Sterile Dressings Research Articles

Revision of unicompartmental knee arthroplasty using the in situ referencing technique.

Revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with the in situ referencing technique aiming to preserve as much ligament function and epi-metaphyseal bone stock as possible. Aseptic loosening, progression of osteoarthritis, periprosthetic fracture, periprosthetic infection, arthrofibrosis, polyethylene wear, malalignment, instability, femoro-tibial impingement. Unexplained pain, localized or systemic active infection (anywhere). Referencing for the tibia and the femur cuts is performed prior to implant removal. The tibial cutting jig and the initial tibial resection level is set in away that the sawblade just fits under the tibial implant. In case too much bone needs to be removed to achieve flush implant sitting on both the medial and lateral tibia, astep cut needs to be performed to build up the medial defect with an augment. Prior to femoral component removal, rotational alignment is determined and intramedullary referencing for the distal femur osteotomy is performed. Level of constraint and additional tibial stem fixation is chosen according to the amount of bone resected and according to ligament stability. Sterile dressings and elastic compression bandaging. No limitation of active/passive range of motion. Full weight-bearing or partial weight-bearing for 2weeks postoperatively in the presence of bone or soft tissue defects. Between 2008 and 2019, 84patients underwent revision of unicompartmental knee arthroplasty. The mean follow-up was 64months (range 3-132 months). Implant survival after revision of UKA to TKA was 92% (95% CI = 82-97%) at 5years of follow-up and 86% (95% CI = 69-93%) at 10years of follow-up. The mean Oxford knee score was 20.1 (6-39, SD ± 6.5) preoperatively and 30.2 (3-48, SD ± 11.3) postoperatively. The mean visual analogue scale was 6.9 (range 1-10, SD ± 1.8) preoperatively and 3.9 (range 0-9, SD ± 2.6) postoperatively.

Use of Calender Extract Cream in Equine Lacerate Wound

Background: Wounds and lacerations are constant in the clinical routine of horses. The treatment of wounds by the second intention is the most common in the equine clinic; it consists in addition to surgical debridement, the use of allopathic or phytotherapeutic healing. In this context, several phytotherapics used in folk medicine have been used with promising results in the equine species, especially marigold (Calendula officinalis L.), recognized by the German scientific committee as antiseptic and healing. The objective of this study was to evaluate the efficacy of the nonionic cream of Calendula officinalis at 2% in an extensive lacerating wound in an equine.Case: A 6-month-old female Quarter Horse, weighing 160 kg, a lacerating wound in the pectoral region of unknown traumatic origin, was treated in the large animal sector of the Veterinary Hospital of Universidade Paranaense (UNIPAR). Clinical examination revealed an exudative wound in the pectoral region, complicated by the presence of environmental organic matter and myiasis, involving transverse pectoral and descending pectoral muscles, with a large tissue separation and exposure of part of the first sternum. After an initial evaluation, a trichotomy was performed around the wound, removal of myiasis and sanitization of the wound with water and PVP-I, which was filled with sterile dressings and covered with a dressing using a tubular mesh. Antibiotic therapy was instituted, along with anti-inflammatory medication and antitetanic serum (5,000 IU). Due to the need for surgical debridement, after previous fasting and general anesthesia followed by site antisepsis, surgical debridement was performed, followed by reduction of dead space with application of standard "Wolf" sutures, for re-approximation of the wound edges was applied suture in Wolf pattern captonated with segments of equipment. In the post-surgical period, topical treatment with nitrofurazone ointment and crystal sugar was instituted. However, after five days of the surgical procedure, there was dehiscence of the wound, at which time another intervention was chosen. After sedation remaining in standard anatomical position, sutures of the same pattern and wire were applied, but captonated with polyester buds and wound dressing was instituted, followed by the application of nonionic cream of marigold (C. officinalis) extract, in the concentration of 2%, twice a day until complete healing of the wound.Discussion: The use of nonionic marigold cream (C. officinalis) 2% showed a significant efficacy, in the case reported, corroborating with literature data that marigold presented an advantage in the inflammatory phase of the healing process, when compared to the other two substances, favored epithelization and demonstrated bactericidal action. This activity is reported to the substances present in C. officinalis, especially the flavonoids, which are phenolic compounds derived from the secondary metabolism of plants. In addition to phenolic compounds such as triterpenes, faradiol esters and taraxasterol are considered responsible for antioxidant, anti-inflammatory, antimicrobial and angiogenic activities, actions that contribute directly or indirectly to the healing process. The present report contributes positively to the use of alternative treatments in wounds as the phytotherapeutic in question, since it proved feasible, besides avoiding the use of allopathic ones with higher associated costs and environmental impact in its production and use, as well as the emergence of bacterial resistance.

Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases.

Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Control of an outbreak of post-transplant cutaneous mucormycosis by removing the vehicle: An intervention study of contiguous cohorts

An outbreak of post-kidney transplant cutaneous mucormycosis (PK-CM), a severe and even fatal complication in immunocompromised patients, occurred in our institution. The objective of this study was to compare the usual fixation of sterile wound dressings with non-sterile elastic bandages and fixation with sterile bandages processed at our centralized sterile services department with regard to PK-CM prevention. We conducted a before-and-after trial in a private tertiary care hospital. The pre-intervention cohort (n = 16) included all patients who had undergone kidney transplant (KT) during the outbreak (June 2010-April 2011), and the post-intervention cohort (n = 49) included all patients who had undergone KT between May 2011 and October 2013. From May 2011, only bandages sterilized by the centralized sterile services department were used to fix wound dressings of KT patients. Differences in age (50.2 years vs 51.3 years), sex (43.8% male vs 59.2% female), weight (63.3 kg vs 69.7 kg), hemodialysis vintage (55.6 months vs 47.8 months), and other risk factors were not observed between the pre- and post-intervention cohorts, respectively. PK-CM incidence dropped from 25% in the pre-intervention cohort (4/16) to 0% in the post-intervention cohort (0/49). Relative risk was 0 (P = .003). With regard to KT patients and sterile wound dressing fixation with non-sterile bandages versus the use of autoclaved bandages, fixation with autoclaved bandages proved to be effective for cutaneous mucormycosis outbreak control and prevention in our institution.

PO 18069 - Management of soft-tissue injuries in lower extremity fractures

Introduction: Patients with lower extremity fractures have a high incidence of peri- and postoperative complications, such as extensive swelling, blisters, surgical wound infection, slow wound healing, persistent wound drainage and suture dehiscence. In calcaneal and tibial plafond fractures and ankle fractures/dislocations, especially in patients older than 50 years and those with diabetes, these complications are associated with a longer hospital stay and increased treatment costs and morbidity and mortality rates. The objective of this study is to perform a literature review of the management of blisters in lower extremity fractures and, based on the findings, to develop a management protocol for these lesions. Methods: Literature review of the state of the art in international databases. Articles published in indexed journals from 1995 to 2014 addressing soft-tissue management in ankle, calcaneal and tibial plafond fractures were selected. Results: Various treatment methods have been described in the literature: observation without intervention, application of sterile dressing, content aspiration, removal of the blister roof and application of an antibiotic ointment or topical treatment alone; all have similar outcomes regarding the delay in definitive surgery and the incidence of mild and severe soft-tissue complications. No large studies comparing these treatment alternatives are available. Conclusion: There is no consensus in the literature on the proper management of blisters. Further studies should be performed to define a protocol for the management of these lesions.

CD93 hematopoietic stem cells improve diabetic wound healing by VEGF activation and downregulation of DAPK-1.

Diabetes is associated with numerous complications, such as diabetic skin wounds or ulcerations. The aim of this study was to evaluate experimentally the effectiveness of applying polycaprolactone (PCL)-gelatin scaffold, with or without rat CD93 hematopoietic stem cells (HSCs), in diabetic wound healing in a rat model. CD93 HSCs were aseptically isolated from rat bone marrow using fluorescent activated cell sorting (FACS) method and FACS-SORTER. A total of 25 Wistar rats were divided into five groups including Group I (sham, nondiabetic, and wound covered only with sterile dressing), II (control, diabetic rat), III (CD93 HSCs alone), IV (PCL-gelatin scaffold), and V (CD93 HSCs+PCL-gelatin scaffold). Animals were killed on Days 7, 14, or 28 posttreatment and histological sections were blindly evaluated by two expert pathologists. Death-associated protein kinase 1 (DAPK-1) gene and vesicular endothelial growth factors (VEGF) protein expression were evaluated using reverse transcription-polymerase chain reaction and western blot, respectively. The thickest and the thinnest epidermises microscopically were belonged to CD93+HSCs+scaffold and the control group, respectively. The growth rate of the epidermis and adnexal epithelia was the highest in both the cell and cell+scaffold groups. Evaluation of the protein expression level of VEGF indicated that the expression levels of this growth factor were the most on Day 7 posttreatment in sham, HSCs alone, and HSCs cell+scaffold groups. While the lowest expression levels of this growth factor was detected in the control and scaffold groups. The gene expression level of DAPK-1 on Day 7 posttreatment was higher than that of the Day 14 posttreatment in all groups. The highest and lowest gene expression levels of DAPK-1 belonged to control and sham groups, respectively. According to our findings, CD93 HSCs offer new prospects for the treatment of diabetic ulcers and concomitant application of these cells with PCL-gelatin nanofiber scaffold significantly improves diabetic wound treatment.

Impact of negative-pressure wound therapy on bacterial behaviour and bioburden in a contaminated full-thickness wound.

The use of negative-pressure wound therapy (NPWT) has displayed significant clinical benefits in the healing of infected wounds. However, the effects of NPWT on bacterial colonisation and infection of traumatic wounds has been controversial. The aim of this study is to evaluate the impact of NPWT treatment in rabbits with a contaminated full-thickness wound on bacterial behaviour, including colony morphology, spatial distribution, fissional proliferation, and bacterial bioburden. Full-thickness wounds were created on the back of rabbits, and were inoculated with bioluminescent Staphylococcus aureus. The wounds were treated with sterile gauze dressings and NPWT with continuous negative pressure (-125 mm Hg). Wound samples were harvested on days 0 (6 hours after bacterial inoculation), 2, 4, 6, and 8 at the centre of wound beds before irrigation. Scanning electron microscopy and transmission electron microscopy (TEM) analyses were performed to determine the characteristic bacteriology. Laser scanning confocal microscopy was performed to obtain bioluminescent images, which were used to observe spatial distribution of the GFP-labelled S. aureus within the tissue and quantify the bacterial bioburden. NPWT resulted in sparse amounts of scattered bacteria on the wound surface or as sparsely spaced single colonies within the tissue. Wound bioburden on day 8 in the NPWT and gauze groups was 34.6 ± 5.5% and 141.9 ± 15.4% of the baseline values (N = 6), respectively (P < .0001). TEM showed a lack of S. aureus active fission within NPWT-treated tissue. NPWT can impact S. aureus colony morphology and spatial distribution both on the surface and within wound tissue, and reduce S. aureus as early as 48 hours after therapy initiation. Additionally, NPWT inhibits bacterial fissional proliferation in microcolonies.

Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag®?

IntroductionAnkle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra®) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. MethodsWe prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra® from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months’ follow-up. ResultsThe statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. ConclusionsThe theoretical advantages of silver impregnated dressings need further prospective randomised controlled studies to assess the appropriate indications for their use in orthopaedic surgery.

Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection

Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated. A total of 137 patients' PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified. Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture. The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.

¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag®?

IntroductionAnkle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra®) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. MethodsWe prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra® from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months’ follow-up. ResultsThe statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. ConclusionsThe theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery.

Effect of rhythmic breathing on pain of dressing change in burn patients

Objective To study the effect of rhythmic breathing on pain in burn patients. Methods A total of 100 patients with burns in Tangshan Workers Hospital were randomly selected from August 2015 to August 2017. They were randomly divided into control group and experimental group by random number table method, with 50 cases in each group. Baseline variables were recorded for each patient, and pain scores for each patient was scored on the fourth day after admission by the pain scale questionnaire score. At the same time, from the fourth day of admission, each group began to give sterile dressings to treat burns. The control group only used a conventional care mode that included dressing coverage therapy. The experimental group added rhythmic breathing on this basis. The pain scores were scored on the 5th day, the 6th day, and the 7th day after admission. The pain scores of the 3 days in each group were compared, and the difference in pain scores between the 2 groups was compared. Results In the experimental group, the pain scores on the 5th day, the 6th day and the 7th day of admission were (1.53±1.90), (1.68±1.37), and (1.97±1.18) points, respectively, and the control group was (3.64±0.85). (3.74±0.78), (3.85±0.81) points, there were significant differences in pain scores between the two groups (U=5.76, 8.65, 7.79, P 0.05). There was statistically significant difference in pain scores between the control group on day 5, day 6, and day 7 (χ2=6.83, P<0.01). Conclusions Rhythmic breathing relieves pain after burns. Key words: Pain; Burns; Dressings; Rhythmic breathing

Computed Tomography-Guided Wire-Marking for Thoracoscopic Resection of Small Lung Nodules in Children.

Introduction: In pediatric patients, thoracoscopic wedge-resection of pulmonary nodules is an established therapy. However, intraoperative localization of small lesions is still challenging. Purpose of this study was to evaluate the efficacy of preoperative computed tomography (CT)-guided wire-marking of small lung nodules. Materials and Methods: Between 2012 and 2017 a total of six cases receiving thoracoscopic resection of CT-marked lung nodules were analyzed. The nodules were preoperatively tagged by a wire, which was attached to the thoracic wall by sterile dressing. Characteristics of interest were stability of wire, complete resection, and prevention of open thoracotomy. Results: Six procedures were performed on five patients, including four men and one woman. Median age at intervention was 16 years (range 11-19 years). All patients had a history of primary malignancies, including osteosarcoma (n = 4) and synovial sarcoma (n = 1). A total of 10 nodules were visualized in CT of which 9 were marked by wire. The median expected size of nodules was 6 mm (range 2-23 mm). Two patients had bilateral, two left-sided and two right-sided lung lesions. There was no wire slippage. In five procedures wedge resection was possible; one case needed a near total lobe resection. In one case a mini-thoracotomy at port insertion site was performed to extract the specimen. There was no conversion to thoracotomy. Histopathology showed R0 resection in all patients. Malignancy was found in all specimens. In one patient postoperative hemorrhagic anemia necessitated transfusion. Conclusions: Preoperative wire-localization of small lung nodules is a safe and effective tool to enable thoracoscopic resection in children and to avoid thoracotomic interventions.

421 Stage One Touch Burn Treatment for Pediatric Patients with DACC (Dialkylcarbamoyl Chloride)

Single-stage one touch burn treatment for pediatric patients is a significant improvement over traditional treatments for young burn patients. Local wound and burn care in pediatric patients is problematic secondary to the amount of pain patients’ experience. Most burns that occur in the pediatric population are scald burns and second-degree burns which require local treatment including daily wound care. A 2% total body surface area burn increases the amount of pain a pediatric patient undergoes due to daily wound care and debridement. Further complicating daily wound care for pediatric burn patients is that often prescribed pain medication is poorly tolerated and suboptimal for daily debridement. Therefore, noting these issues treatment protocols had to be adjusted and changed in order to improve outcomes. Patients with burn injuries are usually seen in the emergency room or by a PCP in the first 24 hours for stabilization. The patient is then brought to the operating room within 72 hours sedated, debrided, and a complete dressing change is performed. Initially silver wound dressings were used in this population. A sterile moist silver dressing is applied covered with Kerlix and a cohesive dressing and changed weekly. Of concern with the pediatric patients is transcutaneous absorption of silver for large total body surface areas. Treatment of these patients has now progressed to use of DACC coated dressings. DACC is a hydrophobic fatty acid derivative that irreversible binds with bacteria rendering then inert. Since DACC is not a chemical agent it avoids the risk of systemic absorption and is safe for use in this population. DACC is applied with the use of a hydrogel and then wrapped in a similar manner and changed weekly. 98% of patients had full closure of second-degree burns after one week. Burn areas of the fingers, chest, legs, and trunk were easily treated with this method. Facial burns proved to be slightly more problematic and required different more appropriate covering dressings. This method of using the DACC coated dressing is cost-effective, safe for patients, and reduces the amount of pain medication required. Patient and family compliance was much higher and outcomes were much improved. This method has decreased the need for silver in burn wounds and alleviated concerns of transcutaneous absorption and toxicity. The introduction of DACC resulted in greater cost savings, anesthetic cosmetic results, and improved safety profile. The one touch technique in pediatric patients with sedation or anesthesia eliminates pain and recurrent dressing changes. It is well tolerated in the pediatric population and compliance is easily attained, with excellent outcomes.

Foot Care Practices among Type 2 Diabetics Mellitus Patients Attending Diabetes Clinics in Embu County, Kenya

Diabetes mellitus has become a global epidemic of 21st century with dispro- portionately high socioeconomic burden in the developing world. Foot ulcerations secondary to peripheral neuropathy and peripheral vascular disease have led to devastating health outcomes including amputations. A descriptive survey targeting a sample size of 301 was drawn from the selected health facility. Majority of the respondents were female and aged between 40 and 70 years old. The duration that a patient had lived with diabetes, history of smoking and respondents age was significantly associated with foot ulcers at P-value < 0.05. Walking bare foot in and out of the house, breaking into new shoes, poor inspection of feet were associated with the development of foot ulcers while dressing of blisters with sterile dressings was associated with the prevention of foot ulcers.

A Comparative Evaluation of the Effectiveness of Chitosan-Based Dressing and Conventional Method of Hemostasis in Patients on Oral Antithrombotic Therapy without Therapy Interruption.

Aims and Objectives:To assess the effectiveness of chitosan-based dressing after extraction in individuals on antithrombotics, without modification of their treatment schedule.Materials and Methods:A randomized comparative study was carried out on 40 subjects who had two extraction sites, in dissimilar quadrants. The surgical site was chosen at random and post-extraction hemostasis was achieved by a custom-cut chitosan dressing (study site) and sterile cotton gauze dressing (suturing if required) at control site. Patients were reviewed on the first, third, fifth, and seventh postoperative days and every week till 4 weeks. The parameters assessed were timing of hemostasis, pain scores, and pus discharge.Results:Out of 40 study subjects, 24 (60%) were males and 16 (40%) were females. The age was 40–65 years (mean age 54 years). The mean time for hemostasis was 0.63 ± 0.27 min in study group, whereas for controls, it was 9.10 ± 2.28 min. The difference in postoperative pain was significant (P = 0.001) on days one, five, and seven. In chitosan group extraction sites, dry socket was not seen, whereas four patients on day three and five patients on day five after extraction experienced dry socket in pressure gauze dressings group, with an insignificant difference (P = 0.058). In chitosan group extraction sites, no pus discharge was seen. Whereas four patients on days three and five after extraction had pus discharge in patients where pressure dressings were applied, with an insignificant difference (P = 0.058).Conclusion:Chitosan dressing is a competent hemostatic agent that significantly reduced the post-extraction bleeding, with better pain control. Chitosan group had no incidences of dry socket and pus discharge.

Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy.

Ventral hernia repair with concurrent panniculectomy (VHR-PAN) is associated with high wound complication rates despite reported increased patient satisfaction. Some surgeons believe negative-pressure therapy after primary closure of the surgical incision (ciNPT) may lower wound complications in high-risk abdominal wounds. This study aims to evaluate if ciNPT improves outcomes in patients undergoing VHR-PAN. An 8-year retrospective cohort study was performed on patients who underwent VHR-PAN. Patients were divided into two groups: those who received closed-incision negative-pressure therapy ("ciNPT") and those who received standard sterile dressings ("SSD"). The primary outcome of interest was the rate of postoperative complications between these groups. Complications were subdivided into surgical site occurrences (which included surgical site occurrences that required an intervention), return to the operating room, and hernia recurrence. A total of 104 patients were analyzed: 62 in the ciNPT group and 42 in the SSD group. Median follow-up duration was similar between both groups (182 days vs 195 days, p = 0.624). Patients in the ciNPT group had fewer total complications (57% vs. 83%, p = 0.004) and fewer SSO (47% vs. 69%, p = 0.025). However, no differences were noted when comparing individual complications (SSI, wound dehiscence, skin necrosis, chronic wound, seroma, and hematoma). There was no difference in return to the operating room (27% vs. 26%, p = 0.890) or hernia recurrence (21% vs 19%, p = 0.811). Multivariate analysis showed that ciNPT decreased the risk of SSOPI nearly fourfold (odds ratio 0.28, 95% CI = 0.09-0.87, p = 0.027). This study showed that closed-incision negative-pressure therapy in ventral hernia repair with concurrent panniculectomy may decrease the rate of wound complications in this high-risk population.

Incisional wound VAC and risk-adjusted SSI rates in colorectal surgery: A tertiary centre experience

BackgroundIn colorectal surgery, indications for incisional negative pressure wound therapy (iVAC) remain unclear. We sought to compare rates of surgical site infection (SSI) in patients who received iVAC or standard sterile dressing (SSD). MethodsInstitutional colorectal NSQIP data between 2014 and 2018 was reviewed. SSI rates were compared between iVAC and SSD cohorts using the NSQIP surgical risk calculator (NSQIP SRC) for risk-adjusted analysis. Secondary outcomes included other wound complications, morbidity, mortality, disposition destination and overall length of stay. Results145 patients received iVAC while 544 received SSD. SSI was greater in iVAC than SSD (17% vs 9%, p = 0.009). iVAC was independently associated with SSI (OR 2.3, 95% CI 1.3–3.9). The presence of a colostomy strengthened this relationship. There was no difference in secondary outcomes. ConclusioniVAC was independently associated with SSI with risk-adjusted analysis. This relationship was stronger in patients with a colostomy.

Lateral femoral bypass for prosthetic arterial graft infections in the groin

ObjectiveProsthetic arterial graft infections (PAGIs) in the groin pose significant challenges in terms of revascularization options and risk of limb loss as well as associated morbidities. Although obturator canal bypass (OCB) has been suggested for revascularization of the extremity in these cases, moderate success rates and technical challenges have limited widespread use. Our study analyzed lateral femoral bypass (LFB) as an alternative approach for the treatment of groin PAGIs. MethodsThis is a retrospective review of a prospectively maintained database of patients who underwent LFB for groin PAGIs at a single center from 2000 to 2017. Patients' data including demographics, comorbidities, perioperative complications, graft patency, and need for reintervention were used. Patients were observed after LFB with duplex ultrasound surveillance in an accredited noninvasive vascular laboratory every 3 months during the first year, followed by every 6 months for the second year and yearly thereafter. After isolation of the infected wound with sterile dressings, remote proximal and distal arterial exposure incisions were made. LFBs were tunneled under the inguinal ligament and lateral to the infected wound from an uninvolved inflow artery or bypass graft to an uninvolved outflow vessel. ResultsA total of 19 LFBs were performed in 16 patients (mean age, 69 ± 12.6 years). Three LFBs were performed urgently for acute bleeding. Choice of conduit included 6 (31.6%) autogenous vein grafts, 10 (52.6%) cadaveric grafts, 2 (10.5%) rifampin-soaked Dacron grafts, and 1 (5.3%) polytetrafluoroethylene graft. Average follow-up was 33 months (range, 0-103 months). Major adverse events occurring within 30 days of the operation included one (5.3%) death and one (5.3%) graft excision for pseudoaneurysm. Primary patency and primary assisted patency at 12 and 24 months were 73% and 83%, respectively. One patient required an amputation 17 months after surgery after failure of repeated revascularization attempts. Overall limb salvage was 93.8% during this follow-up period. ConclusionsIn this series, LFB for management of groin PAGIs demonstrated higher patency and limb salvage rates compared with previous reports of OCB. Diligent postoperative duplex ultrasound surveillance is critical to the achievement of limb salvage and maintenance of graft patency. These results suggest that LFB, which is technically less complex than OCB, should be considered the first choice for revascularization in select cases of PAGIs involving the groin.

Nursing wound care practices in Haiti: facilitators and barriers to quality care

To describe the facilitators and barriers for nurses to perform quality wound care in three surgical wards of a hospital in Port-au-Prince, Haiti. Up to a quarter of patients in low- and middle-income countries may acquire at least one infection while hospitalized. There is a paucity of research investigating nursing wound care practices in low- and middle-income countries regarding the prevention of hospital-acquired infections. The design was qualitative descriptive. We observed nursing staff on the general surgery, orthopaedics and maternity units while they performed routine dressing changes (n=15). We interviewed nursing (n=13) and medical residents (n=3) and inquired about their perceptions of facilitators and barriers for nurses to perform quality wound care. A number of wound care practices appeared well integrated including using gloves to remove dressings, applying sterile dressings, properly disposing of soiled materials, inspecting wounds for signs of infection and employing comfort and privacy measures. Areas that may need improvement included aseptic technique, hand hygiene, pain assessments, patient education and documentation. We identified four themes related to barriers and facilitators to perform quality wound care: (i) materials and resources; (ii) nurse-to-patient ratios, workload and support; (iii) roles and responsibilities of nurses; and (iv) knowledge and training of nurses. Nursing wound care practices may be optimized by improving nurses' professional status and working conditions. Greater financial investment in health care and (continuing) education, self-regulation and development of the nursing role, including more autonomy, are needed to elevate the professional status of nurses in Haiti. Institutional policies should promote best practices, clarify nursing roles and responsibilities and foster interdisciplinary collaboration in patientcare.

Negative-Pressure Wound Therapy in a Pseudomonas aeruginosa Infection Model.

Background Negative-pressure wound therapy (NPWT) is an effective strategy for the management of contaminated wounds, including those infected by Pseudomonas aeruginosa. We hypothesized that NPWT would reduce virulence factors as well as biofilm components and inhibit virulence-regulated gene expression in a model of P. aeruginosa wound infection. Methods Wounds were created in anesthetized rabbits and P. aeruginosa was inoculated to the wound surface for 24 h. Wounds were treated with either NPWT or a sterile gauze dressing. Virulence factors including exotoxin A, rhamnolipid, and elastase were quantified by the enzyme-linked immunosorbent assay, orcinol, and elastin-Congo red methods, respectively. A biofilm component, eDNA, was quantified using a commercial kit. Virulence-regulated genes were determined by quantitative real-time polymerase chain reaction (RT-PCR). Biofilms were observed in vivo by staining with concanavalin A conjugated to Alexa Fluor® 647. Results NPWT was more effective than the control treatment in reducing virulence factors and bacteria counts in vivo. A biofilm component, eDNA, was less abundant in the NPWT group. The results of the RT-PCR indicated that the expression levels of P. aeruginosa virulence-regulated genes and quorum-sensing population density-dependent systems were significantly inhibited by NPWT treatment. Conclusion NPWT reduced bacteria counts, virulence factors, and eDNA in a P. aeruginosa wound infection model in vivo. These beneficial effects are likely to be related to the reduced expression of virulence-regulated genes and the drainage induced by NPWT treatment. These findings may help clinicians to obtain a better understanding of the mechanism of NPWT for the treatment of infected wounds.