Vacuum-assisted Closure System Research Articles

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

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

Usefulness of Endoluminal Vacuum-Assisted Closure Therapy for Pharyngocutaneous Fistula

Pharyngocutaneous fistula (PCF) is a communication created between the pharynx and skin of the neck associated with flap reconstruction or primary closure of a pharyngeal defect. In patients who underwent laryngectomy and pharyngectomy, salivary accumulation in the deep neck space through the pharyngeal dehiscence can cause life-threatening complications, among which is carotid artery blow-out. Broad-spectrum antibiotics, compressive dressing, and artificial nutrition are usually applied first. Many closing methods have been studied, both surgically (direct repair or using flaps) and non-surgically (negative pressure therapy, hyperbaric oxygen therapy, or botulinum toxin injection). The use of a vacuum-assisted closure system placed endoluminally or externally has been recently reported to treat any leaks in the upper gastrointestinal tract. Here, we report a successfully-treated PCF using the endoluminal vacuum-assisted closure system.

Vacuum assisted closure and local drug delivery systems in spinal infections: A review of current evidence

BackgroundSpinal infections are still showing increased incidence throughout the years as our surgical capabilities increase, coupled with an overall aging population with greater number of chronic comorbidities. The management of spinal infection is of utmost importance, due to high rates of morbidity and mortality, on top of the general difficulty in eradicating spinal infection due to the ease of hematogenous spread in the spine. We aim to summarize the utility of vacuum-assisted closure (VAC) and local drug delivery systems (LDDS) in the management of spinal infections. MethodsA narrative review was conducted. All studies that were related to the use of VAC and LDDS in Spinal Infections were included in the study. ResultsA total of 62 studies were included in this review. We discussed the utility of VAC as a tool for the management of wounds requiring secondary closure, as well as how it is increasingly being used after primary closure as prophylaxis for surgical site infections in high-risk wounds of patients undergoing spinal surgery. The role of LDDS in spinal infections was also discussed, with preliminary studies showing good outcomes when patients were treated with various novel LDDS. ConclusionsWe have summarized and given our recommendations for the use of VAC and LDDS for spinal infections. A treatment algorithm has also been established, to act as a guide for spine surgeons to follow when tackling various spinal infections in day-to-day clinical practice.

Sniffing Out Pseudomonas Aeruginosa Wound Infections with Vitamin B12: A Simple and Selective Colorimetric Biosensor for Early Diagnosis

Abstract Background The vacuum-assisted closure (VAC) system is a useful tool to promote wound healing. However, due to its occlusive system, the wound is often prone to Pseudomonas aeruginosa (PA) infections. Early detection and initiation of treatment is essential to limit the damage (e.g., saving a skin graft), but the black sponge occludes the wound and prevents its visual assessment leading to delayed diagnosis. Fortunately, each bacterium emits a spectrum of specific volatile organic compounds that can be used for detection. For PA, the signature compound is hydrogen cyanide. Aims We aimed to develop a colorimetric biosensor for “naked-eye” detection of PA that takes advantage of the negative pressure created by the VAC to collect hydrogen cyanide. Methods We used aquocyanocobinamide, a derivative of vitamin B12, as a colorimetric chemosensor of biological cyanide. By binding cyanide, the color of the sensor changes from orange to violet, which can be quantified with UV-VIS spectroscopy. The sensor was delivered onto the carrier material polyvinyl acetate. Its sensitivity was assessed using laboratory strains and clinical isolates of PA in-vitro and on an ex vivo skin model. Results UV-VIS spectroscopy readings of the sensor were calibrated for the cyanide concentration 0-250ppm. Cyanide produced by 30 laboratory and 20 clinical PA isolates were quantified based on the colorimetric changes of the sensor. While the sensor detected all PA strains, it did not falsely react to other wound pathogens such as Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli and Enterococci, suggesting a high specificity. In a proof-of-principle experiment, the colorimetric change of the sensor was detected by eye after 3 hours incubation with a PA culture. Conclusions The presence of Pseudomonas aeruginosa can be quickly and reliably detected by our vitamin B12-based colorimetric biosensor. Its incorporation inside the VAC-system can allow physicians to detect PA wound infections early on.

Delayed Sternal Closure Using a Vacuum-Assisted Closure System in Adult Cardiac Surgery.

Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.

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.

Do Stoma Formation and Use of Vacuum Assisted Closure System Affect Mortality in Perineal Fourniers Gangrene?

The aim of this study was to identify the effects of creation of stoma and the use of vacuum-assisted closure systems on postoperative mortality and hospital stay in patients with Fournier's gangrene involving anorectal region. A retrospectivestudy. Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey, from January 2010 to September 2021. A total of 66 patients with Fournier's gangrene with anorectal involvement were selected from hospital records and divided into two groups as alive and exitus. Differences between these two groups and the factors affecting mortality were analysed with the SPSS statistics software, version 25.0. The value of p<0.05 was considered statistically significant. The mean age of the patients was 57.9±12.9 years, however, age was higher in exitus group (p=0.013). Debridement count was significantly raised in patients with vacuum assisted closure system (p<0.001). The use of vacuum-assisted closure system was associated with a longer hospital stay (p=0.042). Both stoma creation and the use of vacuum-assisted closure system were not found as risk factors for higher mortality. Stoma creation and the use of vacuum-assisted closure systems have no effect on mortality in patients of Fournier's gangrene with anorectal involvement. Urogenital involvement may be considered as a risk factors for mortality. Fournier's gangrene, Vacuum-assisted closure system, Stoma, Anorectal region, Perineum, Mortality.

A novel anastomotic vacuum-assisted closure system for cervical anastomotic fistula after three-incisional esophagectomy.

A novel anastomotic vacuum-assisted closure system for cervical anastomotic fistula after three-incisional esophagectomy.

Aggressive management of extensive de gloving injury of the left lower limb with debridement and split skin grafting and application of vacuum-assisted closure system over recipient grafting site in a tertiary health care setup

Aggressive management of extensive de gloving injury of the left lower limb with debridement and split skin grafting and application of vacuum-assisted closure system over recipient grafting site in a tertiary health care setup

Using of Vacuum Assisted Closure System in Treatment of Post Sternotomy Mediastinitis Systematic Review and Meta-Analysis

Using of Vacuum Assisted Closure System in Treatment of Post Sternotomy Mediastinitis Systematic Review and Meta-Analysis

VAC System Tortesanal: Alternative for the Treatment of Complex Wounds in the Absence of Commercialized Devices

The vacuum-assisted closure (VAC) technique is a relatively recent procedure that consists of administering negative pressure on the wound in conjunction with a closed environment that decreases edema, facilitating vascularization, oxygenation and healing. In addition, it promotes the formation of granulation tissue. We present the case of an 18-year-old woman with a bloody wound on the anterior side of the left thigh. Surgical washing and negative pressure therapy were performed with an artisanal VAC cure system as there were no commercialized systems, performing the healing technique in a simple and cheap way, using materials easily acquired in the hospital environment. Given the high incidence of bloody injuries and the limited availability of negative pressure systems marketed, it is proposed to carry out an artisanal system that can be carried out in any unit.

Efficiency of the vacuum-assisted closure method in the treatment of chronic venous ulcers and the role of the nurse

Objectives: In our study, it was aimed to reveal the effects of using vacuum-assisted closure (VAC) systems in addition to compression therapy on wound healing in patients hospitalized for chronic venous ulcers. Patients and methods: Fifty-five patients (37 males, 18 females; mean age: 43±5 years, range, 38 to 48 years) who were hospitalized in our clinic for chronic venous ulcers between January 2015 - December 2021 were included in this retrospective study. The demographic data, wound widths, healing times of venous ulcers, length of hospital stay, and surgical treatment methods of patients who did (Group 1) and did not (Group 2) receive VAC therapy in addition to the surgical and medical procedures in the treatment of venous ulcers were compared. Results: The hospital stay of all patients was 9±2 days. While the mean ulcer healing time was 14±2 days in Group 1, it was 48±8 days in Group 2 (p=0.03). The mean hospital stay of the patients was 8±2 days in Group 1, whereas it was 15±3 days in Group 2 (p=0.04). Conclusion: As a result of the study, it was revealed that VAC therapy greatly increased the effectiveness of venous surgical methods and compression therapy in the treatment of chronic venous ulcers and shortened the treatment period; therefore, VAC therapy should be added to the treatment protocol for suitable patients with chronic venous ulcers.

Contralateral necrotizing fascitis after left nephrectomy for emphysematous pyelonephritis

Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma. The management is variable, extending to total nephrectomy in severe or refractory cases. Post-nephrectomy complications are numerous and common, necrotizing fasciitis, and sepsis being among them. We present a case of a 37-year-old woman with obesity and a previous left emphysematous pyelonephritis episode managed conservatively. The patient presented with a second left emphysematous pyelonephritis and underwent a left total nephrectomy. Two weeks later, the patient presented with a contralateral necrotizing fasciitis of the abdominal wall. Subsequently, the patient required several surgical debridement procedures and a vacuum-assisted closure system treatment. Emphysematous pyelonephritis is an aggressive infectious disease that requires high suspicion in patients at risk.

Lower Extremity Necrotizing Fasciitis Managed With Negative Pressure Wound Therapy (NPWT) and Split-Thickness Skin Graft: A Case Report

Introduction: Necrotizing fasciitis (NF) is an infection of the soft tissues (skin, subcutaneous tissue and fascia) that implies a rapidly and progressive evolution. In general, the treatment consists of stabilizing the patient, as well as the use of antibiotics that cover the most common agents, however, in most cases this is not useful without definitive management that consists of cleaning and surgical debridement. In addition to surgical lavage, adjunctive measures are often used in the treatment of complex wounds, such as vacuum-assisted closure (VAC) systems, also known as microdeformation wound therapy (MDWT) or negative pressure wound therapy (NPWT). Objective: The objective is to present a successful case in the treatment of necrotizing fasciitis by negative pressure therapy with subsequent placement of grafts.

Shoelace technique for the management of deep sternal wound infection.

In this article, we describe a practical technique of managing deep sternal wound infection by combining two dynamic wound closure methods, namely gradual approximation of the wound edges using vessel loops: the shoelace technique and the vacuumassisted closure system.

Sweat contamination induced surgical site infections after spine surgery: Three case reports and literature review.

Introduction and importanceSurgical site infection (SSI) is one of the most intractable complications following spine surgery during the early postoperative stage. Elderly (age > 70 years), body mass index > 30, smoking, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, anemia, low serum albumin, operation time > 3 h, and perioperative blood loss > 500 mL are the common risk factors of SSI after spine surgery. However, there are few published reports about sweat contamination induced surgical site infections with Staphylococcus epidermidis up to date. Staphylococcus epidermidis is a permanent member of the normal human microbiota and has emerged as an important opportunistic pathogen in SSI. We aim to detect the influence of sweat infiltration on SSI with Staphylococcus epidermidis and effective management.Case presentationA 73-year-old male, a 54-year-old male and a 73-year-old female were admitted to our hospital. All of them underwent posterior compression and fusion surgery with internal fixation and got surgical site infection after primary surgery. Two of them suffered moderate surgical site infection while the third patient with comorbidities suffered severe surgical site infection. Antibiotic therapy and debridement with internal fixation retained were utilized during which microbiological culture were taken. The moderate infection patients got fully recovered after debridement and primary suture while the serious one had recurrence after the first debridement, and then the second operation was performed. SSI, however, relapsed after three days. Vacuum-assisted closure (VAC) system was placed in the third debridement. The severe patient got well recovered and discharged after displacement of VAC system.Clinical discussionThis report serves to explore a normal but overlooked factor for SSI. SSI is one of the most intractable complications after spine surgery and the report introduce some uncomplicated but effective methods to moderate and severe SSI.ConclusionSweat-contaminated is an inducement of SSI with Staphylococcus epidermidis that should attract surgeons' attention. For mild infection, changing dressing and infrared treatment can achieve good results. For moderate infection, one debridement and primary suture are enough. For severe infection, early application of VAC system can reduce the number of debridement and achieve good clinical outcome.

MP20-20 HIGH 30-DAY COMPLICATIONS AFTER BURIED PENIS REPAIR SUGGEST ROLE FOR PREOPERATIVE OPTIMIZATION

You have accessJournal of UrologyCME1 May 2022MP20-20 HIGH 30-DAY COMPLICATIONS AFTER BURIED PENIS REPAIR SUGGEST ROLE FOR PREOPERATIVE OPTIMIZATION Ethan Matz, Rahul Dutta, Nicholas Deebel, Justin Refugia, Kim Thai, and Ryan Terlecki Ethan MatzEthan Matz More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Nicholas DeebelNicholas Deebel More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Kim ThaiKim Thai More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Buried penis repair (BPR) is typically performed for morbidly obese men with associated comorbidities. Case complexity is variable and often involves penile split thickness skin grafting (STSG) and use of vacuum-assisted closure (VAC). At our institution, BPR is performed with a multidisciplinary team involving urology and plastic surgery. Collectively, we sought to determine the rate of 30-day complications to determine areas for team-based quality improvement and information relevant to preoperative patient counseling and prehabilitation. METHODS: With IRB approval, all cases of BPR from 2012 to 2021 were reviewed. Data was collected for patient demographics, operative case characteristics, and 30-day complications using the Clavien-Dindo classification. RESULTS: Overall, 63 men underwent BPR for the studied interval. Mean age was 55.9±14.4 years and mean BMI was 41.99±9.17 kg/m2. The rate of overall complications was 33% (21/63). Major complications were seen in 8% of patients, classified as Grade IV (4) and Grade III (1). BMI was an independent predictor of complications (p=0.0257). Additionally, patients noted to have preoperative UTI, even when treated, had significantly higher rates of readmission (p=0.006) and unplanned emergency room (ER) visits (p=0.0006). Baseline hypertension (HTN) was independently associated with ER visits (p=0.0148), but not with overall complications. Presence of home assistance, age, history of CAD or PVD, and preoperative A1c values were not associated with overall complication rate. There was no difference in complications with hospital or home negative pressure wound VAC systems. CONCLUSIONS: Short-term complications following BPR were noted in a third of patients, despite multidisciplinary management. Despite all patients having obesity, BMI was a significant predictor of complications. Patients with a history of preoperative urinary tract infection or HTN also appear to be at increased risk. Quality improvement initiatives targeting monitored preoperative weight loss, urinary assessments with test-of-cure and/or prophylaxis, and more aggressive blood-pressure management will be studied prospectively. Patient counseling will also involve setting expectations on the frequency of complicated recovery. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e325 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz More articles by this author Rahul Dutta More articles by this author Nicholas Deebel More articles by this author Justin Refugia More articles by this author Kim Thai More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF DownloadLoading ...

Suralis flap: solution for open midfoot fractures: ­initial management and intraoperative challenges

A 58- year old male patient presented, after a workplace accident with a 1 tonne of a metal plate on the right lower leg and foot, an open midfoot fracture and big soft tissue defect (Gustilo Anderson grade IIIA). Because of the soft tissue situation an external fixator was used for initial treatment. During hospitalization, progressing skin necrosing areas were presented, with the result that surgical depridements and a VAC (Vacuum Assisted Closure) system was necessary to treat the soft tissue damage. On the basis of this situation the decision was taken to treat the fracture with an external fixator instead and waiting until swelling was regressive. After two months, the external fixator could be removed and a dorsalis-pedis- and suralis flap with split-skin graft was performed. Eight months after skin flap the patient presented an ulcer on the heel, which could be managed with an excision and regular wound control. The follow ups during 3 years after surgery showed an acceptable outcome regarding fracture healing with painless posttraumatic arthrosis and skin flap.

Local device infection successfully treated without pacemaker removal in a neonate: a case report

Local device infection is a serious complication, especially in neonates. Complete device removal is the gold standard treatment for cardiac device infection; however, in selected cases alternative strategies could be adopted. We describe a case of a 14-day-old neonate, weighing 2.5kg, who had undergone epicardial double chamber pacemaker implantation for a congenital complete atrioventricular block. The generator pocket was created in the epigastric area below the rectus abdominis. At six days after implantation, pocket infection was found; blood cultures and the transoesophageal echocardiogram were normal. Due to the low weight of the neonate, and the limited possibility of finding a new comfortable site for housing the generator far from the infected area, we opted for a conservative strategy. We successfully applied a combination of antibiotic therapy, a vacuum-assisted wound closure system (KCI, Germany) for 40 days, and then skin transfer flap from the right flank without device removal. At one-year follow-up there were no local or systemic signs of infection.

Usefulness of vacuum-assisted closure after stoma closure with purse string suturing: a retrospective trial.

Surgical site infection (SSI) is a problematic complication after stoma closure. The purse string suture (PSS) technique eliminates this problem, but the area takes longer to heal. The present retrospective study was performed to evaluate the usefulness of a vacuum-assisted closure (VAC) system for the promotion of wound healing after stoma closure. Consecutive patients undergoing stoma closure with the PSS technique were divided into two groups: those treated with and without use of the VAC system. The volume of dead space and the size of the wound were measured after stoma closure in both groups. The same measurements were performed on days 3 and 7 after closure. The time needed for wound closure was also examined in both groups. Outcomes were also evaluated according to age, body mass index, operative time, bleeding volume, wound consistency, patient satisfaction, perioperative inflammatory response, occurrence of SSI, and hospitalization days. The VAC group comprised 31 patients, and the non-VAC group comprised 34 patients. The volume of dead space on days 3 and 7 after closure was significantly smaller in the VAC group than in the non-VAC group (P=0.006 and P<0.001, respectively). The number of SSIs was significantly lower in the VAC group than in the non-VAC group (P=0.014). The dead space volume on days 3 and 7 after stoma closure with PSS significantly decreased by using the VAC system. The incidence of SSI after stoma closure also significantly decreased by using the VAC system.