Negative pressure wound therapy (NPWT) in duodenal breakdown fistulas: negative pressure fistula therapy (NPFT)?

OBJECTIVE

To describe for the first time in literature the specific methodology of use of negative pressure wound therapy (NPWT) for duodenal fistula through clinical cases. The constant increase of use of NPWT for complex surgical situations imposes tailored previously undescribed solutions for the technique.

PATIENTS AND METHODS

Herein, three cases of high output duodenal fistula successfully treated with Negative Pressure Wound Therapy (NPWT) are reported. The technical details for the application of NPWT to these fistulas are discussed and described.

RESULTS

All three patients recovered without the necessity of further surgical operations.

CONCLUSIONS

When using NPWT, management of high-output duodenal fistulas must rely on some degree of customization of the aspiration systems. The aim of the procedure is to put under depression the duodenal hole and surrounding tissues "all in one" and not to separate the complex wound in sectors as usually indicated. We suggest calling this technique Negative Pressure Fistula Therapy.

[VACUUM-THERAPY OF DIFFUSE PERITONITIS]

The experience of treatment of 37 patients, suffering diffuse peritonitis, in 18 of them in complex with vacuum-therapy, is adduced. In a comparison group a sanation relaparotomy was applied only. International classifications SOFA, APACHE II, Manheim’s Index of the Peritonitis Severity were used for estimation of the patients’ state severity. The vacuum-therapy application have promoted significant reduction of the abdominal cavity microbial soiling, permitted to escape the compartment syndrome occurrence, and to reduce the sanation relaparotomy performance rate.

Negative pressure therapy alone or with irrigation in the management of severe peritonitis

BACKGROUND

Ogilvie was the first to publish on open abdomen (OA) for the treatment of the damages caused by penetrating abdominal wounds in war events. Research improved those devices that allow a controlled, homogeneous and continuous extraction of contaminated fluids from all abdominal recesses, which are nowadays the base of the "Open Abdomen" technique.

MATERIALS AND METHODS

From August 2012 to February 2016 at the Department of Emergency Surgery of Cardarelli Hospital in Naples, 40 patients affected by Severe Peritonitis have been treated with OA technique. 13 (32,5%) were treated with only the suction-drainage system, 27 patients (67,5%) were treated with suction drainage and irrigation system. Abthera® device was used in all patients.

RESULTS

The duration of treatment was 15 days in the first group, with 7 device's substitutions, while in the second group it was about 10 days with 4 substitutions At the end of the procedure we were able to perform primary fascia closure in 7 cases (53,8%) in the first group and in 23 cases (85.2%) in the second group. 4 patients (30,8%) died in the first group, and 7 (26%) in the second.

CONCLUSION

The suction/irrigation method seems to be appropriate to use in case of a surgical emergency that causes severe peritonitis. It is associated not only with lower death rates but also with better parameters, that are more frequently worse during prolonged treatments. Irrigation of abdominal cavity causes also less retraction of fascia recti which leads to a higher rate of direct fascia closure. Key Words: Emergency surgery, Irrigation, Open abdomen, Peritonitis.

[APPLICATION OF VACUUM-THERAPY ON STAGES OF SURGICAL TREATMENT OF THE DIABETIC FOOT SYNDROME]

Vacuum therapy of an acute and chronic wounds was used in a complex of surgical treatment of 228 patients, suffering diabetic foot syndrome. There was established a positive local and systemic action of this method for the treatment of the wound defect. Vacuum therapy of the wounds guarantees the wound process clinical course stabilization, improvement of microcirculation, reduction of their microbial soiling, stimulation of regenerative processes, elimination of endogenous intoxication.

[First report of urinary endoscopic vacuum therapy : For large bladder defect after abdomino-perineal excision of the rectum. Video paper. German version]

PURPOSE

The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation and which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdominoperineal resection of the rectum with urine flowing out of the perineal wound.

MATERIAL AND METHOD

A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters has been developed and is constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy by intravesical endoscopy.

RESULTS

The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. After 18 days of treatment with the uEVT the bladder defect was healed. After therapy and removal of the catheters the patient had normal micturition.

CONCLUSION

A novel small-bore OFD has been developed for EVT. The OFD technique now allows endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

Vacuum sealing drainage therapy in the presence of an external fixation device: A case report

RATIONALE

Vacuum sealing drainage (VSD) is widely utilized for treating traumatic wounds.

PATIENT CONCERNS

It is particularly difficult and time consuming to use in combination with an external fixator.

DIAGNOSES

This is because the hardware or pins used for fixation interfere with maintaining a seal, resulting in poor adhesion and subsequent air leakage.

INTERVENTIONS

To resolve this problem, we have devised a new method for sealing the wound dressing, while maintaining the required vacuum.When using this technique, a rubber strip is wrapped around each pin in 3 circles outside the plastic drape, and then tightly tied.

OUTCOMES

After completing this procedure, a vacuum is obtained, and any air leakage stops. We employed this technique to treat a cohort of patients in our department over a period of two years, and obtained good healing of soft tissue without air leakage, as well as good clinical outcomes.

LESSONS

We have observed that patients treated with this method experienced good clinical outcomes without air leakage, and we recommend its use in treating cases where an external fixation device is present.

Sealing procedures for preterm prelabour rupture of membranes

BACKGROUND

Preterm prelabour rupture of the membranes (PPROM) complicates approximately 2% of pregnancies and can be either spontaneous or iatrogenic in nature. Complications of PPROM include prematurity, chorioamnionitis, neonatal sepsis, limb position defects, respiratory distress syndrome, pulmonary hypoplasia chronic lung disease, periventricular leukomalacia and intraventricular haemorrhage.A number of different sealing techniques have been employed which aim to restore a physical barrier against infection and encourage the re-accumulation of amniotic fluid. Routine use of sealants is currently not recommended due to a lack of sufficient evidence to support the safety and effectiveness of such interventions.

OBJECTIVES

To assess the effects of sealing techniques following PPROM against each other, or versus standard care (including no sealant), on maternal and neonatal outcomes.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing different techniques for sealing preterm prelabour ruptured membranes. Cluster-randomised trials and trials using a cross-over design were not eligible for inclusion in this review. We planned to include abstracts when sufficient information was provided.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy.

MAIN RESULTS

We included two studies (involving 141 women - with data from 124 women). We considered both studies as being at high risk of bias. Meta-analysis was not possible because the included studies examined different interventions (both in comparison with standard care) and reported on few, but different, outcomes. One study compared cervical adapter (mechanical sealing), and the other study examined an immunological membrane sealant. Neither of the included studies reported on this review's primary outcome of interest - perinatal mortality. Similarly, data were not reported for the majority of this review's secondary infant and maternal outcomes. Cervical adapter (mechanical sealing) versus standard care (one study, data from 35 participants)No data were reported for this review's primary outcome - perinatal mortality. Data were reported for few of this review's infant or maternal secondary outcomes.There was no clear difference between the mechanical sealing group and the standard care control in relation to the incidence of neonatal sepsis (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.28 to 5.09 (very low-quality evidence)) or chorioamnionitis (RR 1.19, 95% CI 0.28 to 5.09 (very low-quality evidence)). Oral immunological membrane sealant versus standard care (one study, data from 94 participants)No data were available for perinatal mortality (this review's primary outcome) or for the majority of this review's infant and maternal secondary outcomes. Compared to standard care, the immunological membrane sealant was associated with a reduction in preterm birth less than 37 weeks (RR 0.48, 95% CI 0.34 to 0.68 (very low-quality evidence)) and a reduction in neonatal death (RR 0.38, 95% CI 0.19 to 0.75 (very low-quality evidence)). However, there was no clear difference between groups in terms of neonatal sepsis (RR 0.64, 95% CI 0.28 to 1.46 (very low-quality evidence)) or respiratory distress syndrome (RR 0.64, 95% CI 0.28 to 1.46 (very low-quality evidence)).

AUTHORS' CONCLUSIONS

There is insufficient evidence to evaluate sealing procedures for PPROM. There were no data relating to this review's primary outcome (perinatal mortality) and the majority of our infant and maternal secondary outcomes were not reported in the two included studies.There was limited evidence to suggest that an immunological membrane sealant was associated with a reduction in preterm birth at less than 37 weeks and neonatal death, but these results should be interpreted with caution as this is based on one small study, with a high risk of bias, and the intervention has not been tested in other studies.Although midtrimester PPROM is not a rare occurrence, there are only a small amount of published data addressing the benefits and risks of sealing procedures. Most of these studies are retrospective and cohort based and could therefore not be included in our data-analysis.This review highlights the paucity of prospective randomised trials in this area. Current evidence provides limited information both on effectiveness and safety for the interventions described. Given the paucity of high-quality data, we recommend that future research efforts focus on the conduct of randomised trials assessing the effect of promising interventions that have been only evaluated to date in cohort studies (e.g. amniopatch). Future trials should address outcomes including perinatal mortality, preterm birth, neonatal death, respiratory distress syndrome, neonatal sepsis and developmental delay. They should also evaluate maternal outcomes including sepsis, mode of delivery, length of hospital stay and emotional well-being.

Negative pressure wound therapy with instillation: past, present, and future

Negative pressure wound therapy with instillation (NPWTi) is a novel treatment option that provides the combination of negative pressure with intermittent instillation of a solution. Standard Negative Pressure Wound Therapy (NPWT) is an established adjunctive treatment option that offers the ability to promote granulation tissue in wounds. However, there is limited evidence for its utility in the environment of active or senescent infection. Wounds that are acutely infected or that contain deleterious biofilm are a challenging problem, which require an intensive multimodal approach including antibiosis, surgical intervention, and local wound care. Adjunctive application of NPWTi can potentially expedite clearance of infection and wound closure. Although this technology has been commercially available for over a decade, its adoption has been limited. Recently, there has been a resurgence of interest in this therapy with emerging evidence from animal models as well as human clinical studies. There are remaining questions regarding NPWTi including the selection of the optimal instillation solution and device settings. This article discusses the past development, current knowledge, and future direction of NPWTi.

A portable, disposable system for negative-pressure wound therapy

Negative-pressure wound therapy (NPWT) imparts a number of clinical effects that promote a healing response and, as such, is a well-established means of treating a variety of wound types. Historically, the technique has been primarily used in the hospital setting; however, the introduction of more portable devices has led to an increase in the use of NPWT in the homecare setting, thereby facilitating early discharge of patients from hospital and continuity of care in the community. Portable NPWT devices also have the potential to impact positively on patients' quality of life, allowing increased mobility and freedom to undertake normal activities of daily living. Following the development of its standard Avance® NPWT system and associated dressing kits, Mölnlycke Health Care (Gothenburg, Sweden) has introduced a single-patient-use, disposable NPWT system; Avance Solo. This has been developed with a view to maximising patient freedom and mobility, providing a single-patient-use NPWT solution for multi-week treatment to allow quick and easy discharge of patients from hospital to home, and reducing some of the challenges of logistics and administration associated with the provision of NPWT for the caregiver. As with the standard NPWT system, the single-patient use system is supplied with a number of products incorporating Safetac® adhesive technology to minimise the risk of patients suffering unnecessary pain and trauma associated with dressing changes. This article presents a series of case studies describing procedures and outcomes following the application of the Avance Solo single-patient-use system.

Abdominal compartment syndrome and open abdomen management with negative pressure devices

BACKGROUND

Abdominal compartment syndrome (ACS) is defined as an increase of intra-abdominal pressure (IAH) to values higher than 20 mmHg, associated with reduced perfusion and organ dysfunction.

MATERIALS AND METHODS

There is a classification of open abdomen which stratifies patients according to the natural history of improvement or clinical deterioration. The aim of treatment is to maintain the open abdomen at the lowest level and to prevent progression to a more complex level.

DISCUSSION

Surgical treatment essentially consists in abdominal decompression by leaving the abdomen open. Analysis of the literature shows that negative pressure increases the rate of primary fascial closure; entero-cutaneous fistulas are seen in a minority of cases, without seeming consequence of the application of the dressing. Open abdomen management consists of three treatment stages: acute (24-48 hours), intermediate (from 48 hours to 10 days) and late or reconstruction (from 10 days to the final closure).

CONCLUSION

It's important to recognize patients at risk of IAH and the first signs of ACS and intervene early with abdominal decompression if this will establish itself. Management of the open abdomen is now facilitated by negative pressure devices, which positively affect the morbidity and mortality of patients with ACS.

Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention

BACKGROUND

Indications for the use of negative pressure wound therapy (NPWT) are broadening with a range of systems now available on the market, including those designed for use on clean, closed incisions and skin grafts. Reviews have concluded that the evidence for the effectiveness of NPWT remains uncertain, however, it is a rapidly evolving therapy. Consequently, an updated systematic review of the evidence for the effects of NPWT on postoperative wounds expected to heal by primary intention is required.

OBJECTIVES

To assess the effects of NPWT on surgical wounds (primary closure, skin grafting or flap closure) that are expected to heal by primary intention.

SEARCH METHODS

We searched the following electronic databases to identify reports of relevant randomised clinical trials: the Cochrane Wounds Group Specialised Register (searched 28 January 2014); the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, issue 12); Database of Abstracts of Reviews of Effects (2013, issue 12); Ovid MEDLINE (2011 to January 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 24 January 2014); Ovid EMBASE (2011 to January 2014 Week 44); and EBSCO CINAHL (2011 to January 2014). We conducted a separate search to identify economic evaluations.

SELECTION CRITERIA

We included trials if they allocated patients to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with a different type of NPWT.

DATA COLLECTION AND ANALYSIS

We assessed trials for their appropriateness for inclusion and for their quality. This was done by three review authors working independently, using pre-determined inclusion and quality criteria.

MAIN RESULTS

In this first update, we included an additional four trials, taking the total number of trials included to nine (785 participants). Three trials involved skin grafts, four included orthopaedic patients and two included general surgery and trauma surgery patients; all the included trials had unclear or high risk of bias for one or more of the quality indicators we assessed. Seven trials compared NPWT with a standard dressing (two of these were 'home-made' NPWT devices), one trial compared one 'home-made' NPWT with a commercially available device. In trials where the individual was the unit of randomisation, there were no differences in the incidence of surgical site infections (SSI); wound dehiscence, re-operation (in incisional wounds); seroma/haematoma; or failed skin grafts. Lower re-operation rates were observed among skin graft patients in the 'home-made' NPWT group (7/65; 10.8%) compared to the standard dressing group (17/66; 25.8%) (risk ratio (RR) 0.42; 95% CI 0.19 to 0.92). The mean cost to supply equipment for VAC® therapy was USD 96.51/day compared to USD 4.22/day for one of the 'home-made' devices (P value 0.01); labour costs for dressing changes were similar for both treatments. Pain intensity score was also reported to be lower in the 'home-made' group when compared with the VAC® group (P value 0.02). One of the trials in orthopaedic patients was stopped early because of a high incidence of fracture blisters in the NPWT group (15/24; 62.5%) compared with the standard dressing group (3/36; 8.3%) (RR 7.50; 95% CI 2.43 to 23.14).

AUTHORS' CONCLUSIONS

Evidence for the effects of negative pressure wound therapy (NPWT) for reducing SSI and wound dehiscence remains unclear, as does the effect of NPWT on time to complete healing. Rates of graft loss may be lower when NPWT is used, but hospital-designed and built products are as effective in this area as commercial applications. There are clear cost benefits when non-commercial systems are used to create the negative pressure required for wound therapy, with no evidence of a negative effect on clinical outcome. In one study, pain levels were also rated lower when a 'home-made' system was compared with a commercial counterpart. The high incidence of blisters occurring when NPWT is used following orthopaedic surgery suggests that the therapy should be limited until safety in this population is established. Given the cost and widespread use of NPWT, there is an urgent need for suitably powered, high-quality trials to evaluate the effects of the newer NPWT products that are designed for use on clean, closed surgical incisions. Such trials should focus initially on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.

[Successful treatment of Candida albicans mediastinitis after open-heart surgery using vacuum-assisted closure device]

An 82-year-old man suffered from Candida albicans mediastinitis following emergency aortic valve replacement. After repeated debridement of the anterior portion of the mediastinum, we applied a vacuum assisted closure device with UrgoTul Absorb placed on the right ventricle. Despite relatively short-term application of this device, mediastinitis was cured in combination with transposition of the great omentum.

Novel treatment options for perforations of the upper gastrointestinal tract: Endoscopic vacuum therapy and over-the-scope clips

Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure: endoscopic vacuum therapy (EVT), and over-the-scope clip (OTSC). EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage. Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing, comparable to the application of vacuum therapy in cutaneous wounds. The system is changed every 3-5 d. The overall success rate of EVT in the literature ranges from 84% to 100%, with a mean of 90%; only few complications have been reported. OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope. By bringing the edges of the perforation into the cap, by suction or by dedicated devices, such as anchor or twin grasper, the OTSC can be placed to close the perforation. For acute endoscopy associated perforations, the mean success rate is 90% (range: 70%-100%). For other types of perforations (postoperative, other chronic leaks and fistulas) success rates are somewhat lower (68%, and 59%, respectively). Only few complications have been reported. Although first reports are promising, further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations.

Silver negative pressure dressing with vacuum-assisted closure of massive pelvic and extremity wounds

BACKGROUND

Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested.

QUESTIONS/PURPOSES

Does a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition?

METHODS

We evaluated 42 patients with massive (> 200 cm(2)) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing.

RESULTS

Hospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033).

CONCLUSIONS

Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies.

LEVEL OF EVIDENCE

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Exploring portable negative pressure wound therapy devices in the community

Case studies and clinical reviews support the use of negative pressure wound therapy (NPWT) for managing a range of wound types, yet very few scientific studies fully support its effectiveness. However, it has been argued that NPWT can provide excellent symptom management, reduce the frequency of dressing changes and provide a cost-effective alternative to traditional wound therapies due to faster healing times, leading to a reduction in overall treatment costs. Use of NPWT within community environments is increasing as length of hospital in-patient stay decreases, and many patients who would have traditionally been admitted to an acute setting with a complex or highly exuding wound are now managed by community nurses. This article presents a narrative review of NPWT, identifies safety precautions that require consideration and explores the application of smaller/disposable NPWT systems that are now available.

Treatment of pediatric wounds with vacuum assited technology

Vacuum Assisted Therapy (VAC) is a new technic in treatment of acute and chronic wounds. This new way of treatment is widely used in the late decades due to the good results. The authors present five cases with different types of wounds, successfully treated with VAC therapy. This method is proposed because of short time of treatment and value reduction. Each surgical team should be acquainted with VAC therapy method. Their experience and results will contribute to the pediatric wounds treatment.

[Negative pressure therapy in the treatment of leg ulcers]

Leg ulcers are a common pathology. Negative pressure therapy is a second-line treatment which favours granulation and which must be followed by a graft.The main pitfall is the recurrence of ulcers.Whatever the cicatriasation technique, it is essential to consider the indications.

[Negative pressure treatment devices]

Negative pressure therapy systems comprise several types of devices and dressings. Some are specific to particular clinical situations.

The evolution of Negative Pressure Wound Therapy [NPWT1: a review of science, available devices, and evolution in the usage of NPWT

Negative Pressure Wound Therapy (NPWT) is an important clinical tool with multiple published studies reporting more rapid formation of granulation tissue and a decreased time for wound healing.Since the induction of NPWT systems in 1995, there has been wide usage of the device for treatment of wounds. However, the past 18 years has also witnessed a significant shift in the way NPWT is utilized. Meeting the demands and wound care needs of an ever-growing population has resulted in several other companies releasing their versions of the NWPT device. Although there is a significant body of literature supporting the science and clinical advantages of the KCI system, the newer systems differ in terms of suction devices, connecting tubing, and wound interface materials. It cannot be assumed that the newly developed devices have the same science and clinical advantages as the KCI System. The purpose of this article is to review the science behind NPWT, assess and compare the currently available devices, and examine the scientific literature supporting the efficiency and application of NPWT in wound reconstruction.

Effects of a new pocket device for negative pressure wound therapy on surgical wounds of patients affected with Crohn's disease: a pilot trial

INTRODUCTION

Surgical site infections (SSIs) affect costs of care and prolong length of stay. Crohn's disease (CD) represents an independent risk factor for SSI. The risk can be further increased by concomitant administration of immunosuppressive drugs and poor performance status at the time of surgery. Patients suffering from CD often need more than one surgical intervention during life, sometimes requiring fashioning of a stoma. The aim of this pilot study was to compare a portable device for negative pressure wound therapy (PICO, Smith & Nephew, London, UK) to conventional gauze dressings in patients undergoing surgery for stricturing CD.

METHODS

Between January 2010 and November 2011, this controlled trial enrolled 30 patients, who were assigned to treatment with either PICO (n = 13) or conventional dressings (n = 17). Each patient completed a 3-month follow-up.

RESULTS

Patients receiving PICO experienced significantly less postoperative wound complications (P = .001) and SSI (P = .017) compared with those who received conventional dressings. This resulted in shorter hospital stay (P = .0007). No significant differences in cosmetic results were found.

CONCLUSION

These data suggest that PICO allows faster and safe discharge by reducing the incidence of SSI and wound-related complications in selected patients undergoing surgical intervention for stricturing CD. This could be particularly useful in patients receiving steroids.

Use of the ostomy baseplate in negative pressure wound therapy

The advent of the negative pressure wound therapy (NPWT) has been a significant advancement in wound-healing practices. However, as the therapy has gained popularity and increased usage in all areas of the body, obstacles have arisen. In certain areas of the body, namely those with crevices and folds, or an abundance of apocrine glands, the application of NPWT can be problematic. This study presents a novel technique for the application of the NPWT in the treatment of wounds in areas difficult to achieve an appropriate vacuum seal. This method eliminates the traditional problems encountered when applying the NPWT to areas with clefts and folds by utilising an ostomy baseplate to provide a more secure and accessible surface area. The patient is an 84-year-old male with a category IV sacral decubitus ulcer. Traditional methods of NPWT application initially proved inadequate due to difficulty sustaining negative pressure; however, subsequent use of an ostomy baseplate with NPWT successfully secured a seal and allowed for wound healing. Our technique allows for the preservation of a proper seal near clefted areas, provides ease of application, reduces the burden of dressing changes and reduces cost, benefiting both the patient and health care providers.

Silicone-coated non-woven polyester dressing enhances reepithelialisation in a sheep model of dermal wounds

Negative-pressure wound therapy (NPWT) also known as V.A.C. (Vacuum-assisted closure), is widely used to manage various type of wounds and accelerate healing. NPWT has so far been delivered mainly via open-cell polyurethane (PU) foam or medical gauze. In this study an experimental setup of sheep wound model was used to evaluate, under NPWT conditions, the performance of a silicone-coated non-woven polyester (N-WPE) compared with PU foam and cotton hydrophilic gauze, used as reference materials. Animals were anesthetized with spontaneous breathing to create three 3 × 3 cm skin defects bilaterally; each animal received three different samples on each side (n = 6 in each experimental group) and was subjected to negative and continuous 125 mmHg pressure up to 16 days. Wound conditions after 1, 8 and 16 days of treatment with the wound dressings were evaluated based on gross and histological appearances. Skin defects treated with the silicone-coated N-WPE showed a significant decrease in wound size, an increase of re-epithelialization, collagen deposition and wound neovascularisation, and a minimal stickiness to the wound tissue, in comparison with gauze and PU foam. Taken all together these findings indicate that the silicone-coated N-WPE dressing enhances wound healing since stimulates higher granulation tissue formation and causes minor tissue trauma during dressing changes.