Vacuum-assisted Closure Research Articles

Comparing vacuum‐assisted closure against conventional approach in severe deep neck infection: A retrospective case‐control study

AbstractObjectivesTo compare the effectiveness of vacuum‐assisted closure (VAC) against traditional drainage technique, using a retrospective case‐control study design, in terms of managing deep neck infections (DNIs).MethodsPatients presenting to Peking Union Medical College Hospital diagnosed with DNIs were recruited in this study. We analyzed the clinical characteristics of DNI patients and divided them into (a) VAC placement group (26 cases) and (b) traditional drainage group (57 cases) according to whether VAC was placed. The differences in length of stay (LOS), wound healing time, and debridement frequency were compared between the two groups.ResultsEighty‐three patients had multiple‐space infections, i.e. infection at two or more sites. The debridement frequency of the VAC group was significantly lower than that of the traditional drainage group (p = 0.001). The wound healing time of the traditional drainage group and VAC group was 38 days (a range of 13–98 days) and 40 days (a range of 11–106 days), respectively; the average LOS was 15 days (a range of 2–68 days) and 16 days (a range of 4–35 days), respectively; and the debridement frequencies were one time (a range of 0–3 times) and zero times (a range of 0–2 times), respectively. The two groups did not differ significantly in wound healing time and hospitalization duration (p = 0.319 and 0.937).ConclusionsVAC treatment of DNIs has significant advantages in reducing the frequency of debridement and patient suffering, but it does not show significant advantages in wound healing. Randomized trials are still needed to demonstrate its efficacy.

Current Trends on Innovative Technologies in Topical Wound Care for Advanced Healing and Management.

To investigate critically traditional and modern techniques for cutaneous wound healing and to provide comprehensive information on these novel techniques to encounter the challenges with the existing wound healing methods. The financial burden and mortality associated with wounds is increasing, so managing wounds is essential. Traditional wound treatments include surgical and non-surgical methods, while modern techniques are advancing rapidly. This review examines the various traditional and modern techniques used for cutaneous wound healing. Traditional wound treatments include surgical techniques such as debridement, skin flaps, and grafts. Non-surgical treatments include skin replacements, topical formulations, scaffold-based skin grafts, and hydrogel-based skin dressings. More modern techniques include using nanoparticles, growth factors, and bioactive substances in wound dressings. Bioengineered skin substitutes using biomaterials, cells, and growth factors are also being developed. Other techniques include stem cell therapy, growth factor/cytokine therapy, vacuum-assisted wound closure, and 3D-printed/bio-printed wound dressings. Traditional wound treatments have been replaced by modern techniques such as stem cell therapy, growth factor/cytokine therapy, vacuum-assisted wound closure, and bioengineered skin substitutes. However, most of these strategies lack effectiveness and thorough evaluation. Therefore, further research is required to develop new techniques for cutaneous wound healing that are effective, cost-efficient, and appealing to patients.

Non-Surgical Management of Methicillin-Sensitive Staphylococcus Aureus Bacteremia-Related Mediastinitis.

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. 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. 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. Mediastinitis is a rare but severe infection with a high mortality rate.Chronic antimicrobial therapy can be an effective strategy in high surgical risk patients.The present case demonstrates good tolerability of lifelong antibiotic therapy.

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

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. 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. 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). 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.

Pull-through endoscopic vacuum-assisted closure therapy for complicated leaks of the gastrointestinal tract – a novel technique

Background and study aims Endoscopic vacuum-assisted closure (EVAC) of post-surgical leaks is an increasingly applied technique. Precise intracavitary sponge placement is technically challenging. Here, we describe a novel EVAC therapy using a combined external and endoluminal, pull-through technique. Patients and methods In this retrospective cohort study, we included all patients treated with pull-through EVAC for post-surgery leaks. During endoscopy, the proximal tip of the percutaneous drainage was visualized within the extraluminal abscess cavity, grasped with forceps, and pulled out orally while maintaining the distal end of the drainage above skin level. A foam sponge was fixed to the tip of the percutaneous drainage and sutured to a gastric tube at the other end. The sponge was placed in the cavity by pulling at the percutaneous drainage. Finally, the gastric probe was channeled nasally and suction was applied. Re-interventions comprised pulling the gastric tube, exchanging the sponge, and re-positioning, as described above. Therapy was stopped after closure or complete epithelialization of the leakage. Results Overall, 7 patients were included between 2021 and 2023. Median duration of pull-through EVAC therapy was 30 days (IQR 11 – 37 days) and median number of endoscopic interventions was 6 (IQR 4 – 10). Technical and clinical success was achieved in all (100%) and in 6 of 7 patients (85.7%), respectively. In total, one major bleeding complication associated with EVAC therapy occurred (14.3%). Conclusion Pull-through EVAC therapy is safe and effective in patients with large and challenging post-surgical leaks of the upper GI tract.

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.

Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis.

Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a metanalysis of the available data on the clinical success rate of EVAC. Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

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.

TOpClass Class 4 Perineal Crohn's Disease: A Systematic Review and Meta-analysis of Perineal Wound Complication After Proctectomy in Crohn's Patients.

Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing. A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic. We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes. This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD.

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

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

The Efficacy of Negative Pressure Wound Therapy (NPWT) on Healing of Diabetic Foot Ulcers: A Literature Review.

Diabetes mellitus is a complex disorder that requires continuous management to control blood sugar levels and prevent complications. Diabetic foot ulcers (DFU) are the most common complication in diabetic patients. A popular therapy modality with considerable advantages in the management of diabetic foot ulcers today is negative pressure wound therapy (NPWT). This study aimed to review related articles about the efficacy as well as the complications or adverse effects of using NPWT on the healing of DFUs. Searching English databases from PubMed, Ebscohost, Proquest and Science Direct was done to identify relevant citations published between January 2017 and January 2022. A combination of terms was used with the boolean formulation of "negative pressure wound therapy OR NPWT" OR "vacuum-assisted closure or VAC" AND "diabetic foot ulcers OR diabetic foot wound" AND "wound healing" AND "Conventional dressings" and map terms were also used for the subject heading. Some potentially relevant citations of articles from the bibliographies are also reviewed. This study included 8 related articles consisting of 6 RCTs, 1 cohort study and 1 Quasy experimental study. There were various methodological techniques for using NPWT and outcome measures among studies. The results of this literature review showed that NPWT was more efficacious than the other conventional or advanced moist dressings. This therapy revealed a faster healing time with complete wound healing and formation of granulation tissue and reduction in wound size. The complications or adverse effects of NPWT, such as amputation rate, bleeding and pain, were not different from conventional or advanced moist dressings, though. NPWT was more efficacious than other conventional or advanced moist dressings for the healing of DFUs. However, complications or adverse effects of using this therapy showed no significant difference with other conventional or advanced moist dressings.

Advancements in seawater immersion wound management: Current treatments and innovations.

With advancements in naval warfare, the number and severity of seawater injuries have skyrocketed, necessitating effective seawater immersion (SWI) wound management. The unique marine pathogens, salinity, low temperature and alkalinity of seawater are the main environmental factors that can influence SWI wound healing. The current treatment strategy for SWI wounds follows a standard protocol based on terrestrial wound conditions, neglecting seawater conditions. The key requirements for ideal SWI treatment include good adhesion to the wound surface to minimize further exposure to seawater, enhanced wound healing properties to minimize wound healing time and antibacterial properties to prevent infections from marine pathogens. Current SWI wound-specific treatments range from elaborate techniques like vacuum-sealed drainage and vacuum-assisted closure for severe blast injuries to simple application of hydrogels or collagen dressings for minor injuries. This review discusses the current status and development of various treatment modalities for SWI wounds. The development of these treatment strategies and an understanding of their mechanisms of action make us better prepared to manage and treat SWI injuries.

Treatment of a Large Gluteal Hydatid Cyst in Syria Using a Manual Negative Pressure Wound Therapy Device (PragmaVAC)

AbstractThe lungs and liver are the most common sites of hydatid cysts, but they may also be found in other organs. We report the case of a lady in her 50s who presented to a hospital in northwest Syria with a large swelling in the right gluteal region. This was diagnosed as a gluteal abscess, and an incision and drainage were performed. Intraoperatively, a hydatid cyst germinal membrane was noted. She had the required imaging to exclude other cysts, which revealed a liver hydatid cyst of 7.5 cm, which was treated with PAIR (puncture, aspiration, injection, and re-aspiration) and albendazole. The residual wound was closed using a manual vacuum-assisted closure (VAC) pump for seven days. A key lesson is that a hydatid cyst in the gluteal muscles, though rare, should be considered in the differential diagnosis. We also show that the innovative use of a manual VAC pump can be used to support closure of large hydatid cyst cavities in muscles.

Early experience using vacuum-assisted closure for managing soft tissue injuries in open type IIIB tibial fractures, a non-randomised controlled trial from a North African level one trauma centre

Purpose: The primary objective was to investigate our early results of using vacuum-assisted closure (VAC) for wound management in patients with open IIIB tibial fractures and compare the results with a group subjected to conventional daily dressing. Methods: A prospective non-randomised clinical trial (NRCT) with a parallel design and allocation ratio of 1:1 was conducted after obtaining ethical committee approval. Forty skeletally mature patients with unilateral type IIIB open tibia fractures were included over two years, starting from April 2019. In group A, patients were treated with VAC, which was changed every four days if needed, and in group B, patients had daily conventional dressings. Results: Both groups had no differences in the basic demographic, comorbidities, injury mechanism, and associated injuries. The need for secondary debridement surgeries was significantly lower in Group A than in Group B, 1 ± 0.50 versus 2.50 ± 0.85, respectively ( P < 0.001). The time till definitive coverage was significantly lower in Group A than in Group B, 12.22 ± 2.90 versus 23.56 ± 8.68 (days); P < 0.001. All coverage procedures succeeded in Group A, while four (20%) failed in Group B, P = 0.04. Infection was higher in Group B, with six (30%) patients compared to one (5%) in Group A, P = 0.01. Conclusion: Reports on VAC's role in managing severe open fracture wounds are rare in our area, and the initial results we obtained are encouraging, with lower infection rates and less cumbersome reconstruction procedures; however, further evaluation of the procedure's cost-effectiveness is mandatory.

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%.

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.

Effect of Vacuum-Assisted Closure Therapy on Diabetic Wounds Management

Effect of Vacuum-Assisted Closure Therapy on Diabetic Wounds Management

The Largest Phyllodes Breast Tumor in The World: A Case Report

Phyllodes tumor of the breast is an uncommon fibroepithelial neoplasm constituting 0.3% to 0.5% of female breasttumors. Complete wide local excision is frequently used for treatment and risk reduction in local recurrence. This article aims to report the largest phyllodes breast tumor ever reported worldwide. We report the case of a 24-year-old Thai woman was admitted to our hospital with a massive ulcerofungating right breast mass. Her physical examination revealed a 59 cm diameter mass over her right upper body, in which most parts were infected and ulcerated. A right mastectomy was then performed after the patient had already been treated with intravenous antibiotics for infection control and when her nutrition status had improved. This was followed by Vacuum-Assisted closure of the wound, and split-thickness skin graft, which could be performed after there was a good granulation growth at the wound base. Additionally, after histopathology examination, a 59x53x26 cm malignant Phyllodes tumor with free margins, weighing 14,500 grams, in which there was around 20% tumor necrosis, 12/10 high power fields (HPFs) of Mitosis, and the unaffected nipple was observed. The patient was discharged from the hospital after 45 days, and there was no evidence of local and distant recurrence after a one-year follow-up. Phyllodes tumors are considered unusual fibroepithelial breast tumors that have various biological behaviors, in which surgical resection is a major option for treatment.

Theranostic nano-enabled polyurethane eso-sponges coupled to surface enhanced Raman scattering for detection and control of bacteria killing

Herein, a facile approach toward converting a three-dimensional polyurethane sponge (PUS), employed in endoluminal vacuum-assisted closure (endo-VAC) therapies, in a theranostic material able to detect and to inhibit bacteria growth, has been reported. The endo-VAC PUS presented sensitivity to Gram-positive and Gram-negative bacterial species thanks to its functionalization with gold and silver antibacterial nanoparticles (NPs). PUS with chitosan-stabilized Au-NPs achieved 5.26 ± 0.17 logs and 2.78 ± 0.34 logs of reduction of bacteria growth, whereas the sponges functionalized with phenolated lignin Ag-NPs offered slightly inferior values (4.77 ± 0.36 logs and 2.03 ± 0.37 logs, respectively), against Escherichia coli and Staphylococcus aureus pathogens, respectively, after the application of photothermal ablation. The in vitro antimicrobial studies were contrasted with the in-situ monitoring of bacteria localization and inactivation with excitation lasers of 532 and 785 nm wavelengths, respectively, in the Raman equipment. The novel theranostic nano-enabled antimicrobial PU sponges offer unprecedented possibilities for the improvement of the endo-VAC treatments and extrapolation of the methodology to other plastic-based implants to combat antimicrobial resistances.

Wound vacuum-assisted closure temporization after tumor resection of soft tissue sarcomas-A cost analysis in a propensity-score matched population.

Vacuum-assisted closure (VAC) temporization is a technique associated with high local control rates used in myxofibrosarcoma. We sought to compare the costs and postoperative outcomes of VAC temporization and single-stage (SS) excision/reconstruction. We conducted a retrospective analysis of patients with myxofibrosarcoma surgically treated at our institution between 2000 and 2022. Variables of interest included total, direct, and indirect costs for initial episode of care, 90 days and 1 year after initial admission, and postoperative outcomes. Costs were compared between the VAC temporization and SS groups. After matching, 13 patients in the SS group and 23 in the VAC group were analyzed. We found no difference in median and mean total inpatient costs, between the VAC temporization and SS group. While total 90-day and 1-year costs were higher in the VAC group compared to the SS group, mean costs were similar. There were no differences in postoperative complications between groups. A subanalysis of the entire cohort (n = 139) revealed lower local recurrence and overall death rates in the VAC temporization group. VAC temporization had similar inpatient costs and postoperative outcomes toSS excision/reconstruction. While median 90-day and 1-year costs were higher in the VAC group, mean costs did not differ.