Vacuum-assisted Closure Treatment Research Articles

Removal of Spinal Instrumentation Is Not Required to Successfully Treat Postoperative Wound Infections in Most Cases.

Controversy exists regarding whether spinal implants need to be removed to treat postoperative deep wound infections (DWIs). This retrospective study aimed to determine whether the removal or retention of implants impacts the successful treatment of a DWIafter spine surgery. Postoperative spine surgery patients presenting with signs of infection who underwent irrigation and debridement (I&D) at Twin Cities Spine Surgeons at Abbott Northwestern Hospital, Minnesota, USA, were studied. First, the persistence of infection when implants were retained or removed was assessed. Second, we analyzed the persistence of infection with respect to the number of I&D, the use of vacuum-assisted closure (VAC) treatment, pseudoarthrosis status, and functional outcomes. One hundred thirty-five patients were included. Treatment of infection with retention of implants occurred in 64% (87/135); of these, 7% (6/87) had a persistent infection. Of patients with implant removal (36%, 48/135), 6% (3/48) had a persistent infection. Thus, we observed no difference between treatment with implants present compared to implants removed (p = 1.0). Fifty of the 135 patients (37%) received I&D and primary wound closure, and 85 (63%) patients received I&D and VACtreatment. There was no statistical difference between primary wound closure and VAC treatment (p = 0.15) with respect to persistence. Repeat I&D with VAC (three or more times) had a significantly lower rate of recurrence than those with two I&Ds. Pseudoarthrosis and persistent infection were unrelated. At minimum one-year follow-up, achieving a minimum clinically important difference in functional outcome was independent of persistent infection status. Persistent infection was unrelated to the retention of implants. When VAC treatment was deemed necessary, more than two I&Ds resulted in a significantly better cure for infection. Those with a persistent infection were no more likely to exhibit pseudoarthrosis than those with no persistent infection. All patients showed improvement in functional outcomes at minimum one-year follow-up.

Comparative study between vacuum-assisted closure therapy and tetra-silver nitrate in the management of diabetic foot ulcer

Background Diabetes-related foot ulcers are becoming more common. The percentage range is 15 to 25%. Several procedures and dressing agents have been investigated. In the vacuum-assisted closure technique, sub-atmospheric pressure is employed to accelerate the healing process. Aim and objectives In this study, the healing rates of diabetic foot ulcers (DFUs) treated with tetra-silver nitrate dressing were compared with those treated with negative pressure wound care. Patients and methods More than 30 patients were randomly allocated to one of two study groups by the Vascular Surgery department at Aswan University Medical School. Group A received a vacuum-assisted closure (VAC) dressing for a total of 30 patients, while group B received tetra-silver nitrate. Result After 6 weeks, there was a statistically significant difference in wound-healing rates between the two groups. Conclusion Patients who got VAC developed granulation tissue faster than those who received tetra-silver nitrate. VAC treatment is safe and effective in diabetic foot ulcers. Granulation tissue formation accelerates healing and reduces the risk of problems such as infection or amputation.

A Very Rare Pathogen of Osteomyelitis: Alcaligenes faecalis.

To the Editors: Alcaligenes faecalis is a Gram-negative, rod-shaped, oxidase-positive, catalase-positive, obligate aerobic, motile and nonfermenting bacteria.1 It is commonly found in the environment (soil or water) and in the human gut.2A. faecalis has been associated with various infections such as bacteremia, meningitis, endophthalmitis, endocarditis, skin and soft tissue infections, urinary tract infections, peritonitis, otitis media and pneumonia.3 Here, we present 2 patients with osteomyelitis due to A. faecalis, a rarely reported clinical condition in the literature. Patient 1: An 18-year-old female with a medical history of operated for meningomyelocele and pes cavus was admitted with worsening pain in her right lower extremity. On admission, she was afebrile with normal vital signs there was a chronic ulcerated wound with seropurulent discharge on the right foot. On the laboratory evaluation, there was no leukocytosis, C-reactive protein, and procalcitonin were negative, erythrocyte sedimentation rate was 35 mm/h. Clindamycin 30 mg/kg/d and cefotaxime 200 mg/kg/d intravenously (IV) were administered empirically. The contrast-enhanced magnetic resonance imaging showed cellulitis in soft tissue and osteomyelitis in the bone at the level of the 5th finger metatarsal base and proximal shaft (Fig. 1). Wound debridement was performed by orthopedics. She developed emesis and rash on day 4 and the antibiotic was changed to IV ciprofloxacin (30 mg/kg/d). Intraoperative wound culture grew A. faecalis which was sensitive to ampicillin, cefotaxime and gentamicin. Due to clinical improvement, treatment with ciprofloxacin continued and she was discharged after 15 days of IV therapy. The total treatment is planned to be completed in 8 weeks.FIGURE 1.: MRI (T2 weighted) showing osteomyelitis of the right foot. MRI indicates magnetic resonance imaging.Patient 2: A 15-year-old girl presented with a chronic ulcerated wound on her right foot. She had been operated twice for meningomyelocele and had pes planovalgus. She was afebrile and there was a chronic wound without any discharge on her right foot on admission. Laboratory evaluation revealed negative acute phase reactants and erythrocyte sedimentation rate was 24 mm/h. The empirical treatment was administered as IV cefotaxime and clindamycin. The contrast-enhanced magnetic resonance imaging showed findings suggestive of active osteomyelitis on the right calcaneus (Fig. 1). Orthopedics performed wound debridement and inserted vacuum-assisted closure therapy system. A. faecalis growth was detected in the tissue culture which was sensitive to ceftazidime and meropenem but resistant to amikacin. Her treatment was changed to IV ceftazidime (150 mg/kg/d). After vacuum-assisted closure treatment, it was planned to perform tissue repair by plastic surgery and to continue antibiotherapy IV due to the resistance pattern of the microorganism. Opportunistic infections and antimicrobial resistance associated with A. faecalis have been reported but osteomyelitis due to A. faecalis was documented in a few patients with diabetic foot ulcers in the literature.4 It is usually sensitive to beta-lactam antibiotics and trimethoprim/sulfamethoxazole and resistant to aminoglycosides and tetracyclines.5 Most of the previously documented cases have been successfully treated with amoxicillin/clavulanic acid but antibiotic resistance is an emerging problem. In summary, we present 2 patients with osteomyelitis due to A. faecalis, a rare cause of osteomyelitis. In addition to surgery, medical treatment should be arranged based on the antibiotic susceptibility results for successful and appropriate treatment.

Vacuum-assisted closure (VAC) treatment in thoracic surgery infections: A single-center experience

Vacuum-assisted closure (VAC) treatment in thoracic surgery infections: A single-center experience

Outcome of vacuum assisted dressing in open comminuted tibial fracture with primary fixation

Background/Aim: Wound management of the compound open tibia (Gustilo-Anderson grade 2, 3a, 3b) is complicated by a higher infection and the problem of adequate soft tissue coverage is significant. Primary wound closure is not easily advisable in these types of compound open tibial fractures. Early tissue flap or graft procedure might increase the complication rate due to temporary graft rejection and wound infections. The aim of this study was to analyse the duration required for formation of healthy granulation tissue, duration required for making wound fit for skin cover procedure and duration of hospital stay in compound open tibia fracture treated with vacuum assisted closure (VAC). Methods: A prospective interventional study of 22 patients aged 18 to 60 years was done. After assessing the size of the wound, primary bone fixation and wound debridement were carried out as soon as possible and then VAC was applied. Assessment of VAC therapy was based on mean decreases in wound size and "modified Johner and Wruh's criteria", used for assessment of the functional outcome of tibial shaft fracture was recorded during each follow-up. Results: Twenty two patients suffered comminuted open fractures of tibia-fibula. Primary fixation of bone were done with vacuum dressing. During follow-up, the good decrease in wound size considering vacuum dressing remedy was once 18.75 ± 18.36 cm2 (p = 0.001). Six patients achieved excellent results according to "modified Johner and Wruh's criteria" of tibial shaft fracture. Conclusion: This technique effectively reduced wound size, accelerated the formation of healthy granulation tissue of wound with open fracture bone and provided a better functional outcome. The VAC treatment had suggestively increased wound closure rate, decreased morbidity and costs for patients.

Antibiotic-loaded Bone Cement Combined with Vacuum-assisted Closure Facilitating Wound Healing in Wagner 3-4 Diabetic Foot Ulcers.

This study explored the clinical effectiveness of antibiotic-loaded bone cement (ALBC) combined with vacuum-assisted closure (VAC) on the treatment of Wagner 3-4 diabetic foot ulcers (DFUs). This is a retrospective study, including 32 patients with Wagner 3-4 DFUs who had undergone treatment between August 2019 and June 2021. Patient age, sex, Hemoglobin A1c (HbA1c), body mass index (BMI), ankle brachial index (ABI), white blood cells (WBC), C-reactive protein (CRP) levels, comorbidities and wound closure methods were recorded. Patients were divided into the study group and control group according to the treatment modality. Patients in the study group received the combination treatment of ALBC and VAC, while patients in the control group received single VAC treatment. Clinical endpoints were assessed and compared between the two groups, including wound complete healing time and complications after operation. All patients were followed-up 6 months postoperation. Results showed that the mean healing time of the study group (44.20 ± 16.72 days) was shorter than that of the control group (64.00 ± 29.85 days) (P < .05). The infection rate of the study group on the 10th day postoperation was lower than that of the control group (6.67%, 47.06%, P < .05). And there were no significant statistical differences between the two groups in terms of bleeding and necrosis complications postoperation (P = .603, P = .603). Based on the findings, we conclude that the application of ALBC combined with VAC can facilitate wound healing in Wagner 3-4 DFUs patients. It can help to control wound infections and shorten wound healing time.

Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis—the VACOR trial: protocol for a randomised controlled trial

BackgroundSecondary peritonitis is a severe condition with a 20–32% reported mortality. The accepted treatment modalities are vacuum-assisted closure (VAC) or primary closure with relaparotomy on-demand (ROD). However, no randomised controlled trial has been completed to compare the two methods potential benefits and disadvantages.MethodsThis study will be a randomised controlled multicentre trial, including patients aged 18 years or older with purulent or faecal peritonitis confined to at least two of the four abdominal quadrants originating from the small intestine, colon, or rectum. Randomisation will be web-based to either primary closure with ROD or VAC in blocks of 2, 4, and 6. The primary endpoint is peritonitis-related complications within 30 or 90 days and one year after index operation. Secondary outcomes are comprehensive complication index (CCI) and mortality after 30 or 90 days and one year; quality of life assessment by (SF-36) after three and 12 months, the development of incisional hernia after 12 months assessed by clinical examination and CT-scanning and healthcare resource utilisation. With an estimated superiority of 15% in the primary outcome for VAC, 340 patients must be included. Hospitals in Denmark and Europe will be invited to participate.DiscussionThere is no robust evidence for choosing either open abdomen with VAC treatment or primary closure with relaparotomy on-demand in patients with secondary peritonitis. The present study has the potential to answer this important clinical question.Trial RegistrationThe study protocol has been registered at clinicaltrials.gov (NCT03932461). Protocol version 1.0, 9 January 2022.

The importance of the scoring system in Fournier's gangrene.

The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier's gangrene (FG) and develop methods to increase the survival rate. We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taşçıoğlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species. The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively. Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

Management of Chronic Wounds

Chronic wounds are challenging for both the practitioner and the patient. These wounds often cause pain and lead to unemployment, social activity disruption, and quality of life issues for the patient. As the world population advances in age and increases in body mass index, there has been an increase in diabetes and venous insufficiency, ultimately resulting in a rise in the number of patients with chronic wounds. This review covers disease definition, wound-healing necessities, treatment options for management of chronic wounds, special wound care considerations, and investigational therapies. Figures show distribution of chronic wound etiologies, vacuum-assisted closure treatment of chronic wounds, chronic arterial ulcer of the medial foot, a step-wise application of a multilayer compression dressing, and four stages of pressure ulcers. Tables list known causes of tissue hypoxia, types of débridement, common dressings used in chronic wounds, and stages of a pressure ulcer. This review contains 5 highly rendered figures, 4 tables, and 99 references

Management of Chronic Wounds

Chronic wounds are challenging for both the practitioner and the patient. These wounds often cause pain and lead to unemployment, social activity disruption, and quality of life issues for the patient. As the world population advances in age and increases in body mass index, there has been an increase in diabetes and venous insufficiency, ultimately resulting in a rise in the number of patients with chronic wounds. This review covers disease definition, wound-healing necessities, treatment options for management of chronic wounds, special wound care considerations, and investigational therapies. Figures show distribution of chronic wound etiologies, vacuum-assisted closure treatment of chronic wounds, chronic arterial ulcer of the medial foot, a step-wise application of a multilayer compression dressing, and four stages of pressure ulcers. Tables list known causes of tissue hypoxia, types of débridement, common dressings used in chronic wounds, and stages of a pressure ulcer. This review contains 5 highly rendered figures, 4 tables, and 99 references

Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China.

PurposeSurgical drainage is an essential part of treatment for deep neck infections (DNIs) or deep neck multiple-space infections (DNMIs). With the emergence and application of new technologies and new materials, vacuum-assisted closure (VAC) in the treatment of DNMIs has been reported. However, reports on the timing of VAC placement are limited. Herein, we compared simultaneous versus staged VAC placement in the treatment of DNMIs.Patients and MethodsMedical data from 24 patients with DNMIs who had received VAC treatment in the last five years were analyzed. The patients were classified into a simultaneous VAC placement group (11 patients) and a staged VAC placement group (13 patients) according to the timing of VAC placement when incision and drainage were performed.ResultsNo differences in baseline characteristics were found between the two groups. All patients in the two groups survived and recovered. The hospitalization duration (days), time to wound healing (days), number of debridement procedures, and disease course (days) in the simultaneous VAC placement group and staged VAC placement group were 10 (4–18) and 22 (8–35), 21 (4–39) and 50 (9–86), one (1–2) and two (1–4), and 31.5 (11–49) and 56 (19–98), respectively. The results in the simultaneous VAC placement group were better than those in the staged VAC placement group (P = 0.001, 0.016, 0.045, and 0.016, respectively). The numbers of VAC sponge changes in the simultaneous VAC placement group and staged VAC placement group were two (1–2) and two (1–4), respectively, with no statistically significant difference (P = 0.336).ConclusionSimultaneous VAC placement during incision and drainage may shorten the wound healing time, hospitalization duration, and disease course and may reduce the number of debridement procedures.

Vacuum-assisted closure combined with a closed suction irrigation system for treating post-traumatic raw area

Background: Post traumatic raw area is a very troublesome condition to treat which requires long term regular dressings, higher antibiotics and close monitoring of patient vitals. This study evaluates the efficacy of modified Vacuum-assisted closure (VAC) combined with a closed suction irrigation system for treating an post-traumatic wound and infection. Methods: We conducted a retrospective study of 20 patients with post-traumatic raw areas from 2020 to 2021 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound can be closed secondarily. Detailed information was obtained from the medical records. Results: Reduction in wound size was significant after 1 week of VAC with CSIS treatment. The patients had excellent wound beds after an average of 3 -6 days(1 or 2 cycles of VAC with CSIS) All wounds healed completely and were infection free after an average of 15 days, and the average hospital stay was 22 days. Wounds remained infection free after coverage. Conclusions: This study shows that VAC combined with a CSIS is a superior method to treat raw areas compared to conventional VAC. This improved VAC procedure provides an excellent granulation to facilitate wound healing, hasten closure and shorten the hospital stay.

Is vacuum-assisted closure therapy feasible for children with deep sternal wound infection after cardiac surgery? The pooling results from current literature.

Vacuum-assisted closure (VAC) has been used for children with deep sternal wound infections (DSWI); however, the safety and efficiency have not been determined. A meta-analysis was performed for outcomes of VAC therapy in children with DSWI after cardiac surgery. Electronic databases, including PubMed, Scopus, and Cochrane Library CENTRAL were searched systematically from January 1990 to October 2020 for the literature which reported the outcomes of VAC therapy for children with DSWI after cardiac surgery. Meta-regression and subgroup analyses were performed to find risk factors for prolonged length of VAC therapy and hospital stay. Eleven studies were included in this study, involving 217 subjects. VAC therapy was performed due to mediastinitis after congenital heart diseases (CHD) repair. In children with DSWI after cardiac surgery, length of VAC therapy, and hospital stay were 11.1days (95% CI, 9.6-12.5days) and 29.8days (95% CI, 22.8-36.9days), respectively. Incidence of infectious and wound-related complications was 8.5% (95% CI, 4.1%-13.0%). Overall mortality in this setting was 5.8% (95% CI, 2.5%-9.1%). In conclusion, in children with DSWI after cardiac surgery, length of VAC therapy and hospital stay were 11.1 and 29.8days, respectively. Overall mortality was 5.8%. Although not significant, delayed chest closure, complex CHD, and Gram-negative bacilli/fungal infections may potentially contribute to prolonged duration of VAC treatment.

Vacuum-Assisted Closure (Vac) Treatment In Thoracic Surgery: A Single-Center Experience

Vacuum-Assisted Closure (Vac) Treatment In Thoracic Surgery: A Single-Center Experience

Mediastinitis after cardiac surgery: risk factors and our vacuum-assisted closure results.

IntroductionMediastinitis after cardiac surgery is a rare complication, but with high morbidity and mortality.AimTo determine its risk factors and to investigate the efficacy of vacuum-assisted closure (VAC).Material and methodsNine thousand one hundred sixty cases of patients who underwent cardiac surgery during 2010–2017 were reviewed retrospectively. One hundred and twenty-seven patients, the case group, were treated by VAC. Three hundred cases with no diagnosis of mediastinitis were selected as the control group. Both groups’ clinical and demographic characteristics, preoperative variables, and postoperative follow-up parameters were compared. Factors affecting treatment were analyzed.ResultsWe found that the presence of diabetes mellitus, bilateral internal thoracic artery and intra-aortic balloon pump usage are independent risk factors for the development of mediastinitis (p < 0.05). It was found that 74% of tissue cultures were positive and the most common detected organism was Staphylococcus. It was found that many perioperative parameters had a significant effect on the duration of treatment (p < 0.05). However, regression analysis revealed that bacterial growth was the only independent variable in prolonging the treatment period.ConclusionsWe believe that the establishment of perioperative blood glucose regulation, patient selection to use bilateral internal thoracic artery grafts, and maximum attention to sepsis and antisepsis rules in patients who need mechanical support devices such as intra-aortic balloon pump, will significantly reduce the development of mediastinitis. Since we could not find an independent risk factor for the duration of VAC treatment other than culture growth, we think that VAC therapy is successful and safe in the treatment of mediastinitis and should be used more widely.

Vacuum assistance therapy as compared to early reconstructive treatment in deep sternal wound infection.

Background and Aims:Deep sternal wound infection is a major concern after cardiac surgery. This study describes the incidence of postoperative deep sternal wound infections after cardiac surgery and compares two available treatment modalities.Materials and Methods:In Tampere University Hospital, 7973 open heart operations were performed between 2007 and 2016. Patients treated for a postoperative deep sternal wound infection were categorized in two groups based on treatment: revision surgery with early reconstruction (revision group; 74 patients) or vacuum-assisted closure treatment (VAC group; 55 patients). The end points in comparisons were overall mortality and hospitalization time.Results:A total of 129 patients (1.6%) developed a postoperative deep sternal wound infection. The 30-day mortality rates were 8.1% and 3.6%, the 90-day mortality rates were 15.5% and 18.2%, and the 1-year mortality rates were 17.6% and 23.6% for the revision and VAC group, respectively. There was no statistically significant difference in mortality rates. The hospital stay was 18 days in the revision group and 38 days in the VAC group (p < 0.001). The secondary intensive care unit stay was longer in the VAC group (median 1 vs 4, p = 0.011). The most common pathogens isolated in the first reoperation were coagulase-negative staphylococci (33.8% and 41.8%, respectively; p = 0.366), and positive candida findings were more common in the VAC group (4.1% vs 37.0 %, p < 0.001).Conclusion:Vacuum-assisted closure treatment induces an inferior outcome in terms of fungal infections, treatment times, and the number of reoperations.

The Characteristics of Postoperative Mediastinitis During the Changing Phases of Cardiac Surgery

Mediastinitis is a serious complication of open heart surgery associated with high mortality, considerable health care costs, and prolonged hospital stay. We examined characteristics and incidence of mediastinitis during 29 years when indications and patient material have been in a process of change. This was a retrospective population-based study comprising all mediastinitis patients more than 16 years of age after open heart surgery between 1990 and 2018 from a population of 1.7 million. Patient records of 50 mediastinitis patients from 2004 to 2014 were reviewed and compared with 120 patients from 1990 to1999. Annual mediastinitis rate varied 0% to 1.5% with a decreasing trend-from a level exceeding 1.2% to approximately 0.3%-over the study period. In 2004 to 2014 patients with mediastinitis were older, more often smokers, and more often had diabetes mellitus and renal insufficiency than in 1990 to 1999. No difference in length of hospital treatment, antibiotic prophylaxis or treatment, intensive care unit treatment, or mortality was observed between 1990 to 1999 and 2004 to 2014. Coronary artery bypass graft surgery became less common and valve replacement and hybrid operations more common among operations leading to mediastinitis. Staphylococcus aureus increased (from 25% to 56%, p= .005) whereas coagulase-negative staphylococci (46% to 23%, P < .001) and gram-negative bacteria (18% to 12%, P= .033) decreased as causative agents. Surgery for mediastinitis remained similar except introduction of vacuum-assisted closure treatment. The rate of mediastinitis decreased during these 29 years. No difference in 30-day mortality in mediastinitis was seen: 0.9% in 1990 to 1999 and 2% in 2004 to2014.

Efficacy of Endoscopic Vacuum-Assisted Closure Treatment for Postoperative Anastomotic Leak in Gastric Cancer.

Background/AimsEndoscopic vacuum-assisted closure (EVAC) has been attempted as new nonsurgical treatment for anastomotic leakage. We aimed to evaluate the clinical outcomes of EVAC and compare its efficacy with the self-expandable metallic stent (SEMS) for postgastrectomy leakage.MethodsBetween January 2007 and February 2018, 39 patients underwent endoscopic treatment for anastomotic leakage after gastric cancer surgery. Of them, 28 patients were treated with SEMS, seven with EVAC after SEMS failure, and four with EVAC. We retrospectively compared the clinical characteristics and therapeutic outcomes between EVAC (n=11) and SEMS (n=28).ResultsThe median follow-up duration was 17 months (interquartile range, 9 to 26 months) in both groups. In comparison of clinical characteristics between two groups, only the median size of the leak was larger in the EVAC group than in the SEMS group (2.1 cm vs 1.0 cm; p<0.001). All EVAC cases healed successfully; however, two cases (7.1%) failed to heal in the SEMS group. Anastomotic stricture occurred one case (9.1%) in EVAC and four cases (14.3%) in SEMS within 1 year after endoscopic treatment. The median treatment duration of EVAC was shorter than that of SEMS (15 days vs 36 days; p<0.001). Median weight loss after therapy was similar in both groups (8.0 kg in EVAC vs 9.0 kg in SEMS; p=0.356).ConclusionsEVAC can be effective endoscopic treatment for postgastrectomy anastomotic leakage. Substantial leakage could be an important clinical factor for considering EVAC as a treatment option. Large randomized controlled trials are needed to confirm the efficacy of EVAC.

The Vacuum-Assisted Closure Device Increases Value in the Treatment of Gustilo Grade IIIb Open Tibia Fractures in Children.

BackgroundWound management associated with Gustilo grade IIIb open tibia fractures in children often requires muscle flaps, skin grafts, and amputations. The purpose of this study is to report the outcomes and complications of vacuum-assisted closure (VAC) treatment, as well as discuss its role in optimizing value when treating these injuries.MethodsA retrospective review of medical records and imaging studies was performed from 2008-2015. Six pediatric patients with Gustilo grade IIIb fractures managed with the VAC were identified. The time to treatment, frequency of VAC changes, VAC size, and closure attempts, including muscle flaps and skin grafts, were documented. Fracture fixation methods, the incidence of delayed union or nonunion, as well as the occurrence of deep tissue infection and compartment syndrome were detailed.ResultsFive patients were male and one was female with an average age of 12 years (range 8-15 years). All patients sustained a Gustilo IIIb open tibia fracture and were treated with irrigation, debridement, intravenous (IV) antibiotics, fixation, and a VAC as a wound care adjunct. Three patients required both a muscle flap and a skin graft. One patient required a skin graft. There was one case of deep tissue infection. Three patients were treated successfully with the VAC alone and did not require any flap procedures.ConclusionsWound care for Gustilo grade IIIb open tibia fractures in children traditionally involved potentially painful twice-daily dressing changes with solutions such as dilute bleach or iodine. The implementation of VAC markedly reduced the frequency of dressing changes every three days. In the current study, the open wound gradually closed with only a VAC in 50% of Gustilo grade IIIb open pediatric tibia fractures. In summary, the VAC is an adjunct that increases value in the care of pediatric patients with Gustilo grade IIIb open tibia fractures (Value = Outcomes/Cost).Level of evidenceTherapeutic level IV

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.