Vacuum-assisted Closure Research Articles

Evaluation of the effect of vacuum assisted closure in the surgical management of Fournier's gangrene: A single center experience

Fournier's gangrene is a surgical emergency arising in the perineum and genital area and is characterized as necrotizing fasciitis of the perineum and genital area. It quickly spreads between the fascial planes and causes soft tissue necrosis. Diabetes mellitus is the most prevalent predisposing factor. Early diagnosis and management are critical in the progression of the disease. Surgical debridement and wide-spectrum antibiotic therapy are the first steps in treatment. Despite advancements in diagnosis and treatment procedures and changes in critical care techniques, the disease has a death rate of 16-40%. This research compares patients operated on for Fournier's gangrene between January 2016 and January 2022, including those treated with vacuum-assisted closure technique, vs those who were not. We acquired and analyzed the data on the patients' demographic and clinical features from hospital records. The study involved 16 patients, six (38%) in Group 1 and 10 (62%) in Group 2, 11 men (68 %) and five women (32%). Swelling in the wound region was the most prevalent complaint. The most common gangrene site was the perianal region, and diabetes was the most common predisposing condition. Group 2 had a significantly shorter hospital stay (p=0.02). There was no statistically significant difference in mortality or other parameters between the groups. The main advantages of VAC therapy are that it requires fewer dressings, causes less pain, and reduces the risk of contamination. The advantages of the traditional wet dressing include its ease of use and low cost and the fact that VAC therapy promotes faster wound healing and shorter hospital stays.

Negative-pressure wound therapy to treat thoracic empyema with COVID-19-related persistent air leaks: A case report

The novel coronavirus disease (COVID-19) has resulted in a global pandemic. Recently, COVID-19-related pneumothorax has gained attention because of the associated prolonged hospital stay and high mortality. While most cases of pneumothorax respond well to conservative and supportive care, some cases of refractory pneumothorax with persistent air leaks (PALs) do not respond to conventional therapies. There is a lack of evidence-based management strategies to this regard. We describe the case of a 73-year-old man with COVID-19-related acute respiratory distress syndrome (ARDS) who developed delayed tension pneumothorax with PALs caused by alveolopleural fistulas. Despite chest tube drainage, autologous blood pleurodesis, and endoscopic procedures, the PALs could not be closed, and were complicated by thoracic empyema. Subsequent minimally invasive open-window thoracostomy (OWT) with vacuum-assisted closure (VAC) therapy helped successfully control the refractory PALs. Serial chest computed tomography monitoring was useful for the early detection of the pneumothorax and understanding of its temporal relationship with air-filled lung cysts. Our case provides a new perspective to the underlying cause of refractory pneumothorax with PALs, secondary to COVID-19-related ARDS, and underscores the potential of OWT with VAC therapy as a therapeutic alternative in such cases.

Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years

BackgroundNecrotizing soft tissue infections (NSTI) require immediate radical debridement, broad-spectrum antibiotics and intensive care. Hyperbaric oxygen therapy (HBOT) may be performed adjunctively, but unequivocal evidence for its benefits is still lacking.MethodsWe performed a retrospective single-center study including 192 patients with necrotizing fasciitis or Fournier's gangrene to assess in-hospital mortality and outcome dependent on patient, disease and treatment characteristics with or without HBOT.ResultsThe in-hospital mortality rate was 27.6%. Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR) = 2.88, P = 0.003), ineligibility for HBOT despite clinical indication (OR = 8.59, P = 0.005), pathogens in blood cultures (OR = 3.36, P = 0.002), complications (OR = 10.35, P < 0.001) and sepsis/organ dysfunction (OR = 19.58, P < 0.001). Factors associated with better survival included vacuum-assisted wound closure (OR = 0.17, P < 0.001), larger number of debridements (OR = 0.83, P < 0.001) and defect closure with mesh graft (OR = 0.06, P < 0.001) or flap (OR = 0.09, P = 0.024). When participants were stratified into subgroups without requirement of HBOT (n = 98), treated with HBOT (n = 83) and ineligible for HBOT due to contraindications (n = 11), the first two groups had similar survival rates (75.5% vs. 73.5%) and comparable outcome, although patients with HBOT suffered from more severe NSTI, reflected by more frequent affection of multiple localizations (P < 0.001), sepsis at admission (P < 0.001) and intensive care treatment (P < 0.001), more debridements (P < 0.001) and a larger number of antibiotics (P = 0.001). In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P = 0.022).ConclusionThese results point to a benefit from HBOT for treatment of NSTI in critically ill patients.

Lower Extremity Necrotizing Fasciitis Managed With Negative Pressure Wound Therapy (NPWT) and Split-Thickness Skin Graft: A Case Report

Introduction: Necrotizing fasciitis (NF) is an infection of the soft tissues (skin, subcutaneous tissue and fascia) that implies a rapidly and progressive evolution. In general, the treatment consists of stabilizing the patient, as well as the use of antibiotics that cover the most common agents, however, in most cases this is not useful without definitive management that consists of cleaning and surgical debridement. In addition to surgical lavage, adjunctive measures are often used in the treatment of complex wounds, such as vacuum-assisted closure (VAC) systems, also known as microdeformation wound therapy (MDWT) or negative pressure wound therapy (NPWT). Objective: The objective is to present a successful case in the treatment of necrotizing fasciitis by negative pressure therapy with subsequent placement of grafts.

Treatment tactics for a patient with acquired hemophilia: continuous infusion of recombinant activated coagulation factor VII and the inhibitor eradication

Introduction. Acquired hemophilia is a rare autoimmune disease caused by an inhibitor to clotting factor VIII (FVIII). It complicates the course of many diseases, in particular autoimmune diseases, and in women is often associated with pregnancy.Aim — to present a case of successful treatment of a patient with acquired hemophilia using long-term continuous infusion of rFVIIa and inhibitor eradication as a result of immunosuppressive therapy.Main findings. A clinical observation of severe hemorrhagic syndrome in a patient with acquired hemophilia associated with pregnancy is presented. Uterine bleeding in the patient after spontaneous delivery, refractory to standard hemorrhagic syndrome treatment, required multiple surgical interventions. Laboratory tests showed prolongation of APTT, CT in the INTEM rotational thromboelastometry test, a decrease in plasma FVIII activity and presence of inhibitor to FVIII. Vacuum-assisted closure was applied to treat infected laparotomy wound. Therapy for acquired hemophilia consisted of hemostatic therapy and the inhibitor eradication. Hemostatic therapy included a continuous infusion of rFVIIa at a rate of 30 μg/kg/h with a gradual decrease up to 9.6 μg/kg/h, as well as its fractional administration before every surgery at a dosage of 80 μg/kg. The effectiveness of the therapy was assessed by the dynamics of CT in the INTEM test and the shortening of the APTT. The inhibitor eradication was achieved by prednisolone therapy, combined immunosuppression with rituximab and azathioprine, followed by its replacement with cyclophosphamide. As a result, the hemorrhage was stopped, reference plasma activity of FVIII and eradication of the inhibitor were reached.

Superior Pubic Ramus Screw Placement During Complex Acetabular Revision: Acetabular Distraction for Treatment of Pelvic Discontinuity.

With the patient in the lateral decubitus position, the acetabulum is exposed from a standard posterior approach for a revision THA. The location of the superior pubic root is identified after making a recess within the anteroinferior capsule. In order to ensure that the appropriate trajectory is obtained, C-arm imaging (inlet view and orthogonal obturator outlet views) is utilized to safely predrill the screw trajectory into the superior pubic ramus. A Kirschner wire (K-wire) is then placed into the hole. With use of a metal-cutting burr on the back table, customized peripheral screw holes are placed and then the acetabular component is slid and impacted into place over the K-wire. After cup insertion, the K-wire is removed and the superior pubic ramus screw can be placed and confirmed on fluoroscopy. In general, chronic pelvic discontinuity requires surgical management with revision THA and has historically employed the use of a cup-cage construct, custom triflange implants, and/or jumbo acetabular cups with modular porous metal augments1-5. With these treatment options, it is typically necessary to insert "kickstand" screws, which function to prevent abduction failure of the acetabular cup4,5. However, in many cases of discontinuity, there may be severe ischial osteolysis, making ischial screw placement difficult or impossible. The superior pubic ramus, however, remains a reliable option that can be utilized for inferior screw fixation, even in cases of severe acetabular bone loss, and thus is especially beneficial in these difficult cases. The technique of acetabular distraction was developed because of limitations with alternative techniques. This procedure achieves cementless biologic fixation and eventual discontinuity healing as a result of lateral or peripheral acetabular distraction and resultant medial or central compression across the pelvic discontinuity. Acetabular distraction allows for intraoperative customization and cement unitization of the acetabular construct. This procedure requires the use of a "kickstand" screw or of inferior screw fixation in order to prevent abduction failure of the cup. These screws may be placed into either the ischium or superior pubic ramus. If the patient has substantial ischial osteolysis, ischial screw fixation may not be possible. If not placed in a systematic manner, pubic ramus screws can be technically challenging, and incorrect placement can result in neurovascular injury. The present video article demonstrates a reproducible technical method for safely placing a screw in the superior ramus to aid in optimal fixation of the acetabular component in cases of pelvic discontinuity. Thus far, short-term survivorship of acetabular distraction with use of a jumbo cup and kickstand screws has been about 95%. In the largest study to date assessing patients with chronic pelvic discontinuity who underwent revision THA with use of the acetabular distraction technique, only 1 of 32 patients required revision for aseptic loosening6. An additional 2 patients had evidence of radiographic loosening but did not undergo revision, and 3 had migration of the acetabular component into a more stable configuration. Radiographically, 22 of 32 patients in the study demonstrated healing of the discontinuity6. In another study assessing the survivorship of porous tantalum acetabular shells in revision THA to treat severe acetabular defects, patients with inferior screw fixation with superior pubic ramus or ischial screws had a significantly lower incidence of proximal translation of components compared with those without inferior screw fixation7. For reproducible, successful execution of this technique, it is important to confirm correct placement of the acetabular retractors at the correct anatomical locations to ensure adequate surgical visualization of the acetabulum for easy identification of the superior pubic root.It is also critical to check placement of the drill via fluoroscopy with an inlet and obturator outlet views prior to drilling.The drill should be advanced on the oscillate setting to avoid inadvertently perforating the cortical bone and damaging surrounding neurovascular structures. OR = operating roomf/u = follow-upvac = vacuum-assisted closureRSA = radiostereometric analysis.

Free Skin Grafting to Reconstruct Donor Sites after Radial Forearm Flap Harvesting: A Prospective Study with Platelet-Rich Fibrin (PRF).

Reconstruction of the donor site after radial forearm flap harvesting is a common procedure in maxillofacial plastic surgery. It is normally carried out with split-thickness or full-thickness free skin grafts. Unfortunately, free skin graft transplantation faces wound healing impairments such as necrosis, (partial) graft loss, or tendon exposure. Several studies have investigated methods to reduce these impairments and demonstrated improvements if the wound bed is optimised, for example, through negative-pressure wound therapy or vacuum-assisted closure. However, these methods are device-dependent, expansive, and time-consuming. Therefore, the application of platelet-rich fibrin (PRF) to the wound bed could be a simple, cost-effective, and device-independent method to optimise wound-bed conditions instead. In this study, PRF membranes were applied between the wound bed and skin graft. Results of this study indicate improvements in the PRF versus non-PRF group (93.44% versus 86.96% graft survival, p = 0.0292). PRF applied to the wound bed increases graft survival and reduces impairments. A possible explanation for this is the release of growth factors, which stimulate angiogenesis and fibroblast migration. Furthermore, the solid PRF membranes act as a mechanical barrier (“lubrication” layer) to protect the skin graft from tendon motion. The results of this study support the application of PRF in donor-site reconstruction with free skin grafts.

To evaluate the role of VAC therapy in open fractures after primary fixation in term of faster and more effective wound healing

Vacuum-assisted closure (VAC) is a noninvasive, active wound management system that exposes a wound bed to local sub atmospheric pressure, removes fluid from the extravascular space, improves circulation, and enhances the proliferation of granulation tissue. The purpose of this study is to know the rate of wound infection, number of days required for making the wound fit for skin cover procedures, number of days required for formation of uniform granulation tissue bed in the wound healing treated by Vacuum Assisted Closure after primary fixation of fracture.Patients between 18 to 60 years were included in this prospective randomized controlled trial. Primary internal Fixation of fracture was done as soon as possible followed by VAC application. Functional outcome of cases recorded during each follow up according to Johner and Wruh’s (1983).According to this study, 30 patients with open fractures of both bone leg after primary internal fixation with VAC application. During follow up effective decrease (mean ± SD) in wound size after VAC therapy was 9.97±9.59 cm2 with P-value 0.0481. This technique has resulted in the effective decrease in wound size, infection and give a better functional outcome.The greatest advantage of VAC was found to facilitate rapid formation of granulation tissue on wounds with exposed tendons, bones, raw area wounds and exposed implants hence decrease healing time and minimize soft tissue defect coverage procedures.

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.

One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study.

Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation.

Low-cost vacuum-assisted closure dressing in wound management: An effective alternative for Nepal

Background: Low-cost vacuum-assisted closure (VAC) can be used as an alternative method for wound management. Objectives: To observe the effectiveness of low-cost vacuum-assisted closure dressing in wound management. Methods: A descriptive cross-sectional hospital-based study was conducted in the Department of Plastic Surgery, Kathmandu Medical College from April 2021 to February 2022 to observe age, sex, indication, type of wound with history of comorbidities, number of dressings, duration of hospital stays, and complications like: bleeding, haematoma, and delay in wound healing . Results: A total of 22 patients were included by convenience sampling technique in the study with 21 (95.5%) acute and one (4.5%) case of chronic wound with ulcer. The mean age was 39 ± 18.157 years ranging from 13-76 years. Most of them were males (15, 68.2%). The mean duration of wound presentation was 5.45 ± 9.127 days ranging from 1-45 days. The mean duration of hospitalisation was 20.45 ± 11.467 days ranging from 5-45 days. Eight (36.4%) patients were with comorbidities like Diabetes Mellitus, Hypertension, Peripheral vascular diseases etc., and no mortality was recorded. Conclusion: Low-cost Vacuum-assisted closure is a very easy and efficient alternative method for wound care.

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.

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determine the advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods: The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results: In the study sample 10% patients were less than 40 years, 76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions: VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

Endoscopic vacuum-assisted surgical closure (EVASC) of anastomotic defects after low anterior resection for rectal cancer; lessons learned

BackgroundEndoscopic vacuum-assisted surgical closure (EVASC) is an emerging treatment for AL, and early initiation of treatment seems to be crucial. The objective of this study was to report on the efficacy of EVASC for anastomotic leakage (AL) after rectal cancer resection and determine factors for success.MethodsThis retrospective cohort study included all rectal cancer patients treated with EVASC for a leaking primary anastomosis after LAR at a tertiary referral centre (July 2012—April 2020). Early initiation (≤ 21 days) or late initiation of the EVASC protocol was compared. Primary outcomes were healed and functional anastomosis at end of follow-up.ResultsSixty-two patients were included, of whom 38 were referred. Median follow-up was 25 months (IQR 14–38). Early initiation of EVASC (≤ 21 days) resulted in a higher rate of healed anastomosis (87% vs 59%, OR 4.43 [1.25–15.9]) and functional anastomosis (80% vs 56%, OR 3.11 [1.00–9.71]) if compared to late initiation. Median interval from AL diagnosis to initiation of EVASC was significantly shorter in the early group (11 days (IQR 6–15) vs 70 days (IQR 39–322), p < 0.001). A permanent end-colostomy was created in 7% and 28%, respectively (OR 0.18 [0.04–0.93]). In 17 patients with a non-defunctioned anastomosis, and AL diagnosis within 2 weeks, EVASC resulted in 100% healed and functional anastomosis.ConclusionEarly initiation of EVASC for anastomotic leakage after rectal cancer resection yields high rates of healed and functional anastomosis. EVASC showed to be progressively more successful with the implementation of highly selective diversion and early diagnosis of the leak.Graphical abstract

Sweat contamination induced surgical site infections after spine surgery: Three case reports and literature review.

Introduction and importanceSurgical site infection (SSI) is one of the most intractable complications following spine surgery during the early postoperative stage. Elderly (age > 70 years), body mass index > 30, smoking, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, anemia, low serum albumin, operation time > 3 h, and perioperative blood loss > 500 mL are the common risk factors of SSI after spine surgery. However, there are few published reports about sweat contamination induced surgical site infections with Staphylococcus epidermidis up to date. Staphylococcus epidermidis is a permanent member of the normal human microbiota and has emerged as an important opportunistic pathogen in SSI. We aim to detect the influence of sweat infiltration on SSI with Staphylococcus epidermidis and effective management.Case presentationA 73-year-old male, a 54-year-old male and a 73-year-old female were admitted to our hospital. All of them underwent posterior compression and fusion surgery with internal fixation and got surgical site infection after primary surgery. Two of them suffered moderate surgical site infection while the third patient with comorbidities suffered severe surgical site infection. Antibiotic therapy and debridement with internal fixation retained were utilized during which microbiological culture were taken. The moderate infection patients got fully recovered after debridement and primary suture while the serious one had recurrence after the first debridement, and then the second operation was performed. SSI, however, relapsed after three days. Vacuum-assisted closure (VAC) system was placed in the third debridement. The severe patient got well recovered and discharged after displacement of VAC system.Clinical discussionThis report serves to explore a normal but overlooked factor for SSI. SSI is one of the most intractable complications after spine surgery and the report introduce some uncomplicated but effective methods to moderate and severe SSI.ConclusionSweat-contaminated is an inducement of SSI with Staphylococcus epidermidis that should attract surgeons' attention. For mild infection, changing dressing and infrared treatment can achieve good results. For moderate infection, one debridement and primary suture are enough. For severe infection, early application of VAC system can reduce the number of debridement and achieve good clinical outcome.

MP20-20 HIGH 30-DAY COMPLICATIONS AFTER BURIED PENIS REPAIR SUGGEST ROLE FOR PREOPERATIVE OPTIMIZATION

You have accessJournal of UrologyCME1 May 2022MP20-20 HIGH 30-DAY COMPLICATIONS AFTER BURIED PENIS REPAIR SUGGEST ROLE FOR PREOPERATIVE OPTIMIZATION Ethan Matz, Rahul Dutta, Nicholas Deebel, Justin Refugia, Kim Thai, and Ryan Terlecki Ethan MatzEthan Matz More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Nicholas DeebelNicholas Deebel More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Kim ThaiKim Thai More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Buried penis repair (BPR) is typically performed for morbidly obese men with associated comorbidities. Case complexity is variable and often involves penile split thickness skin grafting (STSG) and use of vacuum-assisted closure (VAC). At our institution, BPR is performed with a multidisciplinary team involving urology and plastic surgery. Collectively, we sought to determine the rate of 30-day complications to determine areas for team-based quality improvement and information relevant to preoperative patient counseling and prehabilitation. METHODS: With IRB approval, all cases of BPR from 2012 to 2021 were reviewed. Data was collected for patient demographics, operative case characteristics, and 30-day complications using the Clavien-Dindo classification. RESULTS: Overall, 63 men underwent BPR for the studied interval. Mean age was 55.9±14.4 years and mean BMI was 41.99±9.17 kg/m2. The rate of overall complications was 33% (21/63). Major complications were seen in 8% of patients, classified as Grade IV (4) and Grade III (1). BMI was an independent predictor of complications (p=0.0257). Additionally, patients noted to have preoperative UTI, even when treated, had significantly higher rates of readmission (p=0.006) and unplanned emergency room (ER) visits (p=0.0006). Baseline hypertension (HTN) was independently associated with ER visits (p=0.0148), but not with overall complications. Presence of home assistance, age, history of CAD or PVD, and preoperative A1c values were not associated with overall complication rate. There was no difference in complications with hospital or home negative pressure wound VAC systems. CONCLUSIONS: Short-term complications following BPR were noted in a third of patients, despite multidisciplinary management. Despite all patients having obesity, BMI was a significant predictor of complications. Patients with a history of preoperative urinary tract infection or HTN also appear to be at increased risk. Quality improvement initiatives targeting monitored preoperative weight loss, urinary assessments with test-of-cure and/or prophylaxis, and more aggressive blood-pressure management will be studied prospectively. Patient counseling will also involve setting expectations on the frequency of complicated recovery. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e325 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz More articles by this author Rahul Dutta More articles by this author Nicholas Deebel More articles by this author Justin Refugia More articles by this author Kim Thai More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF DownloadLoading ...

The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers.

In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum-assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.

VACUUM-ASSISTED CLOSURE AND MUSCLE FLAP AS AN ALTERNATIVE MODALITY FOR INFECTED WOUND AFTER ORIF OF TIBIAL FRACTURE: CASE REPORT

Background: The blood supply of a bone can be decreased due to the use of an implant, leading to wound-bed bacterial colonization and the development of the SSI. The principle of vacuum-assisted closure (VAC) is to use a negative pressure environment in the wound to promote increased wound healing. The case shows that VAC application and muscle flap therapy provide the definitive healing of infected wounds after ORIF. Case Report: A 45 years-old male presented with a close comminuted proximal third right tibia fracture and tense skin. The fracture was openly reduced and internally fixated with plate fixation and a skin flap on the fracture area. Still, the wound could not be closed due to difficulty covering the wound, so a counter incision was made. After four days, the patient developed necrosis in the post-operation wound and subsequently underwent debridement and muscle flap with VAC application. Discussion: SSI can be treated by applicating of appropriate antibiotic and surgical procedures. In this case, the infection was treated using third-generation cephalosporin antibiotic, debridement, dissection, and re-elevation of gastrocnemius muscle flap covering the exposed plate area in inferior, split skin graft above the muscle flap and VAC above skin graft with 75 mmHg pressure. Conclusion: Debridement with muscle flap and application of VAC in the deep infected wound of open reduction and internal fixation was found to be successful methods in minimizing complications and obtaining an optimal outcome. This finding was associated with accompanying morbidities or a good wound healing process.

Apendektomiye Bağlı Bridektomi Sonrası Gelişen Enteroatmosferik Fistülün Yönetimi

Enteroatmospheric fistula, which is a fearsome complication of abdominal surgery, has a high rate of mortality despite the developments in open abdomen management. Management of a patient with Enteroatmospheric Fistula requires a multidisciplinary approach and a multifaceted treatment from a team of experienced surgeons and expert nurses. In this article, we aimed to present nursing bottle teat technique combined with vacuum-assisted closure through our own individualized modification method on a patient with a Grade 4 open abdomen.

A case on novel treatment protocol for difficult to treat foot myiasis

Foot myiasis is a rare condition, with only a few reported cases and no treatment consensus. We proposed a conservative and unique treatment approach with VAC dressing method. The patient administered in the hospital with presentation of deep tissue injury from a sharp stone, from 3 months back which was maggot infested. The patient had approached local physicians before been admitted in our facility. The wound was severe with maggot infestation. The patient was non diabetic with no other comorbid conditions. We had the aim of infection free wound with faster rate of healing, which was fulfilled by the novel treatment protocol using vacuum-assisted closure (VAC®) dressing method. Culture sensitivity tests ruled out infection and maggot infestation. The wound was closed surgically after healthy uninfected granulation tissue confirmed with culture sensitivity report. No recurrence of maggot or any other infection were found. The protocol performed was safe and effective in critical case of myiasis.