Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials

Neck reconstruction in burn sequelae: A comparison of full-thickness skin grafts with traditional tie-over versus negative pressure wound therapy for both recipient site preparation and graft fixation

BACKGROUND

Neck reconstruction for burn sequelae can be effectively achieved through release procedures and lower abdomen skin transplantation. This article describes cases in which full-thickness skin grafts (FTSGs) from the lower abdomen were used as donor areas. Although the benefits of negative pressure wound therapy (NPWT) for graft integration are known, its dual use for recipient site preparation and intraoperative graft fixation, specifically in the neck, has been scarcely described. This study evaluates both applications of NPWT-preoperative wound bed optimization and intraoperative graft fixation-highlighting their combined impact on graft take and patient outcomes.

METHODS

Patients treated at a referral burn center between March 2021 and October 2023 with severe neck contractures underwent scar release and FTSG transplantation. Two techniques for graft fixation were compared: the traditional tie-over method and NPWT. Graft integration rates, necrosis percentages, and postoperative complications were assessed.

RESULTS

The study included six patients (tie-over group: 2; NPWT group: 4). The NPWT group demonstrated clinically favorable graft integration rates (92.5 %) and lower necrosis rates (7.5 %) compared with the tie-over group (76.5 % and 23.5 %, respectively). The NPWT technique also resulted in shorter hospital stays and fewer complications.

CONCLUSIONS

The combined use of NPWT for recipient site preparation and intraoperative graft fixation clinically improves graft integration and reduces complications in neck burn reconstruction. These findings suggest that NPWT should be considered a standard of care in settings where resources allow.

Benefits of negative pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Negative pressure wound therapy (NPWT) is a widely used adjunct for wound healing and an alternative to conventional dressings for skin grafts. This meta-analysis aimed to quantify the effectiveness of NPWT versus conventional dressings in this population through randomised control trials (RCTs).

METHODS

A literature search in several databases was conducted from inception to October 2023. Eligible studies were RCTs reporting the efficacy and post-operative outcomes of NPWT and non-NPWT (control) in patients ≥18 years with skin grafts. Pooled proportions were analysed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42023471105).

RESULTS

Overall, 16 RCTs met the criteria for inclusion in the meta-analysis. This included 411 patients and 401 controls. Compared to conventional dressings, NPWT demonstrated 8.3% higher overall graft take (95% CI: 2.97, 13.63, I2 = 85%), 10.0% higher graft take at -80 mmHg (95% CI: 5.69, 14.34, I2 = 0%), higher graft success rates (OR = 1.86, 95% CI: 1.05, 3.30, I2 = 0%), lower graft loss rates (OR = 0.44, 95% CI: 0.23, 0.85, I2 = 0%), lower complication rates (OR = 0.36, 95% CI: 0.13, 0.99, I2 = 76%) and lower reoperation rates (OR = 0.31, 95% CI: 0.13, 0.72, I2 = 0%).

CONCLUSION

NPWT is a safe and effective approach for dressing skin grafts in adult patients compared to conventional wound dressings. NPWT improved graft take and graft success while reducing graft failure, reoperations and overall complications.

The efficacy and safety of negative pressure wound therapy in paediatric burns: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Although the effective application of negative pressure wound therapy (NPWT) has been exemplified in diverse clinical studies, its potential and safety, specifically regarding paediatric burns, are yet to be fully confirmed. Our most recent systematic review and meta-analysis strive to investigate the impact of NPWT within the realm of paediatric burns.

METHODS

We sourced relevant articles from databases including PubMed, Embase, the Cochrane Database, Web of Science, the International Clinical Trials Registry Platform, China National Knowledge Infrastructureris, the VIP Database for Chinese Technical Periodicals, and the Wanfang database. We defined the primary outcome measure as the healing time, while healing rate, numbers of dressing changes, detection rate of positive bacteria, incidence rate of adverse reactions, scar scale scores, and treatment costs were considered as secondary outcome measures. Pooling of data was conducted and the results were articulated as relative risk (RR), mean difference (MD), and standardized mean difference (SMD), all with a 95% confidence interval (CI).

RESULTS

In this systematic review and meta-analysis, a total of 12 studies involving 1033 individuals were examined, including 559 paediatric burn patients who underwent NPWT (referred to as the treatment group) and 543 patients who received treatments other than NPWT (referred to as the control group). The amalgamated data from these studies exhibited that the treatment group experienced significant reductions in healing time (SMD = -1.60; 95% CI: -2.26 - -0.95; p < 0.001, I2 = 92.8%), the number of required dressing changes (SMD = -4.6; 95% CI: -5.84 - -3.36; p < 0.001, I2 = 92.4%), positive bacteria detection rate (RR = 0.61; 95% CI: 0.26-1.46; p = 0.004, I2 = 81.8%), incidence of adverse reactions (RR = 0.61; 95% CI: 0.33-1.12; p = 0.005, I2 = 68%), scar scale scores (SMD = -1.66; 95% CI: -2.54 - -0.79; p < 0.001, I2 = 89.4%), as well as in treatment costs (SMD = 0.92; 95% CI: -1.66-3.49; p < 0.001, I2 = 98.4%). Additionally, these individuals showed an increased rate of healing (RR = 1.17; 95% CI: 0.99-1.39; p < 0.001, I2 = 78%). Subgroup analysis did not find that the degree of burn was one of the sources of high heterogeneity.

CONCLUSION

Our meta-analysis points to the effectiveness of NPWT in treating paediatric burns. Notably, it significantly mitigates healing duration, frequency of dressing alterations, positive bacterial detection rate, adverse reactions incidence, scar scale scores and treatment costs, all while propelling the acceleration of wound healing.

Implementation of negative pressure for acute pediatric burns (INPREP): A stepped-wedge cluster randomized controlled trial protocol

BACKGROUND

Acute application of adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burn patients. This adjunctive treatment has not yet been broadly or routinely adopted as a standard primary burns dressing strategy. The Implementation of Negative PRessurE for acute Pediatric burns (INPREP) trial will implement and evaluate the impact of adjunctive NPWT in parallel with co-designed implementation strategies and resources across four major pediatric hospitals.

METHODS

We will conduct a multi-center, prospective, stepped-wedge cluster randomized controlled trial to implement adjunctive NPWT for acute pediatric burns. Participants will include pediatric burn patients presenting to one of four Australian tertiary pediatric hospitals for burn treatment. The intervention is adjunctive NPWT in parallel with co-designed and tailored implementation strategies and a suite of NPWT implementation resources, which form the INPREP toolkit. Using a hybrid type III design, this trial aims to evaluate the effectiveness of NPWT implementation in parallel with the INPREP toolkit using (i) implementation outcomes (e.g., adoption, appropriateness, acceptability, feasibility, and sustainability) and (ii) clinical outcomes (e.g., days to re-epithelialization, scar management requirements, skin grafting requirements). The primary outcome of this trial is treatment adoption-the proportion of eligible patients who receive NPWT.

DISCUSSION

This manuscript outlines a protocol for a hybrid type III stepped-wedge cluster randomized controlled trial of adjunctive NPWT implementation in acute pediatric burn care. We anticipate that NPWT implementation in parallel with the INPREP toolkit will be generalizable to emergency departments and burn services across Australia, and evidence generated will inform pediatric burn care internationally.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.

A new portable negative pressure wound therapy device: a prospective study investigating clinical outcomes

OBJECTIVE

Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites.

METHOD

The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected.

RESULTS

Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported.

CONCLUSION

In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use.

Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

[Translated article] Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

Securing skin grafts: A network meta-analysis

BACKGROUND

Skin grafting is one of the most common procedures in plastic surgery. However, there are no defined guidelines for optimal fixation. The aim of this network meta-analysis (NMA) was to consolidate existing evidence by comparing various graft securing methods and determining the most effective approach for clinical practice.

METHODS

An NMA was conducted using a predetermined protocol after searching several electronic databases from inception to October 2023 for studies examining skin grafting fixation outcomes in adults.

RESULTS

A total of 27 studies were included in the analysis involving 1937 patients. Negative pressure wound therapy (NPWT) was the only method to significantly improve graft take percentages in comparison with the other modalities, whereas tie-over bolster (TOB) provided the worst results in take rates when examined as events. Fibrin glue (FIB) and TOB reduced hematoma and seroma rates when data were investigated in conjunction.

CONCLUSIONS

NPWT appears to be the most effective for skin graft adherence as opposed to traditional techniques. Its cost-effectiveness remains unclear, as NPWT is a relatively costly intervention compared with other methods. FIB and TOB are methods that can serve as a method of reducing hematoma and seroma rates in patients at high risk of bleeding.

LEVEL OF EVIDENCE

I.

Deep and Superficial Debridement Techniques in Lower Extremity Split-thickness Skin Grafting

Background

Patients with nonhealing lower extremity (LE) wounds often require a split-thickness skin graft (STSG) for closure. Nonviable tissue must be debrided before STSG inset. Our study aimed to compare differences in debridement depth on STSG outcomes.

Methods

Chronic, atraumatic LE wounds receiving STSG from December 2014 to December 2022 at a single institution were reviewed. Demographics, wound characteristics, operative details, and outcomes were collected. Superficially debrided wounds were compared with wounds receiving deep debridement (DD), defined by debriding to the level of white tissue underlying the granulation tissue. Subanalysis was performed on wounds that had a negative and positive postdebridement culture. Primary outcome was graft failure.

Results

Overall, 244 wounds in 168 patients were identified. In total, 158 (64.8%) wounds were superficially debrided and 86 (35.3%) received DD. The cohort had a median Charlson Comorbidity Index of 4 [interquartile range (IQR): 3]. Diabetes (56.6%) and peripheral artery disease (36.9%) were prevalent. The only statically significant demographic difference between groups was congestive heart failure (SD: 14.9% versus DD: 3.0%, P = 0.017). Wound size, depth, and all microbiology results were similar between groups. Postoperatively, the DD group demonstrated significantly less graft failure (10.5% versus 22.2%, P = 0.023). In a multivariate regression, DD was independently associated with lower odds of graft failure (OR: 0.0; CI, 0.0-0.8; P = 0.034). Sub-analysis of graft failure supported this finding in culture-positive wounds (DD: 7.6% versus DD: 22.1%, P = 0.018) but not in culture-negative wounds (13.6% versus 22.2%, P = 0.507).

Conclusions

The DD technique demonstrates improved outcomes in chronic, culture-positive LE wounds receiving STSG.

Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study

PURPOSE

Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.

METHODS

A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.

RESULTS

Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.

CONCLUSION

Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.

Randomized comparative study of negative pressure wound therapy versus compression dressing on split-thickness skin grafts of the lower limbs in an elderly population

INTRODUCTION

Failure to adequately secure the skin graft to the lower limbs recipient bed can result in loss of the graft. Our objective was to compare the healing of split-thickness skin grafts three weeks postoperatively, using either negative pressure wound therapy (NPWT) or conventional compression bandaging.

METHODS

In this multicenter randomized controlled study, patients with tissue loss ranging from 50 cm2 to 600 cm2 on the lower limbs and treated with split-thickness skin grafts were included in three French hospitals. A digital photographic evaluation was performed at 3 weeks.

RESULTS

During 9 years, 70 patients were included in the study and allocated to a treatment group. The grafted area was similar in both groups. Loss of graft was significantly reduced in the NPWT group with 14.6 cm2 compared to 29 cm2 in the control group (p = 0.0003). The hospital stay was also significantly reduced in the NPWT group, at 4 days versus 6.5 days in the control group (p = 0.0284). In the NPWT group, 60% reported pain compared to 22.9% in the control group (p = 0.0048).

CONCLUSIONS

The use of NPWT dressings improves skin graft take by reducing necrosis, improving the graft's adherence to the recipient site, and reducing hospital length-of-stay.

Bacterial cellulose as an ideal potential treatment for burn wounds: A comprehensive review

Burn wound regeneration is a complex process, which has many serious challenges such as slow wound healing, secondary infection, and inflammation. Therefore, it is essential to utilise appropriate biomaterials to accelerate and guide the wound healing process. Bacterial cellulose (BC), a natural polymer synthesised by some bacteria, has attracted much attention for wound healing applications due to its unique properties including excellent physicochemical and mechanical properties, simple purification process, three-dimensional (3D) network structure similar to extracellular matrix, high purity, high water holding capacity and significant permeability to gas and liquid. BC's lack of antibacterial activity significantly limits its biomedical and tissue engineering application, but adding antimicrobial agents to it remarkably improves its performance in tissue regeneration applications. Burn wound healing is a complex long-lasting process. Using biomaterials in wound treatment has shown that they can satisfactorily accelerate wound healing. The purpose of this review is to elaborate on the importance of BC-based structures as one of the most widely used modern wound dressings in the treatment of burn wounds. In addition, the combination of various drugs, agents, cells and biomolecules with BC to expand its application in burn injury regeneration is discussed. Finally, the main challenges and future development direction of BC-based structures for burn wound repair are considered. The four most popular search engines PubMed/MEDLINE, Science Direct, Scopus and Google Scholar were used to help us find relevant papers. The most frequently used keywords were bacterial cellulose, BC-based biocomposite, wound healing, burn wound and vascular graft.

Reconstructive Paradigms: A Problem-Solving Approach in Complex Tissue Defects

The field of plastic surgery is continuously evolving, with faster-emerging technologies and therapeutic approaches, leading to the necessity of establishing novel protocols and solving models. Surgical decision-making in reconstructive surgery is significantly impacted by various factors, including the etiopathology of the defect, the need to restore form and function, the patient's characteristics, compliance and expectations, and the surgeon's expertise. A broad surgical armamentarium is currently available, comprising well-established surgical procedures, as well as emerging techniques and technologies. Reconstructive surgery paradigms guide therapeutic strategies in order to reduce morbidity, mortality and risks while maximizing safety, patient satisfaction and properly restoring form and function. The paradigms provide researchers with formulation and solving models for each unique problem, assembling complex entities composed of theoretical, practical, methodological and instrumental elements.

Reconstruction Using Negative Pressure Wound Therapy with a Cotton Filler for Fixation of Male Genital Skin Grafts in Cases of Fournier's Gangrene

The reliable engraftment of skin grafts into areas with complex shapes can be challenging. Here, we report a case of successful fixation of a genital skin graft using negative pressure wound therapy (NPWT) with RENASYS® Cotton Filler. A 44-year-old male with no relevant medical history underwent split-thickness skin grafting for a genital skin defect caused by Fournier's gangrene. A 0.4-mm sheet graft was applied for the penile skin defect, while 0.4-mm 1.5 times mesh grafting was applied for the testis and spermatic cord. NPWT with a cotton filler was used for seven days of fixation. No postoperative pain or stool contamination was observed. Although a small area of partial necrosis developed, the lesion healed with conservative treatment. Six months after surgery, there was no scar contracture, urination disorder, or pain during erection. Cotton fillers are highly malleable and adaptable, allowing for simple and reliable fixation of skin grafts in complex areas. Moreover, NPWT for genital graft fixation avoids contamination from stools. Therefore, we recommend fixation using NPWT with a cotton filler for genital skin grafting.

Roles of negative pressure wound therapy for scar revision

The purpose of this study is to review the research progress of negative pressure wound therapy (NPWT) for scar revision and discuss the prospects of its further study and application. The domestic and foreign literatures on NPWT for scar revision were reviewed. The mechanism and application were summarized. NPWT improves microcirculation and lymphatic flow and stimulates the growth of granulation tissues in addition to draining secretions and necrotic tissue. As a significant clinical therapy in scar revision, NPWT reduces tension, fixes graft, and improves wound bed. In the field of scar revision, NPWT has been increasingly used as an innovative and constantly improving technology.

Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft

Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

Negative pressure wound therapy: Where are we in 2022?

The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures. Many adjuvants have been engineered into newer generations of NPWT devices such as wound instillation of fluid or antibiotics allowing surgeons to further optimize the wound healing environment or aid in the eradication of infection. This review discusses the recent relevant literature on the proposed mechanisms of action, available adjuvants, and the required components needed to safely apply NPWT. The supporting evidence for the use of NPWT in traumatic extremity injuries, infection control, and wound care is also reviewed. Although NPWT has a low rate of complication, the surgeon should be aware of the potential risks associated with its use. Furthermore, the expanding indications for the use of NPWT are explored, and areas for future innovation and research are discussed.

Long-term results of split-thickness skin grafting with and without additional dermal matrix in severe traumatic soft tissue defects of the lower limb

PURPOSE

Aim of this study was to compare the use of split-thickness skin graft (STSG) with and without additional MatriDerm^® application in a predominantly one-step procedure for the treatment of severe traumatic soft tissue defects of the lower limb.

METHODS

This retrospective study included patients treated in a European level I trauma center between June 2013 and July 2018 in terms of a severe traumatic soft tissue defect of the lower extremity using STSG alone or in combination with the acellular dermal substitute MatriDerm^®. The healing of the soft tissue defect was measured by assessment of the take rate. Outcome quality of the scar tissue was assessed using the Vancouver Scar Scale.

RESULTS

A total of 147 cases were included in this study. The overall healing rate (number of patients with take rate ≥ 75%) was 88/147 (60%) and did not demonstrate significant differences between the treatment groups (p = 0.15). Despite the difference in wound complexity between the treatment groups, there was no difference regarding the scar tissue quality 12 months postoperatively. In about 25% of all cases, a post-operative event was mentioned that had to be revised surgically.

CONCLUSION

Surgical treatment with STSG and additional MatriDerm^® application can be recommended as satisfactory alternative for dermis replacement in patients with severe skin defects, independent of age. The additional MatriDerm^® use allows for bridging of exposed ligaments, tendons, vessels or bones without relevant differences in cosmetical outcome.

Autologous wound margin point columnar full‐thickness skin grafting combined with negative pressure wound therapy improves wound healing in refractory diabetic foot ulcers

Diabetic lower extremity ulcers (DLEUs) are a severe complication of diabetes mellitus (DM) and are difficult to heal. This study aimed to explore the efficacy of autologous point columnar full-thickness skin graft taken from the ulcer wound margin combined with negative pressure wound therapy (NPWT) in refractory DLEUs. This is a prospective cohort study. A total of 40 inpatients with refractory DLEUs were recruited in the Diabetes Foot Center of Guangxi Zhuang Autonomous Region People's Hospital from October 2019 to November 2021. According to the doctors' professional suggestions and the patients' personal wishes, these enrolled patients were divided into two groups based on different topical wound management: the graft group (n = 18) and the conventional wound therapeutic (CWT) group (n = 22). The efficacy evaluations included the time to complete re-epithelialization of the wound and healing speed within 14 days of graft treatment or after 14 days of graft treatment in the two groups. Before the treatment, the graft group had a significantly larger ulcer area than the CWT group [27.22 (15.28, 46.59) versus 10.92 (7.00, 24.93) cm² , P < .01]. However, the time to complete wound re-epithelialization in the graft group was shorter than in the CWT group [58.22 ± 30.60 versus 86.09 ± 49.54 d, P < .05]. Meanwhile, the healing speed in graft group was markedly faster than in CWT group, whether within 14 days [0.60 (0.40, 0.92) versus 0.16 (0.07, 0.34) cm² /d, P < .01] or after 14 days of graft treatment [0.57 (0.45, 0.91) versus 0.13 (0.08, 0.27) cm² /d, P < .01]. However, the total treatment cost in the graft group was lower than in the CWT group [419.59 ± 137.20 versus 663.97 ± 497.02 $, P < .05]. The novel treatment modality of autologous full-thickness skin graft taken from the ulcer wound margin combined with NPWT has hereby proposed for the first time, and is a safe, effective, and reliable method with a good performance-to-cost ratio to promote wound healing and shorten the healing time for DLEUs.

Negative pressure promotes macrophage M1 polarization after Mycobacterium tuberculosis infection via the lncRNA XIST/microRNA-125b-5p/A20/NF-κB axis

Experiments have demonstrated the regulation of long noncoding RNA (lncRNA) in tuberculosis (TB), and negative pressure treatment has been associated with the alleviation of TB. Here, we investigated the interaction of negative pressure and the lncRNA X-inactive specific transcript (XIST) in modulating Mycobacterium tuberculosis (MTB) infection. Initially, we established an in vitro cell model of MTB infection and an in vivo mouse model of MTB infection, followed by treatment with negative pressure. Then, we examined the expression of XIST, followed by analysis of the downstream miRNA of XIST. XIST was overexpressed or underexpressed through cell transfection to examine its effects on macrophage polarization via the miR-125b-5p/A2 axis. The MTB models were characterized by upregulated XIST and downregulated miR-125b-5p. XIST bound to miR-125b-5p, leading to its downregulation, and thus causing higher MTB survival in an ESAT-6-dependent manner. Additionally, negative pressure treatment decreased MTB-driven XIST expression through downregulation of A20 (an NF-κB repressor) via miR-125b-5 expression, promoting the M1 polarization program in macrophages through activation of the NF-κB pathway. In summary, negative pressure treatment after MTB infection can promote the polarization of macrophages to the proinflammatory M1 phenotype by regulating the XIST/miR-125b-5p/A20/NF-κB axis.

Technical Refinements with the Use of Biologic Healing Agents

Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications.