Vacuum Wound Therapy Research Articles

Assessing knowledge and practice of Caregivers regarding Clients Using Vacuum Wound Therapy

Assessing knowledge and practice of Caregivers regarding Clients Using Vacuum Wound Therapy

Endoluminal wound vacuum therapy for gastrointestinal leaks: current state and future directions

Endoluminal wound vacuum therapy for gastrointestinal leaks: current state and future directions

Negative Pressure Therapy for Treatment of Wounds with Exposed Bone and Dura

Introduction: Previous dogma has rejected that it is safe to apply a wound vacuum dressing directly onto the brain dura without a barrier. This case presents successful wound healing in a patient with previous failed free flap and skin grafting of her frontotemporal craniotomy wound with wound vacuum dressing application. Case Presentation: The patient is a 76-year-old female with a past medical history of an osseous meningioma who has undergone four prior resections (1994, 2002, 2012, 2021). She underwent her last craniotomy and resection with neurosurgery, leaving a large frontotemporal defect. At that time, a local flap was utilized by extending the resection incision pre- and post-auricular in a “face lift” fashion to gain closure of 95% of the defect. After two months, she returned to the OR due to loss of two areas of the local flap, anteriorly over the left forehead and posteriorly near the rotation point just superior to the ear. There was exposed bone and cranioplasty. A bipedicle fasciocutaneous flap was then created from the left frontal hairline to the midline occipital region with supraorbital and left occipital artery vascular supply. A split-thickness skin graft was applied to the posterior area that was still uncovered. She continued to experience complications with necrosis of areas of the skin flap, which included an additional cranioplasty and attempted local flap coverage, as well as a radial forearm free flap. Flap healing was complicated by pseudomonas infection, which caused partial failure with an area of exposed bone and scarred dura. Management and Outcomes: A black sponge wound vacuum dressing with silver impregnated barrier dressing was applied to the area on the non-wound side of the sponge. Over the course of three months, the patient experienced marked reduction in the size of the wound with progressive closure. Discussion: There has been literature on the benefit of wound vacuum assisted closure in complex wounds and reconstructions in various parts of the body with evidence of reduced surgical site infections and wound necrosis. However, evidence of benefit in scalp reconstruction is largely limiterrd to case series and reports. In these described case reports patients had improved outcomes with fewer dressing changes, and increased success with subsequent skin grafts. Similarly, our patient underwent wound vacuum therapy, after recurrent chronic wound infection with bony defect and recurrent flap failure. She had improved wound healing, resolution of infection and decrease of the defect size. Conclusion: In conclusion, there is a potential bernefit to using wound vacuum assisted therapy in scalp defects that have failed previous reconstruction attempts that merits serious consideration. In this case, it has allowed for better wound healing and has allowed the patient an improved quality of life. Corresponding Author: Yitzchok Greenberg, 2799 W Grand Bvd, Detroit, MD 48202; 313-673-7190

Профілактика і лікування пролежнів у відділенні інтенсивної терапії (огляд літератури)

У статті з позиції Міжнародної національної нарадо-рекомендаційної ради з пролежнів, Європейської рекомендаційної ради з пролежнів, Всесвітнього альянсу з проблем пролежнів наведено питання термінології, статистики, факторів ризику розвитку, міжнародної класифікації, основних напрямків профілактики, диференціальної діагностики, інспекції шкірних покривів і документування; наведено шкали для прогнозування ризику розвитку пролежнів (PUSH Toll, 2008); викладені вузлові питання інтенсивної терапії залежно від результатів категорії пролежнів; надано правило SPECIAL; рекомендації робочої групи ICSI. Наведено практичні рекомендації Американської колегії фізіотерапевтів. Особливу увагу приділено принципам нутритивної терапії за наявності пролежнів.

First domestic apparatus for vacuum therapy

The first domestic device for vacuum therapy, Impulse KM-1, has been developed. The device is intended for the treatment of wounds, using a method of VAC therapy. Copyright protected by 2 patents. The device includes: an electronic unit with an internal power source, an external battery charge source, a reservoir for collecting of wound discharge, a disposable sterile dressing kit. The kit consists of a sponge, a film covering, a tube with a fixing head, a connector tube. The device is designed for a multiple use, provides continuous, variable and intermittent operation. Clinical trials of the device have been successfully carried out. As part of clinical trials, 17 patients who were treated at the hospital surgery clinic of the Vitebsk State Order of Peoples’ Friendship Medical University with surgical infections of the skin and soft tissues received vacuum therapy of wounds using the Impulse KM-1 apparatus. A significant reduction in the time of wound treatment was noted. The device has established itself as a reliable, easy to use device. The cost of the Impulse KM-1 apparatus is approximately 2500 $ and the cost of a disposable dressing kit is 40 $.

Теоретичне обґрунтування комплексного застосування вакуумної терапії та кінезіотерапії при хронічному рановому процесі

The purpose of the study was to substantiate theoretically the possibility of complex application of vacuum therapy and kinesiotherapy in elderly people with chronic wound healing. Materials and methods. The methodological approach was used in the study: an analysis of literary sources and Internet resources; analysis of advanced foreign and domestic experience, system analysis method, comparison method, organizational analysis. Results and discussion. Vacuum therapy of wounds is considered as an additional method of treatment in patients with chronic wounds and wounds that heal for a long time, which is especially important for the elderly people because of the slowed metabolism and reduced immunological resistance of the body. Vacuum therapy stimulates wound healing by using localized negative pressure on the surface of the wound, and helps to remove excess of exudate around and within the wound. Another method of physical therapy which has a positive effect on the processes of recovery or recuperation of motor function, reducing the risk of complications (thromboembolism, respiratory diseases, pressure ulcers, contractures) and maintaining the patient's overall physical ability is kinesiotherapy. Kinesiotherapy, the main meaning of which is physical exercise, is aimed at improving aerobic performance, muscle performance of strength and endurance, stretching and lengthening of muscles, mechanisms of neuro-muscular control of inhibition and excitation. Any exercise activates not only the musculoskeletal system, but also all body systems, including nervous, hormonal, immune, which significantly accelerates the healing process. The main meaning of physical exercise, along with the use of vacuum therapy, is the dosed performance of physical activity with a healthy limb or a segment of the body to improve trophicity in tissues to achieve a general tonic and trophic effect caused by physical exercise for a faster resorption of inflammation products, preventing the appearance of hyperproliferative processes in wounds. Conclusion. It was theoretically substantiated that the combined use of negative pressure therapy and kinesiotherapy can lead to a reduction in the time of complete wound healing and a decrease in the time of temporary disability / inability to self-care, as well as contribute to an earlier restoration of daily activity. Exercise for the elderly may include: aerobic exercise to improve endurance and recovery; body mechanics training; breathing exercises for the prevention of congestion in the lungs; exercises to develop coordination of movements; self-care skills training; ideomotor exercises; perception training; exercises for the amplitude of movements and stretching of soft tissues; relaxation exercises; exercises for general strengthening, strength and endurance

Використання вакуум-терапії в лікуванні ран у хворих на синдром діабетичної стопи

Вступ. Гострі та хронічні ранові дефекти нижніх кінцівок виникають у 15–25 % хворих на цукровий діабет, слугуючи безпосередньою причиною високих ампутацій нижніх кінцівок у 12 % цих пацієнтів. Одним із сучасних і перспективних напрямків лікування ран є вакуум-терапія. Мета. Вивчити вплив вакуумної терапії на перебіг гострого та хронічного ранового процесу у хворих на синдром діабетичної стопи залежно від патогенетичної форми ураження та на підставі отриманих даних покращити результати хірургічного лікування вищеозначеної патології. Матеріали та методи. Обстежено 239 хворих на ускладнені форми синдрому діабетичної стопи. Моніторинг перебігу ранового процесу доповнено клінічними, цитологічними, мікробіологічними та морфологічними критеріями. В лікуванні хворих використано апарат вакуумної терапії фірми «Агат-Дніпро». Вакуумну терапію ран проведено в режимах від’ємного тиску в межах 80–125 мм рт.ст. Результати. На 2-гу — 3-тю добу лікування вакуумом спостерігалося вірогідне зменшення місцевих проявів гострого запального процесу. Поряд із цим відзначалося й вірогідне зменшення об’єму ранових дефектів. Відбувались позитивні зміни зі сторони мікробної контамінації ранових дефектів. Використання постійної вакуумної терапії в лікуванні ранових дефектів дозволило значно покращити показники місцевої мікроциркуляції. Висновки. Використання вакуумної терапії в комплексному лікуванні гострих і хронічних ран у хворих на синдром діабетичної стопи спричиняє місцеву та системну дію, що дозволяє стабілізувати перебіг ранового процесу, стимулювати регенераторні процеси, ліквідувати прояви ендогенної інтоксикації і порушення імунологічної реактивності.

Вакуум-терапія діабетичних ран м’яких тканин: вплив на активність матриксних металопротеїназ

Метою роботи було вивчити вплив вакуум-терапії на основні стадії загоєння гнійних ран м’яких тканин у пацієнтів із цукровим діабетом, ступінь мікробної контамінації ран та активність матричних металопротеїназ (ММП) тканин ранової поверхні. Проаналізовано результати лікування та обстеження 48 пацієнтів із хронічними діабетичними ранами м’яких тканин. У 26 хворих (основна група) у лікувальному комплексі застосовували вакуум-терапію ран. Під час лікувального періоду проводили визначення мікробіологічних та цитологічних показників. Активність ММП у тканинах ранової поверхні пацієнтів контрольної та основної груп визначали методом желатинової зимографії на різних етапах загоєння. Установлено, що в пацієнтів основної групи очищення ран від гнійного субстрату та мікроорганізмів відбувалося на 5,2 ± 1,5 доби раніше порівняно з пацієнтами контрольної групи. Разом із тим у тканинах ранової поверхні пацієнтів основної групи відбувається статистично вірогідне (р < 0,05) зниження активності ММП, величина якої на 5-ту та 10-ту добу лікування становила відповідно 68 і 45 % від початкового рівня. У ранах пацієнтів із діабетом, які проходили курс традиційного медикаментозного лікування, колагеназна активність залишалася стабільно високою протягом усього періоду спостереження. Отже, разом з антимікробними та протизапальними ефектами нормалізація протеолітичних процесів у рановому ложі може бути одним із ключових механізмів високої лікувальної ефективності VAC-терапії.

Організаційні питання покращення лікування гнійно-септичних ускладнень у поранених з бойовою травмою живота з використанням сучасних методів

SummaryCombat trauma of the abdomen is ranged from 6.6 to 9% in the structure of combatinjuries according to the literature. The specificity of abdomen gunshot wounds resultsin development of functional disorders and complications (51-81%) and, as aconsequence, a high mortality rate (12-31%).Purpose: Improving the results of surgical treatment of purulent-septiccomplications in wounded with combat trauma of the abdomen.Materials and methods. On the basis of the Military Medical Clinical Center of theSouthern Region, up-to-date treatment methods were used for the wounded who wereadmitted with purulent-septic complications of abdominal combat trauma for the period2014-2019, considering the location, clinical manifestations and severity of the injury,namely puncture and drainage interventions under ultrasonography control, installationof vacuum wound therapy systems.During the study period, there were purulent-inflammatory complications of theabdominal cavity, retroperitoneal space, soft tissues in 86 wounded with abdominalcombat trauma (17.3% of the total number of wounded with abdominal trauma).At the first stage of treatment, puncture and drainage interventions were performedunder ultrasonic navigation and gradual remediation for diagnostic and therapeuticpurposes. Vacuum therapy was used in 25 patients with extensive wounds and purulentseptic complications of the soft tissues of the anterior abdominal wall.Thus, the use of interventional sonography, as the primary diagnostic and treatmentmethod for the treatment of purulent-inflammatory complications of abdominal combattrauma, has improved the quality of diagnosis and reduced traumatic interventions,which resulted in reduced number of postoperative complications and terms of inpatienttreatment.Results. 21 (24.4%) cases of puncture and drainage interventions were ineffectiveand required resorting to traditional methods of treatment - opening and drainage ofpurulent-inflammatory foci. Vacuum therapy is an effective method of treatment ofpurulent-septic complications of gunshot wounds of the soft tissues of the abdomen,which, in combination with puncture-drainage interventions, can reduce by 2.5 times thenumber of repeated operations (mainly multi-stage surgical treatments), therebyreducing 1.7 times the length of stay of patients at the hospital.Conclusions. The use of the up-to-date techniques may help to reduce the number ofinvasive treatments, accelerate recovery, reduce terms of hospital stay, reduceintoxication, and increase the rate of return of servicemen.

727 Use of a Biodegradable Dermal Matrix in Conjunction with Meshed and Sprayed Autologous Cell Suspension with a Vacuum Assisted Dressing Achieved Limb Salvage in a 73 Year Old with Deep Full Thickness Burns Despite Exposed Tendon and Bone

Abstract Introduction Deep Full thickness burns require tangential excision of the burned tissues down to viable tissue. This often leaves exposed muscle, tendon and bone. Coverage of these areas is vital to limb salvage. Multiple modalities are necessary with these type of patients, such as, dermal matrix graft, split thickness skin graft, sprayed autologous cell suspension (ACS) and wound vacuum therapy(VAC). A dermal matrix provides a scaffold for tissue and vascular en growth that is suitable for accepting a skin graft and also provides a layer between the muscle, tendon, bone and the skin graft which improves movement and produces a more pliable graft. Biodegradable temporizing matrix(BTM), produced by PolyNovo Ltd, was used to cover the muscle, bone and tendon. This product has a silicone backing which can be delaminated once it has matured with tissue and vascular en growth for auto grafting. A combination of a wide meshed skin graft at 3:1 ratio and a sprayed ACS allows for faster healing and less donor site usage which decreases the overall wound burden. Methods A 73 y/o male with total body surface area burn of 24 % suffered deep full thickness burns to the bilateral lower legs. He underwent multiple debridements with management of the right leg with irrigating wound vacuum therapy. The deeper right leg had a wound base with that consisted of muscle from the thigh down onto the foot with exposed tendons and anterior tibial bone. The open wounds to the right leg were grafted with BTM for dermal substitute coverage. Once the BTM was mature it was delaminated, and the wound surface was covered with a 3:1 ratio split thickness skin graft (STSG) and sprayed on autologous cell suspension. This resulted in using less donor skin than a 1.5 or 2:1 meshed graft STSG which decreased his wound burden. Donor sites were also sprayed with ACS. Results We had nearly 100% take of the STSG and sprayed autologous suspension epidermal graft. There was a small area over the patella tendon where the BTM did not incorporate. This is though to be because of lack of immobilization of his knee and a pseudomonal infection. Donor sites healed faster and there were minimal open areas to the graft POD 11 excluding the patella area. Conclusions BTM can be used to provide a suitable dermal substitute in complex wounds when muscle, tendon and/or bone are exposed. Immobilization of the joints is necessary to allow the tissue en growth into the dermal matrix. Wide meshed graft with sprayed ACS can be used with good results with wound vacuum therapy. Decreased wound burden and time to heal open wounds of the graft and donor sites. Applicability of Research to Practice Use of a dermal matrix, wide mesh split thickness graft and sprayed epidermal ACS with wound vacuum therapy is a good option for limb salvage when vital structures are exposed.

Complex treatment of patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome

Of study is improving the results of treatment of patients with pyo-necrotic complications of diabetic foot syndrome by including the method of negative pressure wound treatment in the complex treatment program in combination with using of the combined antibacterial drug Cifran ST and immunocorrective therapy. The results of examination and treatment of 184 patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome were analyzed. According to choice of treatment methods in the postoperative period all patients were divided into two groups. In 95 patients (group I), iodine-containing ointments based on polyethylene glycol were used for local treatment of purulent foot wounds and standard systemic antibacterial therapy was performed. In 89 patients (group II), negative pressure wound treatment (NPWT) was used to treat wounds in the postoperative period. In addition to standard parenteral antimicrobial therapy, these patients also received an oral combined antibacterial drug Cifran ST and immunocorrective cytokine therapy (Leukinferon). The analysis of the dynamics of the wound process was carried out based on the clinical picture and the results of cytological, bacteriological and immunological studies of the wound exudate. The presented strategy of complex treatment of pyo-necrotic complications of the neuropathic form of diabetic foot syndrome allowed group II patients to significantly reduce the degree of microbial contamination of wounds, to achieve a faster regression of the content of proinflammatory and inflammatory cytokines in the wound exudate, as well as to reduce the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage in comparison with group I patients. This allowed group II patients to reduce the time of plastic closure of the wound from 24.3±0.5 to 15.6±1.7 days, to avoid generalization of infection, death and high level amputation of the limb. At the same time, 11.6% of patients in group I had high level limb amputation due to generalization of infection. The mortality rate in group I was 5.3%. Adding of vacuum therapy of wounds, systemic antimicrobial therapy using the combined antibacterial drug Cifran ST and immunocorrective cytokine therapy in the complex treatment program for patients with neuropathic form of diabetic foot syndrome after radical surgical treatment of the pyo-necrotic lesion allows reducing the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage. On the other hand, this makes it possible for this category of patients to perform plastic closure of the wound at an earlier date, avoid generalization of infection and high level amputation of the limb.

Sternoclavicular Joint Infections: Improved Outcomes With Myocutaneous Flaps

Sternoclavicular joint (SCJ) infection is a rare disease and its management remains controversial. Our institution has adopted an aggressive surgical approach of radical SCJ resection combined with myocutaneous flap (MCF) closure whenever possible. We reviewed our experience with this approach in the management of this condition. From July 2004 to June 2018, 50 consecutive patients were treated surgically for SCJ infections. Patient demographics, imaging studies, microbiology, and operative variables were analyzed. All patients underwent ipsilateral SCJ resection. Wound closure was performed with primary pectoralis advancement MCF closure at the initial operation in 25 patients, delayed MCF closure following temporary wound vacuum therapy and redebridement in 19 patients, and definitive wound vacuum therapy (DWVT) in 6 patients. End points were recurrence of infection, perioperative morbidity, and mortality. Localized swelling (100%) and pain (100%) were the most common presenting symptoms. MSSA was isolated in 50% of tissue cultures. Comorbidities included tobacco smoking 52%, diabetes mellitus 50%, intravenous drug use 34%, poor dental hygiene 32%, and obesity 28%. We had no deaths within 90 days of operation. Complications; seroma in 1 patient (2%), chest wall hernia in 1 patient (2%), retained drains in 1 patient (2%), recurrent osteomyelitis infection in 3 patients (6%), and hematomas in 5 patients (10%). Patients treated with primary MCF closure at the initial operation had a 0% (0/25) rate of recurrence compared to 5.26% (1/19) in delayed MCF closure. Overall, there was only a 2.27% (1/44) recurrence of infection in primary and delayed MCF closure combined, compared to 33.33% (2/6) in patients treated with DWVT closure. SCJ infections require an aggressive approach. Wound closure with an MCF (primary or delayed) is associated with less recurrence of infections compared with DWVT closure. Radical resection of the entire SCJ with MCF (primary or delayed) should be considered the preferred management strategy in patients with SCJ infections.

APPLICATION OF VAC-THERAPY IN THE TREATMENT OF DIABETIC FOOT

The aim. To substantiate the effectiveness of the use of VAC-therapy in the treatment of wounds in patients with diabetic foot syndrome. Materials and methods. The patient with a complicated form of diabetic foot syndrome was examined. The monitoring of the course of the wound process is supplemented by clinical, cytological, microbiological and morphological criteria. In the treatment of patients we used vacuum therapy apparatus. Vacuum wound therapy was performed in negative pressure regimens in the range of 80–125 mm Hg. Results. In the pattern of morbidity in economically developed countries, diabetes mellitus (DM) occupies one of the first places. Its prevalence is 1.5–6 %. The number of patients with diabetes in Ukraine is likely to reach 14 million by 2020. Lesions of the lower extremities of different genesis occur in 30–80 % of people with impaired carbohydrate metabolism. Most often, these lesions are complicated by the development of chronic peptic ulcer defects, which, when untimely diagnosed and inadequate treatment, leads to amputation of the affected limb. Even when radical surgery is avoided, the long and costly treatment of trophic disorders of the soft tissues of the feet and legs leads to huge costs of both material resources and time for medical staff. In 15 % of patients with DM, trophic ulcers of the lower extremities are diagnosed. Recent studies have focused on such important aspects of the study of this issue as the early diagnosis of soft tissue lesions in individuals with DM, the development of treatment aimed at preventing amputations, facilitating the further rehabilitation of patients. Vacuum therapy is one of the new methods of treating wound defects, including in patients with diabetic foot syndrome. Topical application of vacuum therapy has already become an integral therapeutic option for wound debridement in patients with diabetic foot syndrome. However, when applying the classic vacuum therapy technique, these patients have the problem of delaying the outflow of tissue exudate and lysis detritus to the vacuum system. Conclusions. Optimization of the technique of the influence of negative pressure on the wound by applying forced drainage with irrigation of the wound with an antiseptic can maintain a constantly high concentration of antimicrobial agent in the wound, increase the speed of wound dialysis and prevent clogging of pores of the sponge and the bacterial colonies in it. The application of this technique avoids high amputation, accelerates the time of wound healing, and retains the supporting function of the lower extremity.

Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy.
 Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion.
 Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound.
 Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values.
 Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

Knowledge and Practice of Family Caregiver for Clients Using Vacuum Wound Therapy for Infected Limb Surgical Wound

AbstractBackground: Family caregivers had heavy burden and a lot of great responsibilities toward their clients using vacuum wound therapy.Aim of Study: To asses knowledge and practice of family caregiver for clients using vacuum wound therapy for infected limb surgical wound.Material and Methods: Design: A descriptive research design.Setting: Out patient emergency plastic surgical clinic which affiliated to emergency hospital 185 at Cairo university hospital.The Study Sample: A convenient sample of 61 family caregivers and their (61) clients used vacuum wound therapy were included in the study from August 2017 to March 2018. Tool for data collection: One tool Clients and family caregivers a Structured interview questionnaire which divided to four parts. Part (I): Demographic characteristics of the family caregivers and clients. Part (II): Medical history of clients and home environment. Part (III): Family caregiver knowledge about vacuum wound therapy part (IV): Family caregiver practice about vacuum wound therapy. The total knowledge and practice scores for questionnaires are 100.Results: 42.6% of family caregivers age from 20 to less than 30 years and 73 .7% of them were male. The result revealed that positive statistically significant relations between total knowledge of family caregivers and their age, p=0.02. And education level, p=0.07. There was a positive statistical significant total practice and their job, p=0.08.Conclusion: The study concluded that, 51% of them had unsatisfactory total knowledge. Total practice 53% of them had satisfactory score while 47% of them had unsatisfactory score of total practices regarding vacuum wound therapy.Recommendations: The study recommended before appli-cation therapy, knowledge should be developed for family caregiver about definition, uses, benefits and initiation of therapy Improve practice of family caregiver to manage therapy through demonstration and training on safe handling of infectious and hazardous waste are critical to prevent cross contamin ation.

Open Endoaneurysmorrhaphy of 9-cm Ruptured Popliteal Aneurysm 7 Years After Initial Repair

Popliteal aneurysm (PA) is a commonly described vascular disease that has many varied approaches for its contemporary management. From open vs endovascular, there are many points of active discussion. We describe a patient with extensive aneurysmal disease who presented 7 years after initial PA repair (3.5 cm treated with medial approach bypass and exclusion) with an aneurysm measuring 9 × 25.5 cm with a contained rupture. A single-center case is reviewed with detailed operative description and comprehensive management recommendations for large and complex PAs. The literature is reviewed for different topics pertaining to best management, including anatomic considerations, repair approach, durability of repair, intraoperative techniques, postoperative growth and endoleaks, and bypass conduit choice. The 3.5-cm PA was initially treated with an above-knee to below-knee end-to-end bypass with polytetrafluoroethylene and proximal-distal aneurysm ligation from a medial approach without complication. Seven years later, the patient presented with a 9-cm PA rupture (presumably from type II leak) requiring urgent repair. The posterior approach endoaneurysmorrhaphy repair was complicated with significant blood loss requiring transfusion. His inpatient course was otherwise uncomplicated, and he was discharged on postoperative day 5; but on postoperative day 19, he presented with cellulitis and underwent incision and drainage of retained hematoma with cultures positive for Streptococcus dysgalactiae. He was treated with antibiotics plus vacuum wound therapy, and 3 months later, his wound was well healed. Preoperative anatomic mapping, maximizing exposure through the posterior approach, vascular control with an adjunct of a tourniquet, and endoaneurysmorrhaphy are key surgical considerations (Figs 1 and 2). Optimal management of PAs on initial presentation can ensure positive results for patients in the long term, but complications can also be managed effectively, even in the setting of complex, large, and ruptured aneurysms.Fig 2Intraoperative photographs. Left to right, Posterior exposure of popliteal aneurysm (PA) with overlying nerves and densely adherent popliteal vein; decompressed PA after repair; closed posterior incision.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The wound process variants course in patients with diabetic foot syndrome in the vacuum therapy background

Purpose of the study. Study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion.
 Materials and methods. The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 2014–2017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area around the wound.
 Results. Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p < 0,05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization.
 Inpatientswithischemiclesions(chronicarterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 70–80 mm Hg, which makes it possible to stop pain during the day. At 2–3 days of the postoperative period, negative pressure is established at standard values.
 Conclusion. Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduce the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average 4,3 ± 1,7 bed-days, and patients with ischemic form on average 4,1 ± 1,9 bed-days, which has both medical and social significance.

Plastic closure of wounds in patients with ischemic form of diabetic foot syndrome.

In the work the analysis of the results of treatment of 48 patients with ischemic and neurotrophic forms of diabetic foot syndrome has been performed. All patients had diabetes mellitus and IV degree of ischemia by Fontaine. After carrying out revascularization operations, a complex treatment was used that included phototherapy, the phase closure of tissue defects with synthetic coating with the application of fibrin clot and plasma enriched with platelet growth factor, vacuum therapy of wounds, autodermoplastics by Tirsch, free autodermoplastics with split skin scar. The im ­ plementation of the developed tactic s allowed to achiev e complete wound healing in 91.7% of patients, partial healing – in 8.3% of patients and to avoid high amputations.

Application of vacuum wound therapy with split thickness skin grafts in the head and neck area

In vacuum wound therapy (VAC) a negative pressure can continuously clean effusions and enhance the formation of granulation tissue significantly. In visceral, trauma and burns surgery this technique is used frequently in critical wounds. In the head and neck area there is limited experience and publications. Especially in the combined use of split-thickness-skin grafts (STSG) and VAC there is no published evidence. A retrospective database analysis was done and resulted in 36 single VAC therapies in 13 patients. They were treated between 2012 and 2017 in the Department of Otorhinolaryngology of the University Medical Center Ulm, Germany. A data analysis was performed relating to indications, diagnoses, comorbidities as well as the clinical course and outcome with special focus on STSG. Besides classical indications as pharyngo-cutaneous fistulas and troublesome would healing after flap surgery, 7 cases of VAC use with split-thickness skin grafts were identified. The median treatment duration was 11 days, the VAC dressing was changed twice in average, the median negative pressure was 70 mmHg. Wound closure was successful in 13/13 cases, in 7/13 cases wound closure was achieved by split-thickness skin graft with synchronous VAC therapy, 4/13 cases showed healing by secondary intention, in 2/13 cases a local or distant flap was used. We first describe the successful use of VAC therapy in combination with STSG in the head and neck area. This was effective in radiated patients and in critically ill patients with sepsis and necrotizing fasciitis.

Transverse versus Longitudinal Incisions for Femoral Artery Exposure in Treating Patients with Peripheral Vascular Disease

This study evaluates differences in wound complication rate when transverse versus longitudinal incision is utilized to expose femoral vessels in managing patients with peripheral vascular disease. A retrospective review from 2013 to 2015 was conducted of 150 patients undergoing 156 lower extremity revascularizations with femoral artery exposure through a groinincision. Patients were stratified into 2 groups, transverse versus longitudinal groin incision. Data were reviewed for 3 surgeons that utilize either transverse or longitudinal groinincision in patients undergoing common or iliofemoral endarterectomies, or wherefemoral artery was used as inflow and/or outflow vessel for limb revascularization. Eachgroup had a comparative outcomes analysis based on incision type. The primaryoutcome was wound complication, defined as any wound infection, lymphocele, hematoma,dehiscence, pseudoaneurysm, or necrosis. Other outcomes studied included unplanned return to operating room for wound complication, wound vacuum therapy, and soft-tissue flap closure. Data were analyzed using 2-tailed chi-squared test and Student's t-test. Patients in the transverse (n=85 cases) versus longitudinal (n=71 cases) cohorts were similar in relation to demographics and comorbidities. Overall mean follow-up was 220days. Patients with a transverse as compared to longitudinal incision had a significantly lower overall wound complication rate, 7% vs. 42%, respectively (P<0.001). Furthermore, transverse incisions were associated with lower incidence of unplanned return to the operating room to manage wound complications than patients with a longitudinal incision (5% vs. 23%, respectively; P<0.001). Transverse versus longitudinal incisions were also associated with significantly lower need for wound vacuum therapy (6% vs. 15%, respectively; P<0.05) and muscle flap closure (0% vs. 13%, respectively; P<0.001) for wound complications. Transverse groin incisions for femoral artery exposure may offer a lower risk of wound complications for open procedures as compared to a longitudinal incision. While longitudinal incisions may have higher wound complication rates, incisional approach is contingent on anatomical circumstance and treated disease pattern. Patients should undergo appropriate preoperative counseling regarding wound healing in preparation for limb revascularization.