Vacuum-assisted Wound Closure Research Articles

Final results of the Pr\xe4VAC trial: prevention of wound complications following inguinal lymph node dissection in patients with penile cancer using epidermal vacuum-assisted wound closure

PurposeInguinal lymphadenectomy in penile cancer is associated with a high rate of wound complications. The aim of this trial was to prospectively analyze the effect of an epidermal vacuum wound dressing on lymphorrhea, complications and reintervention in patients with inguinal lymphadenectomy for penile cancer.Patients and methodsProspective, multicenter, randomized, investigator-initiated study in two German university hospitals (2013–2017). Thirty-one patients with penile cancer and indication for bilateral inguinal lymph node dissection were included and randomized to conventional wound care on one side (CONV) versus epidermal vacuum wound dressing (VAC) on the other side.ResultsA smaller cumulative drainage fluid volume until day 14 (CDF) compared to contralateral side was observed in 15 patients (CONV) vs. 16 patients (VAC), with a median CDF 230 ml (CONV) vs. 415 ml (VAC) and a median maximum daily fluid volume (MDFV) of 80 ml (CONV) vs. 110 ml (VAC). Median time of indwelling drainage: 7 days (CONV) vs. 8 days (VAC). All grade surgery-related complications were seen in 74% patients (CONV) vs. 74% patients (VAC); grade 3 complications in 3 patients (CONV) vs. 6 patients (VAC). Prolonged hospital stay occurred in 32% patients (CONV) vs. 48% patients (VAC); median hospital stay was 11.5 days. Reintervention due to complications occurred in 45% patients (CONV) vs. 42% patients (VAC).ConclusionsIn this prospective, randomized trial we could not observe a significant difference between epidermal vacuum treatment and conventional wound care.

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.

Prevention of Surgical Site Infections in Gynecologic Surgery: A Review of Risk Factors and Recommendations.

Background: Surgical site infections (SSIs) are a type of health care–associated infection that can cause significant patient harm. Many are preventable. Postoperative courses complicated by an SSI can equate to longer hospital stays, lost time from work, and the need for reoperation.Methods: This review addresses types of SSIs, risk factors, and best practices for preventing SSIs associated with gynecologic surgery.Results: Best practices to reduce SSIs are divided into preoperative, intraoperative, and postoperative activities. Preoperative considerations include patient showering, hair removal, glycemic control, and hand and forearm scrub. Intraoperative concerns are antibiotic prophylaxis, skin preparation prior to the start of surgery, and the operating room environment. Postoperative concerns are surgical dressing, vacuum-assisted wound closure, and patient instructions.Conclusion: Best practices should be established and followed to reduce the risk of SSI associated with gynecologic surgery.

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment.

Postoperative surgical site problems (PSSPs) following spinal surgery may lead to patient mortality, increased treatment costs and possible recurrent medical interventions. Despite efforts to reduce spinal surgery-related infection rates, complications are common and significantly increased by patient comorbidities. Since PSSPs occur regardless of deterrent measures, it is essential to distinguish the related risk factors. Different treatment conventions for PSSPs, for example, antibiotic treatment, debridement, soft tissue care and removal of implants have been prescribed with blended outcomes. The utilization of the wound vacuum-assisted closure (VAC) system has gained increasing popularity in the management of deep wound infections after deformity surgery.

Comparison between two different protocols of negative pressure therapy for healing of chronic ulcers

BackgroundNegative pressure therapy plays an important role in the healing process of different types of wounds. Aim of the study: this study aimed to compare between modified and traditional method of vacuum wound closure for chronic wounds. SubjectsThirty participants with chronic ulcers completed the study, their ages ranged from 47 to 65 years, from Benha city, divided randomly into two groups, it was carried out from December 2017 to March 2019. MethodsThe first group treated by the traditional method of vacuum assisted wound closure for 8 weeks; dressing was changed 3 times weekly, at 125 mmHg. The mode of 2 min off and 5 min on was used. The second group treated by the modified method by switching off the device at the fifth week and applying traditional dressing for one week then ended by three weeks of vacuum wound closure. Assessment was performed before and after the study. Student t-test was used for analysis. ResultPaired t-test showed a significant improvement in wound surface area as well as volume for pre and post treatment in each group (p < 0.05). On the other hand independent t-test revealed a non-significant difference between the two groups pre as well as post treatment (p > 0.05). ConclusionThere is no significant difference between the two programs on healing of chronic ulcers. Clinical trial registration noNCT03701152 - at Clinicaltrials.gov.

Hand-Crafted Endoluminal Vacuum-Assisted Drainage for Anastomotic Leak After IPAA.

The vacuum-assisted drainage has many applications in managing complex wound healing. It quickens the recovery period by its hyperemic effect on the exposed zone, decreasing bacterial colonization, preventing tissue edema, and promoting granulation of the wound. However, its use in anastomotic leak after IPAA is scarcely studied, especially because a proprietary endoluminal vacuum-assisted closure system was removed from the US market. We applied a hand-crafted endoluminal vacuum-assisted closure system using the existing standard wound vacuum-assisted closure supplies to 2 patients who developed an anastomotic leak with a presacral abscess after completion proctectomy with J-pouch construction. We changed the endoluminal vacuum-assisted closure drain every 2 to 3 days, and both patients had substantial improvements in their abscess cavity after the seventh and ninth applications. Anastomotic leak at the IPAA traditionally takes up to a year to heal, which causes a significant toll on the psychosocial life of the patient and delayed stoma closure. Therefore, we believe that facilitating the healing process by using our hand-crafted endoluminal vacuum-assisted closure drain might provide a great value to patients' quality of life.

Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery

In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed. Pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy. In the first 56 robotic cases, 356 total pedicle screws were placed. Eight screws were placed without the robot due to surgeon discretion. Of the 348 pedicle screws inserted by navigated robotic guidance, only 2.6% (9/348) were repositioned, resulting in a 97.4% (339/348) successful screw placement rate. The average age was 64, and 48% were female. Average body mass index was 31 kg/m2. Based on the GRS CT-based grading, 97.7% (340/348) were graded A or B, 1.7% (6/348) screws were graded C, and only 0.6% (2/348) of screws were graded D. Two complications, explantation of interbody and vacuum-assisted wound closure, were reported as requiring a return to the OR, but these were not related to robotic guidance or pedicle screws. This study demonstrated a high level of accuracy (97.7%) in the first 56 cases using navigated, robot-assisted surgery based on the GRS. There were two non-screw-related complications requiring return to the operating room.

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.

Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection.

Infra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection. A retrospective study was conducted over a four-year period. Over this period, 13 patients underwent trans-obturator reconstructions (13 external iliac-popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device. The transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.

Timing of Free Flaps for Traumatic Wounds of the Lower Extremity: Have Advances in Perioperative Care Changed the Treatment Algorithm?

Despite the landmark study by Godina 30 years ago, opinions still vary within the literature about the management of complex traumatic wounds in the lower extremity. We present a large series of lower extremity reconstructions with vascularized free tissue and examine the perioperative factors that influenced the success of these cases. We reviewed 88 patients with free flap reconstruction of traumatic lower extremity wounds over 8 years. Primary outcomes were flap infections, flap loss, total flap-specific complications, and total recipient site complications. Independent variables specific to perioperative care including time to flap coverage, injury classification, exposed or infected hardware, prior osteomyelitis, use of wound vacuum-assisted closure (VAC) therapy, and concurrent polytrauma were investigated to establish their influence on primary outcomes. Each independent variable was assessed using Chi-square or Fisher's exact test and was included in a logistic regression analysis to establish significance. Of the 88 patients, 8 had flap loss, 8 had flap infections, and a total of 23 had primary adverse outcomes. Timing of the reconstruction, VAC use, injury classification, prior hardware or wound status, or presence of polytrauma had no statistically significant impact on the primary outcomes. Injury classification/severity on total recipient site complications (p = 0.051) and flap-specific complications (p = 0.073) trended toward significance; however, subgroup analysis did not achieve significance. Logistic regression of any recipient site complication including all independent variables similarly showed no significance. Although the original study by Godina suggests early coverage is critical to optimize outcomes, in the modern era of advanced wound care, our study adds to a growing body of evidence that supports the de-emphasis of the 72-hour reconstruction interval. Our current management is focused on more effectively coordinating efficient peritraumatic and perioperative care on an individualized basis in the often very complicated polytrauma patient.

Limb Salvage for “Hopeless” Lymphedema: Reviving the Charles Procedure

The Charles procedure offers radical excision of lymphedematous tissue followed by skin grafting. This procedure is rarely offered because of the potential for complications, but it may provide excellent outcomes in improving quality of life. We describe our experience with a modified technique and a multidisciplinary team approach in treating patients with advanced lymphedema. Seven patients with severe lower extremity lymphedema were treated with radical surgical excision. Patients’ demographics, operative details, and postoperative follow-up course were recorded. The operation entailed radical excision of the skin and lymphedematous tissues in a modified Charles procedure. The dissection was taken to the level of the fascia from the dorsal forefoot or ankle and continued to the knee or thigh, with wound vacuum-assisted closure for initial dressings. Split-thickness skin grafting was performed 5 to 7 days postoperatively. All patients were managed with a predefined postoperative care protocol. Seven patients were referred to the clinic for evaluation of massive lower extremity lymphedema. There were four men and three women, with age range of 36 to 64 years. All patients had history of >2 years of lifestyle-limiting swelling and recurrent bouts of cellulitis requiring hospitalization and intravenous antibiotic treatment. Six patients had chronic wounds of the affected legs due to skin breakdown, and three had significant disability in ambulation. Comorbid conditions included obesity (in five patients), hypertension (in four patients), chronic obstructive pulmonary disease or asthma (in three patients), depression (in three patients), and diabetes (in one patient). In the three patients with bilateral disease, intervention targeted the more severely affected limb. One patient in our series had disease confined only to the thigh. Postoperative complications included wound infection, requiring débridement or antibiotics, in four patients; readmission for débridement in one patient; and reintubation postoperatively in one patient. Length of stay was an average of 27 days (range, 14-55 days).Patients were observed for an average of 15 months (range, 3 month-3 years). All patients reported an improvement in quality of life postoperatively and had complete wound healing by final follow-up, without recurrence. Although it is an underused procedure, the Charles procedure presents a viable means of limb salvage for severe lymphedema. We present a multidisciplinary approach with excellent patient outcomes in a series of six patients.

Endoscopic vacuum assisted wound closure (EVAC) device to treat esophageal and gastric leaks: assessing time to proficiency and cost.

Endoluminal vacuum therapy (EVAC) is an emerging procedure used to treat anastomotic leaks and/or perforations that would otherwise require surgery. The aim of this study was to determine time to proficiency in EVAC and the cost effectiveness of the procedure. We retrospectively reviewed a prospectively maintained IRB approved database for all patients undergoing EVAC after esophageal and gastric complications between October 2013 and December 2017. Proficiency was determined by obtaining predicted estimates and analyzing the point at which average procedure time plateaued based on case volume. Total cost was calculated based on supplies and location where the procedure was performed. There were 50 patients (17 males, 33 female), with a mean age of 52.1years. EVAC was placed in 23 (46%) patients with esophageal injuries and 28 (56%) with gastric injuries. Two advanced endoscopists performed all EVAC procedures in this study (1 surgeon, 1 gastroenterologist). The average procedure time for all patients was 43.5min and the average wheel in/wheel out time for all patients was 75.6min. Analysis of the trend based on average procedure times for EVAC revealed that proficiency was obtained after 10 cases. Total cost of the procedure is significantly lower in the GI lab compared to the operating room ($4528 vs. $11889). The majority of EVAC were performed in the GI lab (62%) compared to the operating room (38%). Successful outcomes in managing anastomotic leaks or intestinal perforations non-operatively has led to an increased interest in EVAC. For advanced endoscopists, time to proficiency is approximately 10 cases. Performing the procedure in the GI lab has a 2.5 reduction in total cost compared to the operating room.

Blurring the boundary between open abdomen treatment and ventral hernia repair.

Therapeutic approaches for septic open abdomen treatment remain a major challenge with many uncertainties. The most convincing method is vacuum-assisted wound closure with mesh-mediated fascia traction with a protective plastic sheet placed on the viscera. As this plastic sheet and the mesh must be removed before final fascial closure, such a technique only allows temporary abdominal closure. This retrospective study analyzes the results of a modification of this technique allowing final abdominal closure using an anti-adhesive permeable polyvinylidene fluoride (PVDF) mesh. The outcome of all consecutive patients with septic open abdomen treatment at one academic surgical department from January 2013 to June 2015 was retrospectively analyzed. Retrospectively, 57 severely ill consecutive patients with septic open abdomen treatment with a 30-day mortality of 26% and a 2-year mortality of 51% were included in the study. In 26 patients, no mesh was implanted; in 31 patients, mesh implantation was done at median third-look laparotomy, median 5days postoperative. Re-laparotomies after mesh implantation (median n = 2) revealed anastomotic leakage in 16% but no new bowel fistula. In 40% of those patients who had mesh implantation, fascia closure was not achieved and the mesh was left in place in a bridging position avoiding planned ventral hernia. The application of an anti-adhesive PVDF mesh for fascia traction in vacuum-assisted wound closure of septic open abdomen is novel, versatile, and seems to be safe. It offers the highly relevant possibility for provisional and final abdominal closure.

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.

Bespoke Splinting of a Flail Chest With an Innovative Approach

Purpose: Rib fractures resulting in a flail chest incur significant morbidity and mortality, and often require mechanical ventilation support. Flail chest is often an unrecognised complication of cardiopulmonary resuscitation (CPR). This study described the use of a vacuum-assisted wound closure device (VAC) in an 83-year-old patient to stabilise a flail chest post CPR.

Vacuum-Assisted Wound Closure and Permanent Onlay Mesh-Mediated Fascial Traction: A Novel Technique for the Prevention of Incisional Hernia after Open Abdomen Therapy Including Results From a Retrospective Case Series.

Incisional hernia development is a frequent long-term sequel after open abdomen treatment. This report describes a novel technique, the vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction for temporary and final closure of the open abdomen, with the intention to decrease incisional hernia rates. Primary aim was to evaluate incisional hernia development and secondary aims to describe short-term complications and patient-reported outcome. The basics of the technique is an onlay mesh, applied early during open abdomen treatment by suturing to the fascia in two rows with a 3- to 4-cm overlap from the midline incision, used for traction and kept for reinforced permanent closure. A retrospective case series, including chart review, evaluation of computed tomography/ultrasound images, and an out-patient clinical examination were performed. The patients were asked to answer a modified version of the ventral hernia pain questionnaire. A total of 11 patients were treated with vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction with median follow-up of 467 days. Fascial closure rate was 100% and 30 day mortality 0%. Two of nine patients, eligible for incisional hernia follow-up, developed a hernia. Neither of the hernias were symptomatic nor clinically detectable. Six of 10 patients eligible for short-term follow-up had a prolonged wound-healing time exceeding 3 weeks. One of seven patients eligible for patient-reported outcome have had pain during the last week. The vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction is a promising new technique for open abdomen treatment and reinforced fascial closure. The results of the first 11 patients treated with this technique show a low incisional hernia rate with manageable short-term wound complications and few patient-reported disadvantages.

Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment

BackgroundOpen abdomen (OA) may be required in patients with abdominal trauma, sepsis or compartment syndrome. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) is a widely used approach for temporary abdominal closure to close the abdominal wall. However, this method is associated with a high incidence of re-operations in short term and late sequelae such as incisional hernia. The current study aims to compare the results of surgical strategies of OA with versus without permanent mesh augmentation.MethodsPatients with OA treatment undergoing vacuum-assisted wound closure and an intraperitoneal onlay mesh (VAC-IPOM) implantation were compared to VAWCM with direct fascial closure which represents the current standard of care. Outcomes of patients from two tertiary referral centers that performed the different strategies for abdominal closure after OA treatment were compared in univariate and multivariate regression analysis.ResultsA total of 139 patients were included in the study. Of these, 50 (36.0%) patients underwent VAC-IPOM and 89 (64.0%) patients VAWCM. VAC-IPOM was associated with reduced re-operations (adjusted incidence risk ratio 0.48 per 10-person days; CI 95% = 0.39–0.58, p < 0.001), reduced duration of stay on intensive care unit (ICU) [adjusted hazard ratio (aHR) 0.53; CI 95% = 0.36–0.79, p = 0.002] and reduced hospital stay (aHR 0.61; CI 95% = 0.040–0.94; p = 0.024). In-hospital mortality [22.5 vs 18.0%, risk difference − 4.5; confidence interval (CI) 95% = − 18.2 to 9.3; p = 0.665] and the incidence of intestinal fistula (18.0 vs 22.0%, risk difference 4.0; CI 95% = −10.0 to 18.0; p = 0.656) did not differ between the two groups. In Kaplan–Meier analysis, hernia-free survival was significantly increased after VAC-IPOM (p = 0.041).ConclusionsIn patients undergoing OA treatment, intraperitoneal mesh augmentation is associated with a significantly decreased number of re-operations, duration of hospital and ICU stay and incidence of incisional hernias when compared to VAWCM.

Correction to: Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study.

In the original article the credit line for the reuse of Fig.1 from an article published in the open access journal, World Journal of Emergency Surgery is missing.

Outcomes of Gracilis Muscle Flaps in the Management of Groin Complications after Arterial Bypass with Prosthetic Graft

This study details 2-year outcomes of a modified gracilis muscle flap (GMF) technique in providing tissue coverage for groin complications after arterial bypass surgery with synthetic graft. All patients who developed groin infections after lower extremity arterial bypass with synthetic graft who underwent a GMF technique were included from June 2014 to March 2017 from a prospectively collected, purpose-built institutional database. Modifications to the standard technique included identification of the muscle using ultrasound to ensure precise skip incisions, preservation of the segmental blood supply, widening of the tunnel through which the muscle is retroflexed, placement of a wound vacuum-assisted closure for healing, and lifelong antibiotics. Demographics, laboratory values, bypass procedure, length of stay (LOS), disposition, and 1-, 3-, 6-, 12-, and 24-month follow-up data were collected. Analysis was performed via descriptive statistics. Over the 3-year study period, 22 patients underwent GMF after complications resulted from arterial bypass surgery. Types of bypass included aortobifemoral (32%), axillobifemoral (14%), femoral-femoral (23%), femoral-popliteal or mixed distal (27%), and thigh graft for dialysis (4%). Forty-five percentage of patients presented with graft infection, 50% with wound dehiscence, and 5% with graft disruption and bleeding. Only 23% of patients were candidates for sartorius muscle flap at the time of their initial procedure. The average case length was 64+19min. Sixty-four percentage of patients were discharged home with home health care and the remainder to a skilled nursing facility. The average LOS was 6.1+3.4days. Fifty-four percentages of wounds were healed at 1month and 100% at 3months with adjunctive vacuum-assisted closure therapy and lifelong antibiotics. Sixty percentage of patients were still alive at 24months, with 33% of grafts still patent at that time. Median survival was 18.1months, and median graft patency was 17.9months. GMF is a safe and effective treatment for groin complications after arterial bypass surgery with synthetic graft. Owing to its versatility, area of coverage, ease of use, and durability, it potentially should be considered as a primary form of muscle coverage for groin complications.

Approaches to cutaneous wound healing: basics and future directions.

The skin provides essential functions, such as thermoregulation, hydration, excretion and synthesis of vitamin D. Major disruptions of the skin cause impairment of critical functions, resulting in high morbidity and death, or leave one with life-changing cosmetic damage. Due to the complexity of the skin, diverse approaches are needed, including both traditional and advanced, to improve cutaneous wound healing. Cutaneous wounds undergo four phases of healing. Traditional management, including skin grafts and wound dressings, is still commonly used in current practice but in combination with newer technology, such as using engineered skin substitutes in skin grafts or combining traditional cotton gauze with anti-bacterial nanoparticles. Various upcoming methods, such as vacuum-assisted wound closure, engineered skin substitutes, stem cell therapy, growth factors and cytokine therapy, have emerged in recent years and are being used to assist wound healing, or even to replace traditional methods. However, many of these methods still lack assessment by large-scale studies and/or extensive application. Conceptual changes, for example, precision medicine and the rapid advancement of science and technology, such as RNA interference and 3D printing, offer tremendous potential. In this review, we focus on the basics of wound treatment and summarize recent developments involving both traditional and hi-tech therapeutic methods that lead to both rapid healing and better cosmetic results. Future studies should explore a more cost-effective, convenient and efficient approach to cutaneous wound healing. Graphical abstract Combination of various materials to create advanced wound dressings.