Vacuum-assisted Wound Closure Therapy Research Articles

The efficacy of negative pressure wound therapy for surgical site infections and delayed wound healing in intensive care unit department of ha noi heart hospital from 2020 to 2021

Objective: Describe the clinical characteristics and the results of negative pressure wound therapy for surgical site infections and delayed wound healing.
 Methods: A descriptive, cross-sectional study was conducted between May, 2020 and May, 2021 to evaluate the effectiveness of negative pressure wound therapy among patients with delayed surgical wound healing and wound infection in intensive care unit department of Ha Noi Heart hospital.[1]
 Results: From May 2020 to May 2021, we studied a total of 15 patients with delayed wound healing and surgical wound infection using negative pressure wound therapy. Among them, there are 9 women (60%), 6 men (40%), The majority of patients was over the age of 60 (86.7%). After you have used VAC, 13/15 cases the wound was improved (86.7% proportion). VAC therapy over the wound was administered for an average of 9,4 days.
 Conclusion: Vacuum-Assisted Wound Closure Therapy is a reliable and safe option for patients with postoperative surgical site infections and delayed wound closure to help reduce hospital length of stay, improves financial and clinical outcomes.

The Efficiency of Highly Porous β-Tricalcium Phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in Midfoot Joint Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in midfoot joint arthrodesis. Methods: This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws from January 2014 to May 2019. A total of 44 patients (46 feet) including 89 joints were included in this study. The cohort was then stratified into two groups: 25 patients (26 feet) in arthrodesis with highly porous β-TCP and BMAC (group A) and 19 patients (20 feet) in arthrodesis without highly porous β-TCP and BMAC (group B). The osseous union rate was compared between the two groups. Demographic and operative data including age, sex, body mass index (BMI), smoking, etiology of arthritis, comorbidities such as diabetes mellitus and rheumatoid arthritis, number of joints fixed, use of bone graft or bone substitute, and postoperative midfoot anatomic alignment in the two groups were compared. Results: There was a significant difference in the union rate between the two groups: 91.5 % (43 out of 47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2 % (32 out of 42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B) (P = 0.048). During the follow-up period, a total of four postoperative complications were reported in this study. In group A, two patients developed hardware irritation, and all of them underwent removal of hardware procedure. In group B, one patient had a superficial wound infection, which was resolved completely without further treatment. The other patient in group B developed a deep wound infection with dehiscence, and it was managed with irrigation and debridement followed by vacuum assisted wound closure therapy. Conclusion: This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC compared to arthrodesis without them, suggesting that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis.

S2493 Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery

S2493 Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery

Reconstruction of large abdominal wall tissue defect using vacuum assisted wound closure

Background/Aim: Abdominal wall defects may result from trauma, burn, necrotizing soft tissue infection or complications of abdominal surgeries. Reconstruction poses a great challenge for the surgeon in cases of large abdominal wall defects with lack of surrounding tissue. Abdominal wall defects lack a good functional and aesthetic impact and early reconstruction is prudent for better outcomes. This study evaluates the results of Vacuum assisted wound closure (VAC) therapy in patients with large anterior abdominal wall tissue defect which could not be closed primarily otherwise. Methods: This case series included 20 patients with partial thickness, anterior abdominal wall tissue defects. All patients had suffered an acute trauma. Wound debridement was done and VAC therapy dressing was applied in systematic manner. Dressing was changed every 3 or 4 days and continued up to 9-14 days. Results: Twenty patients underwent VAC therapy with an average age of 32 years (range, 25-52 years). Indications comprised tissue loss after acute trauma due to road traffic accident, burn and other trauma leading to anterior abdominal wall soft tissue defect. VAC was used for an average of 12 days, with an average negative pressure of 125 mm Hg. Healthy granulation tissue was formed in all patients. Subsequently split thickness skin grafts were applied in these patients. This results in early recovery as well as decreased morbidity in all patients. Conclusions: All patients had good tolerance to Vacuum-assisted closure. It offers many benefits comprising fewer dressing changes and an earlier return to daily activities. Patients with large abdominal defects can benefit from this procedure.

Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications.

Negative pressure wound therapy (NPWT) promotes healing by evenly applying negative pressure on the surface of the wound. The system consists of a sponge, a semiocclusive barrier, and a fluid collection system. Its effectiveness is explained by four main mechanisms of action, including macrodeformation of the tissues, drainage of extracellular inflammatory fluids, stabilization of the environment of the wound, and microdeformation. Rarely will complications linked to NPWT occur, but special care must be taken to prevent events such as toxic shock syndrome, fistulization, bleeding, and pain. New NPWT modalities have been recently developed to make NPWT suitable for a wider variety of wounds. These include NPWT with instillation therapy (NPWTi-d), different cleansing options, and application of NPWT on primarily closed incisions. Finally, vacuum-assisted wound closure therapy has been demonstrated to be efficient for various clinical settings, such as the management of diabetic foot ulcers, pressure ulcerations, chronic wounds, and skin grafts.

Novel effective treatment for diabetic foot ulcers [DFU] by vacuum assisted wound closure therapy

Introduction: Foot ulcers are serious complication of Diabetes Mellitus and are known to be resistant to conventional treatments. They may end in severe complications like amputations if not treated wisely at the earliest. Foot ulcers affect 10-25% of Diabetic patients. Management of a Diabetic Foot Ulcer (DFU) is often a challenging problem. Healing of these ulcers often takes a long time and may need one or more methods of treatment. In particular Vacuum assisted wound closure (VAC) therapy has gained popularity for treatment of chronic and complex wounds in patients with Diabetes. Aims and Objectives: To evaluate the efficacy of vacuum assisted wound closure (VAC) therapy for the treatment of diabetic foot ulcers. Materials and Methods: This is a prospective observational study done in Department of Plastic Surgery in Rajah Muthiah Medical College, Annamalainagar, Chidambaram from January 2016 – December 2018 with a total of 30 patients with diabetic foot ulcers. All these patients after admission were started on medical treatment for control of diabetes and antibiotics for infection. They were subjected to wound debridement followed by VAC dressing. The VAC dressing was continued till the ulcer bed developed healthy granulation tissue and ready for definitive procedure like grafting or flap cover. Initial wound surface area and the resultant wound surface area after VAC therapy, duration of hospital stay and procedure done for DFU’s were recorded and statistical analysis was done using paired ‘T’ test to compare wound surface area before and after VAC therapy. Result: This study showed that mean initial wound surface area of 30 patients before VAC therapy was 103.07 cms and after VAC therapy there was significant reduction in wound size to 94.53 cms over a mean duration of 31.9 days. There was statistically reduction in wound size of 9.53 cms. This significantly increased the wound bed granulation tissue and good percentage of graft and flap take up. The daily requirement of antibiotic and analgesic was also reduced. Duration of hospital stay was also reduced due to faster wound healing. There was overall reduction in pain and further complications like amputations were avoided thereby increasing the patients compliance. Conclusion: VAC therapy is newer and a safe method of treatment for Diabetic Foot Ulcers. There is faster wound healing, good graft and flap take with minimal or no complications.

Vacuum-Assisted Wound Closure Therapy in Pediatric Lower Limb Trauma.

Although the importance of vacuum-assisted wound closure therapy has been well established as road to definitive treatment of trauma wound in the adult population, its use in pediatric patients is not well described in the literature. This study was conducted to evaluate the outcome of vacuum-assisted wound closure therapy in pediatric patients. Twenty-two patients were prospectively treated for soft tissue defect in lower limb using vacuum-assisted wound closure device, as these wounds were not amenable for primary closure. After wound evaluation, thorough wound debridement was done. Vacuum-assisted wound closure dressing was applied once hemostasis was achieved. Dressings were changed as per protocol. After the development of healthy granulation tissue, wound coverage was achieved with skin graft or flaps. Mean age of patients was 9.455 years, ranging from 4 to 14 years. Early, healthy granulation tissue had formed in all patients. The average number of vacuum-assisted closure (VAC) dressings required was 2.682. Average duration of VAC therapy was 8.045 days. The sizes of soft tissue defects reduced from an average 69.18 cm2 to 50.73 cm2 after VAC therapy with a mean decrease of 26.66%. There was no complication because of VAC therapy. Vacuum-assisted wound closure therapy accelerated the process of healthy granulation tissue formation, and thus shortened the healing time. VAC therapy lessens the morbidity and pain associated with large wounds in pediatric patients and brings cheer and smile in growing children.

The Role of Vacuum-Assisted Wound Closure Therapy after the Surgical Treatment of the Pilonodal Sinus

Aim. This study is aimed at improving the treatment of patients with the pilonidal sinus (PS) by open wound healing methods. Materials and methods. The study included 54 patients with PS. The main group consisted of 29 patients treated by an open (exposure) management technique and a subsequent vacuum-assisted wound closure therapy. The control group consisted of 25 patients treated with conventional ointment bandages. Results. On the 8th day of vacuum-assisted therapy (VAC-therapy), the areas of granulation tissue were identified in 23 (79.3 %) and 10 (40.0 %) (p = 0.041) cases in the main group and the control group, respectively. Following one month of treatment, complete wound healing was observed in 24 (82.8 %) patients in the main group, with no patients in the control group showing signs of complete healing (p < 0.0001). Cytologically, starting from the 8th day of VAC-therapy, a decrease in inflammation was observed in 24 (82.8 %) patients in the main group, with the wound regenerative processes being recorded on the 16th day in 17 (58.6 %) patients (p < 0.05). The average rate of wound healing in the main group was significantly higher and equal to 2.15 ± 0.15 cm2/day, compared to the value of 0.76 ±0.18 cm2/day in the control group. Conclusion. Vacuum-assisted wound closure therapy is an effective way to stimulate reparative processes during the open management of wounds after the surgical treatment of PS. Aim. This study is aimed at improving the treatment of patients with the pilonidal sinus (PS) by open wound healing methods.Materials and methods. The study included 54 patients with PS. The main group consisted of 29 patients treated by an open (exposure) management technique and a subsequent vacuum-assisted wound closure therapy. The control group consisted of 25 patients treated with conventional ointment bandages.Results. On the 8th day of vacuum-assisted therapy (VAC-therapy), the areas of granulation tissue were identified in 23 (79.3 %) and 10 (40.0 %) (p = 0.041) cases in the main group and the control group, respectively. Following one month of treatment, complete wound healing was observed in 24 (82.8 %) patients in the main group, with no patients in the control group showing signs of complete healing (p < 0.0001). Cytologically, starting from the 8th day of VAC-therapy, a decrease in inflammation was observed in 24 (82.8 %) patients in the main group, with the wound regenerative processes being recorded on the 16th day in 17 (58.6 %) patients (p < 0.05). The average rate of wound healing in the main group was significantly higher and equal to 2.15 ± 0.15 cm2/day, compared to the value of 0.76 ±0.18 cm2/day in the control group.Conclusion. Vacuum-assisted wound closure therapy is an effective way to stimulate reparative processes during the open management of wounds after the surgical treatment of PS.

Healing of severe polystructural limb wounds using vacuum therapy

Vacuum-assisted wound closure has been known for the last two decades as an economically viable and effective treatment method, but the variety of patient injuries caused by severe polystructural (including combat) injuries requires further re­search into the effect of negative pressure on wound healing.Objective: to study the possibilities of vacuum-assisted wound closure therapy for the early management of patients with se­vere open polystructural injuries of limbs with fragmentation or gunshot character in comparison with conventional therapy.Methods: the results of treatment of 34 patients (men, mean age (30 ± 6) years) with open severe musculoskeletal injuries of the lower and upper extremities, which are accompanied by problems of primary closure of the wound, are analyzed. Be­fore the application of vacuum-assisted wound closure therapy or traditional treatment, all patients had wound sanation and fasciotomy. Eighteen patients were included in the study group who underwent variable negative pressure. Standard wound treatment with antiseptics and the imposition of gauze dressings were applied in 16 affected control group. The condition of the wound was checked on the third and seventh day of treatment. The rate of healing was determined, which was determined by the dif­ference between the initial areas and the areas identified dur­ing the study stage.Results: a significant decrease in the aver­age wound area with Vacuum-assisted wound closure therapy (1.6 cm2 after 3 days, 3.9 cm2 after 7 hours) was recorded in com­parison with the traditional method (0.8 and 3 cm2, respec­tively).Conclusions: a significant increase in the rate of initial healing of complex fragmentation and gunshot wounds in pa­tients with vacuum-assisted wound closure therapy compared with traditional treatment in a control group was demonstrated. Primary application of vacuum-assisted wound closure thera­py is most effective in the period corresponding to the second phase of the wound healing (3–7 days).

Mycobacterial panniculitis caused byMycobacterium thermoresistibilein a cat

Case summaryA domestic shorthair cat was evaluated for chronic, bilateral, ulcerative dermatitis affecting the inguinal region and lateral aspects of both pelvic limbs. Histopathologic examination of skin biopsies collected throughout the course of disease revealed chronic pyogranulomatous ulcerative dermatitis. Aerobic bacterial skin cultures yielded growth of a methicillin-resistant Staphylococcus aureus and Corynebacterium amycolatum. Upon referral the clinical findings were suggestive of a non-tuberculous Mycobacterium species infection. Previously obtained skin cultures failed to yield growth of mycobacterial organisms. A deep skin biopsy was collected and submitted for mycobacterial culture. At 5 weeks of incubation Mycobacterium thermoresistibile was isolated. In previous reports, M thermoresistibile has been isolated after 2–4 days of incubation, suggesting that this strain may have been a slower growing variant, or other factors (such as prior antimicrobial therapy) inhibited rapid growth of this isolate. The cat was hospitalized for intravenous antibiotic therapy, surgical debridement of wounds, vacuum-assisted wound closure therapy and reconstruction procedures. The wounds were ultimately primarily closed and the cat was discharged to the owner after 50 days of hospitalization. Seven months after hospitalization, the ulcerative skin lesions had healed.Relevance and novel informationTo our knowledge, only two cases of M thermoresistibile panniculitis have been reported in cats. In the only detailed report of feline M thermoresistibile panniculitis, treatment was not attempted. The second case only reported detection of M thermoresistibile by PCR without a clinical description of the case. In our case report, severe chronic skin infection with M thermoresistibile was addressed using prolonged specific antibiotic therapy, surgical debridement and reconstructions, and treatment of secondary bacterial infections.

A Cost Effective Technique for Vacuum-assisted Closure Therapy With a Portable Suction System

Vacuum-assisted wound-closure therapy is applied to an open wound to create subatmospheric pressures within a sealed dressing. The therapy increases blood flow, decreases edema and bacterial count, and enhance the formation of granulation tissue. It has been used successfully in treating open wounds of the extremities, sternum, and abdominal wall and also pressure or diabetic ulcerative wounds. Patients who needed open wound treatment before surgical closure were included in this study. Healing was determined by development of a clean granulating wound bed (ready for skin grafting) and reduction of wound surface area. The pressure applied creates a suction force that removes excess fluid and debris, decreases bacterial levels of tissue, and increases tissue perfusion, which results in improved wound healing. In our technique, the system consists of a sterilized simple foam sponge, a vacuum drain, 2 blood infusion kits, a negative pressure aquarium air pump, 1 L saline bottle, and a sterile drape. With the technique we are presenting, vacuum-assisted wound-closure therapy can be applied in a similar and cost-effective way.

Contemporary outcome of the surgical management of prosthetic graft infection after a thoracic aortic replacement: is there a room to consider vacuum-assisted wound closure as an alternative?

ObjectiveOnce a replaced prosthetic graft is infected, it is usually necessary to re-replace the thoracic aorta to achieve complete resolution of the infection. It is, however, an exceedingly invasive approach to perform such a repeat surgery on patients in a poor condition. We have managed both re-replacement of an infected prosthetic graft and conservative therapy with vacuum-assisted wound closure (VAC) without re-replacement. These two treatment modalities were retrospectively assessed.MethodsRetrospective clinical chart review was undertaken on 21 patients with prosthetic graft infection after thoracic aortic replacement between December 1999 and December 2012. Surgical outcomes were evaluated between the two groups: re-replacement group (group R, n = 14) and no-replacement group (group NR, n = 7).ResultsIn-hospital survival rates were 64.3 % in group R and 85.7 % in group NR. Mortality in group R included five patients, sepsis in two patients, and intraoperative aortic rupture, heart failure, and cerebral infarction in one. Mortality in group NR included one patient (sepsis). In terms of long-term outcome, one patient in group R and one patient in group NR died of rupture of a residual aortic aneurysm, and one patient in group NR died of renal disease during follow-up (52.8 ± 41.5 months for R and 43.2 ± 28.5 months for NR; mean ± standard deviation).ConclusionsRe-replacement of an infected prosthetic graft after a thoracic aortic operation still carries a significant risk for mortality. VAC therapy may provide an acceptable option for such a subgroup of patients with this serious condition.

Vacuum-assisted wound closure versus alginate for the treatment of deep perivascular wound infections in the groin after vascular surgery

Vacuum-assisted wound closure (VAC) therapy may heal wounds faster than conventional dressings after surgical debridement of perivascular groin infections after vascular surgery. Patients with deep infected wounds (Szilagyi grade III) were surgically revised and left open for secondary healing, then randomized to either VAC or alginate (Sorbalgon) therapy, between February 2007 and November 2011. To test the hypothesis, it was calculated that 42 patients needed to be included (90% power, 5% level of significance). It was decided to perform an interim analysis after inclusion of 20 patients. Among 66 patients undergoing groin revision, 20 patients were included in this study. Patients were randomized to VAC (n = 10) or alginate (n = 10). The two groups were comparable in patient and wound characteristics. Time to full skin epithelialization was significantly shorter in the VAC group (median, 57 days) compared with the alginate group (median, 104 days; P = .026). The number of positive wound cultures of bacteria and C-reactive protein values decreased equally in both groups between surgical revision and day 21. One femur amputation was performed in each group as a consequence of the groin infection, one patient died during the in-hospital stay in the alginate group, and none died in the VAC group. VAC achieves faster healing than alginate therapy after wound debridement for deep perivascular wound infections in the groin after vascular surgery. This finding does not allow further inclusion of patients from an ethical point of view, and this study was, therefore, stopped prematurely.

Vergleich der Effektivität der VAC-Therapie bei der Behandlung von Prothesen- und Weichteilinfektionen

Although vacuum-assisted wound closure (VAC) has been developed into a standard technique in septic surgery, reliable data about the efficacy of the treatment are still lacking. Postoperative infections after arthroplasty or soft-tissue surgery were identified using a prospective database for complications (Critical Incidence Reporting System) which was retrospectively supplemented with items for evaluation of VAC therapy. Eradication success of infection was analysed considering epidemiological parameters, course of treatment, and characteristics of causing bacterial strains. Furthermore, serological C-reactive protein (CRP) concentrations were evaluated for diagnostic and prognostic reliability. 92 patients with an average age of 60 ± 4 years were included in the study. Patients with soft tissue infections (STI, n = 53) were statistically significant younger compared to patients with infections following arthroplasty (AI, n = 39) (53 ± 6 vs. 70 ± 4 years; p < 0.001), but the probability for eradication success was not dependent on age. Mortality was 9-fold higher in the AI group (p < 0.01). Patients with infected endoprostheses were longer treated on intensive care units (6.1 ± 8.4 vs. 3.5 ± 6.5 days; p < 0.01), but there was no statistically significant association to eradication success. Probability for eradication of infection was with 81 % statistically significant higher in the STI group compared to 38 % in the AI group (p < 0.001). Early infections in the AI group were associated with a better healing success when compared to chronic infections (p < 0.05). The same correlation could be shown for the removal of implant (p < 0.0001). Aerobic fermenting bacteria were less effectively eradicated than anaerobic germs following soft-tissue infections (p < 0.01). In cases of osteomyelitis following soft-tissue infection, the probability for eradication of infection was impaired (p < 0.001). Kind and quality of final wound closure in the STI group were statistically significantly associated with eradication success (p < 0.001). There was no critical value concerning the number of revisions until healing of infection was reached. CRP values were higher in the AI group and associated with the prognosis (p < 0.05). Probability of eradication success using VAC therapy is higher after soft-tissue infections compared to infections following arthroplasty. Accordingly, mortality is higher in this group. Chronic courses have worse chances for healing in both groups. For serological CRP values a prognostic relevance could be shown.

The Use of Vacuum-Assisted Wound Closure Therapy in Thoracic Operations

Conventional treatment of complex, nonresolving empyemas after an episode of pneumonia or a chest operation often requires an open-window thoracostomy. This necessitates frequent, often painful dressing changes and is associated with prolonged hospitalization. The wound is often malodorous, causing significant social distress to patients and unquestionably affects their quality of life. We assessed the value of using vacuum-assisted closure (VAC) therapy in managing patients with a persistent infected pleural space. The study included 10 patients. All patients signed an informed consent and were debriefed before the procedure. An empyema developed in 1 patient after an episode of pneumonia. The other 9 had recently undergone a thoracic surgical procedure. All patients underwent initial open drainage of the pleural cavity and debridement. A VAC therapy system was then inserted intraoperatively or on the first postoperative day. The patients were discharged home with a portable VAC therapy system in situ. Subsequent dressing changes were managed by tissue-viability nurses in the community, without the need for further anesthesia or analgesia. Over a period of time, the cavity was sterilized and eventually obliterated spontaneously. All patients were mobilized early and fast-tracked through the hospital. This prevented the need for daily dressing changes; hence, minimizing the disruption of normal activities and reducing the need for nursing care. Overall, the length of hospitalization was shorter, and the VAC therapy facilitated closure of the infected wound cavity. The use of the VAC therapy system negated the need for a second surgical procedure to close the wound cavity. None of the patients reported pain, odor, or inconvenience associated with the VAC therapy system. Our observations suggest that the use of VAC therapy to treat such patients is safe, facilitates early discharge and recovery, and offers a "civilized," cost-effective treatment in a community setting.

Negative pressure wound therapy

Negative pressure wound therapy (NPWT) is also referred to as vacuum or topical negative pressure therapy. Vacuum-assisted wound closure therapy was first described in 1997 in the US. A wide variety of devices has since been developed. NPWT is recognised as an important adjunct in supporting and promoting wound healing although the precise mechanisms of action are not completely understood (Morykwas et al 2006). It is thought that the mechanical action of negative pressure suction helps create an optimum, wet wound base, removing excess wound exudate and interstitial fluid, stimulating tissue granulation by increasing blood flow, reducing oedema and bacterial loading. It is suggested that NPWT may be more clinically effective than modern dressings and compression bandaging (Braakenburg et al 2006), but the evidence base in terms of cost efficiency, clinical efficacy, patient satisfaction and safety, remains limited.

Vacuum-Assisted Wound Closure is Superior to Primary Rewiring in Patients with Deep Sternal Wound Infection

Deep sternal wound infections are serious complications after cardiac surgery. The aim of the present study is to compare the outcome after vacuum-assisted wound closure to that after primary rewiring with disinfectant irrigation. The study additionally focuses on defining predictors for the failure of primary rewiring and its impact on postoperative outcome. Retrospective analysis was performed in 5232 patients who underwent cardiac surgery with a median sternotomy. 192 patients postoperatively developed deep sternal wound infections and were distributed into 2 therapy groups: a vacuum-assisted wound closure (= VAC) group and a primary rewiring (= RW) group, which was subdivided into healing after rewiring (= RW-h) and failure of rewiring (= RW-f). These groups were compared statistically to reveal coincidental pre-, intra- and postoperative parameters. Compared to the VAC group, the RW group showed a poorer outcome, although RW baseline characteristics were apparently beneficial. Primary rewiring failed in 45.8 % of all cases, which led to even worse outcomes. Important predictors for failure of primary rewiring were morbid obesity, diabetes mellitus type II, chronic obstructive pulmonary disease, preoperatively impaired left ventricular function, postoperatively positive blood and wound cultures, bilateral harvesting of internal thoracic arteries and the need for surgical reexploration. In spite of patients being in a worse condition, vacuum-assisted wound closure therapy resulted in improved outcomes and thus should be preferred to primary rewiring. Moreover we report on predictors which may indicate whether there is a high risk of rewiring failure.

Mid-Term Result of the Clinical Treatment for Pacemaker Infection with Vacuum-Assisted Wound Closure

Background: Although pacemaker infection is a rare, but life-threatening complication, the optimal treatment is poorly defined. Methods: We describe 8 cases (7 patients), treated for an infected pacemaker at our institute between 2008 and 2011. The pacemaker pockets were fenestrated and treated with vacuum-assisted wound closure (VAC). Results: Infection was eradicated in seven cases without the need for aggressive surgery or removal of the intra-vascular lead. Fenestrated wounds in two cases were re-sutured without replacement of the entire pacemaker system. The others were implanted with new pacemakers in the contra-lateral side after removing the infected generator. However, in only a case, who had been operated for pacemaker implantation before 42 days, VAC did not lead to eradicate the infection, and intra-vascular lead was removed using traction. A pacemaker became infected again in one patient nine months later. The VAC therapy was repeated and the infection was eradicated by removing the pacemaker generator but not the intra-vascular lead. The mean durations of VAC were 30.3 days, respectively. There is no evidence of recurrent infection for 14–38 months after discharge. Conclusions: Although complete removal of an infected pacemaker system is essential, less invasive VAC might serve as the first option for treating pacemaker infection when the risk of total system explantation is high.

Nutzen und Grenzen der Vakuumtherapie von Wunden

Establish the benefits and limitations of vacuum-assisted wound closure therapy (VWT) on the basis on "best evidence". The core of the review was an internet-based literature search based on the criteria of the Cochrane Collaboration, supplemented by an additional manual search. The identified literature was evaluated and selected following a specified algorithm. The therapeutic benefit was determined using the current benefit definitions of SGB V, GBA and IQWiG, with emphasis on the patient's perspective and on daily routine. The online search revealed n=674 publications on VWT. After the additional manual searching, a total of n=269 original papers filled the criteria for evaluation. The criteria and methods of evaluation for so varied in the clinical studies despite the same indications that no comparative meta-analyses of individual therapy goals could be carried out. Most studies also revealed methodological deficits. A majority of analyzed studies indicate an effectiveness and clinical benefit for VWT. VWT is a standard approach in Germany for treating problematic acute and chronic wounds. It is often an essential treatment option given it's effectiveness in many indications. VWT also has marked clinical benefits from the patient's perspective.

Necrotizing soft tissue infections

The purpose of this review is to consider recent advances in the definition, pathogenesis, diagnostic criteria, and treatment of necrotizing soft tissue infections. The efficacy of early surgical debridement combined with antimicrobial therapy, close monitoring and physiologic support is strongly demonstrated. Novel therapeutic strategies including vacuum-assisted wound-closure therapy and intravenous immunoglobulin have been described. Necrotizing soft-tissue infection is a rare infection of the subcutaneous tissue and fascia that is often associated with sepsis and can progress rapidly with a possible fatal outcome. Although the cause is not yet understood fully, patients often have a prior history of a small, trivial trauma, wound, or scratch. Establishing the diagnosis can be the main challenge in treating patients, and knowledge of all available tools is key for early and accurate diagnosis.