Wound Vacuum Research Articles

A Case-Based Review of LVAD Infection by MABC

Abstract We present a review of literature and report a case of left ventricular assist device (LVAD) infection and postsurgical wound infection with Mycobacterium abscessus complex (MABC) following exposure to sewage and tap water, respectively. The initial infectious process involved the driveline and the deep pocket and progressed to involve LVAD. Prior to availability of culture results, the patient was started on linezolid followed by surgical debridement of driveline site and change of exit site. The debrided tissue grew a smooth and a rough colony variant of MABC. After 2 weeks of imipenem intravenous (IV), tigecycline IV, azithromycin oral (PO), and tedizolid PO, the patient presented to us with worsening of wound status. Antimicrobial therapy was changed to amikacin IV, imipenem IV, and cefoxitin IV along with bedside debridement, removal of 3 sutures, and placement of wound vacuum device. Amikacin IV, imipenem IV, and cefoxitin IV were then replaced with Recarbio (imipenem/cilastatin/relebactam) IV plus amoxicillin PO with significant improvement. The patient underwent LVAD removal and heart transplantation after 5 weeks and was discharged 15 days later. Following showering at home, the patient developed signs of extensive infection involving the surgical wound (chest and abdominal walls). Tigecycline IV and azithromycin IV were started. Imipenem/cilastatin/ relebactam IV plus amoxicillin PO were replaced by bedaquiline PO because of the continued financial burden to the patient. The patent was discharged on bedaquiline PO and azithromycin PO to complete 18 months of antimicrobial therapy at which time he was enjoying a very active lifestyle as he did prior to the diagnosis of advanced heart failure. He continues to do well 2 years 9 months after heart transplantation and more than a year after stopping all antimycobacterial therapy.

Topical Negative Pressure Wound Therapy to Prevent Wound Complications Following Cesarean Delivery in High-Risk Obstetric Patients: A Randomized Controlled Trial

(Aust N Z J Obstet Gynaecol. 2023;63:516–520) The prevalence of cesarean deliveries (CD) has surged in recent decades, paralleling an uptick in medical complications during pregnancy linked to delayed childbearing and rising obesity rates. Consequently, post-CD wound complications have become a significant health concern. Mitigating these complications is a priority, with various wound vacuum systems available. While concerns persist about their effectiveness compared to standard treatments, some evidence suggests modest benefits, particularly in nonobstetric settings. The PICO wound vacuum system has shown promise for clean, noninfected surgical wounds, including cesarean incisions, though data is mainly from small trials or retrospective cohorts. Our study explores the use of PICO in preventing wound infections and breakdown in women with risk factors for complications postcesarean delivery.

Surgeon Preference Regarding Wound Dressing Management in Lumbar Fusion Surgery: An AO Spine Global Cross-Sectional Study.

To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions. A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons' preferences were analyzed. Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001). Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.

Comparison between high transverse and low transverse Pfannenstiel skin incisions during cesarean delivery for morbidly obese patients

Objective This study aimed to evaluate if placement of transverse cesarean skin incision above or below the overhanging pannus is associated with wound morbidity in morbidly obese patients. Study Design We identified a cohort of patients with body mass index (BMI) ≥40 kg/m2 undergoing cesarean delivery at a single center from 2017-2020 with complete postpartum records. Data was abstracted after institutional review board exemption, and patients were grouped by low transverse or high transverse skin incision. The primary outcome was a composite of wound infection, fascial dehiscence, incisional hernia, therapeutic wound vacuum, and reoperation. Secondary outcomes included the individual components of the composite, blood transfusion, operative time, and immediate neonatal outcome. T test and χ2 were used for continuous and categorical comparisons. Logistic regression was used to compute adjusted odds ratios for categorical outcomes and linear regression to compare operative times adjusting for factors associated with wound complications and surgical duration respectively. Results 328 patients met inclusion criteria: 65 with high transverse (infraumbilical and supraumbilical) and 263 with low transverse (Pfannenstiel) incision. 11% of patients had wound morbidity; high transverse incision was associated with 3.64-fold increased odds of composite wound morbidity (23.1% vs 8%, aOR 3.64, 95% CI 1.52-8.70) and 5.73-fold increased odds of wound infection (13.8% vs. 4.9%, aOR 5.73, 95% CI 1.83-17.96). Time from skin incision to delivery was 1.87 min longer (11.09 vs 14.98 min, β = 1.87, 95% CI 0.17-4.61). There was no significant difference in neonatal outcomes, non-low transverse hysterotomy, or total operative time. Conclusion High transverse skin incision for cesarean delivery was strongly associated with increased wound morbidity in morbidly obese patients.

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

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

A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin.

For 9 months (April-December 2022), we performed 32 vacuum wound dressings with the newly developed technique using the 3M ActiV.A.C. Therapy Unit and accessories, and Convatec's VARIHESIVE, avoiding skin contact with the adhesive films. Seven patients with 11 wounds who had sensitive skin or allergy to the conventionally used adhesive films were successfully treated with the new technique. The negative pressure wound dressings remained intact and functioned properly for up to 168 hours without compromising patients' daily activities and therapy. The novel "no foil-to-skin contact" technique for vacuum-assisted wound closure can successfully be incorporated in the treatment of patients in whom conventional negative pressure dressings are otherwise not applicable.

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

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

Repair of Bowel Perforation: Endoscopic State of the Art

Background: Intestinal damage from various etiologies can result in the potentially dangerous complication of bowel perforation. Emergent treatment of small bowel perforation includes surgical repair with or without small bowel resection. As the number of therapeutic and diagnostic endoscopic procedures increase, more studies may be required to properly evaluate and report incidences of bowel perforation. Given the advantages of interventional procedures, novel endoscopic technologies which may prove beneficial in bowel perforation repair are continuously undergoing development. Bowel perforation can lead to peritonitis and sepsis – a medical emergency requiring immediate attention. Following diagnosis, hemodynamically stable patients may be treated conservatively whereas unstable patients undergo more intensive surgical procedures. Endoscopic procedures for bowel perforation repair also exist and recent advances in technology are furthering the scope of such closure methods. Methods and Findings: Endoscopic suturing technologies, while capable, require extensive training and entail prolonged activation processes. Wound vacuum sponge closure via endoscopy provides convergence of wound defects but may not be efficacious in defects larger than 5 cm. Furthermore, this method may be limited by inadequate seal and placement in the intestine. Endoscopic clipping is another modality beneficial for smaller perforations only. T-tag suturing has shown promising results in ex-vivo studies but entails blind placement of T-tags for perforation closure. Stents can be inserted endoscopically under fluoroscopic visual guidance. This technique, however, may result in stent migration, perforations and potential occlusions. Sealants can be injected for perforation closure but have not demonstrated clear efficacy. Robotic flexible endoscopy provides several novel features yet may require advanced training and sometimes more than one operator. As interventional procedures continue to gain popularity, a better understanding of endoscopic modalities is helpful for furthering their development. Regarding bowel perforation, this review aids in an overall understanding of the technologies which exist and are advancing further into more standard modalities for practical medical applications. Conclusion: There are currently various methods to repair perforation of the gastrointestinal wall and except for urgent exploratory laparotomy when indicated, there is likely no single method that is superior to others. It may be beneficial for the physician to consider all options for repair when evaluating a potential bowel perforation, considering physician preference and individual success or difficulty with a given modality. In more recent years as the focus has narrowed on minimally invasive procedures, future modalities will likely include increased automation and ease of use with the help of robotics, which will hopefully lead to decreased time to diagnosis, faster recovery and reduced morbidity and mortality.

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

BackgroundComplex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism.Case presentationA 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid.After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function.ConclusionsPatient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism.

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

Retrospective Cohort Study on the Management of Diffuse Deep Neck Space Infections Using a Modified Submental Approach and Placement of Wound Vacuum

Diffuse deep neck space infection (DDNSI) is an emergent condition that requires efficient surgical and airway management. A novel surgical approach has been developed to enhance access and improve visualization of the involved deep neck spaces, which allows for better evaluation of the extent of tissue necrosis. This study will compare the treatment of DDNSI with traditional incision and drainage with drain placement (Conventional) versus the new incision and drainage design with the use of a wound vacuum (VAC). This retrospective cohort study was performed on DDNSI cases treated with the VAC versus Conventional techniques from July 2014 to September 2020 at Memorial Hermann Hospital by the oral and maxillofacial surgery service. To be categorized as a DDNSI, the patient had to demonstrate radiographic evidence of an infection bilaterally in a minimum of four spaces, such as bilateral submandibular, sublingual, and submental spaces. Primary predictor variable was treatment method for DDNSI, Conventional versus VAC. Primary outcome variables were hospital length of stay (LOS), number of washouts, and days of intubation. Covariates were age, sex, number of spaces involved, presence of necrotic tissues, comorbidities, and mortality. Appropriate uni- and bi-variate statistics were calculated. Statistical significance was set a P < .05. Fifty-one patients (17 female and 34 male) aged 18 to 65years were treated for DDNSI. Twenty-eight patients were treated using the VAC approach and 23 patients were treated with the conventional approach. The average LOS 8.3± 0.8days (P-value=.0001), number of days intubated 3± 0.3 (P-value=.0001), and number of required washouts 2± 0.2 (P-value=.004) were statistically lower in the VAC group compared to the Conventional group. There were significant improvements encountered with overall length of hospital stay, number of days intubated, and the number of required wash outs. There were significant differences in outcomes between patients with comorbidities when compared to those who had none.

Postoperative spine surgical site infections: high rate of failure of one-stage irrigation and debridement

BACKGROUND CONTEXTFollowing spine surgery, postoperative surgical site infection (SSI) is a rare but potentially devastating complication. Previous studies have assessed risk factors for spine SSI and one aimed to develop risk stratification tool to assess management options, but this tool has not been externally validated or regularly used. PURPOSEThe current study aimed to investigate the rate of SSI following elective spine surgery, surgical management pursued, and success of traditionally utilized one-stage of irrigation and debridement (I&D) with closure over drains. STUDY DESIGNRetrospective case-control study. PATIENT SAMPLEAdult, elective spine surgeries performed at a single academic institution between 2013 and 2021 were evaluated. Patients who developed SSI requiring surgical intervention were identified. OUTCOME MEASURESThose who underwent initial management with I&D and closure over drains were assessed for need of subsequent I&D (considered failure of initial infection management). METHODSOf spine surgeries meeting inclusion criteria, those with SSI were identified and management was characterized. For those who did and did not fail attempted one stage I&D with closure over drains, pre-operative and surgical variables from the index procedure as well as infection characteristics were assessed and compared with univariable and multivariable analyses. RESULTSOf 11,023 elective spine surgeries, SSI was identified for 76 (0.7%). For initial management, I&D with closure over drains was used for 66 (86.8%) while I&D and wound vacuum management was used 10 (13.2%). Failure of attempted one stage I&D (requiring subsequent I&D procedure) was identified for 18 (27% of those undergoing I&D and closure over drains). Of multiple patient, surgical, and infection characteristics, the only factor identified as independently predictive of one stage I&D failure was presence of bacteremia (odds ratio [OR] 38.3, p=0.0007). Within the sub-cohort of patients with bacteremia, failure of attempted one stage I&D was noted for 80%. CONCLUSIONLess than one percent of a large cohort of patients undergoing spine surgery were found to develop SSIs. Of those undergoing attempted one stage I&D, most patient, surgical, and infection variables did not influence outcome of the intervention. However, those with bacteremia were at 38.3 times greater odds of failing attempted one-stage I&D. These results suggest considering delayed closure approaches in these cases.

Incisional Wound Vacuum-Evaluation of Wound Outcomes in Comparison With Standard Dressings for Posterior Spinal Fusions in Traumatic Patients.

Postoperative incisional negative pressure wound vacuum-assisted closure (VAC) dressings are being used as a primary dressing to optimize wound healing and help avoid complications of infection and dehiscence. Few studies have investigated whether application of VAC dressings on postoperative posterior spinal wounds can reduce the incidence of surgical site infections. To describe our single-surgeon experience of using primary VAC after posterior spinal fusion (PSF) in a large sample of trauma patients. This was an Institutional Review Board-approved retrospective comparative study and included all trauma patients presenting to our level 1 safety-net trauma center who required PSF and were operated on by the senior surgeon between 2016 and 2021. Primary outcomes were complications (surgical site infection, readmission for infection, and wound-related return to operating room [OR]) within 90 days after surgery. χ2 testing and Student t testing were used to assess differences between treatment groups while bivariate and multivariate regression was performed for outcome assessment. Two hundred sixty-four patients met criteria and were included. One hundred fifty-seven (59%) were treated with standard dressing and 107 (41%) with VAC. Patients treated with VAC were more likely to be older (P = .015), have diabetes (P = .041), have an elevated body mass index (P = .020), and had more levels of fusion (P = .002). Despite this, presence of VAC was independently associated with decreased 90-day infection (hazard ratio = 0.397, P = .023) and decreased 90-day return to OR for wound-related reasons (hazard ratio = 0.099, P = .031). Compared with the use of standard dressing, VAC was found to decrease surgical site infection and return to OR risk in trauma patients undergoing PSF.

PSEUDOMONAS AERUGINOSA COSTOCHONDRITIS ASSOCIATED WITH RECENT IV DRUG USE

PSEUDOMONAS AERUGINOSA COSTOCHONDRITIS ASSOCIATED WITH RECENT IV DRUG USE

Letter to the Editor: A New Twist on an Old Trick: Use of Mafenide Acetate/Amphotericin B Soaks via Irrigating Wound Vacuum System to Treat Angioinvasive Fusarium Infection.

Surgical InfectionsVol. 24, No. 1 Letters to the EditorLetter to the Editor: A New Twist on an Old Trick: Use of Mafenide Acetate/Amphotericin B Soaks via Irrigating Wound Vacuum System to Treat Angioinvasive Fusarium InfectionJennifer Schneider, Philip Antiporta, Sarah Mitchell, and Therese DuaneJennifer SchneiderAddress correspondence to: Dr. Jennifer Schneider, Department of Surgery, Texas Health Harris Methodist Hospital Fort Worth, 1511 South Adams Street, Fort Worth, TX 76104, USA E-mail Address: jschnei@me.comDepartment of Surgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.Search for more papers by this author, Philip AntiportaDepartment of Infectious Disease, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.Search for more papers by this author, Sarah MitchellDepartment of Surgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.Search for more papers by this author, and Therese DuaneDepartment of Surgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.Search for more papers by this authorPublished Online:27 Jan 2023https://doi.org/10.1089/sur.2022.216AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Letter to the Editor: A New Twist on an Old Trick: Use of Mafenide Acetate/Amphotericin B Soaks via Irrigating Wound Vacuum System to Treat Angioinvasive Fusarium Infection." Surgical Infections, 24(1), pp. 95–96FiguresReferencesRelatedDetails Volume 24Issue 1Feb 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Jennifer Schneider, Philip Antiporta, Sarah Mitchell, and Therese Duane.Letter to the Editor: A New Twist on an Old Trick: Use of Mafenide Acetate/Amphotericin B Soaks via Irrigating Wound Vacuum System to Treat Angioinvasive Fusarium Infection.Surgical Infections.Feb 2023.95-96.http://doi.org/10.1089/sur.2022.216Published in Volume: 24 Issue 1: January 27, 2023Online Ahead of Print:September 28, 2022PDF download

Chlorhexidine gluconate lavage during total joint arthroplasty may improve wound healing compared to dilute betadine

PurposeIntraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA.MethodsAll primary TJA between 2019–2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates.ResultsA total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups.ConclusionsAlthough betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determine the advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods: The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results: In the study sample 10% patients were less than 40 years, 76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions: VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

729 "Feets" of Strength: How Glabrous Skin Defied the Odds

Introduction58 year old female with past medical history notable for IDDM with peripheral neuropathy presented to ER after stepping barefoot onto asphalt in August 2020. Patient initially presented to community ER who performed bedside debridement and referred patient to wound clinic for management. After presenting to wound clinic, patient was referred to Burn center. She arrived 10 days after burn and was found to have full thickness burns to the soles of bilateral feet, 3% TBSA. The majority of the soles of both feet were injured. The patient had little residual glabrous skin which was uninjured. Glabrous skin is highly specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes.MethodsThe patient was extremely compliant and willing to do whatever was necessary to maintain function. The patient underwent one debridement, two debridements with allografting, and one debridement with wound vacuum application. Wounds were initially treated with daily silvadene dressings and transitioned to daily damp to dry and finally to daily xeroform dressings. Wounds were measured at each follow up appointment, plan was made to intervene only when wounds stopped showing progress, however this plateau was never reached, and wounds were allowed to heal without any further intervention.ResultsOne year post burn, the right sole is fully healed while the left sole remains with small open area. The patient does have significant alterations to her gait pattern. However, the patient has managed to heal her wounds and is functioning independently.ConclusionsGiven patient’s IDDM, her perceived chances of healing a graft was low. Furthermore, her risk of infection and eventual amputation was high. Given a very compliant patient and diligent wound care, the patient was able to achieve significant healing of wounds without the need for amputation. Glabrous skin is specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes. Allowing the patient’s own glabrous skin to pull across the bed and heal has provided for optimal functional outcomes.

Preventing driveline infection during left ventricular assist device support by the HeartMate 3: A survey-based study.

Driveline infection (DLI) is a significant source of morbidity and mortality during left ventricular assist device (LVAD) support yet limited studies are available to describe the center-level prevalence, preventive practices, and their potential effectiveness. We surveyed LVAD centers in the United States to determine program burden and preventive practices for DLI during HeartMate (HM) 3 support. An online, anonymous, question-based survey was sent to expert providers at implanting centers. Only a single respondent completed the survey for each center. As an exploratory analysis, we compared specific DLI preventive practices between centers with low (≤10%) and high (>10%) reported prevalence of DLI. Seventy-eight centers responded to the survey (response rate: 50%). Respondents were comprised of 37 (47%) heart failure cardiologists, 27 (35%) LVAD coordinators, and 14 (18%) cardiothoracic surgeons. The prevalence of DLI during HM3 was reported as ≤10% by 27 (35%), 11%-25% by 36 (46%), and >25% by 16 (19%) centers. Thirteen (17%) centers had a body mass index threshold for device placement, 29 (37%) utilized a counter incision, 66 (81%) placed an anchor stitch, and 69 (88%) used an external device to stabilize the DL. Proportionally, more centers with a low DLI prevalence used a wound vacuum 6 (22%) versus 3 (6%, p=0.03) than those with high DLI. Variation exists in reported prevalence and practices of preventing and managing driveline infections across centers during HM3 support. Further studies are warranted to develop and assess the effectiveness of standardized preventive strategies.

Esophageal Wound Vacuum Placement for Anastomotic Leak: Lessons Learned From First Time Use at a Tertiary Care Center

Esophageal atresia and tracheoesophageal fistula (TEF) are rare birth anomalies typically requiring corrective surgery over the first few months of life. Esophageal surgery can lead to a life-threatening anastomotic leak. Esophageal wound vacuums have seen increased use in adults and one cohort of children as a therapeutic modality. This case study explores a tertiary care pediatric hospital’s introductory experience in utilizing this technique. A 19-month-old male underwent staged repair for esophageal atresia/tracheoesophageal fistula requiring an esophageal stricture resection with primary anastomosis. An anastomotic leak was successfully managed with wound vacuums. Our experiences highlighted the need for individualized treatment plans with this therapy based on feeding capabilities, side effects of the vacuum, placement method, and replacement strategies.