Vacuum-assisted Closure Therapy Research Articles

Non-surgical management of methicillin-sensitive Staphylococcus aureus bacteremia-related mediastinitis

Background: Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus. Case presentation: In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess. Conclusion: We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach.

Effect of Neoadjuvant Therapy on Endoluminal Vacuum-Assisted Closure Therapy (EVAC) for Anastomotic Leakage After Oesophagectomy

Background: Anastomotic leakage (AL) is a dreaded complication after oesophagectomy. Endoluminal vacuum-assisted closure therapy (EVAC) has been increasingly used as a first-line treatment for AL. We aimed to identify any potential adverse effects of a neoadjuvant therapy (chemotherapy (CT) or radiochemotherapy (RCT)) on EVAC. Methods: We performed a retrospective cohort study at our tertiary centre between 2013 and 2024. All patients who underwent EVAC for AL after oesophagectomy were included in this study. Parameters such as success rate, length of therapy, number of sponges needed, changes in treatment, and survival were analysed. Results: A total of 29 patients were included, 19 of whom received CT/RCT and 10 of whom received no neoadjuvant treatment (NT). There was no significant difference in patient survival (30-day survival rate CT/RCT n = 1 (5.3%) vs. NT n = 1 (10%), p = 0.632), success rate (CT/RCT n = 15 (78.9%) vs. NT n = 9 (90%), p = 0.454), and length of therapy (CT/RCT vs. NT 24.11 vs. 23.8, p = 0.681), the number of sponges required (CT/RCT vs. NT 6.26 vs. 6.6, p = 0.835), and the need for changing treatment (CT/RCT n = 5 (26.3%) vs. NT n = 1 (10%), p = 0.303). Conclusions: NT did not affect the success rate or length of therapy. Thus, we found no significant influence of CT/RCT on EVAC for AL after oesophagectomy.

Vulvar necrotizing wounds: Unveiling mortality-associated parameters and assessing the efficacy of VAC therapy

IntroductionVulvar Necrotizing Fasciitis (VNF) is a critical, severe soft tissue infection characterized by aggressive progression and significant morbidity and mortality. Rapid diagnosis and immediate, comprehensive treatment, including antibiotic therapy, meticulous surgical debridement, and multidisciplinary care, are crucial for improving outcomes. This study aimed to investigate mortality-related factors in VNF and evaluate treatment modalities, focusing on Vacuum-Assisted Closure (VAC) therapy versus traditional debridement. MethodsThis retrospective study analyzed data from 22 VNF patients. Criteria included adults diagnosed with vulvar necrotizing infections, excluding those transferred or not completing treatment at the center. The study examined mortality-related factors and the efficacy of VAC therapy compared to debridement, considering treatment costs and outcomes. ResultsAnalysis divided patients into survivors (13) and non-survivors (9). Higher heart rate, elevated WBC and CRP levels, and higher Clavien-Dindo scores were associated with increased mortality. VAC therapy, compared to traditional debridement, resulted in significantly lower CRP levels and reduced treatment costs. However, other parameters such as the length of hospital stay and debridement frequency showed no significant differences. ConclusionThe study highlights that older age, systemic inflammation, and severe postoperative complications are key factors associated with higher mortality in VNF. VAC therapy emerges as a promising modality, effectively reducing systemic inflammation and healthcare costs. Nonetheless, the retrospective nature and the small sample size of the study limit the generalizability of the findings. Future research, particularly larger, multicentric studies, is essential to further explore and validate the effectiveness of VAC therapy in VNF management.

A comparative analysis of vacuum assisted closure therapy and conventional dressings: outcomes in chronic diabetic foot ulcers among Indian patients

Background: India faces a growing diabetes epidemic, with approximately 77 million individuals affected. Chronic non-healing diabetic foot ulcers (DFUs) are a common complication of diabetes and a major healthcare challenge in Conventional wound care methods often result in prolonged healing times, increasing the risk of infection, hospitalization, and amputations. Vacuum-assisted closure (VAC) therapy, a modern treatment modality, offers a potentially more effective approach to managing these ulcers. Methods: This prospective, observational study was conducted at a tertiary care hospital in India from March 2022 to March 2024. One hundred patients with chronic non-healing DFUs were randomized into VAC therapy or conventional dressing groups. The primary outcomes included wound size reduction and healing time, while secondary outcomes involved patient satisfaction and cost-effectiveness. Results: VAC therapy significantly reduced wound size (65.2% vs. 40.5%) and shortened healing time (6.2 vs. 10.9 weeks) compared to conventional dressings. Additionally, VAC therapy led to higher patient satisfaction and proved more cost-effective due to fewer dressing changes and shorter hospital stays. Conclusions: VAC therapy outperforms conventional dressings in managing DFUs, offering faster healing, better patient satisfaction, and cost-effectiveness. Expanding its use in India could greatly improve diabetic foot care outcomes.

ThP6.9 - Endoluminal vacuum-assisted closure (EndoVAC) therapy in spontaneous duodenal perforation: a novel approach to an undertreated problem

Abstract Introduction Duodenal perforation is a rare but critical condition, with management ranging from conservative to surgical depending on timing of presentation, patient status, and clinician preference. In recent years, minimally invasive techniques have been emerging alternatives for their safety and efficacy. Notably, there have been cases promoting endoluminal vacuum-assisted closure (EndoVAC) therapy as a viable alternative for use among patients with iatrogenic oesophageal perforations. To our knowledge, there has been no reported use of this novel approach specifically in spontaneous duodenal perforations. Case presentation A 55-year-old female with no history of trauma, surgery, NSAID use, or gastrointestinal conditions presented with epigastric pain and vomiting. A CT scan revealed a contained duodenal perforation at the D2/3 junction, accompanied by a complex retroperitoneal collection unsuitable for imaging-guided drainage. Initial management was conservative with intravenous hydration, antibiotics, proton pump inhibitors, and nasogastric tube decompression. She underwent oesophagoduodenoscopy and EndoVAC therapy resulting in complete resolution of collection and a small diverticulum on repeat CT. Discussion Current standard of care for duodenal perforations would be conservative management, though this carries the risk of deterioration due to biliopancreatic leakage and slow resolution of sepsis. Surgical management, when needed, is often technically challenging with high morbidity. EndoVAC gives the benefit of providing targeted drainage and negative pressure therapy to the site of perforation, reducing ongoing contamination, and promoting wound granulation. Conclusion EndoVAC therapy offers a minimally invasive alternative to treatment of duodenal perforations and has the potential for broader application in specialist and tertiary healthcare settings.

Pharmacokinetics of Piperacillin-Tazobactam in Critically Ill Patients with Open Abdomen and Vacuum-Assisted Wound Closure: Dosing Considerations Using Monte Carlo Simulation.

Open abdomen with vacuum-assisted wound closure therapy (OA/VAC) is frequently used in critically ill patients although the impact of OA/VAC on antibiotics pharmacokinetics (PK) remains unknown. We thus aimed to characterize the PK of piperacillin-tazobactam (PTZ) in critically ill patients with OA/VAC and assess the optimal dosing regimens based on pharmacodynamics (PD) target attainment. Over a 15-month study period, 45 patients with OA/VAC treated with PTZ administered continuously and adapted to 24 h creatinine clearance (CLCR) underwent measurements of free concentrations in their plasma, urine, VAC exudate, and peritoneal fluid. Population PK modeling was performed considering the effect of covariates, and Monte Carlo simulations were employed to determine the probability of target attainment (PTA) for the PK/PD targets (100% fT > 16 mg/L) in the plasma and at the peritoneal site at steady state. Piperacillin concentrations were described using a two-compartment model, with age and total body weight as significant covariates for central volume of distribution (V1) and estimated renal function for clearance (CL). Tazobactam concentrations were described using a two-compartment model with estimated renal function as a significant covariate. The central volume of distributions V1 of piperacillin and tazobactam were 21.2 and 23.2 L, respectively. The VAC-induced peritoneal clearance was negligible compared to renal clearance. Most patients achieved the desirable PK/PD target when using a CLCR-pondered PTZ dosing regimen from 12 g/1.5 g/day to 20 g/2.5 g/day. Despite a wide inter-individual variability, the influence of OA/VAC on piperacillin and tazobactam PK parameters is not straightforward. The use of a CLCR-pondered PTZ dosing regimen from 12 g/1.5 g/day to 20 g/2.5 g/day is needed to reach a PTA > 85%.

Causes of Mediastinitis and Its Surgical Treatment

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

Case Study on the Advancements in Diagnosis and Treatment Technologies for Military Personnel with Complex Explosive Injuries

Case(s): A 51-year-old military personnel with severe limb injury from mortar shelling, admitted to Orthopedic Traumatology Department, Ternopil Regional Hospital, Ukraine.Conclusions: Explosive injuries typically arise from the detonation of devices such as landmines, improvised explosive devices, or grenades, causing harm through blast, fragmentation, and thermal effects. Despite a delayed presentation to medical care, the patient underwent multiple debridement procedures, including Vacuum-Assisted Closure therapy, and vascular reconstruction, leading to limb salvage. This case underscore needs for timely medical care, addressing risks of mine blasts and cold weather injuries through training.

The role of reconstructive plastic surgery in the treatment of victims of the 2023 Kahramanmaraş earthquake

Objective: As a result of the 2023 Kahramanmaraş earthquake, medical institutions experienced a large influx of patients requiring acute multidisciplinary surgical and medical care. This study aimed to evaluate the patient demographics and treatment management of survivors admitted to our reconstructive plastic surgery department. Materials and Methods: We retrospectively analyzed the age, sex, time under the wreckage, time of admission, types and locations of injuries, treatment modalities, receipt of hyperbaric oxygen therapy, and receipt of vacuum-assisted closure therapy of the earthquake victims referred to our department. Results: The definitive management of all 42 earthquake survivors admitted to our department was reviewed. This included five free flaps, four regional flaps, 18 split-thickness skin grafts, and one maxillofacial fracture repair. Eight patients were treated conservatively including two with non-displaced maxillofacial fractures. Of the 26 patients treated for lower extremity injuries, four were already amputees. Among the remaining 22 patients with such injuries, one underwent Charcot amputation plus free flap reconstruction to preserve extremity length and one underwent below-the-knee amputation. Of the 16 upper extremity injuries, two patients referred with extensive forearm necrosis underwent forearm amputation. To preserve extremity length and ensure the limbs were suitable for biomechanical orthoses, free transverse upper gracilis musculocutaneous flaps and free chimeric Anterolateral- Vastus Lateralis musculocutaneous flaps were performed. Conclusion: This study illustrates the value of multi-modal reconstructive plastic surgery in the treatment of disaster survivors, particularly in the management of multi-trauma.

Assessment of Vacuum-Assisted Closure (VAC) Therapy in Orthopaedic Infections.

Introduction Chronic and infected orthopaedic wounds may result in profound morbidity, amputation, sepsis andeven death. It may need prolonged hospitalization and multiple surgical procedures for treatment. Vacuum-assisted dressing (VAD) is a comparatively newer modality for treating chronic non-healing wounds which helps in faster wound healing, decreases the frequency of dressing and reduces hospitalization time. The aim of our study is to evaluate the outcome of vacuum-assisted dressing (VAD) in the management of orthopaedic wounds. Materials and methods A case series including 20 patients with post-traumatic open fracture wounds, post-operative infected wounds and wounds with underlying chronic osteomyelitis were treated with VAD. Wound size was measured pre- and post-debridement and every five days, at the time of dressing change until the wound healed or grafted. The duration of wound healing or wound closure was measured and documented. Results Wound size decreased significantly and healthy granulation tissues were observed in all wounds after the application of vacuum-assisted dressing. Wound size decreased by an average of 22% after debridement and first vacuum-assisted dressing removal. Infection control was achieved in 18 out of 20 patients (90%) who had wounds closed either by secondary closure or by skin grafting. Conclusion We conclude that VAD is an efficient technique in the management of orthopaedic wounds, especially in the management of open fracture wounds but less effective in chronically infected wounds with underlying osteomyelitis.

Successful Endoscopic Vacuum-Assisted Closure Therapy for Esophageal Perforation: A Case Report

Esophageal perforation can lead to serious complications, and rapid diagnosis and treatment significantly affect the prognosis. Endoscopic vacuum-assisted closure (EndoVAC) therapy is widely accepted as a safe, well-tolerated, effective, versatile and practical procedure for the management of esophageal perforation in selected patients. We report the successful use of EndoVAC therapy for management of an esophageal perforation secondary to foreign body removal. A 56-year-old man presented to the emergency department for evaluation of chest pain after swallowing the plastic shell of a pill. Emergency endoscopy revealed an esophageal wall laceration (approximately 3 cm) and microperforation. The esophageal laceration and microperforation were limited to the mid-esophagus. The patient underwent EndoVAC therapy, which was repeated every 3–4 days for a total of six sessions over a period of 21 days. We observed improvement in the esophageal injury with granulation tissue formation during the fifth session. Subsequent follow-up evaluation, including esophagography and chest computed tomography confirmed complete healing of the esophageal injury. Following resumption of diet, the patienton a was discharged without any complications.

Vacuum assisted closure therapy in children with complicated abdominal wounds, with or without viscero-cutaneous fistulae

BackgroundManagement of complicated abdominal wounds is challenging in children. Vacuum-assisted closure proved to be beneficial. We aimed to report the outcome of VAC over 5 years’ practice in complicated abdominal wounds with or without viscero-cutaneous fistulae. MethodsRetrospective review of children managed by VAC over 5 years, from January 2017 to December 2022. Included patients had complicated abdominal wounds. Customized VAC devices with continuous negative pressure were used for all patients. The applied pressure was tailored according to the patient's age and the wound condition. ResultsNineteen patients were included, their ages ranged from 3 months to 15 years. Peritonitis was the main pathology in 12 patients, abdominal wall infection in 4, and a combination of both in 3. VAC was applied over closed wounds in 10 patients and over open wounds in 9; 6 of them had cutaneous fistulae. The median duration of VAC application over closed wounds was 7.5 days, while it was 10 days in open wounds. VAC promoted healing in closed and narrow-gapped wounds, while it was successfully used as a bridging therapy in 4 patients with wide-gapped wounds. Patients with viscero-cutaneous fistulae were successfully managed without further surgical intervention. VAC was complicated by fascial dehiscence with evisceration and incisional hernia in two patients. ConclusionVAC could be beneficial to complicated abdominal wounds in pediatric age. It was helpful in managing small viscero-cutaneous fistulae.

Effect of Vacuum Assisted Closure Therapy in Orthopaedic Trauma to Reduce Post-Operative Infection in Lower Limb Compound Fractures

Abstract Background: Patients with road traffic accidents, industrial incidents, falls, or firearm injuries often experience severe polytrauma or orthopedic injuries resulting in compound fractures and grievous soft-tissue injuries, representing a complex clinical situation. The standard treatment of compound orthopedic injuries includes debridement, irrigation, dressing, and antibiotic therapy to control infection, which may or may not require plastic reconstruction procedures once granulation tissue has sufficiently formed. The application of vacuum-assisted closure (VAC) therapy removes local dead space, decreases tissue edema, and promotes granulation tissue formation. VAC shows potential as a novel treatment approach for individuals experiencing severe open fractures following high-energy trauma. This study aimed to compare the postoperative infection rates between VAC and conventional dressing methods in lower-limb compound fractures. Materials and Methods: This study was conducted in the Department of Orthopedic Surgery in King George Medical University, Lucknow, from January 2023 to January 2024, with sample size of 38 patients. Patients were divided into an experimental group (n = 20) and a control group (n = 18) based on the treatment started During VAC application, the wound area was covered with foam and gauze, then an adhesive film was placed over the foam and dressing to seal it. A drainage tube was connected through the foam to a portable vacuum pump. When the pump was turned on, exudate fluid was drawn through the foam and out the drainage tubing into a container. The dressing maintenance time was 5–7 days. As the treatment progressed, serum C-reactive protein and total leukocyte count levels were measured on days 3 and 7, respectively, to study the post-operative infection. Results and Conclusion: There was a statically significant difference between the treatment group compared to the control group in terms of hospital stay, wound healing time, and post-operative infection. In conclusion, VAC dressing in the management of compound fracture reduces the frequency of dressing changes, decreases hospital stay, enhances wound healing, and reduces post-operative infection. Therefore, VAC dressing is a valuable modality as an adjuvant in the treatment of compound fractures in clinical practice.

Role of Vacuum Assisted Closure Therapy Compared to Standard Moist Wound Dressing in the Treatment of Diabetic Foot Ulcers.

Role of Vacuum Assisted Closure Therapy Compared to Standard Moist Wound Dressing in the Treatment of Diabetic Foot Ulcers.

Functional outcome of the three-stitch technique of humerus nailing for comminuted shaft humerus fractures

Abstract Background: Intramedullary nailing for comminuted shaft humerus fractures has emerged as an innovative and advantageous surgical approach, particularly in cases with significant soft tissue injuries complicating open reduction and internal fixation. This study underscores the benefits of minimally invasive intramedullary humerus nailing to mitigate perioperative and postoperative complications. Materials and Methods: This prospective study was conducted at Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India, from March 2022 to March 2024. Informed consent was obtained from all patients, detailing the study’s methodologies and potential complications. Employing a three-stitch technique, we treated 24 adult patients with posttraumatic comminuted humerus shaft fractures through antegrade humerus nailing, encompassing injuries classified up to type 12C according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification. Results: Among the 24 patients, 22 exhibited excellent functional outcomes and good adherence to the rehabilitation regimen. Two patients encountered delayed wound healing; one underwent vacuum-assisted closure therapy, ultimately achieving satisfactory healing after a series of dry dressings over 2–3 weeks. There were no instances of nonunion. Over 6 months, 22 out of 24 patients experienced significant restoration of function, evidenced by an improvement in Mayo Elbow Performance Index scores from 18 to 23 within the excellent outcome group. University of California at Los Angeles scores also exhibited enhancement, with ratings ranging from exceptional to good, increasing from 20 to 23. Only two patients experienced delayed wound healing, and none suffered from nonunions. Conclusion: Our findings suggest that the three-stitch technique presents a viable alternative to external fixators and other plate osteosynthesis methods in the surgical management of comminuted injuries. This approach yields favorable outcomes with reduced complications and improved cosmetic results.

Functional Outcomes in Orthopaedic Open Wounds Treated With Vacuum-Assisted Closure Therapy: A Prospective Case Series.

Open fractures with extensive soft-tissue damage, significant periosteal stripping, and exposed bone ends pose a significant challenge in orthopaedics. So, we conducted a prospective study that investigated the efficacy of vacuum-assisted closure (VAC) therapy in improving functional outcomes for orthopaedic open wounds. A prospective case series was conducted for a period of 18 months at the department of orthopaedics. Seventeen patients with open wounds were included in the study after fulfilling specific criteria. The study involved 17 patients with open wounds, where VAC therapy was applied within 24 hours of admission for 14 patients, and for three patients with superficial infection, thorough wound debridement preceded VAC dressing. Follow-up with patients continued until definitive skin cover procedures were performed. The majority of cases were attributed to open compound fractures caused by road traffic accidents (82.35%), followed by train traffic accidents (11.76%) and accidental falls (5.88%). The leg (47%) was the most common location of injury, followed by the forearm (23.52%). The average treatment duration was 10.5 days, with an average of 3.3 dressing changes, indicating the efficacy and feasibility of VAC therapy in clinical practice. The average wound size reduction at completion was 15mm, and 15 out of 17 patients achieved successful wound healing. The average time required for forming a uniform granulation bed was 10.5 days, highlighting the efficiency of VAC therapy in promoting tissue regeneration. Our study findings revealed that there is a significant reduction in the rate of wound infection with the application of VAC therapy, along with a shorter duration for the formation of healthy granulation tissue, rendering the wound suitable for definitive skin cover procedures such as split skin graft and flap cover at an accelerated rate. Additionally, technical challenges associated with applying VAC dressing in the presence of an external fixator were successfully managed through realignment strategies, further underscoring the adaptability and efficacy of VAC therapy in addressing complex wound scenarios.

Evaluation of Clinical Outcomes of Negative-Pressure Wound Therapy in Gustilo-Anderson Type IIIA/IIIB Open Fractures of Extremities.

Background Open fractures are common and serious injuries that primarily affect young males. Fracture management has improved in the last decade. However, infections with their complications are still a concern, especially in open fractures for primary closure of the injured area. A newer technique called vacuum-assisted therapy has become a therapy of choice for many orthopedic surgeons. This study aimed to determine whether vacuum-assisted closure reduces the duration of wound healing and the frequency of infections after fixation of Gustilo-Anderson Type IIIA/IIIB fractures of the extremities. Methodology An observational analytical study was conducted among 34 patients with Gustilo-Anderson Type IIIA/IIIB fractures of the limbs who presented to the Department of Orthopaedics, R. L. Jalappa Hospital, Kolar, from December 2019 to July 2021. Negative-pressure wound therapy was employed for wound closure after fixation of fractures. Patients were followed up for one month. Results The mean age of the patients was 37.06 ± 10.340 years. The prevalence of infection before vacuum-assisted closure dressing was 80.6%, and the prevalence of infection after vacuum-assisted closure dressing was 19.4%. The difference in proportion before versus after the intervention was statistically significant (p < 0.001) according to the McNemar Test.Hence, vacuum-assisted closure dressing decreased the rate of infection. The mean dimension of the wound before vacuum-assisted closure therapy was 66.05 cm2 and the mean dimension of the wound after vacuum-assisted closure therapy was 27.97 cm2. The difference in the mean before and after the intervention was statistically significant according to the paired t-test (p < 0.001). Hence, vacuum-assisted closure dressing helped decrease the wound size which was proven statistically. Conclusions Vacuum-assisted closure is a viable and beneficial treatment option for complicated fractures with large soft-tissue abnormalities.

Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele

ObjectiveNeural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8–15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique.Patients and methodsIn this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients.ResultsMean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87–175°) and 0.79° (− 20–24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values (p < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1–T12 and T1–S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant (p < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed.ConclusionWe believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.

Vacuum-assisted closure for chest wall reconstruction infection caused by Streptococcus mitis after surgery of lung cancer: a case report

BackgroundAmong a cohort of patients who underwent chest wall resection and reconstruction by rigid prosthesis, 6% required removal of the prosthesis, and in 80% of these cases the indication for prosthesis removal was infection. Although artificial prosthesis removal is the primary approach in such cases of infection, the usefulness of vacuum-assisted closure (VAC) has also been reported.Case presentationA 64-year-old man with diabetes mellitus underwent right middle and lower lobectomy with chest wall (3rd to 5th rib) resection and lymph node dissection because of lung squamous cell carcinoma. The chest wall defect was reconstructed by an expanded polytetrafluoroethylene (PTFE) sheet. Three months after surgery, the patient developed an abscess in the chest wall around the PTFE sheet. We performed debridement and switched to VAC therapy 2 weeks after starting continuous drainage of the abscess in the chest wall. The space around the PTFE sheet gradually decreased, and formation of wound granulation progressed. We performed wound closure 6 weeks after starting VAC therapy, and the patient was discharged 67 days after hospitalization.ConclusionsWe experienced a case of chest wall reconstruction infection after surgery for non-small cell lung cancer that was successfully treated by VAC therapy without removal of the prosthesis. Although removal of an infectious artificial prosthesis can be avoided by application of VAC therapy, perioperative management to prevent surgical site infection is considered essential.

Usefulness of Endoluminal Vacuum-Assisted Closure Therapy for Pharyngocutaneous Fistula

Pharyngocutaneous fistula (PCF) is a communication created between the pharynx and skin of the neck associated with flap reconstruction or primary closure of a pharyngeal defect. In patients who underwent laryngectomy and pharyngectomy, salivary accumulation in the deep neck space through the pharyngeal dehiscence can cause life-threatening complications, among which is carotid artery blow-out. Broad-spectrum antibiotics, compressive dressing, and artificial nutrition are usually applied first. Many closing methods have been studied, both surgically (direct repair or using flaps) and non-surgically (negative pressure therapy, hyperbaric oxygen therapy, or botulinum toxin injection). The use of a vacuum-assisted closure system placed endoluminally or externally has been recently reported to treat any leaks in the upper gastrointestinal tract. Here, we report a successfully-treated PCF using the endoluminal vacuum-assisted closure system.