Vacuum-assisted Wound Closure Research Articles

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.

Assessment of Early and Late Management of Submental Gunshot Wounds.

Background: Management of submental gunshot wounds is becoming more common and requires complex surgical decisions. Objective: Compare outcomes of early and definitive reconstructive techniques following submental gunshot wounds. Methods: Retrospective chart review evaluated subjects who sustained a self-inflicted submental gunshot. The incidence of complications requiring unplanned operations was compared for early management techniques of skin/soft tissue, bone, and mucosal lining and definitive reconstructive techniques using Fisher's or Pearson Chi-square exact test with p ≤ 0.05 considered statistically significant. Results: The total of 27 patients were included. Early techniques included skin = primary soft tissue closure (n = 19) versus wound vacuum-assisted closure (n = 8); mandible = open reduction internal fixation (ORIF) (n = 19) versus external fixation (n = 8); and oral mucosal lining = primary mucosal closure (n = 20) versus dermal substitute (n = 7). Definitive management included ORIF (n = 10, 37%), ORIF with bone grafting (n = 8, 30%), and microvascular free-flap (n = 9, 33%). The incidence of complications requiring unplanned operation when using dermal substitutes for mucosal lining management was statistically higher than primary closure (p < 0.001); otherwise the complication rates of surgical techniques were equivalent. Conclusion: Several surgical decisions and techniques can be utilized at the time of early and definitive management of submental gunshot wounds. Only the use of dermal substitutes for mucosal lining is associated with a significantly higher rate of unplanned operation.

Wound Fluid Extracellular Microvesicles: A Potential Innovative Biomarker for Wound Healing.

Extracellular vesicles, or microvesicles, are a large family of membrane-bound fluid-filled sacs that cells release into the extracellular environment. Extracellular microvesicles (EMVs) are essential for cell-to-cell communications that promote wound healing. We hypothesize a correlation between the concentration of EMVs in wound fluid and the percentage of wound healing in treated chronic, nonhealing, wounds. A prospective, multicenter, randomized, single-blind clinical trial was conducted to evaluate EMV concentration in relation to wound healing percentages. Wound fluid samples were obtained from 16 patients with stage IV trunk pressure ulcers. Patients were divided equally into two groups: (1) control group on negative pressure wound therapy (NPWT) alone and (2) study group with NPWT plus porcine extracellular matrix dressing. NPWT was replaced two times a week, and porcine extracellular matrix applied once weekly for all subjects. An NPWT canister device, called a wound vacuum-assisted closure, containing wound fluid was collected from each patient every 4 weeks. EMVs were isolated and the concentration measured by nanoparticle tracking analysis. The study group's total healing percentage was around 89% after 12 weeks compared with the control group's percentage of about 52% (P ≤ 0.05). Using R programming software, simple linear regression was carried out to investigate the hypothesis. Data demonstrated significant positive correlation (R2 = 0.70; P = 0.05) between EMV concentrations and the healing percentage. There is a positive correlation between EMV concentration and wound healing percentages. Results propose that the EMVs in wound fluid could serve as a biomarker for healing.

The heterogeneous wound microbiome varies with wound care pain, dressing type, and inflammatory gene expression.

Wound dressing changes are essential procedures for wound management. However, ~50% of patients experience severe pain during these procedures despite the availability of analgesic medications, indicating a need for novel therapeutics that address underlying causes of pain. Along with other clinical factors, wound pathogens and inflammatory immune responses have previously been implicated in wound pain. To test whether these factors could contribute to severe pain during wound dressing changes, we conducted an exploratory, cross-sectional analysis of patient-reported pain, inflammatory immune responses, and wound microbiome composition in 445 wounds at the time of a study dressing change. We profiled the bacterial composition of 406 wounds using 16S ribosomal RNA amplicon sequencing and quantified gene expression of 13 inflammatory markers in wound fluid using quantitative real-time polymerase chain reaction (qPCR). Neither inflammatory gene expression nor clinically observed inflammation were associated with severe pain, but Corynebacterium and Streptococcus were of lower relative abundance in wounds of patients reporting severe pain than those reporting little or no pain. Wound microbiome composition differed by wound location, and correlated with six of the inflammatory markers, including complement receptor C5AR1, pro-inflammatory cytokine interleukin (IL)1β, chemokine IL-8, matrix metalloproteinase MMP2, and the antimicrobial peptide encoding cathelicidin antimicrobial peptide. Interestingly, we found a relationship between the wound microbiome and vacuum-assisted wound closure (VAC). These findings identify preliminary, associative relationships between wound microbiota and host factors which motivate future investigation into the directional relationships between wound care pain, wound closure technologies, and the wound microbiome.

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

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

Use of Vacuum-Assisted Closure to Reduce the Likelihood of Wound Complications After Limb-Sparing Resection of Pediatric Primary Bone Sarcomas of the Femur

BackgroundLimb-sparing surgery is the standard of care for primary bone tumors. However, such procedures are associated with high rates of wound complications, specifically in lower-extremity surgeries. Therefore, identifying and implementing interventions to minimize the likelihood of wound complications after limb-sparing resection of the lower extremity is crucial. MethodsPatients who underwent limb-sparing osteosarcoma or Ewing sarcoma resection during a 7-year period at a single institution were retrospectively reviewed. Data were collected on 39 patients who underwent limb-sparing resection of the femur. Patient demographics, tumor characteristics, and perioperative and postoperative data were extracted and analyzed. Patients who underwent resection before April 2017 received conventional postoperative incision dressings. Starting in April 2017, patients received vacuum-assisted closure (VAC) with the 3 M™ Prevena VAC system after surgical closure. Eighteen patients received conventional postoperative incision dressing, and 21 received incisional wound VAC. A wound complication was defined as any Clavien-Dindo classification greater than 0 within a 28-day postoperative period. ResultsPatients who received postoperative incisional wound VAC had lower rates of wound complications than those who received conventional incision dressings (14% vs. 50%; p = 0.035). Additionally, patients in whom wound complications developed had a longer average hospital stay than those without wound complications (5 days vs. 4 days; p = 0.029). ConclusionsWound complications prolong the hospital stay and can delay adjuvant chemotherapy for bone tumors. The use of postoperative incisional wound VAC is associated with less likelihood of wound complications and should be considered in any high-risk surgical closure. Level of EvidenceLevel III Treatment Study.

Early Wound and Sternal Management Following Pediatric Cardiac Surgery.

Early postoperative wound management following congenital heart surgery remains an area without equipoise. Precautionary restrictions can impact quality of life, development, and delay access to other needed care. The influence of different practices on wound healing and complications is unknown. We surveyed Pediatric Acute Care Cardiology Collaborative member centers regarding postoperative wound closure, wound vacuum-assisted closure (VAC) use, sternal precautions, and restrictions in the early postoperative period. We analyzed responses using descriptive statistics. Responses were submitted by 35/46 (76%) centers. Most centers perform primary skin closure with subcutaneous sutures. Wound covers are removed after 48 h at 43% (15/35) of centers and after ≥72 h at 34% (12/35) of centers. For delayed sternal closure, 16 centers close skin with interrupted, externalized sutures, 5 utilize wound VAC-assisted closure, and 12 use variable practices. Generally, 33 centers use wound VACs for wound care. Patient selection for VAC use and length of therapy varies. We found great variability in duration of sternal precautions and in activity, bathing, and submersion restrictions. Finally, 29 centers require a waiting period between cardiothoracic surgery and other surgeries such as tracheostomy or gastrostomy tube placement. Postoperative wound and sternal management lack consistency across North American pediatric heart institutes. Some restrictive practices may prolong length of stay and/or negatively impact quality of life and neurodevelopment. Practices may also impact wound infection rates. Research linking practices with clinical outcomes is needed to better define standards of care and reduce potential negative consequences of overly conservative or aggressive practices.

Does Wound VAC Temporization Offer Patient-Reported Outcomes Similar to Single-Stage Excision Reconstruction After Myxofibrosarcoma Resection?

Vacuum-assisted closure (VAC) temporization is a promising technique to achieve local control in aggressive soft tissue sarcomas. Despite its previously reported efficacy, adoption of VAC temporization remains limited, primarily due to the scarce literature on patient-reported outcomes (PROs) supporting its efficacy. This study compared the postoperative PROs after VAC temporization or single-stage (SS) excision and reconstruction for patients undergoing surgical resection for myxofibrosarcoma management. A retrospective analysis of myxofibrosarcoma patients who underwent surgical resections at our institution from 2016 to 2022 was performed. Postoperative PROs collected prospectively for those treated with VAC temporization or SS excision/reconstruction were compared using a visual analog scale (VAS) for pain and three Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires: Global Health Short-Form Mental (SF Mental), Global Health Short-Form Physical (SF Physical), and Physical Function Short-Form 10a (SF 10a). Absolute and differential (postoperative minus preoperative) scores at the 1-month, 3-month, 6-month, 1-year, and 2-year time points were compared. The analysis included 79 patients (47 treated with VAC temporization and 32 treated with SS excision/reconstruction). All outcomes were similar between the groups except for physical function 1 year after surgery, in which the differential PROMIS SF 10a scores were higher in the SS group (p = 0.001). All the remaining absolute and differential PROMIS and VAS pain scores were similar between the groups at all time points. Postoperative complications did not differ between the groups. The PROs for physical and mental health, physical function, and pain were similar between the myxofibrosarcoma patients who had VAC temporization and those who had SS excision/reconstruction after surgical resection.

P10 The yeast of our worries: a challenging case of persistent candidaemia following emergency abdominal surgery

Abstract Case summary A 47-year-old woman with a past medical history of osteoarthritis only presented to hospital with abdominal pain three days following a diagnostic colonoscopy performed for suspected bowel malignancy. Upon admission, she was diagnosed with a bowel perforation and subsequently underwent an emergency laparotomy and anterior resection for a newly diagnosed sigmoid adenocarcinoma. Her recovery was complicated by an anastomotic leak requiring multiple washouts due to faeculent peritoneal soiling. Following surgery, she was admitted to the ICU with an open abdomen for vacuum-assisted wound closure and mesh-mediated fascial traction. A sample of peritoneal fluid taken during her initial washout grew Escherichia coli, for which she was initially treated with piperacillin/tazobactam, and later, meropenem, after another E. coli isolate from a sample of intra-abdominal pus collected during a subsequent washout demonstrated piperacillin/tazobactam resistance. Despite treatment with meropenem, the patient continued to have intermittent fevers up to 40°C. Blood cultures taken during a febrile episode grew yeasts identified as Candida glabrata, at which point anidulafungin was commenced empirically. Computed tomography imaging of the chest, abdomen and pelvis did not reveal any potential source of invasive candidiasis. To exclude line infection as the source of the Candida, all central lines were removed, leaving only peripheral venous access. Despite this, the candidaemia continued. In total, 18 blood cultures taken over a period of 19 days grew C. glabrata. After 7 days of empirical treatment with anidulafungin, voriconazole was added in view of the persistent elevation in the patient’s serum β-D-glucan (BDG) and recurrent isolation of C. glabrata from blood cultures. Flucytosine was added after a further 10 days with no effect on the patient’s clinical status. Following removal of the abdominal mesh and the eventual closure of the patient’s abdomen, the time to positivity for her blood cultures gradually increased and eventually became negative at 5 days. Flucytosine was then stopped and anidulafungin and voriconazole were continued. A sustained decline in the patient’s serum BDG was observed thereafter and antifungal treatment was eventually stopped after three negative BDG measurements were obtained.1 Conclusions Fungal mesh infection is a rare but serious complication of abdominal surgery involving mesh insertion.2 To our knowledge, this is the first reported case of abdominal surgical mesh infection caused by C. glabrata. Previously reported cases in the literature have been due to other Candida spp. (albicans, krusei and norvegensis), Aspergillus and Coccidioides spp.1–3 C. glabrata is particularly adept at biofilm formation, causing low therapeutic response to antifungal treatment.4 In this case, source control could not be readily achieved as the mesh was required to aid abdominal closure, resulting in treatment failure despite triple antifungal therapy. This case serves as a stark reminder of the devastating and potentially fatal consequences that may result from this surgical complication and the perils associated with the use of mesh in abdominal surgery when the peritoneum has been soiled.

Benefits of negative pressure wound therapy with fat migration during revisional total hip arthroplasty in an obese patient: A case report

Introduction: A 38-year-old African American woman presented with right hip pain and movement restriction. Her medical history included a right hip and knee arthroplasty 10 years prior, history of Slipped Capital Femoral Epiphysis and osteonecrosis of the hip. Preoperative assessment was significant for multiple comorbidities such as obesity (BMI &gt; 38), hypertension, asthma. Patient concerns: The patient presented with right hip pain, rated 7/10, and restricted hip flexion, adduction, and abduction. Diagnosis: Recent imaging showed eccentric deterioration of the polyethylene lining of her prosthesis, acetabular hypertrophy on her right hip prosthesis, and chronic deformity of the pubic bone. Interventions: Based on these findings, a revisional total hip arthroplasty was performed. After the surgical procedure, the WoundVAC and the percutaneous drain were applied outside the tensor fascia lata to reduce seroma and hematoma formation. Postoperative pain control, antibiotics and DVT prophylaxis were given. On post-op day 3, an irrigation and debridement with delayed primary wound closure was performed under sterile conditions. Outcomes: On postoperative assessment, the wound demonstrated adequate healing without any signs of infection. Sutures and staples were removed 4 weeks post-op. Upon palpation there was no edema, effusions, temperature changes, tenderness. Clinical inspection revealed symmetrical alignment of the pelvis and hips. Range of motion testing revealed restriction beyond 80 degrees upon flexion and beyond 5 degrees of adduction and 10 degrees of abduction. The surgical site was noted to be healed at 6 weeks post-op. The patient continued to do well to date, without exacerbations. Conclusion: Obesity increases the risk of post-operative complications and wound healing failure. Therefore, Vacuum-assisted wound closure (WoundVAC), a type of negative pressure wound therapy, was applied outside the tensor fascia lata post-operatively, where the surgical incision was made. Negative pressure wound therapy facilitates wound healing by stimulating angiogenesis and promoting granulation tissue formation, which in turn can reduce the risk of surgical site infection in obese patients undergoing total hip arthroplasty. Highlighted is the mechanism of fat migration in the promotion of wound healing after preoperative weight loss and exercise.

Cold atmospheric plasma (CAP) in wound healing: harnessing a dual-edged sword

Graphical abstract Abstract Chronic wounds take longer to heal and, if left untreated, can result in severe repercussions such as sepsis, gangrene, and amputation. The current treatment procedures followed are wound cleaning and debridement, specialized dressings, antibiotics and antiseptics, hyperbaric oxygen therapy, and vacuum-assisted wound closure. Some of the limitations of these treatment options are multidrug resistance and tissue toxicity. Cold plasma is an emerging technology that has opened a new frontier in biomedical applications and is found to have great utility in wound healing. Cold plasma comprises reactive oxygen and nitrogen species (RONS) that can be targeted against bacterial inactivation and improve wound healing. The amount of RONS produced can be controlled by several parameters such as gas composition, flow rate, power, frequency, voltage, distance, and exposure time. The reactive species causes damage to the cell membrane as well as the intracellular components which ultimately lead to bacterial cell death. It can also accelerate wound healing by activating neutrophils, macrophages, endothelial cells, keratinocytes, and fibroblasts. These help in maintaining tissue oxygenation, initiating angiogenesis, collagen synthesis which aids in rapid wound closure. In this review, we summarize the various characteristics of cold plasma that can be optimized to produce an effective antimicrobial effect. The different mechanisms of bacterial inactivation and the stimulation of wound healing processes by the reactive species are discussed. Furthermore, numerous pieces of evidence from in vitro and in vivo experiments and clinical trials that prove that cold plasma is an effective approach are presented.

Vacuum-assisted scalp repositioning: a novel temporizing approach to acute sinking skin flap syndrome. Illustrative cases

BACKGROUND This report describes the use of a novel approach to address acute sinking skin flap syndrome (SSFS), a postcraniectomy complication arising from brain dysfunction beneath the skull defect. The authors present a case series of two patients, emphasizing the prospective application of an external plaster cast in tandem with a vacuum-assisted closure (VAC) device (wound VAC) to promptly reposition the scalp and relieve brain compression. OBSERVATIONS Following intervention, one patient showed immediate neurological improvement, with complete resolution of symptoms within hours. Conversely, the second patient developed nonconvulsive status epilepticus. Computed tomography scans postintervention validated the successful scalp repositioning and mass effect resolution in both instances. This temporary approach proved successful in one patient with moderate symptoms, serving as a bridge to cranioplasty. LESSONS The integration of an external plaster cast and wound VAC offers a cost-effective and prompt solution for patients with acute SSFS pending cranioplasty. Appropriate patient selection and heightened caution for those with severe symptoms should be exercised.

Negative pressure wound therapy for complex oral wounds

Abstract Negative pressure wound therapy provides a nonsurgical treatment option for many types of complex wounds. This therapy utilizes the vacuum-assisted closure device, which decreases air pressure, removes fluid that accumulates within the wound, and aids to facilitate changes that promote healing. Despite the increased use of negative pressure wound therapy in the head and neck region, there is substantially less data available on the management of transoral vacuum-assisted wound closure. Herein, we present a case of a novel approach for the creation and use of a transoral wound vac for a patient with a refractory orocutaneous wound in the setting of multiple previous free flaps and surgeries. A watertight seal was able to be maintained and the patient was compliant with treatment, resulting in successful management of the wound. We promote the consideration of this novel technique’s use for similar difficult-to-treat oral wounds.

Increasing Use of Prophylactic Open Abdomen Therapy With Vacuum Assisted Wound Closure and Mesh Mediated Fascial Traction After Repair of Ruptured Abdominal Aortic Aneurysm

Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n= 61, 85%). The most frequent comorbidities were cardiac disease (n= 31, 43%) and hypertension (n= 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p= .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p= .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.

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.

Acellular Fish Skin Graft Use in Open Abdomen Management.

Open abdomen (OA) management post damage control laparotomy (DCL) is common in complex abdominal trauma and intra-abdominal catastrophe (IAC). Use of polyglactin 910 mesh (VICRYL™, Johnson & Johnson, New Brunswick, New Jersey) to cover the intra-abdominal contents and wound vacuum-assisted closure (VAC) is current practice in the management of temporary abdominal closure (TAC). This may have complications and requires two to three weeks for granulations to be ready for skin grafting. Acellular fish skin graft (AFSG; Kerecis™, Reykjavik, Iceland), use in wound care management has proven beneficial in the management of both chronic and acute wounds, such as burns, by increasing wound granulation. However, to our knowledge, its utility in OA management has not been reported. The objective of this report is to introduce a novel use of AFSG (Kerecis™) in open abdomen to decrease the time of TACs by accelerating formation of granulation tissue and placement of skin grafts in patients with post damage control laparotomy (DCL) for trauma and IAC when committed to open abdomen management is presented. Illustration of application of AFSG (Kerecis™) in two patients who underwent DCL for IAC and OA management is presented. Two patients with intra-abdominal catastrophe post-DCL and fistulae were enrolled; one with postoperative enteric fistula and the other with post-anastomotic ileo-colonic fistula breakdown and major intra-abdominal sepsis resulting in multiple organ system failure (MOSF). In both cases, a hostile abdomen was present. The application of AFSG accelerated the placement of skin grafts in both patients and decreased the use of wound VAC and hospital length of stay. This report illustrates the use of AFSG (Kerecis™) to accelerate placement of skin grafts in patients post-DCL and OA management. AFSG (Kerecis™) could be considered as part of the OA management strategy.

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.&#x0D; 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]&#x0D; 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.&#x0D; 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.

A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin.

For 9 months (April-December 2022), we performed 32 vacuum wound dressings with the newly developed technique using the 3M ActiV.A.C. Therapy Unit and accessories, and Convatec's VARIHESIVE, avoiding skin contact with the adhesive films. Seven patients with 11 wounds who had sensitive skin or allergy to the conventionally used adhesive films were successfully treated with the new technique. The negative pressure wound dressings remained intact and functioned properly for up to 168 hours without compromising patients' daily activities and therapy. The novel "no foil-to-skin contact" technique for vacuum-assisted wound closure can successfully be incorporated in the treatment of patients in whom conventional negative pressure dressings are otherwise not applicable.

The Impact of Gender and Age in Obese Patients on Sternal Instability and Deep-Sternal-Wound-Healing Disorders after Median Sternotomy.

The aim of this study was to investigate the relationship between age and sex in regard to the development of deep sternal wound infections and sternal instability following median sternotomy. A propensity-score-matching analysis was conducted on 4505 patients who underwent cardiac surgery between 2009 and 2021, all of whom had a BMI of ≥30 kg/m2. A total of 1297 matched pairs were determined in the sex group, and 1449 matched pairs we determined in the age group. The distributions of sex, age, diabetes mellitus, delirium, unstable sterna, wire refixation, wire removal, superficial vacuum-assisted wound closure, deep vacuum-assisted wound closure, clamp time, bypass time, logistic EuroSCORE, and BMI were determined. The 30-day in-hospital mortality was found to be similar in the older and younger groups (8.149% vs. 8.35%, p = 0.947), and diabetes mellitus was also equally distributed in both groups. However, postoperative delirium occurred significantly more often in the older group (29.81% vs. 17.46%, p < 0.001), and there was a significantly higher incidence in men compared with women (16.96% vs. 26.91%, p < 0.001). There were no differences found in the incidence of sternum instability, fractured sternum, superficial vacuum-assisted wound closure, and deep vacuum-assisted wound closure between the age and sex groups. In conclusion, this study found that sternal instability and deep-wound-healing problems occur with equal frequency in older and younger patients and in men and women following median sternotomy. However, the likelihood of postoperative delirium is significantly higher in older patients and in men. These findings suggest that a higher level of monitoring and care may be required for these high-risk patient groups to reduce the incidence of postoperative delirium and improve outcomes following median sternotomy.

Evaluation of Vacuum Assisted Wound Closure and Conventional Wound Closure In Contaminated Major Surgical Wound

Background: Surgical Site Infections (SSI) increase costs, hospital stay, morbidity, and mortality. Vacuum-Assisted Closures (VAC) system has been gaining popularity recently in managing wounds to reduce SSI. But the current guidelines do not recommend its routine use for surgical wounds. This study aimed to compare the effectiveness and safety of VAC with conventional wound closure techniques for preventing SSIs in the major contaminated surgical wound. Methods and materials: Sixty patients with a contaminated surgical wound from the Department of Surgery and Department of Casualty of Chittagong Medical College Hospital were randomized in a 1:1 ratio to receive either VAC (Using Romovac device) or conventional wound closure. The primary endpoint was the rate of uncomplicated wound healing, defined as a Southampton wound score of &lt;2 at 30 days postoperatively. Secondary outcomes include duration of hospital stay and other complications (Defined by the Clavien-Dindo Classification). The primary analysis was an intention-to-treat analysis performed with a Chi-square test. Results: There were no significant differences in mean age, sex, body mass index, smoking history, wound class, indication for surgery and duration of surgery between the two groups. At 30 days postoperatively, 29 (96.3%) of 30 patients undergoing VAC had uncomplicated wound healing compared to 13 (43.6%) in the conventional closure group (p&lt;0.001). Most patients (26/30, 86.6 %) in the VAC group experienced Clavien-Dindo grade I or II complications. In contrast, in the conventional closure group, 28 (93.3%) patients developed Clavien-Dindo Grade III or IV complications (p&lt;0.001). The mean length of hospital stay was significantly shorter in the VAC group than in the conventional closure group (12.2±3.59 versus 29.07±10.36 days, p&lt;0.001). Conclusion: VAC resulted in favourable wound healing with less complication and shorter hospital stay than the conventional technique for the closure of the contaminated surgical wound. IAHS Medical Journal Vol 5(2), Dec 2022; 6-10