Vacuum-assisted Closure Therapy Research Articles

Endoluminal vacuum-assisted closure (E-Vac) therapy for postoperative esophageal fistula: successful case series and literature review

BackgroundTreatment of esophageal perforations and postoperative anastomotic leaks of the upper gastrointestinal tract remains a challenge. Endoluminal vacuum-assisted closure (E-Vac) therapy has positively contributed, in recent years, to the management of upper gastrointestinal tract perforations by using the same principle of vacuum-assisted closure therapy of external wounds. The aim is to provide continuous wound drainage and to promote tissue granulation, decreasing the needed time to heal with a high rate of leakage closure.Cases presentationA series of two different cases with clinical and radiological diagnosis of esophageal fistulas, recorded from 2018 to 2019 period at our institution, is presented. The first one is a case of anastomotic leak after esophagectomy for cancer complicated by pleuro-mediastinal abscess, while the second one is a leak of an esophageal suture, few days after resection of a bronchogenic cyst perforated into the esophageal lumen. Both cases were successfully treated with E-Vac therapy.ConclusionOur experience shows the usefulness of E-Vac therapy in the management of anastomotic and non-anastomotic esophageal fistulas. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy.

Factors associated with revision surgery for olecranon bursitis after bursectomy

The primary aim of our study was to identify the factors associated with revision surgery after bursal excision in patients with olecranon bursitis. The secondary aims were to describe the revision rate after bursectomy and to assess which factors are associated with flap surgery after bursectomy and describe the most common complications after bursectomy of the olecranon bursa. We included 191 adult patients with olecranon bursitis who underwent olecranon bursa excision between January 2002 and October 2018. Patients who were pregnant, patients with incomplete records of the primary surgical procedure, and patients who underwent bursectomy during elbow arthroplasty were excluded. After manual chart review, we found that 22 patients had undergone revision surgery. Bivariate analysis was performed to assess the association between revision surgery and patient characteristics, comorbidities, and clinical characteristics. Additionally, we collected data regarding postoperative complications and intraoperative variables such as the use of drains, vacuum assisted closure therapy, and flap surgery. The overall revision rate in our cohort was 11.5% (22 of 191 patients). Bivariate analysis showed that patients who underwent revision surgery were more frequently women (P = .004), more often had a history of ipsilateral (P = .020) or contralateral (P = .012) olecranon bursitis, and more often received a diagnosis of rheumatoid arthritis (P = .001) or diabetes mellitus (P = .019). The most common complications were delayed wound healing (n = 8, 4.2%) and osteomyelitis (n = 8, 4.2%). Flap surgery was performed in 5 patients (2.6%). Bivariate analysis showed that patients with rheumatoid arthritis underwent flap surgery more frequently (P = .011). The revision rate after bursectomy for olecranon bursitis was 11.5% (22 of 191 patients). Patients with rheumatoid arthritis, diabetes mellitus, or a history of ipsilateral and contralateral olecranon bursitis and female patients underwent revision surgery after bursectomy for olecranon bursitis more frequently. In addition, patients with rheumatoid arthritis underwent flap surgery after bursectomy more frequently.

Comparative Study between Treatment by Vacuum-Assisted Closure (VAC), Treatment by Hyperbaric Oxygen Therapy and Traditional Treatment of Diabetic Foot Infection

Aim: To compare the therapeutic effects of vacuum-assisted closure therapy, hyperbaric oxygen therapy, and traditional moist dressings in improving the healing process of chronic diabetic foot infection. Study design: A prospective randomized study. Patients and Methods: A total of 75 patients, with a chronic diabetic foot infection, were included in this study. After surgical debridement, all patients were randomly classified into 3 groups, with 25 patients in each group. Group A were treated by VAC therapy, Group B were treated by HBOT and Group C were treated by traditional moist dressings respectively. Wounds were evaluated every week for six weeks as regards the size, timing of healthy granulation tissue formation, local wound complications, and number of debridement sessions. Results: There was a significant reduction in the wound size in group A with a mean of 70.25 %, B with 62.65 % compared to group C with 32.46 %. As regards healthy granulation tissue formation onset, it was more rapid in group A with a mean of 6.5, B with 7 compared to group C with 14 days. As regards the number of debridement sessions and local wound complications they were significantly less in group A than the other two groups. Conclusion: Vacuum-assisted closure (VAC) therapy appears to be safe, more effective with less complications than the other two methods in the treatment of diabetic foot infection, and can be used with HBOT simultaneously if indicated.

Comparative Study between Treatment by Vacuum-Assisted Closure (VAC), Treatment by Hyperbaric Oxygen Therapy and Traditional Treatment of Diabetic Foot Infection

Aim: To compare the therapeutic effects of vacuum-assisted closure therapy, hyperbaric oxygen therapy, and traditional moist dressings in improving the healing process of chronic diabetic foot infection. Study design: A prospective randomized study. Patients and Methods: A total of 75 patients, with a chronic diabetic foot infection, were included in this study. After surgical debridement, all patients were randomly classified into 3 groups, with 25 patients in each group. Group A were treated by VAC therapy, Group B were treated by HBOT and Group C were treated by traditional moist dressings respectively. Wounds were evaluated every week for six weeks as regards the size, timing of healthy granulation tissue formation, local wound complications, and number of debridement sessions. Results: There was a significant reduction in the wound size in group A with a mean of 70.25 %, B with 62.65 % compared to group C with 32.46 %. As regards healthy granulation tissue formation onset, it was more rapid in group A with a mean of 6.5, B with 7 compared to group C with 14 days. As regards the number of debridement sessions and local wound complications they were significantly less in group A than the other two groups. Conclusion: Vacuum-assisted closure (VAC) therapy appears to be safe, more effective with less complications than the other two methods in the treatment of diabetic foot infection, and can be used with HBOT simultaneously if indicated.

OUTCOMES OF VAC VERSUS CONVENTIONAL DRESSING IN MANAGEMENT OF DIABETIC FOOT ULCER

Background: Foot wounds in people with diabetes mellitus (DM) are common and serious global health issue. Negative pressure wound therapy can be used to treat these wounds and a clear and current overview of current evidence is required to facilitate decision-making regarding its use. Objective: To assess the efficacy of vacuum assisted closure dressings as compared to conventional moist wound dressings in improving the healing process in diabetic foot wounds. Patients and methods: This prospective randomized comparative study was conducted in the General and Vascular Surgery Departments at Al-Azhar university hospitals and Al-Ahrar teaching hospital, in the period from January 2019 to May 2020. The study included 30 patients randomized into two equal groups: VAC therapy and conventional dressing suffering from diabetic foot wounds. All chronic wounds where conventional dressings indicated were included in the study. Results: Wound bed showed signs of healing by granulation tissue formation in 11 among 15 patients (73.3%) in VAC therapy group. In conventional treatment, 4 showed granulation among 15 patients (26.7%) one week after initiation of treatment. (P=0.01). There was a statistically significant difference between average granulation as % of ulcer area and it was significantly high in vacuum dressing. It was 50.2 ± 18.9 in Conventional treatment compared with 77.4 ± 19.3 in NPWT group (p- value = 0.005). Also, at the end of the study, we found that the total mean cost in conventional dressing group was 1993 ± 193 EP compared to 2261 ± 183 EP in VAC group. There was a difference in the total cost finally. Being higher in cost, VAC therapy although has a shorter hospital stay and faster healing time in comparison with conventional dressing. Conclusion: Negative pressure wound therapy (NPWT) using vacuum-assisted closure (VAC) was more efficacious than conventional therapy in the management of foot ulcers in diabetic patients. Hospital stay was significantly shorter in NPWT patients, so less consuming of hospital service than conventional dressing. This is finally decreasing the total budget to the hospital.

Vacuum assisted closure system in the management of postoperative complex enterocutaneous fistulae: Postoperative Cohort Study‎

Background: There is controversy in the use of vacuum assisted closure therapy (VAC) in management of enterocutaneous fistula (ECF). Due to the increased risk of new fistula formation, its use was contraindicated, but then several studies reported successful closure, fistula effluent control and healing of excoriated skin by keeping it dry. Objectives: The aim of this study is to evaluate the efficacy of VAC in treatment of the complex postoperative ECF. Patient and Methods: Patients with postoperative ECF were enrolled in this prospective study in the period from January 2018 to June 2019. Full history, examination and investigations were done for all patients. Patients had VAC. After one month, responses to VAC in terms of time from fistula to VAC, general condition, fistula output, fistula closure, wound size, skin condition, time to start oral feeding, need to segregate, complications and mortality were recorded. On follow-up, time to complete closure, type of closure and cost were recorded. Results were then analyzed. Results: 60 patients with ECF were enrolled. General condition was improved in 32 patients while ECF output was improved in 52 patients. Early start of Oral feeding had occurred with the use of VAC. Complications as pain, new fistula formation, pulmonary embolism or ongoing sepsis occurred in 40 patients while mortality occurred in 12 patients. Conclusion: VAC is feasible in complex postoperative enterocutaneous fistulae. It enhances the survival, improves the general condition and the perifistular skin and reduces the fistula output and wound size.

Bilateral-pectoral major muscle advancement flap combined with vacuum-assisted closure therapy for the treatment of deep sternal wound infections after cardiac surgery

ObjectivesThe median sternotomy is the most common surgical approach for cardiac surgery. Deep sternal wound infection is a fatal complication after median sternotomy. The aim of this study was to evaluate the therapeutic effect of Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy on rehabilitation for the treatment of deep sternal wound infection after cardiac surgery.MethodsBetween January 2016 to January 2018, 21 patients (10 males, 11 females) with deep sternal wound infection after cardiac surgery underwent Bilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy. These patients were followed-up 12 months postoperative. The patient characteristics, duration of vacuum-assisted closure therapy, the mean hospital stay, postoperative complications, long-term survival of patients were retrospectively analyzed.ResultsMost patients undergone 1–3 times vacuum-assisted closure treatment sessions before closure. All patients were cured to discharge, the mean hospital stay was 21.1 days. Most patients’ healing wounds were first-stage healing, only one patient’s wound was second-stage healing, none was third-stage healing. One patient developed pulmonary infection and respiratory failure during the 12-month follow-up. None of the patients died during follow-up.ConclusionsBilateral-pectoral major muscle advancement flap combined with Vacuum-assisted closure therapy for the treatment of deep sternal wound infections after cardiac surgery can shorten the hospital stays and few complications. However, this is a retrospective case series presentation with no comparison group, the number of inferences is limited, so further large-scale controlled studies are needed.

Use of cord blood platelet gel to enhance healing of deep surgical site dehiscences after peripheral bypass.

Surgical site dehiscence after lower limb revascularization through bypass represents a serious postoperative complication, especially in diabetic and obese patients, with subsequent risk of early graft failure, infection, sepsis, hemorrhage, major amputation and sometimes death. To prevent bypass exposure and subsequent complications, physicians recur to reoperation, antibiotic therapy, advanced dressing and vacuum-assisted closure therapy. To improve the process of wound healing, cord blood platelet gelcan be used to fill deep and large wounds. Growth factors released from platelets in the cord blood platelet gel stimulate the process of healing and allow patients to be followed up in Outpatient Surgery, thus reducing hospital stay and costs, while providing excellent results.

Management of chronic seromas: A novel surgical approach with the use of vacuum assisted closure therapy.

Postoperative seroma is a common complication of many surgical procedures in which anatomical dead space has been created. A particular case of lesion in which seroma occurs is the Morel-Lavallée lesion (MLL), which is an uncommon closed soft-tissue degloving injury that develops after high-energy trauma or crush injury where shearing forces separate the subcutaneous tissue from the underlying fascia. The diagnostic evaluation begins with an adequate history and physical examination, followed by instrumental research with ultrasonography, computed tomography, and magnetic resonance imaging. Postoperative seromas and MLLs share a similar pathology and natural evolution as both injuries, once chronic, develop a pseudobursa; thus, the authors think that the same treatment algorithm may be suitable for both the lesions. Several strategies for the treatment of post-surgical and post-traumatic seromas have been described in the literature, ranging from conservative measures for acute and small injuries to surgical management and sclerotherapy for chronic and large ones. Despite some seromas resolving with conventional management, lesion recurrence is a matter of concern. The authors present their experience in the treatment of both post-surgical and post-traumatic chronic seromas not responsive to conservative treatments by surgical drainage of the seroma, capsulectomy, and application of vacuum-assisted closure therapy to allow granulation tissue formation, dead spaces obliteration, and wound healing. Primary wound closure with closed suction drain placement and an elastic compression bandaging are finally performed. From 2014 to 2019, a total of 15 patients (9 females and 6 males) were treated for recurrent chronic seromas with the proposed surgical approach. Five cases were MLLs, while 10 cases were postoperative seromas. The patients were between 33 and 79 years old, and they were followed up at 4 weeks and 3 and 6 months after surgery. All 15 patients with chronic seromas not responsive to conservative treatment showed a complete resolution of the lesions with the proposed treatment approach with no evidence of lesion recurrence, proving its effectiveness.

A case of refractory massive morel lavallee lesion of the thigh: Pitfalls in diagnosis, management and the role of vac therapy

Morel-Lavallee lesion has been described as a post-traumatic soft tissue degloving injury. It is commonly seen in association with road traffic accidents or sports injuries where there is separation of the hypodermis layer from the deeper fascia caused by a shearing force. These injuries occur around the mid-torso, specifically at the flank, lumbar spine, scapula, buttocks and the knee but are most commonly seen over the greater trochanter. There is a complex serosanguinous fluid collection containing blood, lymph and necrotic material within the separated tissue planes. Various treatment modalities like compression bandaging, sclerodesis, percutaneous aspiration, open debridement, quilting sutures and VAC (vacuum assisted closure) therapy have all been described in literature, however a clear consensus on the management protocol does not exist. Herein we reported a 45 year old gentleman who presented with a persistent fluctuant swelling over his left thigh following a motor vehicle accident. He had a history of multiple aspirations of the collection. Upon presenting to our Institute he underwent incision and drainage with sclerotherapy followed by open drainage and debridement with low suction drains. However on follow up visits there was recurrent swelling over the inferior most dependent aspect of the lesion which was finally managed by VAC therapy. The patient eventually returned to normal activity after 4 months from the initial injury with no residual loss of function. The clinical significance of this case is to emphasize that a high degree of suspicion and early use of imaging modalities like MRI in suspected patients are essential to provide timely and appropriate treatment. We also aim to discuss the efficacy of various forms of treatment as per the available literature which shows that a low threshold for operative management is associated with lower recurrence and complication rates.

Management of the Postsurgical Lower Extremity Groin Wounds and Secondary Lymphatic Disorders

Background and Aims: Delayed wound closure and secondary lymphatic problems prolong hospital stay. The femoral exposure is one of the most commonly used access way for the cardiac and peripheral vascular surgery. In this study, we investigated the effect of vacuum-assisted closure (VAK) treatments on the recovery time in non-healing groin wounds after femoral vessel exposure and secondary lymphatic problems in the lower extremity. Materials and Methods: In this retrospective study, we examined 335 patients hospital records who had groin incision for access to femoral vessels in major vascular surgeries performed in our clinic in the last two years. We observed non healing inguinal wounds and lymphatic problems such as secondary lymphorrhea, lymphocele or lymphedema in 32 of these patiens (9.5%). The patients with insufficient wound healing in the first 10 days postoperatively and associated lymphatic disorders were primarily treated with surgical debridement of the femoral incision, ligation of lymphatics and removal of lymphocele. Afterwards, only surgical debridement and wound care was used in 16 patients (Group 1) and additional to these therapies vacuum assisted closure (VAC) device used in 16 patients (Group 2). Demographic data, risk factors and duration of the treatment for wound healing in both groups were compared. Results: There was no difference in demographic characteristics between groups. When comorbid diseases were compared, there were no difference between the groups. There was no difference with regard to etiological risk factors for wound site complications such as prosthetic grafts in the femoral region, hypoalbuminemia, recurrent operations. But there was more obese patients in Group 2. The mean wound healing time was shorter in Group 2 but it was not statistically significant. Conclusion: The basic treatment of postsurgical secondary lymphedema and groin wound healing problem is debridement and optimal surgical wound care. VAC usage enhances the drainage of the lymphatic flow of lower extremity and strengthen wound base by granulation tissue formation. VAC therapy may be an effective therapeutic option to accelerate healing of lower extremity femoral wounds and secondary lymphedema.

Surgical treatment of diastasis recti: the importance of an overall view of the problem.

Diastasis recti (DR) is characterized by an alteration of the linea alba with increased inter-recti distance (IRD). It is more frequent in females, and when symptomatic or associated with midline hernia it needs to be surgically repaired. This retrospective study aims to demonstrate how an overall approach to DR leads to good results in terms of functional and morphological outcomes and quality of life (QoL). From January 2018 to December 2019, 94 patients were operated for DR > 50mm, with or without midline hernias. Three different surgical approaches were used: complete laparoabdominoplasty, laparominiabdominoplasty and minimally invasive (endoscopic) technique. QoL was assessed with the EuraHS-QoL tool. All patients were female except two males. We performed 26 endoscopic treatments (27.7%), 39 laparoabdominoplasties (41.5%) and 29 laparominiabdominoplasties (umbilical float procedure) (30.9%). The total median operative time was 160min. No intraoperative complications were registered. In three (4.2%) cases, major surgical complications occurred, all after open operations. In 13 open surgery cases, vacuum-assisted closure (VAC) therapy was used to repair the cutaneous ischemic defect. No recurrence was registered to date. Minimally invasive surgery showed fewer complications and lower hospital stay than the open approach. The QoL was significantly improved. Our experience shows the importance of an overall view of the functional and cosmetic impairment created by DR. The surgeon should obtain an optimal repair of the function, by open or minimally invasive surgery, also considering the morphological aspects, which are very important for the patients in terms of QoL.

A low incidence of perineal hernia when using a biological mesh after extralevator abdominoperineal excision with or without pelvic exenteration or distal sacral resection in locally advanced rectal cancer patients

BackgroundExtralevator abdominoperineal excision (ELAPE), abdominoperineal excision (APE) or pelvic exenteration (PE) with or without sacral resection (SR) for locally advanced rectal cancer leaves a significant defect in the pelvic floor. At first, this defect was closed primarily. To prevent perineal hernias, the use of a biological mesh to restore the pelvic floor has been increasing. The aim of this study, was to evaluate the outcome of the use of a biological mesh after ELAPE, APE or PE with/without SR.MethodsA retrospective study was conducted on patients who had ELAPE, APE or PE with/without SR with a biological mesh (Permacol™) for pelvic reconstruction in rectal cancer in our center between January 2012 and April 2015. The endpoints were the incidence of perineal herniation and wound healing complications.ResultsData of 35 consecutive patients [22 men, 13 women; mean age 62 years (range 31–77 years)] were reviewed. Median follow-up was 24 months (range 0.4–64 months). Perineal hernia was reported in 3 patients (8.6%), and was asymptomatic in 2 of them. The perineal wound healed within 3 months in 37.1% (n = 13), within 6 months in 51.4% (n = 18) and within 1 year in 62.9% (n = 22). In 17.1% (n = 6), the wound healed after 1 year. It was not possible to confirm perineal wound healing in the remaining 7 patients (20.0%) due to death or loss to follow-up. Wound dehiscence was reported in 18 patients (51.4%), 9 of whom needed vacuum-assisted closure therapy, surgical closure or a flap reconstruction.ConclusionsClosure of the perineal wound after (EL)APE with a biological mesh is associated with a low incidence of perineal hernia. Wound healing complications in this high-risk group of patients are comparable to those reported in the literature.

The use of negative pressure therapy for the treatment Of lower-extremity wounds.

Abstract Background: lower extremity wounds with exposed bone, tendon or orthopedic hardware present a difficult treatment challenge. Objective: The purpose of this study is to assess the role of the vacuum assisted closure (VAC) therapy in the management of lower extremity wounds. Material and methods: A prospective analytic cohort study was conducted among 15 patient referred for reconstruction of lower extremity wounds. The study was conducted between January 2019 to June 2019. The wounds were inspected, surgical debridement was done if needed, and the VAC dressings were changed every 72 hours. Primary outcome was wound healing and granulation tissue formation. Secondary outcome was wound infection and wound size. Results: Vacuum- assisted closure therapy greatly decrease the surface area of the wound. Profuse granulation tissue formed rapidly, covering the bone and hardware. There was no statistically significant difference between the included patients regarding the pattern of wound infection pre and after negative pressure therapy (p=0.655). Results were both functionally and aesthetically satisfactory. Conclusion: VAC therapy appears to be a simple and more effective than conventional dressings for the management of difficult wound in terms of reduction in wound volume, depth, treatment duration and cost minimize the number of local and free-flap transfers.

Management of Wounds with Exposed Bones or Tendons in Children by Vacuum-Assisted Closure Therapy: A Prospective Study.

Background The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children. Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children. Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018. Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment. Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population.

Comparison of Standard Open Wound Care and Vacuum-assisted Closure Therapy in Fournier’s Gangrene

Comparison of Standard Open Wound Care and Vacuum-assisted Closure Therapy in Fournier’s Gangrene

Vacuum-assisted closure vs. bilateral pectoralis major muscle flaps for deep sternal wounds infection.

BackgroundDeep sternal wound infection (DSWI) is a life-threatening complication after cardiac surgery. The aim of this study was to retrospectively evaluate the outcomes of reconstructing infected poststernotomy wounds with either vacuum-assisted closure (VAC) after previous debridement or bilateral pectoralis major muscle flaps (BPMMFs).MethodsIn total, 565 patients with postoperative DSWI were enrolled in this study from January 1, 2014, to June 1, 2018. Of these patients, 247 received BPMMFs. To address the indicated biases, a 1:1 propensity score-matched cohort was created based on age, body mass index, preoperative diabetes mellitus, chronic obstructive pulmonary disease (COPD), internal thoracic artery grafting (ITAG), type of cardiac surgery, time before treatment for DSWI and wound classification. After matching, 132 patients who had similar risk profiles were enrolled in the study population (66 in the VAC group: 66 in the BPMMF group).ResultsAt 21.9±12.1 (median: 24, IQR: 14–28) months of follow-up, the survival rate was 93.9% in the BPMMF group and 74.4% in the VAC group (P<0.01). Compared with the VAC group, the BPMMF group had a significantly decreased length of hospital stay (P<0.01). At the spirometry assessment, the forced expiratory volume in the 1st second (FEV1), vital capacity (VC), and FEV1/VC ratio showed no significant differences in survival between the VAC group and BPMMF group.ConclusionsIn our study, compared with VAC therapy, BPMMFs guaranteed better early- and late-term outcomes, as shown by less length of hospital stay, a higher rate of long-term survival and unimpaired respiratory function.

Multidisciplinary treatment of a complicated crural degloving injury in a diabetic patient

Diabetes is a common disease that potentially interferes with healing processes after lower limb trauma. In our presented case a trimalleolar ankle fracture with undiscovered serious soft-tissue injuries resulted in chronic soft-tissue complications in a diabetic patient, requiring three and a half months of hospitalization in a higher level center and the application of state-of-the-art wound treatment, including vacuum-assisted closure therapy, Integra bioengineered skin substitute, split-thickness skin-grafting, and methods enhancing wound healing, such as polarized light therapy and transdermal CO2 delivery. The presented case emphasizes the importance of soft-tissue care and multidisciplinary approach in diabetic trauma patients with poor compliance.

Low-cost vacuum assisted closure therapy for extensive musculoskeletal trauma and infection: Outcomes, efficacy and limitations

Low-cost vacuum assisted closure therapy for extensive musculoskeletal trauma and infection: Outcomes, efficacy and limitations

Feasibility of vessel sealing devices in surgical excision of vascular malformations– novel approach

IntroductionVascular malformations are localized defects in vascular morphogenesis that are believed to be caused by dysfunction in embryogenesis and vasculogenesis. However, with the development of new vessel sealing devices, surgical removal of the vascular malformations can be safely undertaken. The aim of this study was to test the feasibility of vessel sealing devices in the complete excision of vascular malformations. MethodsWe retrospectively analyzed medical records of all patients with vascular malformation who underwent a surgical excision of vascular malformations at our institution from January 2015 to June 2018. All patients were followed up after 1 week; 1, 3, 6 months; and 1 year. ResultsWe assessed 14 patients with vascular malformation (median age, 21 years; malformation: arteriovenous, n = 5; venous, n = 7; lymphatic, n = 1; and combined, n = 1). These vascular malformations were localized in the right lower (n = 5) and left upper (n = 3) limbs, right upper limb (n = 2), head and neck (n = 3), and chest wall (n = 1). Using vessel sealing instruments, the nidus in AVM was excised, and complete excision of vascular malformations was achieved without depriving the skin of dermal blood supply. One patient died three weeks later due to secondary hemorrhage. Complication related to gangrenous skin over the patella was healed by vacuum-assisted closure therapy. Post-excision MRI after 18 months suggested recurrence in one patient. ConclusionThe use of vessel sealing devices was found to be feasible, for surgical excision of vascular malformations. However, further evidence from larger studies, prefereably randomized controlled trials, is required to support the routine use of these devices.