Wound Closure Device Research Articles

Evaluation of a New Wound Closure Device for Linear Surgical Incisions: 3M Steri-Strip S Surgical Skin Closure versus Subcuticular Closure

Technological innovations are often adopted before scientific comparison to an accepted standard. The authors' study compared suture with a new coaptive film device, 3M Steri-Strip S Surgical Skin Closure, on linear incisions. Patients undergoing Wise-pattern breast reduction or abdominal procedures had paired incisions randomly assigned to Steri-Strip S or suture closure. Key outcome measures were closure time, patient comfort, and scar quality at 6 months by patients and surgeons using a new scar evaluation tool, visual assessment of linear scars. Statistical differences between the two closure techniques were assessed by Wilcoxon signed rank test. Of 59 patients, eight were excluded from randomization (a surgeon judged Steri-Strip S to be a nonviable closure technique for mismatched wound edges). Fifty-one patients (breast, n = 24; abdomen, n = 27) were randomized. Operative time with Steri-Strip S for breast was 2.0 minutes (SD = 1.1) versus suture closure at 4.6 minutes (SD = 1.5; p < 0.001). Similarly, Steri-Strip S versus suture for the abdomen was faster (p < 0.001; 4.9 minutes, SD = 2.3 versus 10.1 minutes, SD = 3.4). Comfort scores did not differ between closures [5.8 (SD = 2.7) versus 6.9 (SD = 2.0), respectively, on breast (p = 0.142) and 7.7 (SD = 1.8) versus 7.7 (SD = 2.3) on abdomen (p = 0.903)]. Complication rates did not differ between closure types. Patients' visual assessment of linear scars rating of breasts was 3.8 (SD = 2.9) for Steri-Strip S and better at 2.6 (SD = 2.9) for suture (p = 0.008). One surgeon rated breast Steri-Strip S scars worse than suture scars (4.3 versus 3.7; p = 0.014). For abdominal scars, there was no difference in the patient or surgeon ratings. Steri-Strip S permits faster wound closure than suture. On the basis of patient reports of comfort and scar quality, surgeons increase efficiency and maintain quality with the use of Steri-Strip S on abdominal wounds but not on breast wounds.

Barbed Suture for Gastrointestinal Closure: A Randomized Control Trial

In an effort to make laparoscopic suturing more efficient, the V-Loc advanced wound closure device (Covidien, Mansfield, MA) has been produced. This device is a self-anchoring barbed suture that obviates the need for knot tying. The goal of this initial feasibility study was to investigate the use of the barbed suture in gastrointestinal enterotomy closure. A randomized study of 12 pigs comparing enterotomy closure with barbed versus a nonbarbed suture of similar tensile strength was performed. To this end, 25 mm enterotomies were made in the stomach (1 control, 1 treatment), jejunum (2 controls, 2 treatments), and descending colon (1 control, 1 treatment). Animals were killed at 3, 7, and 14 days postoperatively (4 each group) and their gastrointestinal tracts harvested; 6 of the 8 enterotomies from each pig underwent burst strength testing. The remaining 2 were fixed in formalin and sent for histological examination. All 12 pigs survived until they were killed without any major complications. Enterotomy closure with barbed suture revealed adhesion scores, burst strength pressures, and histology scores that were similar to those for the control. Jejunal closures resulted in 6 failures at 7 days (3 control, 3 barbed) and 4 failures at 14 days (2 control, 2 barbed). The barbed suture significantly reduced suturing time in the stomach, jejunum, and colon. The V-Loc wound closure device appears to offer comparable gastrointestinal closure to 3-0 Maxon while being significantly faster. Further studies with V-Loc are required to assess its use in laparoscopic surgery.

An In-Vivo Study of the Wound-Bursting Strengths of Octyl-Cyanoacrylate, Butyl-Cyanoacrylate, and Surgical Tape in Rats

Several non-invasive wound-closure devices are available. Clinical studies of low-tension lacerations suggest similar clinical outcomes with these devices. We compared the wound-bursting strengths (WBS) of octyl-cyanoacrylate (Dermabond), butyl-cyanoacrylate (Histoacryl Blue), and adhesive tape (Steri-Strips). Design-randomized, controlled, blinded experiment. Setting-university-based division of laboratory animal research. Subjects-15 Sprague-Dawley rats weighing 250-350 g. Interventions-standardized 2-cm full-thickness incisions were made in duplicate on both sides of the rat's dorsum with a #15 surgical blade and closed with one of the three study wound-closure devices following manufacturer instructions. The order of closure was randomized. Measurements-WBS was measured after wound closure with a validated vacuum-controlled wound chamber device (BT-2000) that measures the pressure required to disrupt the closed wound. Data analysis-between-group comparisons were performed with pair-wise t-tests and chi-squared tests. This study had 80% power to detect a 75-mm Hg between-group difference in WBS (two-tailed alpha = 0.05). We evaluated 30 incisions in 15 rats. The mean WBS of octyl-cyanoacrylate (298 +/- 58 mm Hg) was significantly higher than that of butyl-cyanoacrylate (199 +/- 87 mm Hg; difference 98 mm Hg [95% confidence interval (CI) 32-165], p = 0.006) or Steri-Strips (129 +/- 67 mm Hg; difference 169 mm Hg [95% CI 112-227], p < 0.001). The WBS of butyl-cyanoacrylate was stronger than that of Steri-Strips; difference 71 mm Hg (95% CI 4-138), p = 0.035. Octyl-cyanoacrylate tissue adhesive has a higher WBS than butyl-cyanoacrylate, whose WBS is greater than that of surgical tape.

Robotic Urethrovesical Anastomosis: Combining Running and Interrupted Sutures

Journal of EndourologyVol. 22, No. 9 Tricks of the TradeRobotic Urethrovesical Anastomosis: Combining Running and Interrupted SuturesAlexander M. Berry, Fernando Korkes, Marcos Ferreira, and Jim C. HuAlexander M. BerrySearch for more papers by this author, Fernando KorkesSearch for more papers by this author, Marcos FerreiraSearch for more papers by this author, and Jim C. HuSearch for more papers by this authorPublished Online:23 Sep 2008https://doi.org/10.1089/end.2008.0099AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byThe Urethrovesical Anastomosis3 March 2018Technique and outcomes of bladder neck intussusception during robot-assisted laparoscopic prostatectomy: A parallel comparative trialUrologic Oncology: Seminars and Original Investigations, Vol. 34, No. 12Neoadjuvant Systemic Therapy Before Radical Prostatectomy in High-Risk Prostate Cancer Does Not Increase Surgical Morbidity: Contemporary Results Using the Clavien SystemClinical Genitourinary Cancer, Vol. 14, No. 2The Transperitoneal Robotic-Assisted Radical Prostatectomy26 October 2013Does the Use of a Barbed Polyglyconate Absorbable Suture Have an Impact on Urethral Anastomosis Time, Urethral Stenosis Rates, and Cost Effectiveness During Robot-assisted Radical Prostatectomy?Urology, Vol. 82, No. 1The Urethrovesical Anastomosis28 February 2013Anastomosis During Robot-assisted Radical Prostatectomy: Randomized Controlled Trial Comparing Barbed and Standard Monofilament SutureUrology, Vol. 78, No. 3The Impact of Prostate Size, Median Lobe, and Prior Benign Prostatic Hyperplasia Intervention on Robot-Assisted Laparoscopic Prostatectomy: Technique and OutcomesEuropean Urology, Vol. 59, No. 4Athermal Division and Selective Suture Ligation of the Dorsal Vein Complex During Robot-Assisted Laparoscopic Radical Prostatectomy: Description of Technique and OutcomesEuropean Urology, Vol. 59, No. 2Randomized Controlled Trial of Barbed Polyglyconate Versus Polyglactin Suture for Robot-Assisted Laparoscopic Prostatectomy Anastomosis: Technique and OutcomesEuropean Urology, Vol. 58, No. 6A Novel Method of Urethrovesical Anastomosis During Robot-Assisted Radical Prostatectomy Using a Unidirectional Barbed Wound Closure Device: Feasibility Study and Early Outcomes in 51 Patients Sanjeev Kaul, Jesse Sammon, Akshay Bhandari, James Peabody, Craig G. Rogers, and Mani Menon3 November 2010 | Journal of Endourology, Vol. 24, No. 11Current World LiteratureCurrent Opinion in Urology, Vol. 20, No. 2Overcoming the Learning Curve for Robotic-assisted Laparoscopic Radical ProstatectomyUrologic Clinics of North America, Vol. 37, No. 1Anatomic Bladder Neck Preservation During Robotic-Assisted Laparoscopic Radical Prostatectomy: Description of Technique and OutcomesEuropean Urology, Vol. 56, No. 6 Volume 22Issue 9Sep 2008 InformationMary Ann Liebert, Inc.To cite this article:Alexander M. Berry, Fernando Korkes, Marcos Ferreira, and Jim C. Hu.Robotic Urethrovesical Anastomosis: Combining Running and Interrupted Sutures.Journal of Endourology.Sep 2008.2127-2130.http://doi.org/10.1089/end.2008.0099Published in Volume: 22 Issue 9: September 23, 2008PDF download

Inkjet printing of bioadhesives

Over the past century, synthetic adhesives have largely displaced their natural counterparts in medical applications. However, rising concerns over the environmental and toxicological effects of the solvents, monomers, and additives used in synthetic adhesives have recently led the scientific community to seek natural substitutes. Marine mussel adhesive protein is a formaldehyde-free natural adhesive that demonstrates excellent adhesion to several classes of materials, including glasses, metals, metal oxides, and polymers. In this study, we have demonstrated computer aided design (CAD) patterning of various biological adhesives using piezoelectric inkjet technology. A MEMS-based piezoelectric actuator was used to control the flow of the mussel adhesive protein solution through the ink jet nozzles. Fourier transform infrared spectroscopy (FTIR), microscopy, and adhesion studies were performed to examine the chemical, structural, and functional properties of these patterns, respectively. FTIR revealed the piezoelectric inkjet technology technique to be nondestructive. Atomic force microscopy was used to determine the extent of chelation caused by Fe(III). The adhesive strength in these materials was correlated with the extent of chelation by Fe(III). Piezoelectric inkjet printing of naturally-derived biological adhesives may overcome several problems associated with conventional tissue bonding materials. This technique may significantly improve wound repair in next generation eye repair, fracture fixation, wound closure, and drug delivery devices.

Dynamic Wound Closure for Decompressive Leg Fasciotomy Wounds

Decompressive fasciotomy for preservation of lower extremity function and salvage is an essential technique in trauma. The wounds that result from the standard two incision four-compartment leg fasciotomy are often accompanied by a wide soft tissue opening that in the face of true compartment syndrome are often impossible to close in a delayed primary fashion. We describe a technique using a device that allows for dissipation of the workload across the wound margin allowing for successful delayed primary closure. Consecutive patients who presented to the 28th Combat Support Hospital in Baghdad, Iraq with a diagnosis of compartment syndrome of the leg, impending compartment syndrome of the leg, or compartment syndrome of the leg recently treated with fasciotomies were followed. All patients underwent placement of the Canica dynamic wound closure device (Canica, Almonte, ON, Canada). Eleven consecutive patients treated at a combat support hospital in support of Operation Iraqi Freedom underwent four-compartment fasciotomies for penetrating injuries. There were five patients that underwent a vascular repair [three superficial femoral artery (SFA) injuries and two below knee popliteal artery injuries] and six patients that had orthopedic injuries (three comminuted tibial fractures, two fibula fractures, and one closed pilon fracture). Patients returned to the operating room within 24 hours for washout and wound inspection. Mean initial wound size was 8.1 cm; mean postplacement size was 2.7 cm; average time to closure was 2.6 days. All patients were able to undergo primary wound closure of the medial incision and placement of the Canica device over the lateral incision. Ten of the 11 patients (91%) could be closed in delayed primary fashion after application of the device. In our series of patients with penetrating wartime injuries and compartment syndrome of the leg we have found the use of this dynamic wound closure device to be extremely successful and expedient.

Novel Devices for Wound Closure in Interventional Radiology

Wound closure issues are not as common in the field of interventional radiology when compared with other surgical fields, such as plastic surgery or dermatology. A common exception to this rule involves the placement and removal of chest wall vascular ports. This article reviews newer wound closure devices such as skin adhesives and closure film.

The Use of an Innovative Device for Wound Closure after Upper Extremity Fasciotomy

The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds. A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG). Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days). We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a second-stage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.

Invited commentary

The current study by Gorlitzer and colleagues [1Gorlitzer M. Grabenwoeger M. Meinhart J. et al.Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy.Ann Thorac Surg. 2007; 83: 393-396Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar] describes an alternative approach to the treatment of descending necrotizing mediastinitis in 5 patients at a single institution. Although a variety of surgical approaches (ie, transcervical, subxiphoid, transthoracic, and transternal) have been adopted and published, no single approach has been widely accepted as the optimal form of mediastinal drainage. The authors prefer median sternotomy as the primary mode of debridement followed by vacuum-assisted drainage and delayed sternal closure. The use of a vacuum-assisted wound closure device for the treatment of descending necrotizing mediastinitis is relatively novel. Despite a favorable outcome in 80% of the patients, one of the major criticisms of this approach includes the potential transmission of infectious complications to the sternum. Moreover, the risk of sternal osteomyelitis is compounded by the need for tracheostomy in many of these patients.We all agree that early surgical intervention is paramount in patients who present with descending necrotizing mediastinitis. High resolution chest imaging with computed tomography provides the best road map for developing a surgical strategy for optimal debridement and drainage. Treatment should be individualized to each patient since the disease process is not uniform. Each surgical approach offers potential advantages and disadvantages. Descending infections in the posterior mediastinum are probably best drained through a transthoracic approach while infections in the anterior or middle mediastinum (pretracheal or perivascular space) can be approached with combined techniques. Although median sternotomy has not been historically favored in the literature for the treatment of descending mediastinitis [2Papalia E. Rena O. Oliaro A. et al.Descending necrotizing mediastinitis: surgical management.Eur J Cardiothorac Surg. 2001; 20: 739-742Crossref PubMed Scopus (103) Google Scholar], Gorlitzer and colleagues [1Gorlitzer M. Grabenwoeger M. Meinhart J. et al.Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy.Ann Thorac Surg. 2007; 83: 393-396Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar] should be commended on their good outcomes and the absence of sternal osteomyelitis or sternal wound dehiscence in their patients. The current study by Gorlitzer and colleagues [1Gorlitzer M. Grabenwoeger M. Meinhart J. et al.Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy.Ann Thorac Surg. 2007; 83: 393-396Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar] describes an alternative approach to the treatment of descending necrotizing mediastinitis in 5 patients at a single institution. Although a variety of surgical approaches (ie, transcervical, subxiphoid, transthoracic, and transternal) have been adopted and published, no single approach has been widely accepted as the optimal form of mediastinal drainage. The authors prefer median sternotomy as the primary mode of debridement followed by vacuum-assisted drainage and delayed sternal closure. The use of a vacuum-assisted wound closure device for the treatment of descending necrotizing mediastinitis is relatively novel. Despite a favorable outcome in 80% of the patients, one of the major criticisms of this approach includes the potential transmission of infectious complications to the sternum. Moreover, the risk of sternal osteomyelitis is compounded by the need for tracheostomy in many of these patients. We all agree that early surgical intervention is paramount in patients who present with descending necrotizing mediastinitis. High resolution chest imaging with computed tomography provides the best road map for developing a surgical strategy for optimal debridement and drainage. Treatment should be individualized to each patient since the disease process is not uniform. Each surgical approach offers potential advantages and disadvantages. Descending infections in the posterior mediastinum are probably best drained through a transthoracic approach while infections in the anterior or middle mediastinum (pretracheal or perivascular space) can be approached with combined techniques. Although median sternotomy has not been historically favored in the literature for the treatment of descending mediastinitis [2Papalia E. Rena O. Oliaro A. et al.Descending necrotizing mediastinitis: surgical management.Eur J Cardiothorac Surg. 2001; 20: 739-742Crossref PubMed Scopus (103) Google Scholar], Gorlitzer and colleagues [1Gorlitzer M. Grabenwoeger M. Meinhart J. et al.Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy.Ann Thorac Surg. 2007; 83: 393-396Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar] should be commended on their good outcomes and the absence of sternal osteomyelitis or sternal wound dehiscence in their patients. Descending Necrotizing Mediastinitis Treated With Rapid Sternotomy Followed by Vacuum-Assisted TherapyThe Annals of Thoracic SurgeryVol. 83Issue 2PreviewDescending necrotizing mediastinitis (DNM) is a life-threatening emergency after oropharyngeal infection. The diagnosis must be established rapidly. DNM is associated with septic shock and respiratory insufficiency. Because mortality rates may be as high as 60%, aggressive surgical treatment is indicated. Full-Text PDF

Prospective, Randomized, Blinded Study of a New Wound Closure Film Versus Cutaneous Suture for Surgical Wound Closure

Wound closure devices include sutures, tissue adhesives, adhesive strips, and staples. Recent studies suggest no differences between various tissue adhesives and sutures for dehiscence, infection, and satisfaction when assessed by patients or surgeons. To date, no studies have investigated ClozeX, a novel adhesive strip, for closure of surgical incisions. To compare surgical wounds repaired with ClozeX versus suture. A prospective, randomized study was conducted, in which 15 patients with surgical incisions were allocated to closure with ClozeX on half of the wound and monofilament suture on the other half. Physician satisfaction with blinded assessment, patient satisfaction, complication rates, and closure times were recorded. Application with ClozeX was faster than with suture (p=.007). There were no complications in either group. Sixty-nine percent of the patients gave ClozeX a higher satisfaction score (p=.02). More physicians were satisfied with the ClozeX half than with the suture half (p=.007). This pilot study demonstrates ClozeX to be a safe and effective closure device. The cosmetic outcome seems to be at least as good as simple running suture. Physicians and patients were generally more satisfied with ClozeX. No difference was found in the rate of dehiscence or infection between the groups.

Giant Eccrine Adenocarcinoma of the Scalp with Intracranial Invasion:Resection and Reconstruction Using a Vacuum-assisted Closure Device:Technical Case Report

Carcinoma of the adnexal structures of the skin is a rare malignancy, and is even more unusual in the scalp. We report an unusual case of scalp adnexal carcinoma of eccrine origin that went untreated for years, resulting in a giant tumor with extension through the cranium. The tumor resection and reconstruction of the cranium and scalp defects posed unique challenges. A 54-year-old woman experienced a large recurrence of her scalp adnexal carcinoma after an incomplete wide local excision, which invaded through the cranium. The entire vertex of the scalp and cranium were removed en bloc. After cranioplasty, a free vascularized muscle flap was used for soft tissue coverage, but failed owing to poor vascular inflow. A large area of dura was left open, using a vacuum-assisted wound closure device to generate granulation tissue by secondary intention. Another split thickness skin graft was used to provide a cosmetically acceptable outcome. Scalp adnexal tumors of eccrine origin rarely metastasize and can be resected for cure with complete removal. Reconstruction options for large scalp and cranial tumors may be limited, and allowing the dura to granulate by secondary intention has been very rarely described. The novel use of a vacuum-assisted wound closure device was a very useful adjunct in this situation, and may be beneficial in the reconstruction of other patients with large scalp and cranial defects after neurosurgical procedures. It should be used with caution, since it may risk injury to a major venous sinus, especially when used in the midline, or cerebrospinal fluid leakage.

Clinical application of vacuum pack system for temporary abdominal closure

To investigate the clinical application of a new temporary abdominal wound closure,vacuum system for temporary management of the open abdomen. Vacuum pack system consisted of polyethylene sheet,surgical towel,silicone drain, adhesive plastic drape. Clinical data of the patients undergoing exploratory celiotomy were recorded,and the indications for such temporary abdominal closure and its complications were reviewed. Thirteen trauma patients underwent such vacuum abdominal closure for 15 times, including 5 times (33.3%) for increased intra- abdominal pressure so that tension-free fascial closure was unable to achieve, 4 times (26.7%) for reexploration, 2 times (13.3%) for damage control, and 4 times (26.7%) for combined factors. Finally, seven patients (53.8%) received direct closure and 5 patients (38.5%) received skin grafting after granulation because the defect could not be closed directly. One patient (7.7%) died before abdominal closure was attempted. None of the patients developed enterocutaneous fistula and evisceration. Three patients (23.1%) developed intra-abdominal abscess. The vacuum pack is a better temporary abdominal wound closure device, and primary closure can be achieved in most of the patients. The technique is simple and easily mastered with a low complication rate.

Vacuum-Assisted Closure for Sternal Wounds: A First-Line Therapeutic Management Approach

Vacuum-assisted closure therapy has gained widespread use since its introduction in 1997. Previous studies have attributed significant benefit to its use for treatment of sternal wounds with or without mediastinitis. Management of sternal wounds with this therapy has been shown to decrease the number of dressing changes, reduce the time between débridement and definitive closure, and reduce costs associated with a protracted course of in-hospital dressing changes. The therapy has been used both as a bridge between débridement and definitive closure and as a catalyst to secondary sternal-wound healing. The authors performed a retrospective review of 103 patients who underwent vacuum-assisted closure therapy after median sternotomy between June of 1999 and March of 2004 at a single institution. The wounds were classified as sterile wounds, superficial sternal infections, and mediastinitis. The wound closure device, consisting of a polyurethane sponge and evacuation tube with in-line suction, was applied sterilely to all wounds over a layer of Acticoat. Vacuum-assisted closure was utilized in the treatment of sternal wounds for 103 patients (67 male patients and 36 female patients) whose mean age was 52 years (range, 3 months to 91 years). Patient comorbidities included diabetes, chronic obstructive pulmonary disease, end-stage renal disease, immunosuppression, and others. Sixty-four percent of the patients had a diagnosis of mediastinitis; 36 percent had either superficial infections or a sterile wound. The therapy was utilized for an average period of 11 days per patient. Sixty-eight percent of the patients (70 of 103) had definitive chest closure with open reduction internal fixation and/or flap closure. The remaining 32 percent had no definitive closure method. The overall mortality rate was 28 percent (29 of 103 patients), although no deaths were directly related to use of the therapy, and only four deaths resulted from sepsis as a consequence of mediastinitis. The authors report the largest series of patients treated with this therapy for post-sternotomy sternal wounds and believe it is safe and effective as a first-line therapy in the management of sternal wounds. The mortality rate from their study represents the patients' underlying disease process and comorbidities and is not a reflection of complications associated with the therapy. Vacuum-assisted closure therapy has been shown to decrease wound edema, decrease the time to definitive closure, and reduce wound bacterial colony counts. The authors have implemented the therapy for most patients with sternal wounds/mediastinitis at their institution, and believe it should be a standard protocol in the first-line management of these types of wounds.

Discussion

Background: Vacuum-assisted closure therapy has gained widespread use since its introduction in 1997. Previous studies have attributed significant benefit to its use for treatment of sternal wounds with or without mediastinitis. Management of sternal wounds with this therapy has been shown to decrease the number of dressing changes, reduce the time between debridement and definitive closure, and reduce costs associated with a protracted course of in-hospital dressing changes. The therapy has been used both as a bridge between debridement and definitive closure and as a catalyst to secondary sternal-wound healing. Methods: The authors performed a retrospective review of 103 patients who underwent vacuum-assisted closure therapy after median stemotomy between June of 1999 and March of 2004 at a single institution. The wounds were classified as sterile wounds, superficial sternal infections, and mediastinitis. The wound closure device, consisting of a polyurethane sponge and evacuation tube with inline suction, was applied sterilely to all wounds over a layer of Acticoat. Results: Vacuum-assisted closure was utilized in the treatment of sternal wounds for 103 patients (67 male patients and 36 female patients) whose mean age was 52 years (range, 3 months to 91 years). Patient comorbidities included diabetes, chronic obstructive pulmonary disease, end-stage renal disease, immunosuppression, and others. Sixty-four percent of the patients had a diagnosis of mediastinitis; 36 percent had either superficial infections or a sterile wound. The therapy was utilized for an average period of 11 days per patient. Sixty-eight percent of the patients (70 of 103) had definitive chest closure with open reduction internal fixation and/or flap closure. The remaining 32 percent had no definitive closure method. The overall mortality rate was 28 percent (29 of 103 patients), although no deaths were directly related to use of the therapy, and only four deaths resulted from sepsis as a consequence of mediastinitis. Conclusions: The authors report the largest series of patients treated with this therapy for post-sternotomy sternal wounds and believe it is safe and effective as a first-line therapy in the management of sternal wounds. The mortality rate from their study represents the patients' underlying disease process and comorbidities and is not a reflection of complications associated with the therapy. Vacuum-assisted closure therapy has been shown to decrease wound edema, decrease the time to definitive closure, and reduce wound bacterial colony counts. The authors have implemented the therapy for most patients with sternal wounds/mediastinitis at their institution, and believe it should be a standard protocol in the first-line management of these types of wounds.

Vakuumassistierter Wundverschluss nach Exzision eines malignem Melanoms an der Ferse mit dem Fersen-Schaum (V.A.C.®-Heel-Dressing)

Vacuum-assisted wound closure is established in acute wound treatment and assists granulation tissue as well as promotion of graft survival in critical localisation. A new vacuum-assisted wound closure device is launched for the treatment of heel wounds (V.A.C. GranuFoam Heel Dressing). First experience with this heel contour shaped dressing is presented in a case of primary surgical care of a high risk melanoma. The initial defect after excision, measuring 8 x 6 x 3.5 cm, granulated by V.A.C. treatment in 5 weeks to skin surface niveau and was successfully covered with a full thickness skin graft. The V.A.C. Heel Dressing is easy to apply, reduces vacuum leakage und increases patients' comfort and treatment safety in comparison to "classic" vacuum dressings.

Role of skin stretching device for wound closure

The Sure Closure indexed skin stretching device was used in four patients with considerable skin defects of varying etiology. The bedside application of the device under local anesthesia and incremental stretching proved to be an effective and easy method. Gradual tightening of the tension meter and simple wound care for 24–48 h resulted in tension-free approximation of wound margins which could then be sutured easily. Three wounds healed primarily with acceptable scars, but in one patient the sutures had to be removed 6 h postoperatively, as this resulted in a gaping wound because of impending compartment syndrome. This case shows that the use of the device intraoperatively is quite safe for smaller defects, but when used in much wider defects in the extremities, it carries the risk of compartment syndrome. The device is good for acute as well as subacute and chronic but clean wounds. It is a good adjunct for wound care with minimal surgery, few complications, and eventual good scarring.

Role of skin stretching device for wound closure

Role of skin stretching device for wound closure

Toxic Shock Syndrome Associated With the Use of the Vacuum-Assisted Closure Device

The vacuum-assisted wound closure technique and device (the V.A.C.) has become a widely accepted technique in the management of chronic and difficult wounds. The authors present the first reported case of toxic shock syndrome associated with its use. This article does not question the efficacy of the V.A.C. technique in the treatment of difficult wounds, but focuses on raising the index of suspicion of toxic shock syndrome in patients with wounds managed with the V.A.C. who develop early signs or symptoms that may be consistent with the diagnosis.

Abstracts

Diagnostic features of lethal acrodermatitis in 28 bull terriers McEwan, N. A., McNeil, P. E., Thompson, H. &amp; McCandlish, I. A. P. (2000) Diagnostic features, confirmation and disease progression in 28 cases of lethal acrodermatitis of bull terriers. Journal ofSmallAnimal Practice 41, 501‐507Skin‐stretching device for closing wounds in dogs and cats Pavletic, M. M. (2000) Use of an external skin‐stretching device for wound closure in dogs and cats. Journal of the American Veterinary Medical Association 217, 350‐354

Use of an external skin-stretching device for wound closure in dogs and cats.

Use of an externally applied, noninvasive skin-stretching device in 24 dogs and cats is described. The device uses adhesive-coated pads that are applied to the skin of an animal; pads are positioned on opposite sides of a surgical site and are connected by means of adjustable elastic cables. The cables maintain continuous tension, and cable tension is adjusted and progressively increased at intervals of 6 to 8 hours to promote skin recruitment (stretching), using the cutaneous viscoelastic properties of mechanical creep and stress relaxation. Consequently, skin adjacent and distant to the surgical site can be recruited to facilitate wound closure, typically within 72 to 96 hours after application of the device. The skin-stretching device has been used effectively in dogs and cats to stretch skin prior to elective surgical procedures, stretch skin during management of open wounds prior to suturing, and alleviate incisional tension after surgery.