.87 p = 0.007). In both nRCT trials, NPWT also showed a reduction in amputations (OR, 0.03; 95% CI, 0.00, 0.24 p = 0.001). Generally speaking, NPWT can help to heal the wound and lower the risk of amputations in people with diabetes. The subgroup analysis showed similar results for the RCT and non-RCT trials. NPWT can be used to treat diabetes foot ulcers caused by diabetes.

Effect of platelet-rich plasma combined with negative pressure wound therapy in treating patients with chronic wounds: A meta-analysis.

A meta-analysis was conducted to comprehensively explore the effects of platelet-rich plasma (PRP) combined with negative pressure wound therapy (NPWT) in treating patients with chronic wounds. Computer searches were conducted, from database infection to November 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the use of PRP combined with NPWT technology for treating chronic wounds. Two researchers independently screened the literature, extracted data and conducted quality assessments according to the inclusion and exclusion criteria. Stata 17.0 software was employed for data analysis. Overall, 18 RCTs involving 1294 patients with chronic wounds were included. The analysis revealed that, compared with NPWT alone, the use of PRP combined with NPWT technology significantly improved the healing rate (odds ratios [OR] = 1.92, 95% confidence intervals [CIs]: 1.43-2.58, p < 0.001) and total effective rate (OR = 1.31, 95% CI: 1.23-1.39, p < 0.001), and also significantly shortened the healing time of the wound (standardized mean difference = -2.01, 95% CI: -2.58 to -1.45, p < 0.001). This study indicates that the treatment of chronic wounds with PRP combined with NPWT technology can significantly enhance clinical repair effectiveness and accelerate wound healing, with a high healing rate, and is worth further promotion and practice.

412 Incisional Negative Pressure Wound Therapy Following Posterior Instrumented Spinal Fusion: A Single Surgeon’s Experience and Cost-Benefit Analysis

INTRODUCTION: Surgical site infections (SSIs) following spine surgery are associated with significant morbidity and resource utilization. METHODS: We retrospectively reviewed all patients who received posterior instrumented spinal fusion by the senior author between July 2017 and December 2019 at a Level I trauma center. Statistical analysis was performed using Chi-square and Student’s t-tests. RESULTS: A total of 85 patients with standard surgical dressings and 144 patients with iNPWT were included for analysis. Patients in the iNPWT group were significantly older (61.8 vs. 58.5 years, p = 0.042) and more likely to be diabetic (36.8% vs. 23.5%, p = 0.037). Surgeries in the iNPWT group were associated with significantly greater blood loss (1298 mL vs. 998 mL, p = 0.036) and involved more instrumented levels (6.6 vs. 4.9, p &lt; 0.0001). Prophylactic iNPWT use was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI requiring operative treatment (8.3% vs. 21.2%, p = 0.005). The incidence of wound dehiscence requiring operative wound revision was lower with iNPWT (14.6% vs. 24.7%, p = 0.056), though it did not reach statistical significance. Number needed to treat (NNT) with iNPWT to prevent one SSI was 7.79. The cost of preventing one operative SSI was $5,096. Cost-benefit analysis demonstrated a potential mean savings of $26,149 per operative SSI and $326,862 per 100 patients undergoing posterior instrumented spinal fusion with iNPWT. CONCLUSIONS: Prophylactic iNPWT use significantly reduced rates of wound dehiscence, SSI requiring operative treatment, and affords a potential SSI-related cost savings of $326,862 per 100 patients treated.

A commentary on 'A systematic review and meta-analysis comparing negative pressure wound therapy to conventional wound dressings in the treatment of open fractures'.

A commentary on 'A systematic review and meta-analysis comparing negative pressure wound therapy to conventional wound dressings in the treatment of open fractures'.

The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service

The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service

The first experience of the abdominal VAC- therapy application on role II medical support of combat actions

Purpose. To conduct an analysis of the first experience of using abdominal VAC therapy during the implementation of Damage Control Surgery (DCS) tactics in the treatment of combat surgical abdominal trauma during large-scale combat operations.&#x0D; Material and methods. An analysis of the use of abdominal VAC therapy in the conditions of the advanced surgical group of the Military Mobile Hospital at the Role II of medical support in 45 wounded with penetrating gunshot wounds to the abdomen and damage to internal organs was carried out.&#x0D; Results. The paper describes the injuries of the abdominal organs in the case of a combat surgical injury of the abdomen, which underwent abdominal VAC therapy at the Role II of medical care. The technique of using abdominal VAC therapy in the irrigation mode is described in detail, with the specifics of its implementation for various injuries. The features of performing abdominal VAC therapy during the evacuation of the wounded are highlighted. The purpose of abdominal VAC therapy at the Role II of MS in the conditions of large-scale combat operations, indications, contraindications to its use and the peculiarities of its implementation in combat surgical abdominal trauma are summarized. &#x0D; Conclusions. Abdominal VAC therapy for combat surgical injury of the abdomen is the optimal way to temporarily close the abdominal cavity at the end of the I phase of the DCS tactics at the Role II of combat medical support, which allows you to remove pathological exudate effectively from the abdominal cavity and rehabilitate it (including during medical evacuation to the next level of medical care ) and is preparation for performing reconstructive operations and final closure of the abdominal cavity in the III phase DCS tactics.

A Biodegradable Janus Sponge for Negative Pressure Wound Therapy.

Negative pressure wound therapy (NPWT) is effective in repairing serious skin injury. The dressing used in the NPWT is important for wound healing. In this paper, we develop biodegradable amphiphilic polyurethanes (PUs) and fabricate the PUs into sponges as wound dressings (Bi@e) with Janus pore architectures for NPWT. The Bi@e is adaptive to all the stages of the wound healing process. The Janus Bi@e sponge consists of two layers: the dense hydrophobic upper layer with small pores provides protection and support during negative pressure drainage, and the loose hydrophilic lower layer with large pores absorbs large amounts of wound exudate and maintains a moist environment. Additionally, antibacterial agent silver sulfadiazine (SSD) is loaded into the sponge against Escherichia coli and Staphylococcus aureus with a concentration of 0.50 wt%. The Janus sponge exhibits a super absorbent capacity of 19.53 times its own water weight and remarkable resistance to compression. In a rat skin defect model, the Janus Bi@e sponge not only prevents the conglutination between regenerative skin and dressing but also accelerates wound healing compared to commercially available NPWT dressing. The Janus Bi@e sponge is a promising dressing for the NPWT.

Comparison of negative pressure wound therapy against normal dressing after vascular surgeries for inguinal wounds: A systematic review and meta-analysis

BackgroundNegative Pressure Wound Therapy (NPWT) is a therapeutic technique of applying sub-atmospheric pressure to a wound to reduce inflammation, manage exudate, and promote the formation of granulation tissue. It aims to optimise the natural physiological processes of wound healing for more effective recovery, and NPWT has emerged as a promising alternative to traditional dressings. MethodsThe protocol followed in the study was prospectively registered. Appropriate search terms and Boolean operators were used to search electronic databases for relevant articles. Screening of articles was performed, and data extraction was done. The effect measure was chosen according to the nature of the variable, and the effect model was chosen as per heterogeneity. Forest plot was used to give visual feedback. ResultsThis study included 11 randomized controlled trials (13 publications) with a total of 1310 patients (1497 inguinal wounds). The NPWT group had lesser odds of developing surgical site infection (OR: 0.40; 95 % CI: 0.29–0.54; n = 1491; I2 = 20 %; p-value ≤0.00001) and lesser odds of needing surgical wound revision (OR: 0.48; 95 % CI: 0.26–0.91; n = 856; I2 = 0 %; p-value = 0.02) as compared to the normal dressing group. No significant difference was observed in duration of hospital stay, cost of care, wound healing time, or other complications. ConclusionNPWT application in inguinal wounds significantly reduces the surgical site infection and the need for wound revision in patients who have undergone vascular surgery.

Negative Pressure Wound Therapy: Challenges, Novel Techniques, and Future Perspectives.

Significance: Negative pressure wound therapy (NPWT) has been in practice for decades, proving its utility in many applications, ranging from acutely infected wounds to complex combat wounds and skin grafting. It has been routinely demonstrated that NPWT has superior wound healing outcomes compared with previous standard-of-care therapies. However, the technique involves some challenges related to each of the components that comprise the therapy. The purpose of this article is to highlight the challenges, introduce the recent advancements, and discuss about the future directions in NPWT systems. Recent Advances: New techniques and materials have been developed to improve the currently used NPWT systems with promising results when utilized with appropriate indications. Many advancements have been introduced in modes of negative pressure delivery, pumps, interface dressings, adhesive dressings, and tubing technology. Critical Issues: An optimal NPWT system would avoid the common problems such as failure to deliver negative pressure due to loss of an airtight seal or tissue ingrowth into the interface dressing causing painful dressing changes and bleeding. Other challenges include infection control and patient pain and discomfort that may contribute to noncompliance. Future Directions: Many studies have been performed to evaluate the optimal combination of settings and components in various wounds; however, there is still no clear "best" answer for many specific patient-wound scenarios. Novel and emerging tissue engineering and regenerative medicine approaches could potentially be utilized in the future NPWT systems and thus, this review will discuss some novel ideas for future considerations.

Prophylactic negative pressure wound therapy to improve wound healing rates following ileostomy closure: a randomized controlled trial.

Reversal of ileostomy is associated with morbidity including wound infection and prolonged wound healing. Negative pressure wound therapy (NPWT) has been shown to reduce time to wound healing by secondary intention. The aim of this study was to determine whether NPWT improved wound healing rates, compared with simple wound dressings, in patients undergoing reversal of ileostomy where the skin wound is closed with a purse-string suture. This was a dual-centre, open-label, randomized controlled trial with two parallel intervention arms. Patients undergoing elective loop ileostomy reversal were randomized 1:1 to receive NPWT or simple wound dressings. The primary endpoint of the study was assessment of complete wound healing at day 42 post reversal of ileostomy and the secondary endpoints were patient-reported wound cosmesis using a visual analogue scale and rates of surgical site infection (SSI). The study was conducted from June 2018 to December 2021. The trial was approved by the local ethics committee. We enrolled 40 patients, 20 in each arm. One patient in each arm was lost to follow up. Nine patients (9/19, 47.36%) in the simple dressing group had wound healing vs. 13 patients (13/19, 68.42%) in the NPWT group (P = 0.188). There was no significant difference in patient- reported wound cosmesis or SSI. There was no difference in wound healing rates when comparing NPWT to simple wound dressings at early and late time points post reversal of ileostomy, where the skin wound was closed with a purse-string suture.

A method for treatment of deep and superficial enteroatmospheric fistulas in an open abdomen, ChimneyVAC: Ten years experience.

Leakage of intestinal fluid is a challenging event when it appears in an open abdomen (OA) and surgical deviation does not seem possible. Intestinal contents in the abdominal cavity maintain inflammation and drainage is there for essential. We have developed a method, ChimneyVAC, to treat both deep and superficial enteroatmospheric fistulas (EAF) AIMS: To describe this innovative surgical technique and our 10-year experience. This single-center observational cohort study included all 16 consecutive patients treated with ChimneyVAC. Seven women and 9 men; median age: 47; (interquartile range [IQR]:39-63) years, 15 with a small bowel fistula and 1 with a large bowel fistula. All except of the colonic fistula were classified as a high output fistula; 14 were deep and 2 superficial. In this technique, a negative-pressure source is applied directly above the fistula opening, in addition to negative pressure wound therapy for the OA. This controls the leakage of intestinal fluid by direct drainage into a vacuum system, thereby avoiding contamination of the abdomen. A controlled enterocutaneous fistula (ECF) then forms as the traction from the ChimneyVAC brings the fistula opening to skin level. In 14 patients, an ECF formed after a median of 42 (IQR:28-55) days and 12 (IQR:7-16) dressing changes. The median length of hospitalization was 103 (IQR:58-143) days. Two patients died of multiorgan failure and 14 initially survived. This study showed that 14 out of 16 patients survived the initial treatment for enteric leakage with the ChimneyVAC method. The outcome of ChimneyVAC treatment is a controlled ECF, which was then corrected after a median of six months. However, hospitalization is lengthy, the patients undergo several dressing changes and many needs additional parenteral nutrition until intestinal continuity is reestablished. ChimneyVAC is a feasible method for treatment of EAF in an OA, with favorable survival.

Negative-Pressure Wound Therapy for the Management of Complex Surgical Wounds in a Minority Population.

Introduction Negative-pressure wound therapy (NPWT) has been used for decades as an established treatment modality for complex wounds, now commonplace in hospitals and various clinical and outpatient settings. Several studies have noted improved healing outcomes with this device, but the current state of literature is in debate on both clinical and economic effectiveness. The use of NPWT can become expensive, largely because of the complexity of wounds and the need for outpatient management, from which a majority of the benefit is derived. This creates a disparity in access to this therapy. A lack of insurance and limited access to healthcare that is present in minority populations contribute to this inequality. Methods We reviewed the clinical courses of eight patients who were treated with NPWT at a single acute care facility in an underserved area caring for a minority population. Results We describe several different anatomic wounds along with details including the size of wounds, number of debridements, length of hospital stay, duration of treatment, and ensuing courses of the minority patients who received NPWT for the entire duration of their wound care course. Conclusions This case series demonstrates desirable wound healing outcomes with the use of NPWT in the minority population. The authors draw attention to the outpatient benefit of this device that may be lost in those with limited insurance in minority populations and seek to encourage further studies in this population in resource-limited settings to determine its true clinical effectiveness.