Use Of Negative Pressure Research Articles

879 The Review of Autologous Fat Grafting Utilizing Negative Pressure for Breast Augmentation

Abstract Aim There may be a role for topical negative pressure in autologous fat grafting to breasts since it enhances angiogenesis during wound healing for open and closed wound. Here, we present a review of the literature on this topic. Method Medline and Embase were utilised, with searches ranging between 1960 – 2019. Terms (“Liposculpting” OR “Fat grafting” OR “Lipofilling” OR “Lipograft” OR “Fat transfer”) AND (“Negative Pressure” OR “Brava” OR “Kiwi”) AND (“Breast”) were merged as keywords. Inclusion criteria were females, autologous fat graft to breast with negative pressure prior to procedure. Studies were excluded if there was no primary endpoint or non-original article. Primary outcome measured was fat graft survival post breast augmentation with post-operative morbidity as a secondary outcome. Results Upon reviewing 219 articles, 2 met inclusion criteria. A total of 611 breasts were treated using negative pressure devices, with each cohort having different pre- and post-operative pressure settings. Khouri et al. cohort had higher graft survival (79%) compared to Del Vecchio et al. cohort (64%), however the latter had fewer complications compared to Khouri’s cohort e.g. fat necrosis, pneumothorax and infection. Conclusions There is still limited evidence regarding the use of topical negative pressure for fat grafting to the breasts. Autologus fat grafting to breasts without the use of negative pressure is shown to have graft survival of 60-70%. Given its potential benefits, more future studies are needed to fully understand the impact of this technique.

Design and climbing control of an underwater robot for ship hull cleaning

Underwater robot has significant potential to clean the fouling on the ship hull. The design of robotic solution as well as control scheme is, however, still challenging. The use of negative pressure and magnetic adsorption technologies in cleaning robots will severely limit their utility in rough hulls and warships. Here we propose an underwater cleaning robot that driven by six thrusters and two crawler belts. The key advantage of our robot is that thrusters can provide enough and reliable adhesive forces to adapt to more common hulls. Furthermore, we present a climbing controller to track the planned coverage path that can guide the robot covering the ship hull without repetition and omission. The difficulties lie in two aspects: inconsistency between two crawler belts and inaccurate depth measurement that caused by changing wave near the water surface. Here we use velocities of crawler belts and pitch angle of the robot to replace the inaccurate depth measurement, and then design a consensus-based sliding mode controller to relieve the inherent inconsistency for tracking the coverage path accurately. Finally, field experimental results on giant ship verify the effectiveness of the presented robotic solution and controller.

A Comparison of Negative Pressure and Conventional Therapy in Spine Infections: A Single-Center Retrospective Study

Purpose: To investigate the effectiveness and safety of negative-pressure wound therapy (NPWT) in treating primary spinal infections. Methods: Patients who underwent surgical treatment for primary spinal infection between January 2018 and June 2021 were retrospectively evaluated. They were divided into two groups based on the type of surgery: one that underwent negative-pressure wound therapy (NPWT) and another that underwent conventional surgery (CVSG-Posterior debridement, bone grafting, fusion, and internal fixation in one stage). The two groups were compared in terms of the total operation time, total blood loss, total postoperative drainage, postoperative pain score, time for the postoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to return to normal, postoperative complications, treatment time, and recurrence rate. Results: A total of 43 cases of spinal infection were evaluated, with 19 in the NPWT group and 24 in the CVSG group. The NPWT group had a superior postoperative drainage volume, antibiotic use time, erythrocyte sedimentation rate and CRP recovery times, VAS score at 3 months after the operation, and cure rate at 3 months after operation compared with the CVSG group. There were no significant variations in the total hospital stay and intraoperative blood loss between the two groups. Conclusions: This study supports the use of negative pressure in the treatment of a primary spinal infection and indicates that it has a notably better short-term clinical effect than conventional surgery. Additionally, its mid-term cure rate and recurrence rate are more desirable than those of conventional treatments.

Comparative study in patients treated by negative pressure wound therapy versus conventional wound treatment for abdominal wounds

Background: The use of negative pressure to enhance wound healing is a well-known notion. If excess fluid is not effectively evacuated from a wound during surgery, its constituents may act as both physical and chemical impediments to wound healing. Furthermore, mechanical stresses can alter tissue form and growth. A buried drain tube has little mechanical impact on the surrounding tissue. Aims and Objectives: The aim of the study was to compare the effectiveness of negative pressure wound therapy (NPWT) versus conventional wound treatment (CWT) in abdominal wounds after surgery in clinical practice. Materials and Methods: The present and prospective study was conducted among 60 patients taking treatment for abdominal wounds after surgery at General surgery Department at BJ Medical College, Ahmedabad, Gujarat, India, during June 2022–May 2023. The cases divided in two groups: Group A: Patients treated with NPWT (n = 30), Group B: Patients treated with CWT (n = 30). Results: Cases treated by NPWT had faster reduction of surface area, higher rate of granulation achieved in lesser time and had better outcome with wound closure by delayed primary suturing. Conclusion: NPWT is the safe and effective compare to CWT in term of duration of wound closure, faster reduction in surface area, and faster proliferation of granulation tissue.

Upotreba negativnog pritiska u terapiji rana

The use of negative pressure in wound therapy is an innovative therapeutic method that accelerates the wound healing process. This technique is applied to various types of acute and chronic wounds and can shorten their healing time and improve the quality of the scars. Negative pressure therapy acts on the wound by improving blood circulation, reducing swelling, promoting the growth of granulation tissue, reducing the risk of infection, and improving the quality of scar formation. At the molecular level, negative pressure increases the expression of cytokines and growth factors that promote angiogenesis, extracellular matrix remodeling, and tissue regeneration. Negative pressure therapy, as one of the techniques for temporary abdominal closing, is used in situations where the abdominal cavity must remain open for some time, in complex injuries, infections, and where there is a risk of compartment syndrome. In recent years, endoscopic vacuum therapy, a minimally invasive modality of treatment in colorectal surgery and surgery of the upper gastrointestinal tract, has emerged. The possibilities of this therapy have not been completely exhausted. In addition to its multiple applications, it has been shown that negative pressure therapy reduces treatment costs, shortens the duration of hospital stay, and enables faster patient recovery.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

Use of negative pressure in the treatment of anaerobic non-clostridial perineal infection

The article presents a clinical case of a successful complex treatment anaerobic non-clostridial perineal infection in a 54-year-old patient with long-term diabetes mellitus. Particular attention is paid to the possibilities of local treatment using negative pressure wound therapy in the management of this patients category.

The use of the negative pressure wound therapy in management of the perineal wounds after abdominal-perineal extirpation (literature review)

The review presents data from the analysis of the literature on various options of using negative pressure wound therapy after abdominal-perineal extirpation of the rectum. We have selected 10 scientific papers for analysis, and no randomized trials have been found in the literature. The use of local negative pressure led to an acceleration of tissue repair and a decrease in complications in the perineal wound area. However, at the moment, the data presented in the literature are insufficient for an objective assessment of the effectiveness of the technique. It is necessary to conduct randomized trials to objectively evaluate the methodology.

Ultrasonic cavitation in the treatment of neuro-ischemic diabetic foot the presence of biofilm forms of bacteria (literature review)

The constant increase in the number of patients with diabetes mellitus, among whom the incidence of long-term non-healing wounds is many times higher than in the general population, requires constant analysis of treatment protocols and their correction, if necessary. The peculiarities of the wound healing process in the presence of diabetes mellitus include phase perversion and reduced reparative potential. Another problem is the infectious process taking place against the background of diabetes mellitus. Its features include a tendency towards chronicity, frequent persistence of resistant and multiresistive forms of bacteria, and the formation of biofilms. All these factors are pushing to search for new approaches to treatment, and one of the dynamically developing areas is additional treatment of wounds with various types of physical energies. On the one hand, the use of negative pressure, ultrasound, plasma flows, a pulsating jet of liquid, etc. of the wound healing process has been studied for several decades. At the same time, there are still many unanswered problems. One of them is the effectiveness of ultrasonic cavitation in the treatment of purulent-necrotic complications of the neuro-ischemic diabetic foot in the presence of biofilm forms of bacteria in the wound.

The Use of Negative Pressure in Medicine

Pressure is considered negative if it is below the standard atmospheric pressure, i.e. one atmosphere (1 atm). Negative pressure could occur naturally in few occasions such as out space, but it also could be deliberately inducted for the use of human. One of these uses is for medical purposes. The history of negative pressure use in health and disease management draws back to the establishment of the Chinese traditional medicine and continued to develop till the contemporary medical advances. In this review, the author aimed to elaborate the history and advancement in the usage of negative pressure in health aspects and classify the different modalities of negative pressure incorporated in treatment management and clinical trials.

Split Skin Graft Take in Leg Ulcers: Conventional Dressing Versus Locally Adapted Negative Pressure Dressing

BackgroundSplit-thickness skin grafting is widely used in the management of leg ulcers but is fraught with suboptimal take especially in less than ideal wound beds. The use of negative pressure dressing to prepare wound beds is an established practice. However, its use to improve graft survival is yet to be a common practice. We aim to compare quantitative and qualitative split thickness skin graft take in leg and foot ulcers using either traditional wound dressing or negative pressure dressing methods. MethodsSixty-two cases were recruited for the study and assigned into two groups of 31 cases each by convenient sampling method. Group A patients had negative pressure dressings in both phases, whereas group B patients had traditional wound dressing in both phases. The percentage skin graft take for both groups, and the pattern of complications were assessed. Results were analyzed using IBM SPSS statistics for windows (version 21.0; IBM Corp, Armonk, NY). Student t-test was used to compare the percentage graft take, whereas Chi-square was used to compare significance of complications in both dressing methods. ResultsThe negative pressure dressing showed better skin graft take with mean value of 99.2 ± 0.95% compared with traditional dressing with mean take of 89.7 ± 6.44%, which was statistically significant with a P value of <0.001. The complication rate was 12.9% in the negative pressure dressing group and 96.8% in the traditional wound dressing group, showing about 7.5 times more complication in the traditional wound dressing. This is statistically significant with a P value < 0.001. ConclusionsNegative pressure dressing for split-thickness skin graft contributes significantly to improved split-thickness skin graft take with reduced complication rate as compared with conventional wound dressing method.

Is negative-pressure wound therapy beneficial in modern-day breast surgery?

Negative-pressure wound therapy (NPWT) is used to treat many different types of wounds, but there is still a lack of large studies describing its effectiveness in breast surgery. Enhanced recovery, reduction of complications, and good scar quality might be improved by the application of NPWT. Existing data show that vacuumassisted closure (VAC) application after expander-based breast reconstruction may be beneficial because of decreasing overall complications in comparison with standard wound treatment. There are few cases in which the use of negative pressure resulted in healing of complicated breast wounds after implant insertion – most breasts achieved healing, wherein duration of NPWT ranged from seven to 21 days. The use of NPWT leads to a decrease of seroma formation (from 70% to 15%), the mean percutaneous aspirated volume (from 193 ml to 26 ml) and the numbers of percutaneous aspirations (from three to one) in latissimus dorsi flap reconstruction. Furthermore, a prospective, within-patient, randomised study with 200 participants showed that treating closed incisional wounds after reduction mammoplasty with a VAC system resulted in a decrease of overall complications and protected against wound dehiscence. In the literature, there are cases showing that NPWT may be useful for the successful treatment of chronic and non-healing wounds, included non-puerperal mastitis and surgical sites affected by radiation therapy due to breast cancer. There is still a need for evidence confirming the effectiveness of NPWT in breast surgery because of the deficiency of large prospective studies that compare NPWT with standard treatment.

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

Vacuum assisted closure: Review on current application for post-operative wound management in orthopaedics

Background: Post operative wound dehiscence is a significant health problem. In imposes social and financial burdens. If the injury involves the exposure of bone, early coverage of the defect must be a goal of treatment to prevent secondary problems such as an osteogenic infection. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimise conditions for wound healing and requires fewer painful dressing changes. It is a wound management system that exposes a wound bed to local negative pressure to promote healing. This article reviews the use of VAC therapy in a post operative of wound. Material and method: A prospective study conducted in department of orthopaedic surgery, Grant medical college and sir JJ Group of hospital, Mumbai from 2016-2017. A total of 25 subjects were consecutively recruited. Patients included in study are classified according to the grade of the ulcer. Patients age group 21-70 years with the following risk factors and comorbidities diabetes mellitus, hypertension, chronic obstructive pulmonary disease, dyslipidaemia, and smoking. Post operative wound dehiscence of proximal tibia, distal tibia and olecranon selected. Pre and post VAC culture collected. Patients were evaluated post VAC after definitive management for functional outcome. Result: Our study of confirms that vacuum assisted closure is an excellent treatment modality for post operative wound dehiscence. Patients had an average of 8 treatment sessions. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24 days. Amongst this maximum patients being in the age group of 30-70 years. VAC dressing found to produce more secondary closure of wound and split skin graft, also reduced more invasive procedures like flap surgery and in worst case amputation. Also it found reduces bacterial count of the wound. Conclusion: Promotes early rehabilitation, and alleviates the need for a second procedure. Significant reduction in hospital stay subsequent lower in hospital cost, decreased amputations, increasing the number of patients undergoing skin grafting and improving culture sterility.

The Use of Negative Pressure Wave Treatment in Athlete Recovery

Lower body negative pressure (LBNP) treatment was developed for astronauts in order to maintain the arterial blood supply of the lower body and compensate for weightlessness. In clinical applications the use of negative pressure has proven substantial in treatment of general soft-tissue injuries, open fractures, and management of diabetic and pressure ulcers. In competitive sport, regeneration and recovery of athletes play a vital role to maximise their performance. PURPOSE: Validation of the LBNP device by assessing if intermittent negative pressure therapy applied to the lower body of athletes has a systemic effect resulting in faster recovery time. METHODS: A random designed cross-over study with repeated measures was performed. Healthy male cricket players (n=22), aged 18-22 years continued to follow their weekly regular physical training program (7 hours conditioning and 10 hours cricket specific skills, with one competitive match on weekends), for the duration of the study. Additionally they were subjected to an intense and structured 1 hour exercise training program and power gym session on the day treatment started. Players were exposed to one 30 minute LBNP treatment session for three consecutive days (i.e. at 0, 24 and 48 hours). Heart rate, blood pressure, blood serum lactate and -creatine kinase (CK) were measured. RESULTS: During treatment sessions the heart rate and blood pressure decreased drastically but reverted back to baseline levels within an hour. Using the repeated measures ANOVA test, the lactate concentration did not show an individual (p=0.41) nor a period effect (p=0.11). In the group effect the lactate decreased significantly (p=0.008) after termination of exercise. The ratio of the period directly after training vs. the period directly after treatment was analysed. The LBNP device resulted in lowering lactate measurements significantly (control group 0.868; treatment group 0.575). ANOVA analysis of CK did not indicate a significant decrease after 3 treatment sessions. The CK concentration ratio after the third therapy session vs. after the first therapy session did not significantly decrease. CONCLUSION: LBNP therapy seems to have a systemic effect in lowering serum lactate levels, but not CK levels. Enhanced regeneration and recovery of athletes are still unconfirmed.

Negative pressure wound therapy in grade IIIB tibial fractures: fewer infections and fewer flap procedures?

Grade IIIB open tibia fractures are devastating injuries. Some clinicians advocate wound closure or stable muscle flap coverage within 72 hours to limit complications such as infection. Negative pressure wound therapy was approved by the FDA in 1997 and has become an adjunct for many surgeons in treating these fractures. Opinions vary regarding the extent to which negative pressure wound therapy contributes to limb salvage. Evidence-based practice guidelines are limited for use of negative pressure wound therapy in Grade IIIB tibia fractures. This systematic literature review of negative pressure wound therapy in Grade IIIB tibia fractures may substantiate current use and guide future studies. We sought to answer the following: (1) Does the use of negative pressure would therapy compared with gauze dressings lead to fewer infections? (2) Does it allow flap procedures to be performed safely beyond 72 hours without increased infection rates? (3) Is it associated with fewer local or free flap procedures? We conducted a systematic review of six large databases (through September 1, 2013) for studies reporting use of negative pressure wound therapy in Grade IIIB open tibia fractures, including information regarding infection rates and soft tissue reconstruction. The systematic review identified one randomized controlled trial and 12 retrospective studies: four studies compared infection rates between negative pressure wound therapy and gauze dressings, 10 addressed infection rates with extended use, and six reported on flap coverage rates in relation to negative pressure wound therapy use beyond 72 hours. None of the 13 studies was eliminated owing to lack of study quality. Negative pressure wound therapy showed a decrease in infection rates over rates for gauze dressings in two of four studies (5.4% [two of 35] versus 28% [seven of 25], and 8.4% [14 of 166] versus 20.6% [13 of 63]), an equivalent infection rate in one study (15% [eight of 53] versus 14% [five of 16]), and an increased infection rate in the fourth study (29.5% [23 of 78] versus 8% [two of 25]). In terms of the second question regarding infection rates with negative pressure wound therapy beyond 72 hours, eight of 10 studies concluded there was no increase in infection rates, whereas two of 10 reported an increase in infection rates associated with negative pressure wound therapy use beyond 72 hours. Infection rates varied from 0% to 57% in these 10 studies. Five studies reported low infection rates of 0% to 7% and five reported rates of 27% to 57%. The third question (addressed by six studies) regarded the potential decreased use of a soft tissue flap in patients treated with extended negative pressure wound therapy. Flap rates were reduced by 13% to 60% respectively compared with those of historical controls. Grade IIIB tibia fractures by definition required soft tissue procedures. The patients in these six studies had Grade IIIB tibia fractures after the first débridement. However, after extended negative pressure wound therapy, fewer patients required flaps than grading at the first débridement would have predicted. There is an increasing body of data supporting negative pressure wound therapy as an adjunctive modality at all stages of treatment for Grade IIIB tibia fractures. There is an association between decreased infection rates with negative pressure wound therapy compared with gauze dressings. There is evidence to support negative pressure wound therapy beyond 72 hours without increased infection rates and to support a reduction in flap rates with negative pressure wound therapy. However, negative pressure wound therapy use for Grade IIIB tibia fractures requires extensive additional study. Level III, therapeutic study.

Numerical simulation of three-dimensional flow field in compact spinning with Hollow Roller

Purpose – Condensing roller is the most key parts of compact spinning system. Hollow Roller is one of the most important kinds of condensing roller, the surface structure of which influences the flow field in condensing zone directly and affects the qualities of spun yarn. The purpose of this paper is to study the effect of Hollow Roller surface structure on flow field in condensing zone is investigated by using Fluent Software. Design/methodology/approach – In this paper, the effect of Hollow Roller surface structure on flow field in condensing zone is investigated by using Fluent Software. The numerical simulations of the three-dimensional flow field in Hollow Roller compact spinning with two different kinds of roller surface structure, round hole structure and strip groove structure, are given according to the three-dimensional physical model of condensing zone. The flow velocity and static pressure distributions in condensing zone are given. Findings – It is shown that the flow velocity streamline distribution is denser with strip groove structure than that of round hole structure, especially on the center line of strand, and flow velocity value is also larger in both Y-Z and X-Y cross-sections, and in X-Z cross-section shows the embracing inlet airflow, which is benefit for fiber condensing directly and improving negative pressure use efficiency. Furthermore, the simulations with three strip groove widths 0.4, 0.8 and 1.2 mm are given. The theatrical results obtained are illustrated by experiments. Originality/value – In this paper, the effect of Hollow Roller surface structure on flow field in condensing zone is investigated by using Fluent Software in detail. A more accurate three-dimensional physical model of condensing zone is given. A new kind of strip groove structure of Hollow Roller is proposed. The theatrical results obtained are illustrated by experiments, and lay a foundation for practical Hollow Roller design.

Optimization of photodynamic therapy using negative pressure.

The goal of this study is to demonstrate an alternative procedure to perform topical photodynamic therapy (PDT). Here, we propose the combined use of negative pressure and a 5-Aminolevulinic acid (5-ALA) cream occlusion to increase protoporphyrin IX (PPIX) formation. PDT using topical 5-ALA as a prodrug and precursor of PPIX has been used in the treatment and diagnosis of different types of cancer and skin diseases. The use of 5-ALA offers many advantages as a localized and non-systemic application, but it shows limitations in relation to skin penetration. Many authors have discussed the limitations of 5-ALA penetration through the skin. The skin penetration of 5-ALA can be optimized using mechanical devices associated with typical PDT procedure. For this study, 20% 5-ALA cream was applied to a 9 cm(2) area of skin, and an occlusive dressing was placed. The PPIX production was collected at the skin surface, using fluorescence spectroscopy and widefield fluorescence imaging, for 7 h, and after 24 h. We observed that in the presence of negative pressure therapy, the PPIX production, distribution, and elimination are greater and faster than in the control group. The PPIX formation was ∼30% in deeper skin layers, quantified by fluorescence spectroscopy analysis, and ∼20% in surface skin layers, quantified by widefield fluorescence imaging analysis. Negative pressure induction can also help PDT application in the case of inefficient PPIX production. These results can be useful for optimizing the PDT.

Tissue Expander‐Assisted Ventral Hernia Repair for the Skin‐Grafted Damage Control Abdomen

In the article under discussion, Carr presents a series of three patients with late reconstruction of skin grafted large ventral hernias [1]. What makes his article exceptional is that he has used tissue expansion before reconstructing the hernias. Tissue expansion is more a tradition of pediatric plastic surgeons and is rarely used in the treatment of abdominal wall defects. In his work, tissue expansion was used in patients with enterostomies that were not published before. He did not encounter any infectious complications in his patients which is significant. Nevertheless, the number of patients is so small that it is not possible to draw very strong conclusions regarding this treatment method. The report can be judged more or less as an extended case study. Moreover, there are a few remarks that I would like to make. In the introduction the author claims that after damagecontrol surgery many patients are now surviving with skingraft-on-bowel ventral hernias. In the past this has been the case, but the number of skin grafted open abdomen patients has become strongly reduced lately. This is so because of the use of negative pressure devices with mesh-mediated traction in the initial phase of open abdomen treatment. With such techniques it is now rare for an open abdomen patient to end up having a skin grafted hernia [2]. Carr also states that: ‘‘operative steps do not include any mention of what to do in the patient who does not have sufficient skin to close the wound after the skin graft is removed.’’ This might be true according to the references used in this article, but for a reconstructive surgeon a large full-thickness abdominal wall defect is a straightforward indication for a flap reconstruction [3]. For fascial closure, Carr has used component separation and acellular dermal matrix (ADM) mesh with the bridging method. According to current experience, a bridged ADM is only a temporary solution for hernia repair. A bulking or recurrent hernia is to be expected in long run [4]. In this series one patient already had a recurrent hernia, and two were good at one year of follow-up and it is to be seen if this might show up after the follow-up period for these two patients. Late correction of a ventral hernia after skin expansion is not a piece of cake. The defect should be closed with a material more durable than ADM in the secondary phase. The risk of a wound complication is evident because the expanded thin skin has to be released in order to replace the ADM with a new mesh. For these reasons my choice would be a flap reconstruction is this kind of case. With a thigh flap one can get a living fascia to replace the missing fascia and skin. Under a flap one can use a mesh for temporary closure to make sure that the hernia will not recur. Tissue expansion is principally an easy operation. Creating a pocket for an expander is not difficult. Nevertheless, tissue expansion is combined with a lot of problems that are faced by surgeons who use it a lot. Placing the expanders, choosing the form and size, and determining filling intervals and the amount of filling, etc. require a lot of experience to be done safely and effectively. There are well known complications with expanders like infection, extrusion, and rupture of the implant, for which the surgeon has to be prepared. In one case reported by Carr, one of the expanders ruptured and was not replaced by another. Because of this, the author could not remove the skin graft completely, leading to an expected wound necrosis and secondary healing. Looking back, he should have completed the expansion as planned by replacing the ruptured implant with another. Carr states that ‘‘what is unique about the experience described in this article is that the tissue expanders were H. Kuokkanen (&) Tampere University Hospital, Tampere, Finland e-mail: hannu.kuokkanen@pshp.fi

Sistema reproducible de presión negativa controlada de bajo costo, para curación de heridas problema

As plastic surgeons we deal frequently with the management of problem wounds. The literature describes as a therapeutic option the use of negative pressure. ...