Vacuum-assisted Closure Device Research Articles

Analysis of Early Surgical Treatment of Incorrectly Consolidated Gunshot Fractures of the Scapula

Objective. The objective of our study was to analyze the structure of incorrectly consolidated gunshot fractures of the scapula and early outcomes of surgical treatment. Material and Methods. We analyzed 10 cases of incorrectly consolidated gunshot fractures of the scapula in Ukrainian Armed Forces servicemen, received as a result of combat operations, and early outcomes of surgical treatment. The main indications for surgical treatment were as follows: severe impairment of function of the upper limb due to pain, fractures of the articular surface of the scapula with displacement of fragments over 2 mm, fractures of the acromion with displacement of more than 8 mm, and damages to muscles and skin. In addition to radiography in standard projections, preoperative examination included computed tomography (CT). Evaluation of functional outcomes was carried out within 1 to 4 months according to the Oxford Shoulder Score (OSS) scale. The average period of postoperative survey was 2.6 months. Results. Incorrect consolidation of fractures was caused by a long period of preoperative preparation and conservative treatment of wounds in patients due to openness and infection of bullet wounds in 2 patients and shrapnel wounds because of mortar, artillery, tank and rocket attacks in 8 patients. Staged treatment until wound healing was carried out in hospitals and military hospitals of Ukraine using VAC (Vacuum-Assisted Closure) devices. Four cases were right-sided and six were left-sided; 7 of 10 cases were intra-articular fractures with displacement of fragments of the articular surface by 2 mm or more. The average duration of injury at the time of surgery was 4.2 months (range from 2 to 8 months). In addition to eliminating displacements and deformities of incorrectly consolidated fractures and osteosynthesis of fragments, the treatment included replacing the soft tissue defect of the shoulder and shoulder girdle with a non-free thoracodorsal musculocutaneous flap on a neurovascular pedicle in 3 of 10 patients. Seven patients had an isolated wound to the scapula area. Three of 10 patients had a combined wound to the scapula with a defect of the humeral head, upper third of the humerus, and acromial end of the clavicle. These patients underwent implantation of an articulating spacer, restoration of the configuration of the proximal end of the humerus, and reconstruction of the rotator muscles to make possible the shoulder joint arthroplasty. The average value according to the results of a survey of patients on the OSS scale was 20.2 (±4.39) points before surgery and 34.1 (±7.56) points after surgery, which can be considered a good result according to the OSS scoring system. Conclusions. The analysis of the early outcomes showed that reconstructive treatment of gunshot old fractures of the scapula creates biomechanical prerequisites for restoring the function of the upper limb, reduces pain syndrome, and allows for active postoperative rehabilitation.

Conventional Bolster Dressing Versus Vacuum-Assisted Closure Device for Securing Split-Thickness Skin Graft in Contoured Wide Raw Area Reconstruction: A Randomized Clinical Trial

Conventional Bolster Dressing Versus Vacuum-Assisted Closure Device for Securing Split-Thickness Skin Graft in Contoured Wide Raw Area Reconstruction: A Randomized Clinical Trial

Comparison of vacuum-assisted closure device versus bolster dressing for securing skin grafts: a randomized controlled trial

Comparison of vacuum-assisted closure device versus bolster dressing for securing skin grafts: a randomized controlled trial

Laparoscopic repair for a recurrent epigastric incisional hernia following xiphoidectomy: A case report

Introduction: Xiphodynia is a rare musculoskeletal disorder characterized by epigastric or anterior chest pain, for which xiphoidectomy is considered as a definitive treatment. This procedure and its complications are not well researched, particularly within Australasian populations. We describe the novel laparoscopic incisional hernia repair from a xiphoidectomy complicated by recurrent epigastric hernias. Case Report: A 49-year-old female presented with chronic epigastric pain post-xiphoidectomy for xiphoidynia. The patient previously underwent open mesh repair for an incisional epigastric hernia, complicated by infection and subsequent removal of the mesh. A vacuum-assisted closure device was then utilized, followed by delayed primary closure. However, she experienced ongoing pain, a recurrent mass, and hypertrophic scarring, confirmed by abdominal computed tomography (CT) scan. Our laparoscopic approach involved a standard supine position with three ports and preperitoneal dissection similar to transabdominal preperitoneal (TAPP) hernia repair. The defect was 5 × 8 cm in size. A simple prolene mesh (9 × 12 cm) was secured with AsorbaTack and Glubran 2, followed by peritoneal closure with a 3/0 V-Loc suture. At two months follow-up, the patient had no evidence of recurrent hernia, no ongoing pain, and satisfactory wound healing. Conclusion: Laparoscopic surgical repair using a TAPP approach is a safe alternative to open repair of an incisional recurrent epigastric hernia post-xiphoidectomy.

Vacuum-assisted scalp repositioning: a novel temporizing approach to acute sinking skin flap syndrome. Illustrative cases

BACKGROUND This report describes the use of a novel approach to address acute sinking skin flap syndrome (SSFS), a postcraniectomy complication arising from brain dysfunction beneath the skull defect. The authors present a case series of two patients, emphasizing the prospective application of an external plaster cast in tandem with a vacuum-assisted closure (VAC) device (wound VAC) to promptly reposition the scalp and relieve brain compression. OBSERVATIONS Following intervention, one patient showed immediate neurological improvement, with complete resolution of symptoms within hours. Conversely, the second patient developed nonconvulsive status epilepticus. Computed tomography scans postintervention validated the successful scalp repositioning and mass effect resolution in both instances. This temporary approach proved successful in one patient with moderate symptoms, serving as a bridge to cranioplasty. LESSONS The integration of an external plaster cast and wound VAC offers a cost-effective and prompt solution for patients with acute SSFS pending cranioplasty. Appropriate patient selection and heightened caution for those with severe symptoms should be exercised.

Negative pressure wound therapy for complex oral wounds

Abstract Negative pressure wound therapy provides a nonsurgical treatment option for many types of complex wounds. This therapy utilizes the vacuum-assisted closure device, which decreases air pressure, removes fluid that accumulates within the wound, and aids to facilitate changes that promote healing. Despite the increased use of negative pressure wound therapy in the head and neck region, there is substantially less data available on the management of transoral vacuum-assisted wound closure. Herein, we present a case of a novel approach for the creation and use of a transoral wound vac for a patient with a refractory orocutaneous wound in the setting of multiple previous free flaps and surgeries. A watertight seal was able to be maintained and the patient was compliant with treatment, resulting in successful management of the wound. We promote the consideration of this novel technique’s use for similar difficult-to-treat oral wounds.

Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review.

The Clagett procedure is one of the last treatment options for chronic stage pleural empyema. It involves the formation of an open-window in the thoracic wall to allow for continuous drainage and irrigation of the pleural cavity. Once the empyema has been resolved, reconstruction of the chest wall is sometimes challenging. This review aims to identify and summarize the options for reconstructing soft tissue defects of the chest wall following the Clagett procedure and other types of open-window thoracostomy. A narrative review was performed of the literature on PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar, including all relevant studies published until January 2023. This review contains an overview of the reconstruction methods and the outcomes of the included studies on reconstructive options after the Clagett procedure and other types of open-window thoracostomy. A subdivision was made based on reconstruction type: pedicled flaps, free flaps, and the use of a vacuum-assisted closure (VAC) device. The advantages of pedicled flaps are reliable vascularization, better tissue match, reduced scarring, and shorter operation time compared to free flaps. However, when pedicled flaps are not available due to damage during previous surgeries or offer insufficient volume to obliterate the cavity, free flaps might be a solution. In cases where an open-window thoracostomy necessitates chest wall reconstruction, a pedicled flap is the preferred choice, followed by free flaps. Additionally, vacuum-assisted negative pressure wound therapy (VANPWT) techniques have shown potentially promising results (as an adjunct to surgical treatment).

Primary Closure Versus Delayed Primary Closure of Class III and IV Surgical Wounds Following Emergency Laparotomy: A Prospective Comparative Study.

Introduction Emergency surgery has a high risk of complications due to the detrimental effect of perioperative sepsis and the relative lack of preoperative optimization of patients. Despite advances in critical care for the management of sepsis, its prevention is dependent on various patient and surgeon factors. Surgical site infection continues to be a major determinant of morbidity and mortality following emergency abdominal surgery, especially in contaminated or dirty wounds. This study aims to compare two techniques of abdominal wall closure, primary closure with subcutaneous suction drains and delayed primary closure following negative pressure wound therapy, in terms of incidence of surgical site infection and morbidity. Materials and methods The study was a prospective comparative study including 50 patients with an acute surgical abdomen requiring laparotomy. The patients were randomized into two groups, Group A (n=25) who underwent primary closure, and Group B (n=25) who underwent delayed primary closure. In Group B patients, a vacuum-assisted closure device was applied in the subcutaneous space for five days prior to the closure of the skin. Outcomes were compared in terms of the incidence of superficial and deep surgical site infection, its association with diabetes mellitus, and the total duration of hospital stay. A chi-square test and an unpaired t-test were used for the test of significance. Results A total of 50 patients, comparable in age, were included in the study. The overall incidence of surgical site infection was significantly higher in patients of Group A as compared to Group B (p=0.0046). There was a positive correlation between diabetes mellitus and the occurrence of wound infection in both groups with the odds ratio being 2.67 and 2.38 respectively. The incidence of superficial wound infection was significantly higher in Group A when compared to Group B (52% versus 24%; p=0.04). Deep surgical site infection was higher in patients of Group A (20% versus 8%) but was not statistically significant (p=0.22). The average duration of hospital stay was 41.56 ± 6.96 and 37.86 ± 6.68 days for patients who developed complications fromGroups A and B respectively, while it was nearly two and a half times lower in uncomplicated cases of Groups A and B (11.71± 1.70 days and 16.58± 1.06 days respectively). The one-tailed unpaired t-test showed a significant difference in means of hospital stay between patients with and without complications (T: 17.06, critical value: 1.677). Conclusion Delayed primary closure is an effective method of managing contaminated and dirty wounds following emergency laparotomy. Negative pressure wound therapy is one technique for preventing wound bed infection and accelerating wound healing in such cases. By combining the above in emergency surgeries, the incidence of surgical site infection and duration of hospital stay can be significantly reduced.

Application of endoluminal vacuum-assisted closure device in the treatment of gastrointestinal fistula

Application of endoluminal vacuum-assisted closure device in the treatment of gastrointestinal fistula

ThTP8.6 A novel method for stoma isolation in a complex abdominal wound treated with vacuum assisted closure

Abstract Introduction Vacuum assisted closure (VAC) is a well established method in the treatment of abdominal wounds where the fascia is intact. The presence of one or multiple intestinal stomas or fistulae may present challenges in successful application of VAC therapy. Key concerns with the presence of intestinal stomas alongside open abdominal wounds is the risk of contamination with stoma effluent or the potential for the negative pressure to create enterocutaneous fistulae. Here we describe a novel method for isolating a small bowel stoma existing within a large abdominal wound, allowing successful resolution having failed conventional management. Method No device currently exists to allow a functioning stoma to be isolated within an abdominal wound requiring VAC therapy. This method relies on modification of a standard silicone fistula crown, this is then integrated into the standard VAC dressing, using stoma seals to provide successful vacuum. Stoma output is then successfully isolated, protecting surrounding tissue and supporting wound granulation without concern of wound effluent contamination. Discussion Of key importance in this case is the proximity of clean wounds with skin grafts done by plastic surgeons also being managed with VAC therapy and the importance of preventing contamination to allow successful granulation without further debridement of an already large wound. Conclusion Although this situation is rare with the increasing use of vacuum assisted closure devices for the management of wounds across many specialities this scenario is certainly not unprecedented. The technique described allowed successful treatment of a complex wound with significant existing comorbidities allowing resolution of a very challenging situation.

Management of floating arm: a case report.

This study report a 59-year-old man with a rare humeral fracture and a severe crush injury of the forearm. There is a paucity of evidence regarding the management of concomitant floating arm and soft tissue injuries in the literature.The patient was managed by minimally invasive plate osteosynthesis (MIPO) and vacuum-assisted closure (VAC) followed by a split-thickness skin graft. The concurrent presence of the two pathologies exacerbated the patient's condition and made the management challenging. In this case, the authors have used the MIPO approach to fix both fractures with minimal soft tissue injury. To manage the prominent soft tissue injury, we applied the VAC device. VAC has the advantages of reducing edema, controlling bacterial growth, and promoting granulation tissue formation, leading to faster cellular turnover and healing. In patients with floating arm, especially with concomitant soft tissue damage, the MIPO approach is a safe, minimally invasive, and quick method with minimal bleeding.

The Era of Vascular Surgery in a War Country

The objective of this presentation is to reflect on the limited choices for vascular reconstruction in Yemen, which is under war and siege; to emphasize the challenges for vascular surgeons to conduct such a risky and complicated operation with the lack of vascular instruments and materials needed; and to point out that an immensely critical and almost amputated upper limb of a young man could be saved despite the limited facilities. A 25-year-old man presented with acute ischemia after massive bleeding. While he was operating a factory machine, his left hand slipped into the sharp spiral processing machine, and the hand was dissected like minced meat from the palm up to the elbow, with massive loss of skin, muscles, and soft tissues. The initial decision was above-elbow amputation. The computed tomography angiogram showed a defect of the brachial artery from 5 cm above the elbow joint to 2 cm before the radio-ulnar bifurcation and a variant anomaly of the blood arteries with trifurcation of the radial, ulnar, and the origin of the common interosseous artery. The vascular intervention started immediately to reduce the ischemia time with a brachia-trifurcation autologous bypass with the basilic vein in reversed technique and muscle-flap coverage for the distal anastomosis due to lack of skin and soft tissue, then followed by orthopedics fracture fixation. Because of the multi injury of the radial artery at the wrist joint, we decide to ligate the radial artery and let the blood supply of the hand with the ulnar artery alone. After 63 days of inpatient treatment with multiple washouts; unfortunately in Yemen, we do not have basic devices such as a vacuum-assisted closure device of a wound VAC; therefore, we had to do every second-day washout at the operation theater. However, if that device was available, we would have conducted an intraoperative dressing with silver foam every 7 days. Vascular trauma in a war country leads to a catastrophic endpoint and represents a significant cause of morbidity and mortality following injury. Ligation of vascular injury remains the first choice for many surgeons for the initial treatment strategy, especially for minor or distal vascular injuries, but unfortunately for femoral or brachial arteries, injury management is with the amputation of the limb. Despite the limitation of surgical facilities, we managed to save the patient's massively traumatized hand.

What Has Changed in the History of Fournier's Gangrene Treatment: The Single-Center Experience.

Fournier's gangrene (FG) is a rapidly progressive infection that requires emergent intervention. Wound closure is an important treatment step after surgery, and vacuum-assisted closure (VAC) can be preferred as an alternative method for wound closure. FG severity index (FGSI) scales that can be developed to evaluate the prognosis in FG. This study aims to compare VAC therapy, which was used and developed in the historical development of FG therapy, with conventional wound dressing (CWD). Data on who 85 patients treated at our hospital with a diagnosis of FG from January 2010 to July 2021. In the VAC group, the vacuum device was applied in a sealed manner. In the CWD group, mesh dressing was prepared. The VAC device was adjusted to subatmospheric pressure. Broad-spectrum antibiotics were administered to all patients during their follow-up. During the follow-up, as necrotic tissues were detected, redebridements were performed by providing appropriate analgesia and anesthesia. Demographic data of the patients were collected on the records. The clinical and laboratory data were obtained from the records at the 1st h, 72 h, and 1st week FSGI values were calculated. In statistical analysis, continuous variables were expressed as mean±standard deviation, ordinal variables were expressed as median [IQR], and categorical variables were expressed as n (%). In intergroup analyses, student's t-test was used if the data were normally distributed. If it did not show normal distribution, the Mann-Whitney U-test was applied. Fifty-five patients who were diagnosed with FG were included in our study. CWD was applied to 18 patients, and VAC was applied to 37 patients. The mean 1st h FGSI of the patients who used VAC was 7.05 (3.75-8), and the patients who had CWD were 5.5 (5-9) (p=0.067). Mean 72nd-h FGSI was found to be 5.35 (3.5-7) in the VAC group and 5.33 (4.75-6.25) in the CWD group (p=0.714). The mean 1st-week FGSI VAC group was 2.97 (1-5), and in the CWD group, it was 5 (4-6) (p=0.0001). VAC significantly reduces the length of hospital stay. In our analysis, both groups observed a significant difference between the 1st-week FGSIs. This is the first study to evaluate FGSI, which is an essential predictor of the effect of VAC therapy used in treating FG. In the history of FG treatment, CWD has been replaced by VAC.

Carotid EndoVAC: a novel hybrid technique for carotid Dacron patch infection

This paper reports the use of the EndoVAC technique in a case of left carotid artery Dacron patch infection. The EndoVAC technique involves a sequence of endovascular relining with a stent graft, surgical debridement with explantation of infected graft material and secondary intention wound healing with a vacuum-assisted closure (VAC) device and long-term antibiotic treatment. Our patient was considered a high-risk surgical candidate due to previous cranial nerve injury, high carotid stent graft positioned in zone 3 of the neck, and high stroke risk due to aberrant cerebrovascular anatomy. The carotid EndoVAC technique was performed without complication and a successful outcome was observed at 1-year follow-up. Although currently not recommended as first-line management in treating vascular graft and endograft infections of the carotid vessels, the EndoVAC approach should be considered in a select cohort of patients when neither traditional radical surgery nor conservative simple VAC therapy are considered feasible or safe.

In Unusual Bronchopleural Fistula Scenarios, Stick With Your Principles!

Bronchopleural fistula (BPF) is a relatively uncommon but taxing problem after pneumonectomy. Depending on the clinical presentation and timing after resection, the basic tenets of treatment include broad-spectrum antibiotics along with wide drainage and débridement of the pleural cavity. Wide drainage can be achieved with the creation of an Eloesser flap or Claggett window with the aid of vacuum-assisted closure devices, whereas space obliteration with vascularized flaps can complete the healing once the contamination from the BPF has been controlled.

Comparison of Vacuum Assisted Closure (VAC) Therapy Versus Conventional Dressing in the Management of Diabetic Foot Ulcer

Background: Debridement of all necrotic, callus, and fibrous tissue is a mainstay of diabetic foot ulcer therapy, with the primary goal of wound closure. The best topical treatment for diabetic foot ulcers is yet unknown. To aid wound healing, a vacuum-assisted closure (VAC) device is used. Objective: To compare the outcome of vacuum-assisted wound closure (VAC) versus conventional wound dressing in diabetic foot ulcers. Material and methods: Study Design: Randomized Control Trial. Setting: Department of Surgery, Services Hospital, Lahore.Duration of Study: 6 months i.e. from-to-Data Collection: Forty patients with diabetic foot ulcer were included. Patients were randomly assigned in two groups. In group A, the dressing was applied by using adhesive drape to create the airtight seal. Conventional group received gauze dressingsoaked in saline once daily. Patients were followed regularly for 2 weeks to check for appearance of granulation tissue. Outcome was determined in terms of appearance of granulation tissue. Results: In VAC group, the mean age of patients was 42.95±9.29years. In conventional group, the mean age of patients was 46.30±9.33years. In VAC group, there were 12 (60%) males and 8 (40%) females. In conventional group, there were 16 (80%) males and 4 (20%) females. In VAC group, the mean duration of wound healing was 7.50±2.82days. In conventional group, the mean duration of wound healing was 10.60±5.55days. The difference was significant (p<0.05). In VAC group, there were 20 (100%) patients who had treatment success. In conventional group, there were 13 (65%) patients who had treatment success while 7 935.0%) did not have complete healing within 2weeks. The difference was significant (p<0.05). Conclusion: Thus, VAC is more successful in achieving granulation of tissues in patients with diabetic foot ulcer as compared to conventional dressing Keywords:Type II diabetes mellitus, diabetic foot ulcerations, Vacuum-assisted wound closure, conventional dressings, Negative pressure wound therapy

Preservation of Deep Epigastric Perforators during Anterior Component Separation Technique Results in Equivalent Wound Complications Compared with Transversus Abdominis Release

BACKGROUND: In complex abdominal wall reconstruction, the use of CST increases fascial medialization and facilitates fascial closure; however, ACST has been associated with a high rate of wound complications.1 The purpose of this study was to compare wound complications and perioperative outcomes between a perforator sparing (PS)-ACST and (TAR). METHODS: From a prospective, tertiary hernia center database, patients who underwent open abdominal wall reconstruction with PS-ACST or TAR from 2016 to 2020 were identified. Patients undergoing concurrent panniculectomy were excluded. Outcomes included wound complications, need for reintervention, length of stay, and 30-day readmission. The Carolinas Equation for Determining Associated Risks application was used to predict wound complication rates. A univariate analysis was performed between the PS-ACST and TAR groups. Standard statistical methods and logistic regression were performed. RESULTS: A total of 92 patients met criteria; 37 had PS-ACST and 55 had TAR performed. The PS-ACST and TAR groups were similar in terms of BMI (29.8 ± 8.9 versus 31.3 ± 6.3 kg/m2, P = 0.23) and diabetes (16.2% versus 25.5%, P = 0.32), but the PS-ACST group a greater history of smoking (51.4% versus 14.5%, P < 0.01). Both groups had five comorbidities on average (P = 1.00). Most hernias were recurrent (59.5% versus 61.8%, P = 0.83). CDC wound classes were equivalent. The Carolinas Equation for Determining Associated Risks predicted wound complication rates were: PS-ACS-56.9% (range: 14.2–92.9%) and TAR-39.7 % (range: 7.3–92.2%). Preoperative botulinum toxin A was performed in 43.8% versus 19.1% of cases (P = 0.06). The PS-ACST group had a larger hernia defect size (374.9 ± 156.4 versus 223.7±119.7 cm2, P < 0.01) and increased intraoperative time (242.1 ± 63.8 versus 209.5 ± 71.0 min, P < 0.01). Despite the larger defect size, the mesh size was comparable (1096.0 ± 535.6 versus 944.4 ± 391.5, P = 0.71). Biologic mesh was more frequently utilized in PS-ACS patients (51.4% versus 27.3%, P = 0.03). All PS-ACST patients had a bilateral CST compared with 72.7% who received a TAR (P < 0.01). The fascial defect was fully closed in all but two cases (94.6% versus 100.0%, P = 0.16). Placement of an incisional vacuum-assisted closure device occurred more frequently in the PS-ACST group (32.4% versus 14.5%, P < 0.01). The overall wound complication rate was not significantly different (16.2% versus 20.0%, P = 0.79), neither was superficial dehiscence (5.7% versus 5.7%, P = 1.00), deep wound infection (5.7% versus 9.5%, P = 0.70), or seroma requiring reintervention (5.4% versus 5.5%, P = 0.99). There were no patients in the PS-ACST who required return to the operating room for wound-related issues (0.0% versus 9.6%, P = 0.08), and requirement for a percutaneous drain was uncommon (2.9% versus 7.7%, P = 0.64). Length of stay was one and a half days longer for PS-ACST patients (8.9 ± 5.4 versus 7.3 ± 4.0 days, P = 0.04), but 30-day readmissions were no different (5.4% versus 10.9%, P = 0.47). Using logistic regression, none of the factors that were significantly different in the univariate analysis correlated with wound complications (P > 0.05). CONCLUSIONS: PS-ACST, despite being used for larger defects, had equivalent rates of wound complications and need for reintervention compared with patients undergoing TAR. REFERENCE: 1. Maloney SR, Schlosser KA, Prasad T, et al. Twelve years of component separation technique in abdominal wall reconstruction. Surgery (United States). 2019;166:435–444. doi:10.1016/j.surg.2019.05.043

Peripheral Angioinvasive Aspergillosis in the Setting of End-Stage Liver Disease

Invasive aspergillosis of the peripheral arteries is a rare complication in vascular surgery. Angioinvasion can compromise vascular wall integrity, leading to local and systemic complications. We report the case of peripheral angioinvasive aspergillosis of the common femoral artery (CFA) and superficial femoral artery in a patient with decompensated alcoholic liver cirrhosis. We reviewed the electronic medical records for the patient's medical history, diagnostic imaging, operative reports, and in-hospital course. All information was de-identified. A 58-year-old man with advanced alcoholic liver cirrhosis had presented to our tertiary care center for orthotopic liver transplant evaluation. A part of the workup included coronary angiography, which was performed through a 6F femoral sheath access. Subsequently, the patient developed right groin hematoma with a CFA pseudoaneurysm and evidence of femoral nerve compression. He underwent hematoma evacuation and CFA repair that required endarterectomy. His postoperative course was complicated by a recurring surgical site hematoma requiring transfusions, several groin reexplorations, and creation of a sartorius flap to provide coverage of the femoral vascular bundle. A vacuum-assisted closure device was used for wound dressing. During the ensuing days, sartorius flap necrosis developed, and the patient experienced acute arterial bleeding. On reexploration, the CFA was noted to have sieve-like bleeding with complete disintegration of the arterial wall. Ligation of the CFA, profunda femoris, and superficial femoral artery as lifesaving measures was required. The patient's condition continued to worsen, with liver failure and right leg ischemia. After the goals of care were discussed with the family, they decided for terminal extubation, after which the patient died. Evaluation of samples of the femoral vessels obtained during surgery returned positive for the presence of Aspergillus species on fungal stains within the arterial wall, with large fungal bodies protruding into the vessel segment lumen (Fig). Distorted vessel wall anatomy was also observed with dense infiltration and hyphae and evidence of vessel microperforation. The presence of invasive aspergillosis was most likely responsible for the arterial wall disintegration. Peripheral angioinvasive aspergillosis is a rare infectious complication in vascular surgery and can occur in patients with end-stage liver disease. Angioinvasion is difficult to treat and can result in vascular wall compromise, presenting as life-threatening hemorrhage.

560 Vacuum Assisted Dressing can be Used as an Effective Dressing Over Non-cultured, Autologous Skin Cell Suspension (ASCS) Combined with Wide Meshed Split Thickness Autografts (mSTSG)

Abstract Introduction There are accounts of various dressings being applied over epidermal spray cell suspension graft(s) (SCSG) with varying success and no one perfect dressing. We present 3 patients with ASCS grafts used in combination with mSTSG that were treated with vacuum assisted dressing with excellent outcomes. Methods All 3 of our patients received surgical debridement, down to healthy viable tissue with exposed tendon. BTM Dermal matrix was used in 2 of the 3 patients with exposed tendon. All three patients had mSTSG with ACSS autografts. All grafts were covered with telfa ™ clear, followed by tacky macroporous silver dressing, then a vacuum assisted closure device. These were left undisturbed until post operative day (POD) 5. Results All patients had their dressings taken down on POD #5 with excellent results. The interstices were closed quickly with no negative outcome noted from the vacuum dressings. All patients had excellent wound closure and good function postoperatively. Conclusions Vacuum assisted closure devices can be used to cover ASCS and wide meshed grafts with good outcomes. They provide patients with a stable dressing that does not need to be changed and leads to excellent graft take and wound closure.

The utility of incisional vacuum-assisted closure in surgical Management of Hidradenitis Suppurativa: a retrospective cohort study

Wide local excision is the gold standard treatment for severe hidradenitis suppurativa but remains challenging due to high rates of complications and recurrence. Incisional vacuum-assisted closure devices are powerful adjuncts to enhance postoperative wound healing. We performed a retrospective cohort study of all patients who underwent surgical excision for hidradenitis over a 10-year period. The cohort was divided into patients who received standard sterile dressings and those who received incisional vacuum-assisted closure. The primary outcomes were surgical site complications and recurrence of disease. The data were analysed using univariate and multivariable logistic regression analyses. We included 79 patients; patients had multifocal disease which resulted in 220 operative sites. Fifty-eight operative sites (26%) received vacuum-assisted closure and 162 (74%) did not. Operative sites with vacuum-assisted closure were larger (140 vs 60 cm2, p < 0.001) and had longer operations (72 vs 46 min, p < 0.001), and longer hospital stays (6 vs 0 days, p < 0.001). When adjusted for preoperative and operative factors, vacuum-assisted closure did not significantly decrease the odds of experiencing a complication (OR 0.70, p = 0.409) but, however, did significantly reduce the odds of disease recurrence (OR 0.28, p = 0.020). The use of vacuum-assisted closure does not alter risk of complications but may play a role in preventing hidradenitis recurrence. Given the high costs associated with long hospitalisations, more cost-effective solutions should be investigated, such as home vacuum-assisted closure therapy. Level of evidence: Level III, therapeutic study.