Standard Wound Dressing Research Articles

Randomized Controlled Trial: Does the Use of Occlusive Hydrocolloid Silver-Containing Wound Dressing after Sternotomy Reduce Surgical Site Infection after Cardiac Surgery?

(1) Background: To reduce the incidence of surgical site infections (SSIs) following median sternotomy in cardiac surgery, we compared an occlusive hydrocolloid silver-containing wound dressing (OHSCWD) with a standard wound dressing. (2) Methods: This study was designed as a single-center randomized controlled trial. The primary endpoint was the overall rate of incidence of any kind of SSI. Secondary endpoints were the number of dressing changes, the severity of SSIs, and whether there was a need for treatment. Wounds were monitored daily until the seventh and on the 30th postoperative day. (3) Results: Of the 423 patients included, 352 were analyzed. No differences in demographics, cardiovascular risk factors, intraoperative processes, and postoperative care were found between both groups. Additionally, the incidence or extent of SSI showed no significant differences between the two groups. (4) Conclusions: In summary, out of all pre-, intra-, and postoperative factors, the contribution of postoperative wound care to the development of SSIs appears to play a subordinate role. However, by offering equivalent wound protection and a reduced number of dressing changes, OHSCWD after median sternotomy in cardiac surgery patients could be a good alternative to standard dressings from the point of view of the patient, the staff, and the clinic.

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.

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

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

The Utility of Prevena Negative Pressure Wound Therapy on Groin Incisions for Critical Limb-Threatening Ischemia: A Single Institution Experience.

Incisional negative pressure wound therapy (iNPWT) is an adjunctive treatment that uses constant negative pressure suction to facilitate healing. The utility of this treatment modality on vascular operations for critical limb-threatening ischemia (CLTI) has yet to be elucidated. This study compares the incidence of postoperative wound complications between the Prevena Incision Management System, a type of iNPWT, and standard wound dressings for vascular patients who also underwent plastic surgery closure of groin incisions for CLTI. We performed a retrospective cohort study of 40 patients with CLTI who underwent 53 open vascular surgeries with subsequent sartorius muscle flap closure. Patient demographics, intraoperative details, and wound complications were measured from 2015 to 2018 at the University of California San Francisco. Two cohorts were generated based on the modality of postoperative wound management and compared on wound healing outcomes. Of the 53 groin incisions, 29 were managed with standard dressings, and 24 received iNPWT. Patient demographics, comorbidities, and operative characteristics were similar between the 2 groups. Patients who received iNPWT had a significantly lower rate of infection (8.33% vs 31.0%, P = 0.04) and dehiscence (0% vs 41.3%, P < 0.01). Furthermore, the iNPWT group had a significantly lower rate of reoperation (0% vs 17.2%, P = 0.03) for wound complications within 30 days compared with the control group and a moderately reduced rate of readmission (4.17% vs 20.7%, P = 0.08). Rates of infection, reoperation, and dehiscence were significantly reduced in patients whose groin incisions were managed with iNPWT compared with standard wound care. Readmission rates were also decreased, but this difference was not statistically significant. Our results suggest that implementing iNPWT for the management of groin incisions, particularly in patients undergoing vascular operations for CLTI, may significantly improve clinical outcomes.

Dual therapeutic approach: Biodegradable nanofiber scaffolds of silk fibroin and collagen combined with silver and gold nanoparticles for enhanced bacterial infections treatment and accelerated wound healing

The development of novel multifunctional wound healing materials based on natural bioactives has garnered significant interest in recent years due to their ability to stimulate the healing process and alleviate problems associated with standard wound dressings. In the presented work, a bimetallic combination of silver (Ag) and gold (Au) nanoparticles incorporated into silk fibroin (SF) and collagen (CL) composite nanofiber (CNF) using the electrospinning technique. The physicochemical investigations confirmed the successful integration of Ag and Au nanoparticles sizes of approximately 6.76 nm and 9.75 nm, with an average nanofiber diameter of 189.46 ± 108.73 nm. The evaluation of composite nanofiber treated in the in vitro antibacterial tests zone of inhibition value S. aureus (17 mm) and E. coli (18 mm). Additionally, we analyzed the cell proliferation study using NIH3T3 fibroblast cell line treated with the composite nanofiber material. The SF/CL/Ag–Au composite nanofiber exhibited the highest level of cell proliferation compared to other matrices. This increased cell proliferation offers significant advantages in wound healing applications. Furthermore, in vivo study on wound healing activity in Sprague-Dawley rats demonstrated a remarkable healing percentage of 98.85%. These findings collectively highlight the promising potential of the SF/CL/Ag–Au composite nanofiber in promoting accelerated wound healing. The composite nanofibers demonstrated remarkable hemocompatibility of erythrocyte lysis percentages varying between 1.5% and 3.9%. Besides, swelling tests revealed that the material can absorb exudates from wound sites, facilitating tissue regeneration and cell adhesion. Finally, this research highlights the potential of the SF/CL/Ag–Au composite nanofiber excellent antibacterial activity, highest biocompatibility, enhanced wound healing, and highly suitable for various biomedical applications.

PROphylactic closed incision Negative-PRESSure treatment in open incisional hernia repair: Protocol for a multicenter randomized trial (PROPRESS study)

BackgroundNegative Pressure Therapy in closed incisions (ciNPT) after surgery has shown positive effects including reduction of Surgical Site Infection (SSI) incidence. In patients undergoing elective open incisional hernia repair, however, ciNPT is not standard care, perhaps due to high-quality evidence still not provided. This study hypothesizes that this patient group would benefit from ciNPT by reducing wound complications and improving postoperative quality of life. MethodThis is a multicenter Randomized Controlled Trial (RCT) including a total of 110 patients allocated in a 1:1 ratio with one intervention arm and one active control arm receiving ciNPT (i.e., Prevena™) and standard wound dressing, respectively. The primary outcome is the incidence of SSI at 30 days postoperatively and secondary outcomes are 1) pooled incidence of Surgical Site Occurrence (SSO), 2) patient-reported pain and satisfaction with the scar, and 3) hernia-related quality of life. ConclusionPatients undergoing elective open incisional hernia repair are fragile with a high risk of wound complication development. This multicenter RCT seeks to deliver the high-quality evidence needed to establish the role ciNPT must play for exactly this group with the aim of reducing SSI incidence and health economic costs, and finally improving quality of life. There are no theoretical or clinical experience of unwanted consequences of this treatment.

FTP2.6 Topical skin adhesive 2-octylcyanoacrylate dressing reduces the risk of superficial surgical site infections (SSI) in colorectal stoma surgery

Abstract Background Superficial surgical site infection is a common morbidity following bowel resection surgery involving stoma formation with clinical and financial implications. The aim of the study was to evaluate the role of topical skin adhesive, 2-octylcyanoacrylate (2-OCA) in reducing wound infections following colorectal stoma surgery. Methods We performed a retrospective, single centre, cohort study using clinical notes. Patients over the age of 18, undergoing bowel resection (elective or emergency) with stoma formation over a period 5 years from January 2015 to December 2019 were included. The primary endpoint was surgical site infection. Patients either received wound dressing with 2- OCA or standard wound dressing. Results 604 patients were included. Median age was 69 (Range 18- 97). 187 (31%) patients received 2-OCA (group 1) and 417 (69%) received standard care (Group 2). 288 (47%) patients were female, 134 (22%) had body mass index &amp;gt; 30, 87 (14%) were diabetic and 90 (15%) were smokers. 279 (46%) patients had ASA score of 3 and 4 (37% vs 50% p=0.0006). 282 (47%) patients went through emergency surgery (34% vs 53% p&amp;lt;0.0001). 279 (64%) patients underwent dirty surgery (17% vs 32% p&amp;lt;0.0001). 220 (35%) patients developed SSI (28% vs 40% p&amp;lt;0.0015). BMI greater than 30 (OR 2.32, p&amp;lt;0.0001), Diabetes (OR 0.54 p&amp;lt;0.0241), dirty surgery (OR 0.43p&amp;lt;0.0001), standard care, no 2-OCA use (OR 1.52 p=0.0343) were associated with SSI. Conclusion Our study demonstrates that there is association between 2-OCA use and reduced SSI in colorectal surgery involving stoma formation when compared to standard methods of wound dressing. Further randomised clinical trial is recommended to demonstrate causation.

Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacteriumulcerans disease, a protocol for a randomised controlled trial in Ghana.

Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings. Pan African Clinical Trials Repository (registration number; PACTR202011867644311). Registered on 30 th November 2020.

Plasma-Functionalised Dressings for Enhanced Wound Healing.

Fundamental knowledge about cell-surface interactions can be applied in the development of wound dressings and scaffolds to encourage wounds to heal. As surfaces produced with acid-functionalised monomers encourage keratinocyte adhesion, proliferation and migration, whilst amine functionalisation enhances fibroblast proliferation and migration in vitro, standard care wound dressings were plasma-coated with either acrylic acid or allylamine and applied to 6 mm excisional wounds on the backs of mice to test their effectiveness in vivo. At day 3, the rate of wound healing was increased in mice treated with dressings that were plasma-coated with allylamine compared to uncoated dressings, with a significantly reduced wound area. However, healing may be impaired following prolonged treatment with allylamine-functionalised dressings, with delayed re-epithelialisation and increased cellularisation of the wound site at later timepoints. Acrylic acid functionalisation, however, offered no early improvement in wound healing, but wounds treated with these dressings displayed increased collagen deposition at day 7 post wounding. These results suggest that plasma polymerisation may allow for the development of new dressings which can enhance wound closure by directing cell behaviour, but that the application of these dressings may require a timed approach to enhance specific phases of the wound healing response.

Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacterium ulcerans disease, a protocol for a randomised controlled trial in Ghana [version 1; peer review: 2 approved

Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings.

Cost Savings Associated with Vacuum-Assisted Closure in Trauma Patients Undergoing Posterior Spinal Fusion

To investigate the implications of vacuum-assisted closure (VAC) versus standard wound dressings on postoperative posterior spinal fusion (PSF) wounds with respect to potential cost savings associated with reduced incidence of surgical site infections. This was a retrospective review of trauma patients who underwent open PSF under the care of a single surgeon at a Level I trauma center. Patients were postoperatively monitored for 90 days. Statistical analysis was performed with χ2 testing with the calculation of number needed to treat values. Inclusion criteria were met by 208 patients who underwent open PSF. The χ2 test revealed a significant increase in incidence of surgical site infections (20% vs. 8%; P= 0.021) in the non-VAC group (n= 112) compared with the VAC group (n= 96). Cost-benefit analysis revealed that use of VAC in patients undergoing open PSF could enable a mean cost savings of $163,492 per 100 patients. Use of VAC in patients undergoing open PSF was associated with a 2-fold decrease in incidence of surgical site infections and an infection-related cost savings of $163,492 per 100 patients. Further investigation is needed to ascertain additional benefits of VAC usage in patients undergoing open PSF.

Cell-free therapy based on stem cell-derived exosomes: A promising approach for wound healing.

There are several successive and overlapping phases in wound healing as a complex process. By the disruption of each of these phases, chronic non-healing wounds are resultant. Despite the present soothing surgeries, standard wound dressings and topical gels, the wound is often not completely closed. Today, stem cells have attracted a huge deal of attention therapeutically and pharmaceutically considering their unique features. However, they have some restrictions. Moreover, it is hoped to eliminate the limitations of cellular therapies based on their derivatives known as exosomes. Exosomes are extracellular vesicles secreted from cells. They have a diameter of almost 30-150 nm and miRNAs, mRNAs, and proteins that are possibly different from the source cell are included in exosomal contents. Such nanovesicles have a key role in the intercellular communication of pathological and physiological procedures. Exosome-based therapy is a new significant method for wound healing. By exosomes effects, wound management may be improved and a new therapeutic model may be highlighted for cell-free therapies with reduced side effects for the wound repair.

Effect of negative pressure wound therapy in exploratory laparotomies with coexisting ostomy

Background:&#x0D; Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy.&#x0D; &#x0D; Methods:&#x0D; A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed.&#x0D; &#x0D; Results:&#x0D; A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI.&#x0D; &#x0D; Conclusions:&#x0D; In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies.&#x0D; &#x0D; Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy

Can prophylactic negative pressure wound therapy improve clinical outcomes in spinal fusion surgery? A meta-analysis.

Recently negative pressure wound therapy (NPWT) is increasingly being prophylactically used to prevent wound complications in various types of surgeries, but its role in spinal fusion surgery was less well established. This study aimed to evaluate the efficacy of prophylactic NPWT (PNPWT) usage in spinal fusion surgery. Following PRISMA guidelines, databases PubMed, Embase and Web of Science were searched for relevant studies. Studies comparing PNPWT with standard wound dressing (SWD) were included and analyzed. The primary outcome was the incidence of surgical site infection, and secondary outcomes were incidence of wound dehiscence, overall wound complication, readmission and reoperation. A total of five studies were included; there were 279 patients in PNPWT group and 715 patients in SWD group. Four studies investigated surgical site infection; the pooled analysis showed a significantly lower incidence of surgical site infection in PNPWT group (OR: 0.399; 95% CI: 0.198, 0.802). Two studies explored wound dehiscence, three studies reported overall wound complication, and there were no significant differences between the two groups ((OR: 0.448; 95% CI: 0.144, 1.389) and (OR: 0.562; 95% CI: 0.296, 1.065), respectively). Two studies evaluated readmission, three studies compared reoperation rate, and the pooled results demonstrated no significant difference between the two groups ((OR: 1.045; 95% CI: 0.536, 2.038) and (OR: 0.979; 95% CI: 0.442, 2.169), respectively). The current evidence suggested PNPWT could effectively reduce postoperative surgical site infection, but it had no significant benefit on reducing the incidence of wound dehiscence, overall wound complication, readmission and reoperation.

Does negative pressure wound therapy reduce the odds of infection and improve health-related quality of life in patients with open fractures?

AimsTo evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following open fractures.MethodsPatients from the Fluid Lavage in Open Fracture Wounds (FLOW) trial with Gustilo-Anderson grade II or III open fractures within the lower limb were included in this secondary analysis. Using mixed effects logistic regression, we assessed the impact of NPWT on deep wound infection requiring surgical intervention within 12 months post-injury. Using multilevel model analyses, we evaluated the impact of NPWT on the Physical Component Summary (PCS) of the 12-Item Short-Form Health Survey (SF-12) at 12 months post-injury.ResultsAfter applying inverse probability treatment weighting to adjust for the influence of injury characteristics on type of dressing used, 1,322 participants were assessed. The odds of developing a deep infection requiring operative management within 12 months of initial surgery was 4.52-times higher in patients who received NPWT compared to those who received a standard wound dressing (95% confidence interval (CI) 1.84 to 11.12; p = 0.001). Overall, 1,040 participants were included in our HRQoL analysis, and those treated with NPWT had statistically significantly lower mean SF-12 PCS post-fracture (p < 0.001). These differences did not reach the minimally important difference for the SF-12 PCS.ConclusionOur analysis found that patients treated with NPWT had higher odds of developing a deep infection requiring operative management within 12 months post-fracture. Due to possible residual confounding with the worst cases being treated with NPWT, we are unable to determine if NPWT has a negative effect or is simply a marker of worse injuries or poor access to early soft-tissue coverage. Regardless, our results suggest that the use of this treatment requires further evaluation.Cite this article: Bone Jt Open 2022;3(3):189–195.

A comparative study between topical short and long-acting insulin preparations in management of wounds in diabetic patients

Wounds of diabetic patients often require weeks of adequate and appropriate care for full recovery. The use of systemic insulin in diabetic patients was reported to enhance wound healing. Thus, the present study was conducted to evaluate the effect of topical insulin on diabetic wounds. Our objective was to compare the effectiveness of topical short and long acting insulin combined with standard wound dressings in healing of wounds in diabetic patients. Thirty adult patients of both sexes from the outpatient settings of the General and Plastic surgery wards at Minia University Hospital were included in the study. Patients were assigned into three groups; control, patients applying short acting insulin and those applying long-acting insulin. The wounds were compared for healing time, inflammation and pain at days 0, 14, and 21. The mean age of patients included in the study was 58.9±5.3 years. The unit healing time for diabetic control group was 25.1±22.9 which was significantly higher than the two other groups (10.02±5.4 and 5.1±2.4, respectively) with no significant difference between topical short and long-acting insulin applying groups. Upon scoring of wounds, the long acting score of the short acting insulin was significantly lower than the control group at day 14 (p=0.001) while both topical insulin groups showed significantly reduced scores at day 21 compared to the control group (p=0.001 and p=0.009 for short and long-acting insulin, respectively). Both topical insulin treatments resulted in an acceleration of the wound healing process with no significant difference between short and long-acting insulin.

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

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

Prophylactic negative pressure wound therapy after open ventral hernia repair: a systematic review and meta-analysis.

Negative pressure wound therapy on closed incisions (iNPWT) is a wound dressing system developed to promote wound healing and avoid complications after surgical procedures. The effect of iNPWT is well established in various surgical fields, however, the effect on postoperative wound complications after ventral hernia repair remains unknown. The aim of this systematic review and meta-analysis was to investigate the effect of iNPWT on patients undergoing open ventral hernia repair (VHR) compared with conventional wound dressing. This systematic review and meta-analysis followed the PRISMA guidelines. The databases PubMed, Embase, Cochrane Library, Web of science and Cinahl were searched for original studies comparing iNPWT to conventional wound dressing in patients undergoing VHR. The primary outcome was surgical site occurrence (SSO), secondary outcomes included surgical site infection (SSI) and hernia recurrence. The literature search identified 373 studies of which 10 were included in the meta-analysis including a total of 1087 patients. Eight studies were retrospective cohort studies, one was a cross-sectional pilot study, and one was a randomized controlled trial. The meta-analysis demonstrated that iNPWT was associated with a decreased risk of SSO (OR 0.27 [0.19, 0.38]; P < 0.001) and SSI (OR 0.32 [0.17, 0.55]; P < 0.001). There was no statistically significant association with the risk of hernia recurrence (OR 0.62 [0.27, 1.43]; P = 0.26). Based on the findings of this systematic review and meta-analysis iNPWT following VHR was found to significantly reduce the incidence of SSO and SSI, compared with standard wound dressing. INPWT should be considered for patients undergoing VHR.

Topical oxygen treatment relieves pain from hard-to-heal leg ulcers and improves healing: a case report

Pain from hard-to-heal wounds is common and challenging to manage with current therapies. Most hard-to-heal wounds show some degree of hypoxia that impairs healing and contributes to pain. Regular oxygen therapy is given in hyperbaric oxygen chambers and is costly, time-consuming and cannot be offered to most patients. Moreover, hyperbaric oxygen therapy (HBOT) only increases tissue oxygen for a short time and is given only for a few hours per week. Topical oxygen therapy (TOT) was introduced as an alternative and in this report we focus on topical continuous oxygen therapy (TCOT), which has been shown to be associated with healing of hard-to-heal ulcers. We report on a patient with type 1 diabetes with a painful hard-to-heal lower leg ulcer that failed to heal with standard wound dressings and that had insufficient response to pharmacological analgesia. The patient was on three different analgesics before treating the wound with TCOT. As the wound was considered hypoxic, due to longstanding diabetes and probable microangiopathy, TCOT was commenced. Within one week of treatment starting, the patient spontaneously ceased all his analgesics as he was free of pain; and after 2.5 months, the ulcer healed. The patient reported no adverse effects. In addition to promoting healing, TCOT may also be considered for its potential analgesic effects in hard-to-heal wound management.

The Effect of Kiwifruit Therapeutics in the Treatment of Diabetic Foot Ulcer.

Diabetes mellitus is considered a silent disease with possible late chronic complications such as diabetic foot ulcer. This condition is managed by surgical debridement. To improve surgical outcome, some surgeons use proteolytic agents after surgery. Kiwifruit contains a type of proteolytic enzyme called actinidin that may play a role in the treatment of such complication. In the current study, we evaluate the role of kiwifruit extract in the treatment of diabetic foot ulcer. Eighteen diabetic foot ulcer patients were included in a randomized, double-blind clinical trial. The patients were divided randomly to control and experimental groups. Patients in the control group underwent daily wound dressing using base ointment (Eucerin). In the experimental group, we added kiwifruit extract to the standard wound dressing. Clinical data including general appearance of wound (according to recorded photographs before and after medical intervention) were analyzed using SPSS version 22. The mean wound area of the experimental group was significantly less than in the control group (P = .005) after 4 weeks of treatment. Comparison of the average of size difference, before and after the treatment in the experimental group and the control group, shows that kiwifruit can have a good impact on wound healing (P = .0001). In patients with diabetic foot ulcer, wound dressing using kiwifruit extract may help reduce time of treatment and may replace surgical debridement for some selected cases.