Vacuum-assisted Wound Closure 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.

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

A case of necrotizing fasciitis developing after cesarean section

Necrotizing fasciitis (NF) is a rare condition that is observed in obstetric and gynecological practices. It is a rapidly progressive and often fatal complication. Failure to obtain an early diagnosis and delay in initiating appropriate treatment can lead to significant morbidity and mortality. Our case was 25 years old, and she was in her first pregnancy. The patient had no systemic disease or history of previous surgery. Our patient’s baby was delivered by cesarean section with an indication of emergency fetal distress. During the cesarean section, it was observed that the amniotic fluid contained very dark meconium. No complications occurred during the cesarean section. Our patient presented with complaints of severe pain, bullae, and hyperemia at the level of the incision line one week later. In her vital findings, fever was 39.3 ºC, blood pressure was 90/60 mmHg, and heart rate was 110 /min. In laboratory tests, white blood cell count was 25,280 /mm3, C-reactive protein (CRP) was 431 mg/dL, and sedimentation was 100 mm/hour. On the ultrasonographic examination, air, significant edema, and thickening were observed in the incision line, skin, and subcutaneous tissues. On the computed tomography scan, thickening of the skin and subcutaneous tissues, fluid locations, and areas of air densities were observed over a wide area extending to the level of the thoracic 10th and 11th vertebrae superiorly and to the mons pubis inferiorly. Based on these findings, the patient was diagnosed with NF. After broad-spectrum antibiotic therapy and fluid-electrolyte support, extensive surgical debridement was performed under emergency conditions. Before applying the skin graft, vacuum-assisted wound closure was performed, and a very good response was obtained. The patient, whose pathology result was compatible with necrotizing fasciitis, was discharged on the 20th post-operative day. In this case, we aimed to present a case of NF after cesarean section.

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit.

Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit. A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients. There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01). The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.

Handmade spacers for two-stage exchange at the hip.

Two-stage exchange with implantation of atemporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes asimple and safe technique for handmade spacers at the hip. Periprosthetic joint infection of the hip. Septic arthritis of the native joint. Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange. Patient unfit to undergo two-stage exchange. Bony defect situation at the acetabulum impeding stable reduction of the spacer. Bone loss at the femur jeopardizing stable fixation of the stem. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy. Tailoring bone cement with antibiotics. Preparation of ametal endoskeleton. Molding of spacer stem and head by hand. Customizing spacer off-sets to bony anatomy and soft tissue tension. Implantation assuring rotational stability at the femur with abone cement collar. Confirmation of correct position by intraoperative radiography. Restricted weight-bearing. Range of motion as possible. Reimplantation after successful treatment of infection.

Handmade articulating spacer for two-stage exchange at the knee.

Two-stage exchange with implantation of atemporary spacer is considered gold standard treatment for chronic periprosthetic joint infection of the knee. This article describes asimple and safe technique for handmade articulating spacers at the knee. Chronic or relapsing periprosthetic joint infection of the knee. Known allergy against components of polymethylmethacrylate (PMMA) bone cements or admixed antibiotics. Inadequate compliance for two-stage exchange. Patient not able to undergo two-stage exchange. Bony defect situation at the tibia or femur leading to collateral ligament insufficiency. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy. Removal of the prosthesis, thorough debridement of necrotic and granulation tissue, tailoring bone cement with antibiotics. Preparation of atibial and femoral stem. Customizing the tibial and femoral articulating spacer components to bony anatomy and soft tissue tension. Confirmation of correct position by intraoperative radiography. Protection of the spacer with an external brace. Restricted weight-bearing. Passive range of motion as possible. Intravenous-followed by oral antibiotics. Reimplantation after successful treatment of infection.

Cierre dinámico y toxina botulínica: una alternativa novedosa para el cierre definitivo del abdomen abierto y contenido

We report the case of a 54-year-old male patient hospitalized for COVID-19 pneumonia who developed septic shock due to acute Hinchey IV diverticulitis and required Hartmann’s surgery. The patient evolved with colonic ischemia and underwent total colectomy and open abdomen (OA) with temporary abdominal closure (TAC) that was managed with a vacuum-assisted wound closure (VAWC) system for 7 weeks, resulting in a Björck grade 3A OA with a 16-cm gap. As he had a favorable clinic course, dynamic closure with mesh-mediated fascial traction was decided, associated with botulinum toxin (BT) injection. This strategy allowed primary fascial closure (PFC) of the abdominal wall 5 weeks after treatment was initiated, thus avoiding the complications of healing by secondary intention.

Infiltrating Wound Vacuum-Assisted Closure With Topical Amphotericin for Mucormycosis Infection of the Achilles Tendon.

The rarity and heterogeneity of mucormycosis make treatment variable, and no prospective or randomized clinical trials exist in plastic surgery literature. The use of wound vacuum-assisted closure in combination with the instillation of amphotericin B to treat cutaneous mucormycosis is not well documented. A 53-year-old man underwent left Achilles tendon reconstruction with allograft after a complete tear during exercise. About 1 week after the operation, he began having incisional breakdown later found to be secondary to mucormycosis infection, prompting presentation to an emergency department. The use of negative pressure wound therapy with wound vacuum-assisted closure and intervals of instilling amphotericin B facilitated infection control in this lower extremity mucormycosis infection. Patients with a localized mucormycosis infection may benefit from treatment with an instillation wound vacuum-assisted closure with topical amphotericin B as presented in this case study.

Open abdominal vacuum pack technique for the management of severe abdominal complications after cytoreductive surgery in ovarian cancer

IntroductionThe aim of this study was to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. MethodsRetrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open abdomen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmental syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh.The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula). ResultsTwo percent of patients who underwent CRS required VAWC during the study's patient inclusion period. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used.Median hospital stay was 65 days (range: 18–153). Four patients died during hospitalization, three of these within 30 days of VAWC completion. ConclusionVAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications.

Practice Patterns in Fournier’s Gangrene in Europe and Implications for a Prospective Registry Study

Fournier's gangrene (FG) is a life-threatening, necrotizing infection. Due to the rareness of the disease, it is challenging to plan robust prospective studies. This study aims to describe current practice patterns of FG in Europe and identify implications for planning a prospective FG registry. Online non-validated 17-items survey among urologists treating FG in in European hospitals. Questionnaires were analyzed with LimeSurvey (LimeSurvey GmbH Hamburg, Germany). 229 responses from ten different European countries were submitted, and 117 (51.1%) urologists completed the questionnaire. The departments treat a mean of 4.2 (SD 3.11) patients per year. The urology department mostly takes the lead in treating FG patients (n = 113; 96.6%). The practice in FG is very heterogenic and mostly case-based all over Europe, e.g., vacuum-assisted wound closure (VAC) is mostly used (n = 50; 42.7%) as adjunct wound. The biggest challenges in FG are the short time to diagnosis and treatment, standardization and establishment of guidelines, and disease awareness. Additionally, participants stated that an international registry is an outstanding initiative, and predictive models are needed. There is no standard of care in the diagnosis, treatment, and long-term care of FG all over Europe. Further research could be conducted with a prospective registry.

DIFFERENT APPROACHES IN THE MANAGEMENT OF DIABETIC FOOT ULCERS – EXPERIENCE AT A TERTIARY CARE HOSPITAL

Aims and Objectives: To compare the outcomes of the usage of the negative pressure wound therapy (NPWT) using vacuum assisted wound closure/ Collagen granules/ Offloading techniques with the conventional moist gauze dressing in the treatment of diabetic foot ulcers (DFU). Methods: Prospective, interventional study. Study conducted at B.L.D.E (DU)’s Shri B.M.Patil Medical College Hospital and Research Center, Vijayapur over a period of 5 years. The demographic characteristics, type of foot lesions and treatment with different modalities of dressings and outcome were studied. 50 cases in each group – NPWT/Collagen granules dressing/ offloading techniques and conventional moist gauze dressings were allocated alternatively. Results: 200 patients were included in the study, saw the gradual increase in the granulation tissue development, but the results were better in other groups than the conventional group and the collagen dressing group had more granulation tissue from week 1. There was early recovery among the other groups when compared to the conventional methods. The mean recovery were least in the collagen dressing group. 90% had good outcome in the negative dressing group. The outcome was 92% among the off loading group and 96% good outcome among the collagen group. But the conventional group had only 64% good outcome. And the difference was statistically significant. Conclusion: The comparison of different methods to treat the diabetic foot ulcer showed that collagen method of dressing to be superior to others followed by offloading and then by topical negative pressure dressing. The conventional method had less favorable and slow outcome.

FOURNİER GANGRENİ HASTALARINDA VAC KULLANIMININ HASTANE YATIŞ SÜRESİNE ETKİSİ

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Cutaneous Blastomycosis Presenting as a Nonhealing Wound in the Northeast United States: A Case Report.

Primary cutaneous blastomycosis is a rare presentation of infection caused by direct inoculation of a wound. We present a 61-year-old male with an extensive history of wound dehiscence and wound care noncompliance after a bite from a brown recluse spider on the left thigh while on vacation in Cape Cod in September of 2020. After antibiotic therapy and culture, treatment involved debridement, split thickness skin grafting, strict wound vacuum-assisted closure care, and oral itraconazole. This brief demonstrates a case of blastomycosis arising from trauma in a non-endemic region for infection and serves as an example of successful management of the longstanding wound.

Abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm: A case report and literature review

Background: Abdominal compartment syndrome (ACS) arises in approximately 7% after ruptured abdominal aortic aneurysm (RAAA) treatment. Decompressive laparotomy is a satisfactory way to treat ACS. The problem is deciding when to complete abdominal closure with appropriate alternative treatments.[1]&#x0D; Methods: This is a case report of successful ACS treatment following RAAA intervention at Ho Chi Minh University Hospital of Medicine and Pharmacy with a literature review.&#x0D; Clinical case: A 61-year-old male patient was hospitalized for abdominal pain. Computed tomography angiography demonstrated RAAA. He underwent the emergency endovascular repair of ruptured aneurysms (rEVAR). At 30 minutes post-intervention, the patient's abdomen was distended following intraabdominal hypertension measured via bladder catheter. Within ACS diagnosing, emergency decompressive laparoscopy was performed. The abdominal wall was left open and covered with a sterile nylon cover. The fascial closure was performed on the sixth postoperative day with the support of vacuum-assisted wound closure (VAC) and mesh-mediated fascial traction. On the 27th postoperative day, the wound could close completely, and the patient could be discharged successfully.&#x0D; Conclusion: A bladder pressure is required to monitor intraabdominal pressure postoperatively after decompressive laparotomy. Delayed fascial closure is appropriate with supporting VAC until total abdominal closure.

Fish Skin–Derived Wound Adjunct as an Alternative to Vacuum-Assisted Wound Closure for Contaminated and Infected Wounds

INTRODUCTION: Vacuum-assisted wound closure (VAWC) is standard therapy for contaminated wounds. Fish skin–derived wound adjunct (FDWA) is used in wound care for contaminated wounds with great success. We postulated that FDWA would be an effective alternative, reducing overall cost and pain. METHODS: Our FDWA database of all patients where FDWA (Kerecis, Reykjavik Iceland) was placed intraoperatively was retrospectively reviewed to identify patients who met the criteria for the use of VAWC. Surgical wound infection (SSI) was defined as described by the CDC. Cost metrics were calculated based on actual cost for VAWC compared with the cost of FDWA. Before the use of FDWA, the average length of use for VAWC was 11.5 days. RESULTS: Fifteen patients (7 men: 8 women) with a mean age of 60 years (range 41to 84 years) and a mean follow-up of 29 days (range 6 to 59 days) were identified who met criteria. Level 1 criteria for VAWC were identified in 7 patients. Two or more level 2 criteria were identified in 8 patients. No SSI was identified in the FDWA patients (Table 1). The daily cost of VAWC is $111.18/day for a total of $1,278.57. The cost for a single application of FDWA is $890. Patients do not require any dressing changes in the FDWA group. Table 1. - Criteria for Vacuum-Assisted Wound Closure Level 1 Level 2 Risk factors No. of patients Risk factors No. of patients Extended duration of surgery 4 ASA physical status ≥ 2 14 Previous surgery at the site/multiple incisions 2 Age >65 y 5 BMI ≥40 kg 1 Steroids for a chronic condition 5 Regularly scheduled dialysis 1 Smoking 4 BMI (30–39.9) kg 3 Peripheral vascular disease 1 CONCLUSION: This pilot study suggests that FDWA is an effective alternative to VAWC with lower cost and less patient discomfort. Further study is needed to fully define the role of FDWA in the management of contaminated surgical wounds.

Endoluminal Wound Vacuum-Assisted Closure: Bridging the Gap

INTRODUCTION: Endoluminal vacuum therapy (EVAC) is used to divert gastrointestinal contents and aid closure of esophageal, gastric, and colonic perforation. Recent publications demonstrate a high success rate in defect closure and avoidance of high-risk, salvage operation. We describe our experience with EVAC at 2 tertiary care centers. METHODS: Retrospective review of prospectively maintained database of patients undergoing EVAC therapy from 2018 to 2022. Baseline demographics were recorded, as well as primary operation, severity of illness, indication for therapy, duration of EVAC, and overall success in defect closure. RESULTS: Thirteen patients underwent EVAC therapy, the average age was 52 years, and 12 (92%) were men. Eight (62%) patients underwent EVAC therapy for an upper gastrointestinal tract perforation/leak and 5 (38%) for a lower gastrointestinal tract defect. EVAC therapy in 12 (92%) led to healing of the defect and full closure in 9 (69%) with EVAC alone. One (8%) patient was transitioned to comfort care and died while undergoing EVAC therapy. Four (31%) patients were critically ill at time of placement with a Sequential Organ Failure Assessment score of 5.5 (range 3 to 9). EVAC therapy required an average 16.7 (range 4 to 41) days with 3 (range 0 to 7) exchanges. Three (23%) were successfully managed on the floor and 1 (8%) as an outpatient. CONCLUSION: EVAC therapy is a versatile technique that can safely and effectively manage complicated injury throughout the gastrointestinal tract, replacing some high-risk surgical salvage procedures. EVAC therapy has a high success rate in appropriately selected patients with limited gastrointestinal tract defects.

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