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Baucom MR, Wallen TE, Youngs J, Singer KE, Delman AM, Schuster RM, Blakeman TC, Strilka R, Pritts TA, Goodman MD. Effectiveness of Negative Pressure Wound Therapy During Aeromedical Evacuation Following Soft Tissue Injury and Infection. Mil Med 2023; 188:295-303. [PMID: 37948243 PMCID: PMC10637296 DOI: 10.1093/milmed/usad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Negative pressure wound therapy (NPWT) is utilized early after soft tissue injury to promote tissue granulation and wound contraction. Early post-injury transfers via aeromedical evacuation (AE) to definitive care centers may actually induce wound bacterial proliferation. However, the effectiveness of NPWT or instillation NPWT in limiting bacterial proliferation during post-injury AE has not been studied. We hypothesized that instillation NPWT during simulated AE would decrease bacterial colonization within simple and complex soft tissue wounds. METHODS The porcine models were anesthetized before any experiments. For the simple tissue wound model, two 4-cm dorsal wounds were created in 34.9 ± 0.6 kg pigs and were inoculated with Acinetobacter baumannii (AB) or Staphylococcus aureus 24 hours before a 4-hour simulated AE or ground control. During AE, animals were randomized to one of the five groups: wet-to-dry (WTD) dressing, NPWT, instillation NPWT with normal saline (NS-NPWT), instillation NPWT with Normosol-R® (NM-NPWT), and RX-4-NPWT with the RX-4 system. For the complex musculoskeletal wound, hind-limb wounds in the skin, subcutaneous tissue, peroneus tertius muscle, and tibia were created and inoculated with AB 24 hours before simulated AE with WTD or RX-4-NPWT dressings. Blood samples were collected at baseline, pre-flight, and 72 hours post-flight for inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor alpha. Wound biopsies were obtained at 24 hours and 72 hours post-flight, and the bacteria were quantified. Vital signs were measured continuously during simulated AE and at each wound reassessment. RESULTS No significant differences in hemodynamics or serum cytokines were noted between ground or simulated flight groups or over time in either wound model. Simulated AE alone did not affect bacterial proliferation compared to ground controls. The simple tissue wound arm demonstrated a significant decrease in Staphylococcus aureus and AB colony-forming units at 72 hours after simulated AE using RX-4-NPWT. NS-NPWT during AE more effectively prevented bacterial proliferation than the WTD dressing. There was no difference in colony-forming units among the various treatment groups at the ground level. CONCLUSION The hypoxic, hypobaric environment of AE did not independently affect the bacterial growth after simple tissue wound or complex musculoskeletal wound. RX-4-NPWT provided the most effective bacterial reduction following simulated AE, followed by NS-NPWT. Future research will be necessary to determine ideal instillation fluids, negative pressure settings, and dressing change frequency before and during AE.
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Affiliation(s)
- Matthew R Baucom
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Taylor E Wallen
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Jaclyn Youngs
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Kathleen E Singer
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Aaron M Delman
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Rebecca M Schuster
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Thomas C Blakeman
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Richard Strilka
- United States Air Force School of Aerospace Medicine, En Route Care Training Department, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
| | - Michael D Goodman
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA
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2
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Yamashiro T, Kushibiki T, Mayumi Y, Tsuchiya M, Ishihara M, Azuma R. Negative-Pressure Wound Therapy: What We Know and What We Need to Know. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1436:131-152. [PMID: 36922487 DOI: 10.1007/5584_2023_773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Negative-pressure wound therapy (NPWT) promotes wound healing by applying negative pressure to the wound surface. A quarter of a century after its introduction, NPWT has been used in various clinical conditions, although molecular biological evidence is insufficient due to delay in basic research. Here, we have summarized the history of NPWT, its mechanism of action, what is currently known about it, and what is expected to be known in the future. Particularly, attention has shifted from the four main mechanisms of NPWT to the accompanying secondary effects, such as effects on various cells, bacteria, and surgical wounds. This chapter will help the reader to understand the current status and shortcomings of NPWT-related research, which could aid in the development of basic research and, eventually, clinical use with stronger scientific evidence.
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Affiliation(s)
- Toshifumi Yamashiro
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Yoshine Mayumi
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masato Tsuchiya
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Miya Ishihara
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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Maruo A, Oda T, Mineo R, Miya H, Muratsu H, Fukui T, Oe K, Kuroda R, Niikura T. Continuous local antibiotic perfusion: A treatment strategy that allows implant retention in fracture-related infections. J Orthop Surg (Hong Kong) 2022; 30:10225536221111902. [PMID: 35765727 DOI: 10.1177/10225536221111902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Fracture-related infections are difficult to treat because of the formation of biofilms around implants. Systemic antibiotics are notoriously ineffective against biofilms due to their insufficient penetration of tissues with poor vascularity. The goal of treating fracture-related infections is to achieve bone union while retaining the implant. Our proposal of continuous local antibiotic perfusion is a sustained local delivery system of sufficient antibiotics to bone and soft tissue infection sites, including to bone marrow via needles as intra-medullary antibiotics perfusion and to soft-tissue via double-lumen subcutaneous tubes as intra-soft tissue perfusion. METHODS In this study, we examined the outcomes of 40 patients treated for fracture-related infections using continuous local antibiotic perfusion between 2015 and 2021 at Steel Memorial Hirohata Hospital, Himeji, Japan. RESULT The antibiotic used for continuous local antibiotic perfusion was gentamicin in all cases. Implant removal was required in five patients. Two patients required toe amputation and knee arthrodesis, while the remaining 38 patients achieved fracture union. Only one case of transient acute renal injury as a systemic side effect was observed, but it soon resolved. The blood concentration of gentamicin could be adjusted to less than the trough level. CONCLUSIONS Continuous local antibiotic perfusion is a novel local drug delivery system that has the potential of delivering sufficient concentrations of antibiotics with few systemic side effects; it is a useful option for the treatment of fracture-related infections.
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Affiliation(s)
- Akihiro Maruo
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Takahiro Oda
- Department of Orthopaedic Surgery, 13705Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Ryowa Mineo
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
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4
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Lin CJ, Chen CE, Chen YC, Chen YR, Chuang YH. Use of negative pressure wound therapy with simultaneous instillation for treatment of Gustilo type IIIC tibia-fibula fracture during COVID-19 pandemic. FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_96_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Ogawa K, Nitta H, Masuda T, Matsumoto K, Okino T, Miyamoto Y, Baba H, Takamori H. Efficacy of delayed primary closure with intrawound continuous negative pressure and irrigation treatment after surgery for colorectal perforation. Acute Med Surg 2021; 8:e633. [PMID: 33604056 PMCID: PMC7871202 DOI: 10.1002/ams2.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/03/2021] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
AIM Surgical-site infections (SSIs) often occur after surgery for colorectal perforation. We introduced delayed primary closure (DPC) after intrawound continuous negative pressure and irrigation treatment (IW-CONPIT) to prevent SSIs. We aimed to evaluate the efficacy of DPC after IW-CONPIT compared with primary closure (PC) after surgery for colorectal perforation. METHODS We undertook a retrospective study including 22 patients who underwent DPC (DPC group) and 18 patients who underwent PC (PC group) at our hospital between April 2015 and January 2017. The primary outcome was the SSI rate. The secondary outcomes were other complications (<30 days), length of hospital stay, and costs. RESULTS The SSI rate was significantly lower in the DPC group than in the PC group (40% vs. 94%, P = 0.0006). Moreover, superficial and deep incisional SSIs, infectious complications, and Clavien-Dindo classification grade ≥ 2 complications were also significantly diminished in the DPC group. Conversely, the length of hospital stay and costs were not significantly different between the two groups. Multivariate analyses revealed that the significant independent protective factor against SSI after surgery for colorectal perforation was DPC after IW-CONPIT (odds ratio 0.04; 95% confidence interval, 0.002-0.25). CONCLUSION Delayed primary closure after IW-CONPIT reduced SSIs after surgery for colorectal perforation compared with PC.
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Affiliation(s)
- Katsuhiro Ogawa
- Division of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
- Department of Gastroenterological SurgeryGraduate School of Life ScienceKumamoto UniversityKumamotoJapan
| | | | - Toshiro Masuda
- Division of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
| | | | - Tetsuya Okino
- Division of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
| | - Yuji Miyamoto
- Department of Gastroenterological SurgeryGraduate School of Life ScienceKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Life ScienceKumamoto UniversityKumamotoJapan
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Tanaka H, Rikimaru H, Rikimaru-Nishi Y, Muraoka N, Anegawa M, Ueki S, Oishi O, Kiyokawa K. Surgical Management of Deep Brain Stimulator Infection without Electrode Removal: Report of Two Cases. J Neurol Surg Rep 2020; 81:e15-e19. [PMID: 32257764 PMCID: PMC7108948 DOI: 10.1055/s-0039-3399569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/28/2019] [Indexed: 11/02/2022] Open
Abstract
Objective Stimulation of the subthalamic nucleus by implanted electrodes (deep brain stimulation [DBS]) is performed to suppress symptoms of Parkinson's disease. However, postoperative wound dehiscence and infection can require removal of the implanted electrode leads. This report describes treatment of intractable unilateral wound infection in two patients without removing the DBS device. Methods First, components of the DBS system were removed except for the electrode lead and thorough debridement of the infected wound was conducted. Second, the edges of the bone defect left by removal of DBS components were smoothed to eliminate dead space. Subsequently, the electrode lead was covered by using a pericranial-frontalis-muscle flap or a bi-pedicled-scalp flap with good blood supply. Closed intrawound continuous negative pressure and irrigation treatment was conducted for 1 week after the surgery, and then the drain was removed. Results We treated two patients with wound infection after implantation of DBS electrodes. Case 1 developed a cutaneous fistula and Case 2 had wound dehiscence. After treatment by the method described above, complete wound healing was achieved in both patients. Conclusion DBS is always associated with a risk of infection or exposure of components and treatment can be very difficult. We successfully managed intractable wound infection while leaving the electrode lead in situ, so that it was subsequently possible to continue DBS for Parkinson's disease.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan.,Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Norihiro Muraoka
- Department of Neurological Surgery, National Center Hospital of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan.,Department of Neurological Surgery, Takagi Hospital, Okawa-shi, Fukuoka, Japan
| | - Mina Anegawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Shoya Ueki
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Ou Oishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan.,Department of Plastic and Reconstructive Surgery, Takagi Hospital, Okawa-shi, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
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Less invasive treatment for the pilonidal sinus combined use of negative-pressure wound therapy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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Rikimaru H, Rikimaru-Nishi Y, Yamauchi D, Ino K, Kiyokawa K. New Alternative Therapeutic Strategy for Gustilo Type IIIB Open Fractures, Using an Intra-Wound Continuous Negative Pressure Irrigation Treatment System. Kurume Med J 2019; 65:177-183. [PMID: 31723082 DOI: 10.2739/kurumemedj.ms654009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The treatment of Gustilo type IIIB and IIIC open fractures remains a challenging problem, because the infection rate is 15-45%. Infection can lead to serious complications such as osteomyelitis or amputation. The intra-wound continuous negative pressure and irrigation treatment (IW-CONPIT) was developed for infected wounds and intractable ulcers, and is very effective in suppressing infection and accelerating wound healing. Here the IW-CONPIT was applied to severe open fractures for the purpose of preventing infection. After thorough debridement and lavage of the wound, bony stabilization is performed by external fixation. Dermal matrix is grafted onto any areas where the bone or tendon is exposed. A sponge containing two tubes is placed over the entire surface of the wound including the dermal matrix. Then it is covered with a film dressing to make the wound completely airtight. A bottle of physiologic saline solution is attached to one tube, and a continuous aspirator is attached to the other. This system maintains negative pressure on the wound surface, which is continuously irrigated. Thirty-five patients were treated with this method. A superficial infection developed in two cases but was resolved by additional debridement and continued application of IW-CONPIT. Complete wound healing was obtained with split thickness skin graft in all cases. There were no complications such as osteomyelitis, delayed bone union or amputation. IW-CONPIT was able to definitively prevent wound infection in Gustilo type ⅢB open fractures. We believe this method will become a standard treatment option for this condition.
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Affiliation(s)
- Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine.,Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Daisuke Yamauchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Koh Ino
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine
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9
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Inatomi Y, Kadota H, Yoshida S, Kamizono K, Shimamoto R, Fukushima S, Miyashita K, Matsuo M, Yasumatsu R, Tanaka S, Fukushima J. Utility of negative-pressure wound therapy for orocutaneous and pharyngocutaneous fistula following head and neck surgery. Head Neck 2019; 42:103-110. [PMID: 31617619 DOI: 10.1002/hed.25989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/28/2019] [Accepted: 09/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Because of the difficulty of airtight sealing and risk of salivary contamination, negative-pressure wound therapy (NPWT) has rarely been applied for postoperative fistula following head and neck surgery; thus, its utility remains unclear. METHODS We applied NPWT in 34 patients who developed orocutaneous and pharyngocutaneous fistula after head and neck surgery. Here we retrospectively analyzed the utility of NPWT for managing those fistulas. RESULTS Thirty-two patients (94.1%) underwent NPWT as scheduled without adverse events. In 28 patients (82.4%), fistula closure was completed only by NPWT, and the mean period to fistula closure was 30.4 days. The mean period to closure did not differ significantly between fistulas with (21.7 days) and without (39.1 days) previous irradiation. CONCLUSIONS Airtight sealing can be maintained and postoperative fistula can be closed by NPWT with a high success rate, even after previous irradiation. NPWT is an effective and minimally invasive treatment for postoperative fistula.
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Affiliation(s)
- Yusuke Inatomi
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Sei Yoshida
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Kamizono
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Ryo Shimamoto
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Seita Fukushima
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kayo Miyashita
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Mioko Matsuo
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryuji Yasumatsu
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunichiro Tanaka
- Department of Otorhinolaryngology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Junichi Fukushima
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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10
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Yoshida R, Yamamoto N, Nishijima A, Maruyama E, Takikawa M, Yanagibayashi S. A case of mediastinitis with an exposed artificial blood vessel that was associated with right ventricular wall damage during treatment. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:55-59. [PMID: 31143825 PMCID: PMC6522979 DOI: 10.1080/23320885.2019.1611435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
We report a serious case of right ventricular wall damage during mediastinitis treatment, which was successfully treated with negative-pressure wound therapy with continuous instillation (NPWT-CI).
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Affiliation(s)
- Ryuichi Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan
| | - Naoto Yamamoto
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan.,Department of Plastic and Reconstructive Surgery, University of Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akio Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan
| | - Eri Maruyama
- Department of Plastic and Reconstructive Surgery, University of Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Megumi Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan
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Treatment of Abdominal Surgical Wound Dehiscence With Bowel Exposure and Infection. Ann Plast Surg 2019; 82:213-217. [DOI: 10.1097/sap.0000000000001739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Esumi G, Matsuura T, Hayashida M, Takahashi Y, Yoshimaru K, Yanagi Y, Wada M, Taguchi T. Efficacy of Prophylactic Negative Pressure Wound Therapy After Pediatric Liver Transplant. EXP CLIN TRANSPLANT 2019; 17:381-386. [PMID: 30696394 DOI: 10.6002/ect.2018.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Wound dehiscence is a common surgical complication, especially among pediatric liver transplant recipients in our center. In 2013, we introduced negative pressure wound therapy as a preventive treatment. We herein report the clinical outcomes of this intervention. MATERIALS AND METHODS We conducted a retrospective review of the 26 pediatric liver transplant recipients in our center since 2011. We excluded 1 girl whose wound could not be closed due to bowel edema. The first 13 of the 25 remaining patients were treated with conventional wound management (conventional group). The latter 12 were treated with prophylactic negative pressure wound therapy (prophylactic group). Incidences of surgical complications and patient characteristics were compared between groups. RESULTS Wound dehiscence occurred in 7 of the 13 patients in the conventional group and 3 of the 12 patients in the prophylactic group. When restricted to dehiscence that required surgical debridement, there were 6 cases in the conventional group and no cases in the prophylactic group. Although background data showed that liver insufficiency in the prophylactic group was more severe, this group had a lower incidence of wound dehiscence (P = .015). CONCLUSIONS Prophylactic negative pressure wound therapy is thought to be effective for preventing wound dehiscence among pediatric liver transplant recipients.
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Affiliation(s)
- Genshiro Esumi
- From the Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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13
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Vacuum-assisted closure combined with a closed suction irrigation system for treating postoperative wound infections following posterior spinal internal fixation. J Orthop Surg Res 2018; 13:321. [PMID: 30558614 PMCID: PMC6297981 DOI: 10.1186/s13018-018-1024-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wound infections after posterior spinal surgery are a troublesome complication; patients are occasionally forced to remove the internal fixation device, which can lead to instability of the spine and injury to the spinal cord. The purpose of this study was to evaluate the efficacy of modified vacuum-assisted closure (VAC) for treating an early postoperative spinal wound infection. METHODS We conducted a retrospective study of 18 patients with wound infections after posterior spinal surgery from 2014 to 2017 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound satisfied the secondary closure conditions. Detailed information was obtained from the medical records. RESULTS Wound size decreased significantly after 1 week of the modified VAC treatment. Three patients were treated with VAC three times and one patient received the VAC treatment four times; the remaining patients received the VAC treatment twice. The patients had excellent wound beds after an average of 8 days. The wound healed completely after an average of 17 days, and the average hospital stay was 33 days. There was no recurrence of infection at the 1-year follow-up. CONCLUSIONS This study demonstrates that VAC combined with a CSIS is a safe, reliable, and effective method to treat a wound infection after spinal surgery. This improved VAC procedure provides an excellent wound bed to facilitate wound healing and shorten the hospital stay.
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15
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Bonne SL, Kadri SS. Evaluation and Management of Necrotizing Soft Tissue Infections. Infect Dis Clin North Am 2018; 31:497-511. [PMID: 28779832 DOI: 10.1016/j.idc.2017.05.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.
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Affiliation(s)
- Stephanie L Bonne
- Division of Trauma and Critical Care, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101, USA
| | - Sameer S Kadri
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, 10 Center Drive 10/2C145, Bethesda, MD 20892, USA.
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16
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The combination application of space filling and closed irrigation suction in reconstruction of sacral decubitus ulcer. Int Surg 2016; 99:623-7. [PMID: 25216432 DOI: 10.9738/intsurg-d-13-00033.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dead space and poor drainage are the main reasons for intractable sacral decubitus ulcers. The objective of this study was to investigate the effects of treatment for sacral decubitus ulcer using space filling through muscle flap and closed irrigation. A total of 22 patients with serious sacral decubitus ulcer were treated with space filling through muscle flap and closed irrigation. After debridement of the decubitus ulcer, the infected areas over the bony prominence and osseous prominences were debrided. We elevated biceps femoris long head or semitendinosus and semimembranosus muscle. Pedicled by proximal part of muscle, the muscle flap was elevated to cover the ischial tuberosity. Transfusion systems of inflow and outflow drainage were placed between the muscle flap and ischial tuberosity. Wound healing and complications were observed. One wound dehiscence healed after secondary suturing. One wound gradually healed by dressing change after 3 weeks. The other cases had good results. Space filling and closed irrigation were complementary. The use of these two methods simultaneously is useful for the management of sacral decubitus ulcers.
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The Efficacy of Continuous Negative Pressure and Irrigation Treatment Inside the Wound by a Closed System in Reconstruction of All Layers of the Cranium Accompanying Infection and Cerebrospinal Fluid Leakage. J Craniofac Surg 2016; 27:e10-3. [DOI: 10.1097/scs.0000000000002278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Frankel JK, Rezaee RP, Harvey DJ, McBeath ER, Zender CA, Lavertu P. Use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis. Head Neck 2015; 37:E157-60. [PMID: 25756193 DOI: 10.1002/hed.24028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 12/12/2014] [Accepted: 03/04/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is an aggressive infection that can be rapidly fatal if aggressive therapies are not initiated early. Negative pressure wound therapy has been established as an effective tool in promoting wound healing, but its use in the acutely infected wound has been avoided because it limits frequent irrigations and standard dressing changes. METHODS We discuss a novel application of negative pressure wound therapy with instillation in an immunocompromised patient with extensive cervical necrotizing fasciitis. RESULTS The negative pressure wound therapy with instillation provided pain relief by minimizing the frequency of dressing changes, increased the speed of healing, helped to control infection, and facilitated the development of a healthy wound bed sufficient for reconstruction with a split thickness skin graft. CONCLUSION The role of negative pressure wound therapy with instillation continues to expand and can be used in the management of both acute and chronic wounds in the head and neck.
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Affiliation(s)
- Jonathan K Frankel
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Rod P Rezaee
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Donald J Harvey
- University Hospitals Case Medical Center, Plastic Surgery, Cleveland, Ohio
| | - Evan R McBeath
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Chad A Zender
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Pierre Lavertu
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
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Negative pressure wound therapy of chronically infected wounds using 1% acetic Acid irrigation. Arch Plast Surg 2015; 42:59-67. [PMID: 25606491 PMCID: PMC4297808 DOI: 10.5999/aps.2015.42.1.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 11/08/2022] Open
Abstract
Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.
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Yasui G, Furukawa H, Warabi T, Hayashi T, Oyama A, Funayama E, Yamamoto Y. Combined therapy of NPWT and bipedicled flap as an alternative approach for giant abdominal wall defect with significant visceral edema: report of a case. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2015; 2:25-8. [PMID: 27252963 PMCID: PMC4623546 DOI: 10.3109/23320885.2014.982654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
Open abdomen management is commonly used for the critically injured patients to avoid abdominal compartment syndrome. But it usually continues for days to weeks and finally results in abdominal wall defect that is too wide to close at once. This article presents an alternative approach to close the giant abdominal wall defect by using the combination of bipedicled flaps with the components separation technique and V.A.C.® system.
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Affiliation(s)
- Go Yasui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Takehiro Warabi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Akihiko Oyama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University , Sapporo, Japan
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Application of continuous negative pressure irrigation and negative pressure fixation to treat a bronchopleural fistula with thoracic empyema. J Am Coll Surg 2014; 218:e87-90. [PMID: 24745581 DOI: 10.1016/j.jamcollsurg.2013.12.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/17/2013] [Indexed: 01/22/2023]
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Back DA, Scheuermann-Poley C, Willy C. Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions - when, where and how to use: what does the evidence show? Int Wound J 2013; 10 Suppl 1:32-42. [PMID: 24251842 PMCID: PMC7950486 DOI: 10.1111/iwj.12183] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Infections of contaminated or colonised acute or chronic wounds remain a grave risk for patients even today. Despite modern surgical debridement concepts and antibiotics, a great need exists for new therapies in wound management. Since the late 1990s, advantageous effects of negative pressure wound therapy (NPWT) have been combined with local antiseptic wound cleansing in the development of NPWT with instillation (NPWTi). This article summarises the current scientific knowledge on this topic. MEDLINE literature searches were performed on the subject of negative pressure wound and instillation therapy covering publications from the years 1990 to 2013 (36 peer-reviewed citations) and regarding randomised controlled trials (RCTs) covering wound care with bone involvement (27 publications) or soft-tissue wounds without bone participation (11 publications) from 2005 to 2012. The use of NPWTi in the therapy of infected wounds appears to be not yet widespread, and literature is poor and inhomogeneous. However, some reports indicate an outstanding benefit of NPWTi for patients, using antiseptics such as polyhexanide (concentration 0·005-0·04%) and acetic acid (concentration 0·25-1%) in acute and chronic infected wounds and povidone-iodine (10% solution) as prophylaxis in contaminated wounds with potential viral infection. Soaking times are recommended to be 20 minutes each, using cycle frequencies of four to eight cycles per day. Additionally, the prophylactic use of NPWTi with these substances can be recommended in contaminated wounds that cannot be closed primarily with surgical means. Although first recommendations may be given currently, there is a great need for RCTs and multicentre studies to define evidence-based guidelines for an easier approach to reach the decision on how to use NPWTi.
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Affiliation(s)
- David A Back
- Department of Traumatology and Orthopedics, Septic and Plastic Surgery, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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Morinaga K, Kiyokawa K, Rikimaru H, Aoyagi S, Tayama K, Akashi H. Results of intra-wound continuous negative pressure irrigation treatment for mediastinitis. J Plast Surg Hand Surg 2013; 47:297-302. [DOI: 10.3109/2000656x.2013.765885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sano H, Kajikawa A, Ueda K. Study of continuous irrigation negative-pressure treatment using an original ulceration model. J Plast Surg Hand Surg 2013; 47:175-9. [PMID: 23676011 DOI: 10.3109/2000656x.2012.747961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A continuous irrigation with intermittent aspiration (CIIA) method has previously been developed in the treatment of infected expander sites. For the purpose of treatment of infected wounds, a new intermittent negative pressure irrigation treatment (INPIT) has been developed that is a combination of CIIA with topical negative-pressure therapy. This study aims to investigate the efficacy of INPIT. The efficacy of irrigation was investigated by changing the conditions including the location and the number of irrigation tubes, flow volume, and the timetable of negative-pressure application using original ulcer models. Although the presence of side holes and increase in the number of tubes or flow volume improved the irrigation efficacy, non-washed-out areas remained. On the other hand, INPIT allowed more uniform and wide area washing even at low flow volume. The results suggest that INPIT is superior to general conventional continuous irrigation treatment in irrigation efficiency.
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Affiliation(s)
- Hitomi Sano
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan
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Ino K, Kiyokawa K, Akaiwa K, Ishida M, Furuyama T, Onohara T. A team approach to the management of intractable leg ulcers. Ann Vasc Dis 2013; 6:39-45. [PMID: 23641282 DOI: 10.3400/avd.oa.13.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/23/2013] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The management of intractable leg ulcers requires a team approach which includes vascular surgeons and plastic surgeons. We retrospectively reviewed the results of the management of intractable leg ulcers by plastic surgeons. PATIENTS AND METHODS A total of 73 patients with intractable leg ulcers, (79 limbs) were treated at the Department of Plastic Surgery at our institution. Skin perfusion pressure (SPP) around the ulcer on the limb was measured before and after arterial reconstructive procedures. Local ulcer management involved intra-wound continuous negative pressure and irrigation therapy or negative pressure wound therapy. We examined the rates of wound healing and associated prognostic factors. RESULTS There were 21 limbs without ischemia (non-peripheral arterial disease [Non-PAD] group) and 58 limbs with ischemia (PAD group). The healing rates were 66% in the PAD group and 81% in the Non-PAD group, but the difference between the groups was not significant. A total of 41 limbs in the PAD group underwent revascularization, which involved bypass surgery in 18 limbs and endovascular therapy in 23 limbs. The salvage rate of the revascularized limbs was 83% at 1 year. The primary patency rates at 1 year were 87% for bypass surgery and 58% for endovascular therapy. The healing rate of the revascularized limbs was 66%, and the presence of concomitant hemodialysis, infected ulcers, and limbs without improved SPP were shown to be poor prognostic factors. Limbs treated with bypass surgery had a better healing rate than limbs treated with endovascular therapy, but the difference was not significant. CONCLUSION Good ulcer-healing rates were achieved by effective revascularization and aggressive local management. These results suggest that a team approach is useful for the management of intractable leg ulcers. (English translation of Jpn J Vasc Surg 2011; 20: 913-920).
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Affiliation(s)
- Kou Ino
- Department of Plastic Surgery, Kyushu Medical Center, Fukuoka, Fukuoka, Japan
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Negative-pressure wound therapy: a hemostatic adjunct for control of coagulopathic hemorrhage in large soft tissue wounds. J Trauma Acute Care Surg 2013; 73:1188-94. [PMID: 23117379 DOI: 10.1097/ta.0b013e31826f98ea] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative-pressure wound therapy has been commonly used for treating chronic wounds and recently applied for treatment of traumatic wounds. We investigated the potential hemostatic benefit of negative-pressure wound therapy for control of refractory hemorrhage in a soft tissue wound model in swine. METHODS Coagulopathy was induced in pigs (n = 38, 36 kg) by hemodilution and hypothermia. Next, a large soft tissue wound (diameter, approximately 20 cm) was created by slicing the gluteus maximus muscle. Free bleeding was allowed for 1 minute, and wounds were then randomly dressed with either laparotomy gauze (G) alone or TraumaPad (TP, a kaolin-coated dressing) alone or in combination with negative pressure (NP, approximately -500 mm Hg). All wounds were sealed with adhesive drapes. Fluid resuscitation was administered and targeted to mean arterial pressure of 60 mm Hg. Pigs were observed for 150 minutes or until death after which tissues were sampled for histologic examination. RESULTS Induced coagulopathy as measured by increases in prothrombin time (12%) and activated partial thromboplastin time (22%) and decreases in fibrinogen (48%) were similar in all groups. There were no differences in initial bleeding rates (4.5 mL/kg/min). Dressing the wounds with G or TP produced hemostasis only in one pig (1 of 18 pigs). Addition of NP to these dressings secured hemostasis in 70% (G) and 90% (TP) of animals with average hemostasis time of 34 minutes and 25 minutes, respectively. Blood losses and fluid resuscitation requirements were significantly less, and survival times were significantly longer in NP adjunct groups than in the other groups. Survival rates were 80% (G+NP) and 90% (TP+NP) versus 0% (G) and 10% (TP) in the respective groups. Histologic examination showed similar superficial myofibril damages in all groups. CONCLUSION To our knowledge, the present data provide the first evidence that NP serves as an effective hemostatic adjunct and when combined with standard hemostatic dressing it is able to stop lethal coagulopathic bleeding in large soft tissue wounds.
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Matsushita Y, Fujiwara M, Nagata T, Noda T, Fukamizu H. Negative pressure therapy with irrigation for digits and hands: pressure measurement and clinical application. ACTA ACUST UNITED AC 2012; 17:71-5. [PMID: 22351536 DOI: 10.1142/s0218810412500116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/09/2011] [Accepted: 08/09/2011] [Indexed: 11/18/2022]
Abstract
We recently developed continuous negative pressure therapy with irrigation (NPI) and successfully applied it to an infected digit with a narrow wound. With this technique, however, the dressing circumferentially wraps the digit or hand, and the pressure that the digit or hand receives and the influence on peripheral circulation are unclear. In this report, we evaluated the external pressure that a digit and hand received during NPI in vitro. Under circumferential NPI dressing, the skin perfusion pressure (SPP) of the peripheral portion was measured. Pressure was maintained at 1.3 mm Hg, and suction pressure ranged from -50 to -200 mm Hg. The pressure that a digit or hand receives during NPI is much lower than that at which tissue may be damaged (40-50 mm Hg). The SPP of the peripheral portion was much higher than 40 mm Hg, which is the pressure at which wound healing may be predicted. In clinical cases, NPI has been useful for wound bed preparation.
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Affiliation(s)
- Yuki Matsushita
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Yoshida S, Yokoyama R, Sakamoto A. Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap. Microsurgery 2011; 31:655-8. [PMID: 21919051 DOI: 10.1002/micr.20932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 05/06/2011] [Accepted: 05/16/2011] [Indexed: 01/13/2023]
Abstract
The treatment of wound complications and deep infection after hemipelvectomy is challenging. We describe a 17-year-old woman with Ewing sarcoma in the pelvis who underwent hemipelvectomy and reconstruction with an artificial hip joint and bone cement. After the operation, skin necrosis and deep infection with methicillin-resistant Staphylococcus aureus (MRSA) were observed. Debridement resulted in exposure of the artificial joint and bone cement. Topical negative pressure (TNP) and irrigation successfully eradicated the infection. The skin and soft-tissue defect was subsequently reconstructed using a combination of free latissimus dorsi myocutaneous flap and serratus anterior muscle flap. To our knowledge, this is the first described case of combined TNP and irrigation with myocutaneous flap for the treatment of pelvic infection and skin and soft-tissue defect with endoprosthesis exposure.
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Affiliation(s)
- Sei Yoshida
- Department of Plastic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
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Birke-Sorensen H, Malmsjo M, Rome P, Hudson D, Krug E, Berg L, Bruhin A, Caravaggi C, Chariker M, Depoorter M, Dowsett C, Dunn R, Duteille F, Ferreira F, Martínez JF, Grudzien G, Ichioka S, Ingemansson R, Jeffery S, Lee C, Vig S, Runkel N, Martin R, Smith J. Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) – Steps towards an international consensus. J Plast Reconstr Aesthet Surg 2011; 64 Suppl:S1-16. [DOI: 10.1016/j.bjps.2011.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/22/2011] [Accepted: 06/03/2011] [Indexed: 01/14/2023]
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Fujiwara M, Matsushita Y, Fukamizu H. Negative pressure therapy with irrigation for an infected digit: a preliminary report. ACTA ACUST UNITED AC 2011; 16:99-103. [PMID: 21348041 DOI: 10.1142/s0218810411005151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/28/2010] [Accepted: 10/25/2010] [Indexed: 11/18/2022]
Abstract
When tendons, bones or joints are exposed in infected digits, functional and cosmetic sequelae are frequent. We propose continuous negative pressure therapy with irrigation (NPI) for an infected digit with an open wound. Continuous NPI was evaluated in vitro and subsequently applied to a clinical case. Acceptable functional and cosmetic results were obtained without any problems when continuous NPI was performed in the clinical case. Continuous NPI may be a useful alternative for treatment of an infected digit with an open wound.
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Affiliation(s)
- Masao Fujiwara
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Mirza MAR, Gill NA, Hameed A. Negative pressure therapy for lower limb complex wounds. EUROPEAN JOURNAL OF PLASTIC SURGERY 2011. [DOI: 10.1007/s00238-010-0485-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Methicillin Resistant Staphylococcus Aureus Infection in Descending Necrotizing Mediastinitis From Retropharyngeal Perforation. J Wound Ostomy Continence Nurs 2010; 37:209-13. [DOI: 10.1097/won.0b013e3181d0feea] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Capobianco CM, Zgonis T. An overview of negative pressure wound therapy for the lower extremity. Clin Podiatr Med Surg 2009; 26:619-31. [PMID: 19778692 DOI: 10.1016/j.cpm.2009.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since its introduction into the market, negative pressure wound therapy (NPWT), also known as topical negative pressure, has become an important adjuvant therapy for the treatment of many types of wounds. Surgeons and physicians of all subspecialties have adopted NPWT into their practices. NPWT has become a mainstay in the management of lower extremity soft tissue pathology, especially in patients with traumatic, diabetic, postsurgical, and peripheral vascular disease-associated wounds. This article reviews the background, currently understood mechanisms of action, applications, contraindications, reported complications, advantages, criticisms, and techniques in the lower extremity.
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Affiliation(s)
- Claire M Capobianco
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am J Surg 2009; 197:660-5; discussion 665. [DOI: 10.1016/j.amjsurg.2008.04.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 04/07/2008] [Accepted: 04/10/2008] [Indexed: 11/17/2022]
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Salvage of infected tissue expanders using a new continuous irrigation method with intermittent aspiration. J Plast Reconstr Aesthet Surg 2009; 62:e69-72. [DOI: 10.1016/j.bjps.2008.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/08/2008] [Accepted: 09/29/2008] [Indexed: 11/21/2022]
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Pirela-Cruz MA, Machen MS, Esquivel D. Management of large soft-tissue wounds with negative pressure therapy-lessons learned from the war zone. J Hand Ther 2008; 21:196-202; quiz 203. [PMID: 18436141 DOI: 10.1197/j.jht.2007.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 12/27/2007] [Accepted: 12/28/2007] [Indexed: 02/03/2023]
Abstract
The recent conflicts in Afghanistan and Iraq have demonstrated that body armor has led to increase survival of combatants but the extremity injuries have been alarming. The increased numbers of extremity injuries have led to the acceptance and use of negative pressure therapy (NPT) in managing large wounds. This article reviews some of the lessons learned in treating wounds of the upper extremity using NPT.
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Affiliation(s)
- Miguel A Pirela-Cruz
- Texas Tech University Health Science Center, Department of Orthopaedic & Rehabilitation, El Paso, Texas 79905, USA.
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New Continuous Negative-Pressure and Irrigation Treatment for Infected Wounds and Intractable Ulcers. Plast Reconstr Surg 2008; 122:318. [DOI: 10.1097/prs.0b013e3181774835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Does Continuous Negative-Pressure and Irrigation Treatment Really Rinse the Whole Closed Wound? Plast Reconstr Surg 2008; 122:319-320. [DOI: 10.1097/prs.0b013e31817747ea] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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