Negative Pressure Wound Therapy Research Articles

303. VACUUM-STENT TREATMENT FOR TRANSMURAL DEFECTS IN THE UPPER GASTRO-INTESTINAL TRACT: CASE SERIES AND NEW INSIGHTS IN A TERTIARY REFERRAL CENTER

Abstract Background Transmural defects in the upper gastro-intestinal (GI) tract are associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has recently been established as promising endoscopic treatment option for such defects and is most often applied using endoscopically placed vacuum-sponges. The vacuum-stent is a novel device to apply EVT, combining the advantages of negative pressure wound therapy and an intraluminal stent, allowing for oral intake. Methods The aim of this prospective cohort study is to describe the experiences of, and lessons learned by a tertiary referral center with EVT experience since 2018, regarding the vacuum-stent for transmural defects in the upper GI tract. All patients treated with a vacuum-stent between November 2022 and October 2023 were included. Outcome measures included successful defect closure, reasons of treatment failure, adverse events and strictures. Results 31 patients were included. Baseline characteristics and outcomes are displayed in Table 1. Success rates of combined vacuum-stent and –sponge treatment and vacuum-stent treatment alone were respectively 83% and 78%. In this cohort, some notable reasons of failure were observed: a defect too close to the upper esophageal sphincter (UES), inadequate vacuum on the esophago-jejunal anastomosis, a carcinoma at a persisting perforated ulcer, and adverse events. Two adverse events occurred (6%): two patients developed a secondary defect at the site of the proximal vacuum-stent flange, of whom one had a cervical anastomosis with a narrow proximal esophagus and one Boerhaave syndrome. Three out of four patients with a severe structure had underwent a McKeown esophagectomy. Conclusion The vacuum-stent is a valuable treatment option for AL after Ivor Lewis esophagectomy, Boerhaave syndrome and iatrogenic defects with success rates of 78-83%. Treating cervical anastomotic leaks is not recommended by us, due to the narrow lumen of the proximal esophagus, the proximity of the UES and high risk of severe strictures. Furthermore, caution is recommended in case of a narrow esophagus. In our experience, vacuum-stent and –sponge treatment complement each other and might be indicated in different situations. Sharing experiences on the topic is important to assess the best techniques and indications, to be able to reach the full potential of the vacuum-stent and further increase the success rate.

Incisional negative pressure wound therapy for the prevention of surgical site complications in Paediatric patients with non-idiopathic scoliosis: A randomized clinical trial.

Surgical wound complications are adverse events with important repercussions for the health of patients and health system. Surgical site infections and wound dehiscences are among the most important surgical wound complications, with a high incidence in paediatric patients undergoing surgery for non-idiopathic scoliosis. Incisional negative pressure wound therapy for surgical incisions is used as a preventive measure against surgical wound complications in adults; however, there has been scant evidence for using it in children. The purpose of this study is to evaluate the cost-effectiveness of incisional negative pressure wound therapy in preventing surgical wound complications in paediatric patients undergoing surgery to treat non-idiopathic scoliosis. Randomized clinical trial. Children younger than 18 years of age undergoing surgery for non-idiopathic scoliosis were randomly assigned into two groups to receive one of two different types of dressings for the first 7 days after surgery. One group were treated with a postoperative hydrofibre and hydrocolloid dressing with silver for wounds (control group), and the other group received a single-use incisional negative pressure wound therapy system (intervention group). The wounds were assessed after removal of the dressings at 7 days after surgery and again at 30, 90, and 180 days after surgery. Surgical wound complications, sociodemographic variables, variables related to the procedure and postoperative period, economic costs of treatment of surgical wound complications, and time to healing of the surgical wound were recorded. Per protocol and per intention to treat analysis was made. The per protocol incidence of surgical wound complications was 7.7% in the intervention group versus 38.5% in the control group (p = 0.009; Fisher exact test. RR = 0.20 IC95%: 0.05-0.83). Surgical wound dehiscence, surgical site infections, seroma, and fibrin were the most common surgical wound complications. The type of surgery, duration of surgery, and patients' age were associated with a higher risk for surgical wound complications. Postoperative hydrofibre and hydrocolloid dressing with silver for wounds were found to be associated with a longer time to healing. Initial costs for dressings in the group receiving incisional negative pressure wound therapy were higher, but the total postoperative costs were higher for those receiving postoperative hydrofibre and hydrocolloid dressing with silver for wounds. It was found that for each US$1.00 of extra costs for using incisional negative pressure wound therapy, there was a benefit of US$12.93 in relation to the cost of complications prevented. Incisional negative pressure wound therapy is cost-effective in the prevention of surgical wound complications in children undergoing surgery for non-idiopathic scoliosis.

PICO™ (Closed-Incision Negative-Pressure Wound Therapy) Dressing Use as Postoperative Prophylaxis for Preventing Surgical Site Infections in Spinal Surgery: A Retrospective Single-Centre Study.

Introduction Surgical site infections (SSIs) are one of the dreaded complications of spinal surgery. These typically develop within the first 30 days following surgery. The overall pooled incidence of SSIs is reported at 3.1%. Negative pressure wound therapy (NPWT) has been employed for the management of open wounds and soft tissue injury. There has been a recent trend towards the use of closed incision NPWT (ciNPT), such as PICO. There are only a few studies evaluating the prophylactic use of ciNPT in spinal surgery. The aim of this study was to evaluate whether prophylactic use of PICO dressings can reduce SSI incidence and complications in spinal surgery. Methods Data were collected retrospectively for patients undergoing spinal surgery, with a PICO dressing used for closed surgical incisions, from February 2021 to October 2022. Each patient was followed up for 30 days. The results were compared with local hospital infection control statistics for previous years. Results A total of 50 patients underwent spinal surgery and had PICO dressings post-operatively. None of the patients developed a seroma. Two out of 50 (4.0%) patients developed wound dehiscence and then subsequent SSI (1 superficial, 1 deep). These were managed conservatively with the use of antibiotics and prolonged ciNPT. None of these patients returned to the theatre. The average SSI incidence from previous years was 9.27 ± 4.14 per annum (1.15%), but with an average of 77.3% of these requiring a return to theatres. Conclusion Our study reflects that there is no difference in the incidence rates for SSIs for patients who have PICO dressings versus those having standard occlusive dressings as post-operative closed surgical incision site wound closure following spinal surgery. For those who do develop SSIs, there was no difference in the rates of return to theatres among the two patient populations.

Novel insights into vancomycin-loaded calcium sulfate and negative pressure wound therapy in preventing infections in open fractures

BackgroundOpen fractures are challenging due to susceptibility to Staphylococcus aureus infections. This study examines the impact of Vancomycin-Loaded Calcium Sulfate (VLCS) and negative pressure wound therapy (NPWT) on macrophage behavior in enhancing healing and infection resistance. Both VLCS and NPWT were evaluated individually and in combination to determine their effects on macrophage polarization and infection resistance in open fractures.MethodsThrough single-cell RNA sequencing, genomic expressions in macrophages from open fracture patients treated with VLCS and NPWT were compared to a control group. The analysis focused on MBD2 gene changes related to macrophage polarization.ResultsRemarkable modifications in MBD2 expression in the treatment group indicate a shift towards M2 macrophage polarization. Additionally, the combined treatment group exhibited greater improvements in infection resistance and healing compared to the individual treatments. This shift suggests a healing-promoting atmosphere with improved infection resilience.ConclusionsVLCS and NPWT demonstrate the ability to alter macrophage behavior toward M2 polarization, which is crucial for infection prevention in open fractures. The synergistic effect of their combined use shows even greater promise in enhancing outcomes in orthopedic trauma care.

Exploring the efficacy of negative pressure wound therapy in the management of mycobacterium ulcerans wounds: a comprehensive literature review

Mycobacterium ulcerans (M Ulcerans) infection leads to the debilitating Buruli ulcer (BU), characterized by necrotizing skin and soft tissue lesions. Conventional treatment primarily focuses on an antibiotic regimen, but wound management remains paramount to patient recovery. This literature review aims to evaluate the efficacy and benefits of Vacuum Assisted Dressing (VAC) in the treatment and management of BU wounds. A systematic literature search was undertaken using databases such as PubMed, Cinahl, Cochrane database, Joanna Briggs Institute, Medline, Internurse, Nursing & Allied Health database, and Scopus search from January 1995 to December 2023. The key search terms included “Mycobacterium ulcerans”, OR “Buruli ulcer”, AND “vacuum assisted dressing”, “vacuum assisted therapy”, “Vacuum Assisted Dressing”, “negative pressure wound therapy”, and “Negative Pressure Wound Therapy (NPWT)”. The exclusion criteria were animal studies and studies not in the English language. The current literature emphasizes the importance of antibiotic treatment for BU and highlights the skin and soft tissue damage that results in open, infected wounds. However, there is a notable lack of quantitative data on the efficacy of NPWT for treating BU wounds. Early evidence indicates that NPWT might accelerate wound healing, decrease secondary infections, and enhance wound bed readiness for grafting or secondary healing. While more comprehensive quantitative studies are warranted, NPWT emerges as a promising adjunctive therapy in the holistic management of BU wounds, offering benefits that may improve patient outcomes and reduce morbidity.

The efficacy of cuff-shaving combined with negative pressure wound therapy in refractory exit-site and tunnel infections: a single center experience

BackgroundRefractory exit-site infections (ESIs) and tunnel infections (TIs) are challenging complications for patients undergoing peritoneal dialysis (PD). This study compared the outcomes of surgical intervention, notably the cuff-shaving (CS) procedure coupled with negative-pressure wound therapy (NPWT), and conservative management strategies for patients with refractory ESI and TI.MethodsWe retrospectively reviewed patients who underwent PD at our center, focusing on the incidence and management of ESI and TI. We evaluated and compared treatment outcomes, including ESI scores, frequency of ESI and/or TI, identification of causative microorganisms, and duration of catheter survival or time until removal.ResultsWe identified 97 episodes of catheter-related ESI and/or TI across 71 patients with an incidence rate of 0.15 episodes per patient-year. Of the 23 patients with refractory ESI and/or TI, surgical intervention was performed in 8, while 15 chose conservative management. In the one-month follow-up, patients who underwent CS combined with NPWT showed no complications such as leakage, and their local symptoms resolved completely. The mean PD catheter survival time was significantly longer in the surgical group (29.38 ± 7.25 months) than in the conservative group (7.86 ± 2.13 months). Surgical intervention demonstrated a significantly higher therapeutic efficacy and extended catheter survival.ConclusionsThe combination of CS and NPWT as a surgical approach is crucial for eradicating infectious foci and significantly improving the longevity of PD catheter function. This integrated surgical strategy offers a promising solution for the management of refractory ESI and TI in patients undergoing PD.

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.

Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

Association of negative pressure wound therapyand surgical site infections in patients undergoing cytoreductive surgery: An entropy balanced analysis.

Surgical site infections (SSIs) after cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) are a major cause of potentially avoidable morbidity. We explored the association of negative pressure wound therapy (NPWT) with SSI in patients undergoing CRS/HIPEC. Retrospective analysis of consecutive patients undergoing CRS/HIPEC for non-gynecologic cancers. Exposure was the receipt of NPWT versus traditional skin closure. Primary outcome was SSI within 90 days of surgery. We performed multivariable logistic regression (before and after entropy balancing) to evaluate the association of exposure with outcomes. A total of 251 patients were included, of which 43 (17%) received NPWT and 26 (10.4%) developed SSIs. Baseline demographics and clinicopathologic characteristics were similar between the two groups with some exceptions: Patients who received NPWT had a higher Peritoneal Carcinomatosis Index (median 19 vs. 11, p = 0.002) and operative time (10 vs. 8.2 h, p = 0.003) but were less likely to undergo HIPEC (84% vs. 95%, p < 0.05). After entropy balancing, on multivariable logistic regression, NPWT was not associated with 90-day SSI (odds ratio = 0.90; 95% confidence interval = 0.21-3.80; p = 0.89). NPWT was not associated with a reduction in SSIs. These findings prompt a reevaluation of the routine use of NPWT in CRS/HIPEC.

Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease.

Severe pilonidal diseases have refractory symptoms despite multiple surgeries and optimal therapy remains unclear. We hypothesized that standardized minimally invasive protocol could be an effective rescue treatment. We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic 2019-2023. We treated these patients with standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination. We treated 34 refractory patients (23 males) with median follow-up 405days. Median age of first symptoms was 17.1years; presentation to our clinic 20.0years. Prior to our clinic, 27 received one surgery (cleft lift-2, excision no closure-1, excision primary closure-18, wound vac after excision-3, excision flap closure-3); 7 had two surgeries (excision without closure + cleft lift-1, primary closure after excision twice-3, flap closure after excision twice-2, excision primary closure + excision without closure-1). We treated all patients with regular epilation ± local wound care. 14 (41%) underwent trephination ± debridement. All patients achieved complete resolution after median 52days. Five (14.7%) recurred and were treated with trephination + debridement-2 or wound care alone-3. Symptom length had no correlation with resolution time, skin type, hair amount. Standardized minimally invasive protocol requiring only selective surgical intervention can treat refractory pilonidal disease with low recurrence rate.

Reconstructive Surgery of the Head and Neck in Organ Transplant Recipients: A Case Report and a Review of the Literature.

The number of solid organ transplant recipients (SOTRs) is growing as a consequence of an increase in transplantations and longer survival; these patients, thus, frequently suffer various comorbidities and are subjected to the detrimental effects of immunosuppressive agents, which expose them to a higher risk of developing malignancies. These drugs also complicate the surgical treatment of neoplasms, as they can hinder wound healing, especially when associated with other unfavorable factors (e.g., previous radiotherapy, diabetes, etc.). We herein present our experience with a 74-year-old SOTR who underwent a radical extended parotidectomy and reconstruction with a submental island flap for a persistent cutaneous squamous carcinoma after radiotherapy; his complicated clinical course was characterized by incredibly slow wound healing. The current literature was reviewed to provide a succinct overview of the main difficulties of head and neck surgery in SOTRs. In particular, the immunosuppressive regimen can be tapered considering the individual risk and other elements should be carefully assessed, possibly prior to surgery, to prevent cumulative harm. New developments, including intraoperative monitoring of flap vascularization through indocyanine green fluorescence video-angiography and the prophylactic application of negative pressure wound therapy, when feasible, may be particularly beneficial for high-risk patients.

Use of VAC System and Dermal Matrix as a Surgical Alternative for Lower Extremity Degloving Treatment

Introduction: Soft tissue degloving injuries are the result of high-energy forces that produce compression, twisting or friction of tissues causing soft tissue avulsion, in which a large portion of skin and subcutaneous tissue is detached from the underlying fascia and muscles with musculocutaneous damage and perforating fasciocutaneous vessels. Case Report: The case of a 67-year-old female patient was reported, who as a result of a traffic accident (run over) suffered cutaneous loss (degloving) of the left lower limb. The patient underwent surgical cleaning with debridement of dead tissue plus full-thickness skin autograft for partial coverage of the exposed area in the proximal region. At the same time the surgery was performed, the VAC system was placed. After multiple surgical cleanings, scarce granulation tissue was revealed in the middle and distal third of the left leg. Therefore, it was decided to cover the exposed area with dermal matrix for later definitive coverage. The patient is being followed up by outpatient service. It is revealed that the patient already performs assisted mobility, and the grafts are assimilated. Conclusions: Traffic accidents are a major problem worldwide, especially those of high-energy may require multidisciplinary treatment, prolonged surgical time until recovery and return to daily activities. The initial treatment for degloving has to be performed by trained professionals since the criterion for assessing flap vitality is indispensable. When complex skin grafts are not an option, advanced wound treatment should be used, as in this case, where VAC therapy and permanent synthetic substitute were used for the total coverage of a major defect with lost dermal tissue.

The impact of negative pressure wound therapy on surgical site infection rates in obese women following cesarean section: A systematic review and meta‐analysis

Background &amp; Aim: This study aims to assess the surgical site infection (SSI) rate in obese women undergoing C-sections, comparing negative pressure wound therapy (NPWT) and standard dressings. Methods &amp; Materials: In this systematic review and meta-analysis, databases including Science Direct, Medline/PubMed, Web of Science, Scopus, and Cochrane Library were searched for articles published up to January 2024. The selection criteria included randomized controlled trials and cohort studies comparing the effect of (NPWT) with standard dressings on wound complications in women with obesity undergoing C-sections. Data collection and analysis Pooled effect sizes were calculated using random effects models based on heterogeneity. Results: Out of 20 included studies, 18 reported SSI rates, which included 9243 cases and showed that NPWT reduces the rate of SSIs in obese women undergoing C-section (RR: 0.8, 95% CI: 0.66–0.96, I2= 24.5%, P= 0.01). An in-depth examination of 13 high-quality studies, in which NPWT devices were used, reveals a pooled Mantel-Haenszel (M-H) Risk Ratio (RR) of 0.92 for Prevention- Reduction - Epithelialization- Vacuum- Environment- Negative pressure- Advanced (PREVENA) (95% CI: 0.67–1.26, I2= 0%, P= 0.6) and 0.76 for Pressure- Incision- Closed- Optimization (PICO) (95% CI: 0.44–1.33, I2= 15%, P= 0.05), with a significant difference among devices (P=0.05). Conclusion: NPWT reduces the SSI rate in obese women undergoing C-sections, regardless of the type or device used. Economic evaluations are crucial to justify NPWT device costs against expenses for treating surgical infections, supporting its widespread use in infection prevention.

Customized Negative Pressure Wound Therapy: Innovative Design in Polyurethane Foam for Complex Burn Reconstruction.

The use of negative pressure wound therapy (NPWT) throughout the entire treatment of a burn patient boosts wound healing and recovery. Hand burns require specialized management that enhances wound healing and facilitates early physical rehabilitation. Thus, this article showcases a novel idea of NPWT foam customization that boosts recovery and rehabilitation in patients with hand burns. We present two patients with hand burns treated with NPWT using a customized foam design that allowed for early rehabilitation while providing and optimized recovery. In the two cases presented, the patients required two surgical stages; in the first surgery, debridement of the burns was performed and customized NPWT with instillation was applied, and in the second surgical stage, the bed was reconstructed with partial-thickness skin grafts, which were bolstered with customized conventional NPWT. The management, reconstruction, and rehabilitation were accomplished in under 2 weeks, achieving a remarkable 100% success rate in graft integration during the acute phase on the first attempt. This highlights the effectiveness of incorporating NPWT across all burn treatment phases, expediting recovery and ensuring optimal functional outcomes for patients. Surgeons can customize different NPWT foam shapes that facilitate its use on difficult-to-treat areas, allowing for a faster recovery and better rehabilitation outcomes.

Five-year outcomes for patients sustaining severe fractures of the lower limb from the Wound Healing in Surgery for Trauma (WHIST) trial.

The aims of this study were to report the outcomes of patients with a complex fracture of the lower limb in the five years after they took part in the Wound Healing in Surgery for Trauma (WHIST) trial. The WHIST trial compared negative pressure wound therapy (NPWT) dressings with standard dressings applied at the end of the first operation for patients undergoing internal fixation of a complex fracture of the lower limb. Complex fractures included periarticular fractures and open fractures when the wound could be closed primarily at the end of the first debridement. A total of 1,548 patients aged ≥ 16 years completed the initial follow-up, six months after injury. In this study we report the pre-planned analysis of outcome data up to five years. Patients reported their Disability Rating Index (DRI) (0 to 100, in which 100 = total disability), and health-related quality of life, chronic pain scores and neuropathic pain scores annually, using a self-reported questionnaire. Complications, including further surgery related to the fracture, were also recorded. A total of 1,015 of the original patients (66%) provided at least one set of outcome data during the five years of follow-up. There was no evidence of a difference in patient-reported disability between the two groups at five years (NPWT group mean DRI 30.0 (SD 26.5), standard dressing group mean DRI 31.5 (SD 28.8), adjusted difference -0.86 (95% CI -4.14 to 2.40; p = 0.609). There was also no evidence of a difference in the complication rates at this time. We found no evidence of a difference in disability ratings between NPWT compared with standard wound dressings in the five years following the surgical treatment of a complex fracture of the lower limb. Patients in both groups reported high levels of persistent disability and reduced quality of life, with little evidence of improvement during this time.

Management of Postoperative Pancreatic Fistulas After Pancreaticoduodenectomy Using Open Drainage and Negative Pressure Wound Therapy With Instillation and Dwell Times.

Introduction Postoperative pancreatic fistula (POPF) is a common complication of pancreatoduodenectomy (PD) that may cause lethal complications. Therefore, it is important to properly treat POPF and prevent its aggravation during the postoperative management of PD. We have used a combination of open drainage, in which the wound above the fluid collection is opened, and negative pressure wound therapy with instillation and dwell time (NPWTi-d) to manage POPF after PD. To evaluate the feasibility and efficacy of this combination treatment, we analyzed the outcomes of patients with POPF after PD. Methods Patients who underwent PD were reviewedand those who developed POPF were extracted and divided into three groups according to the management of POPF: N group (patients treated with open drainage and NPWTi-d), O group (patients treated with open drainage without NPWTi-d), and C group (patients treated with catheter drainage). The perioperative outcomes were compared among the three groups. Results During the study period, 133 patients underwent PD, out of which 39 (29%) developed POPF (≥grade B). Among the 39 patients with POPF, eight, four, and 27 were classified into the N, O, and C group, respectively. No mortality was observed in the patients with POPF. No severe complications were observed in the patients who underwent open drainage (N and O groups), while two patients in the C group developed severe complications. Among the patients who underwent open drainage, the N group tended to have a shorter postoperative hospital stay than the O group. Conclusions The current study suggests that open drainage safely and effectively healed POPF and NPWTi-d promoted wound closure. The combination of open drainage and NPWTi-d may prevent the aggravation of POPF, reduce failure to rescue, and shorten hospital stay after PD.

The use of incisional negative pressure wound therapy on high-risk breast cancer mastectomy patients

BackgroundThe main complications seen in patients who have undergone modified radical mastectomy (MRM) are seroma, surgical site infection, hematoma, wound dehiscence, flap necrosis, and nerve damage. While these complications lead to some problems the most feared effect in the early period is that they cause a delay in adjuvant treatment. Incisional Negative Pressure Wound Therapy (iNPWT) decreases wound dehiscence by reducing oedema and tension, especially in the incision line. This study aim to compare recovery times and wound site complications between patients treated with conventional wound dressings and patients treated with iNPWT after MRM. MethodsA retrospective screening was made of the data of 50 patients who underwent MRM because of breast cancer in the General Surgery Clinic of XXX Hospital between 2018 and 2022, and were at high-risk of wound site complications. Two groups were formed as 30 patients applied with iNPWT and 20 patients applied with conventional dressings. ResultsThe mean age of the 50 female patients was 53.58 years (range, 30–80 years). The most frequently seen complications were seroma (20 patients) and partial flap ischaemia (14 patients). The mean number of iNPWT applications was 1.30 (range, 1–2), and the mean number of days of application was 4.47 (range, 2–9). Postoperative seroma was observed in 8 patients in the iNPWT group and in 12 patients in the conventional dressings group (p = 0.018). Flap ischaemia and the probability of dehiscence was determined at a statistically significantly higher rate in the patients in the conventional dressings groups (p = 0.005, p = 0.021). ConclusionThe results of this study demonstrated that the use of iNPWT significantly reduced the amount of postoperative drainage, thereby contributing to early drain removal. Furthermore, iNPWT significantly reduced postoperative seroma, flap ischaemia, and flap dehiscence compared to conventional dressings.

Incisional Negative Pressure Wound Therapy for Wounds in Patients with Lower Intestinal Perforations.

Laparotomy for lower intestinal perforation is associated with a high incidence of surgical site infections. This study aimed to assess whether incisional negative pressure wound therapy (iNPWT) could reduce the incidence of these infections and wound dehiscence in patients with lower intestinal perforation. This single-center prospective study was conducted between September 2019 and July 2022. In the therapy group, wounds were closed with subcuticular sutures, and iNPWT was applied at -120 mmHg for 5 days. A total of 10 days of iNPWT was employed. These patients were compared with a historical control group. The iNPWT group (Group A) comprised 22 patients.The historical control group (Group B) had 65 patients. Table outlines patient characteristics and compares the two study groups. Patient characteristics were demographically similar. The incidence of surgical site infections was lower in the therapy group than in the control group (9.1% vs. 52.3%, p < 0.001). Wound dehiscence was not observed in the therapy group but was noted in three patients (4.6%) in the control group. In univariate and multivariate analysis, an application of the therapy device was associated with reduced incidence of surgical site infections (p < 0.001 and p = 0.002, respectively). The application of iNPWT in patients with lower intestinal perforation was associated with reduced surgical site infections.

Causes of Mediastinitis and Its Surgical Treatment

Mediastinitis remains a potentially fatal complication of cardiac surgery. This study reviews the risk factors for mediastinitis after cardiac surgery, and discusses current treatment and prevention of this complication. This review explores three major independent risk factors for mediastinitis including individual patient factors, surgical procedures and microbiology. The perioperative period is influenced by the utilization of the internal mammary artery in conjunction with coronary artery bypass grafting, sternal fixation, vacuum-assisted closure, and negative pressure wound therapy. Staphylococcus aureus and Staphylococcus epidermidis are frequently encountered microorganisms. Additionally, aerobic gram-negative microorganisms and other infrequent microorganisms are also exhibiting a rising trend. Since sternal fixation devices effectively enhance sternal stability, alleviate wound pain, and decrease the occurrence of postoperative mediastinitis, they have been specifically incorporated into certain therapeutic and prophylactic approaches for addressing this complication. Despite the heightened awareness regarding mediastinitis, the large proportion of individuals at risk underscores the crucial need for rigorous monitoring of potential risk factors, posing a significant challenge to the implementation of effective therapeutic and preventative strategies.

Evolving Trends in the Management of Diabetic Foot Ulcers: A Narrative Review.

The prevalence of diabetic foot ulcers (DFUs) is projected to increase worldwide, which necessitates a review of the current management principles and the development of new approaches to care. The principles of management involve proper glycemic control, infection control, pressure redistribution, wound care debridement, and revascularization. Other modalities of management, such as hyperbaric oxygen therapy and negative wound pressure therapy, are also being explored. While some aspects of DFU care lack high-quality evidence, a multidisciplinary approach incorporating these evolving trends has the potential to improve outcomes and prevent lower extremity amputations in this challenging condition. This review highlights the need for further research to establish definitive treatment protocols for optimal DFU management.

Comparison of Negative-Pressure Wound Therapy and Gradual Wound Approximation Treatments for Infected Fasciotomy Wounds.

Negative-pressure wound therapy (NPWT) and gradual wound approximation (GWA) are effective and reliable methods of treating fasciotomy wounds. However, the effectiveness of these 2 methods in treating infected wounds remains unclear. The aim of our study was to compare these 2 delayed primary closure methods of treating infected fasciotomy wounds on the limbs. Patients who underwent fasciotomy surgery on the extremities after sustaining crushing injuries in the 2023 Kahramanmaraş-centered earthquakes and who were referred owing to infected open wounds during follow-up were included in the study. Patients who completed the wound closure process at our clinic were divided into 2 groups: the NPWT and GWA groups. Using retrospectively collected data, the groups were compared in terms of demographic characteristics, time until wound closure, number of surgeries, skin graft requirements, and complications. Laboratory parameters were also examined. Thirteen patients, (with 21 wounds) who underwent NPWT and 14 (with 22 wounds) who underwent GWA, were examined. The average age of the NPWT group was 32.85 ± 18.37 years, whereas that of the GWA group was 25.21 ± 16.31 years. The number of surgeries in the NPWT and GWA groups were 5.38 ± 2.11 and 4.23 ± 1.27, respectively, and the difference was statistically significant (P = .040). The average wound closure times of the NPWT and GWA groups (P = .0210) (11.00 ± 4.86 days and 8.27 ± 2.41 days, respectively) also differed significantly. Skin grafting was performed in 5 patients in the NPWT group and 2 in the GWA group. There were no significant differences between the 2 groups in terms of skin graft requirements or complication rates. NPWT and GWA are effective and reliable methods of closing infected fasciotomy wounds. Closure of these wounds can be achieved in a shorter time and with fewer surgeries using GWA than using NPWT.