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Moris V, Cristofari S, See LA, Guillier D, Zwetyenga N, Pluvy I. Randomized comparative study of negative pressure wound therapy versus compression dressing on split-thickness skin grafts of the lower limbs in an elderly population. Expert Rev Med Devices 2024:1-8. [PMID: 38712592 DOI: 10.1080/17434440.2024.2350494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
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.
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Affiliation(s)
- Vivien Moris
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, Dijon, France
| | - Sarra Cristofari
- Lipids Nutrition Cancer team NuTox UMR866, université de Bourgogne Franche-Comté, Dijon, France
| | - Leslie Ann See
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, Dijon, France
| | - David Guillier
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, Dijon, France
| | - Narcisse Zwetyenga
- Service de chirurgie plastique, reconstructive, esthétique, microchirurgie et régénération tissulaire, hôpital Tenon, Paris, France
| | - Isabelle Pluvy
- Service de chirurgie orthopédique, traumatologique, plastique, reconstructrice et assistance main, CHU Jean-Minjoz, Besançon cedex, France
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Alhaskawi A, Ezzi SHA, Dong Y, Zhou H, Wang Z, Lai J, Yao C, Kota VG, Abdulla MHAH, Lu H. Recent advancements in the diagnosis and treatment of acral melanoma. J Zhejiang Univ Sci B 2024; 25:106-122. [PMID: 38303495 PMCID: PMC10835211 DOI: 10.1631/jzus.b2300221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/21/2023] [Indexed: 02/03/2024]
Abstract
Acral melanoma (AM) is the most common histologic subtype of melanoma in dark-skinned patients and is associated with a worse prognosis and a high mortality rate, largely due to the inconspicuous nature of early-stage lesions, which can lead to late diagnosis. Because of the overlapping clinical and histopathological features of AM with other forms of cutaneous melanomas, early detection of AM requires a multidisciplinary approach that integrates various diagnostic modalities, including clinical examination, dermoscopy, histopathology, molecular testing, radiological imaging, and blood tests. While surgery is the preferred method of treatment for AM, other therapeutic options may be employed based on the stage and underlying etiology of the disease. Immune checkpoint inhibitors, molecular targeted therapy, radiotherapy, chemotherapy, and oncolytic virotherapy represent promising advanced treatment options for AM. In this review, we provide an overview of the latest advancements in diagnostic and therapeutic methods for AM, highlighting the importance of early detection and the prompt, individualized management of this challenging disease.
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Affiliation(s)
- Ahmad Alhaskawi
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | | | - Yanzhao Dong
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Haiying Zhou
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zewei Wang
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jingtian Lai
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Chengjun Yao
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | | | | | - Hui Lu
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou 310058, China.
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Imam MS, Abdel‐Sattar RM, Alqarni F, Aljumayi SYS, Altukhais I, Altukhays AS, Abdelrahim MEA. Prevalence of surgical site wound infection after spine surgery in nasal colonization of methicillin-resistant Staphylococcus aureus: A meta-analysis. Int Wound J 2023; 21:e14470. [PMID: 37909167 PMCID: PMC10898389 DOI: 10.1111/iwj.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023] Open
Abstract
The purpose of the meta-analysis was to evaluate and compare the prevalence of surgical site infection (SSI) after spine surgery (SS) in nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random- or fixed-effect models. For the current meta-analysis, 14 examinations spanning from 2014 to 2022 were included, encompassing 18 410 people who were tested for nasal colonization after SS. MRSA-positive had a significantly higher SSI (OR, 3.65; 95% CI, 2.48-5.37, p < 0.001) compared with MRSA-negative in SS subjects. However, no significant difference was found between methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus negative (OR, 0.94; 95% CI, 0.32-2.79, p = 0.91), and Staphylococcus aureus positive and negative (OR, 2.13; 95% CI, 0.26-17.41, p = 0.48) in SS subjects. The examined data revealed that MRSA colonization had a significant effect on SSI; however, methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus had no significant effect on SSI in SS subjects. However, given that some comparisons included a small number of chosen studies, attention should be given to their values.
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Affiliation(s)
- Mohamed S. Imam
- Pharmacy Practice Department, College of PharmacyShaqra UniversityShaqraSaudi Arabia
- Clinical Pharmacy Department, National Cancer InstituteCairo UniversityCairoEgypt
| | - Randa M. Abdel‐Sattar
- Biomedical Sciences Department, College of PharmacyShaqra UniversityShaqraSaudi Arabia
| | - Faisal Alqarni
- Department of PharmacySecurity Forces HospitalRiyadhSaudi Arabia
| | - Saad Yousef S. Aljumayi
- Department of PharmacyMedical Center at the Facilities Security Forces Command, Medical ServicesRiyadhSaudi Arabia
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Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer. Cancers (Basel) 2022; 14:cancers14153835. [PMID: 35954498 PMCID: PMC9367341 DOI: 10.3390/cancers14153835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery. Abstract Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.
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Mandili A, Aljubairy A, Alsharif B, Patwa W, Alotibey K, Basha S, Alharbi Z. Application of Negative Pressure Therapy on Skin Grafts after Soft-Tissue Reconstruction: A Prospective Observational Study. Clin Pract 2022; 12:396-405. [PMID: 35735663 PMCID: PMC9221738 DOI: 10.3390/clinpract12030044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
A split-thickness skin graft (STSG) is one of the main tools used in the reconstruction of skin defects. Negative-pressure wound therapy (NPWT) has been widely used as adjunct therapy for wound healing for decades. Few studies have conducted the outcomes of NPWT use as a postoperative dressing for STSGs. This study aimed to compare the outcomes of the application of NPWT versus conventional dressing on STSGs after soft-tissue reconstruction. A prospective observational study was performed at the King Abdullah Medical City. A total of 18 patients with STSGs for acute or chronic skin defects were recruited. Patients from the two groups—10 patients in the NPWT group and 8 in the No-NPWT group—were postoperatively evaluated for three weeks. Assessment included the STSG take rate, wound healing, pain, infection, hematoma formation, and the need to re-graft the same recipient area. Our data demonstrated a higher mean skin graft take rate in the second and third weeks of the No-NPWT group compared to the NPWT group, but it was not statistically significant (p > 0.05). No significant differences between the two groups in terms of wound healing, pain, infection, hematoma formation, and the need to re-graft (p > 0.05) were found. Our study showed that the conventional dressing of STSGs is not inferior to NPWT. In addition, conventional dressing was shown to be easier to use and less expensive to apply, as well as having a higher skin graft take rate and lower infection rate.
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Affiliation(s)
- Aeshah Mandili
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, P.O. Box 40047, Jeddah 21499, Saudi Arabia;
| | - Abdullah Aljubairy
- Intensive Care Service Department, King Fahad Armed Force Hospital, P.O. Box 9862, Jeddah 21159, Saudi Arabia;
| | - Bayan Alsharif
- General Surgery Department, Security Forces Hospital, P.O. Box 14799, Mecca 21955, Saudi Arabia;
| | - Wala Patwa
- General Surgery Department, International Medical Center, P.O. Box 2172, Jeddah 21451, Saudi Arabia;
| | - Khlood Alotibey
- General Pediatric Department, King Abdulaziz Medical City, P.O. Box 9515, Jeddah 21423, Saudi Arabia;
| | - Sara Basha
- General Surgery Department, Heraa General Hospital, Mecca 24227, Saudi Arabia;
| | - Ziyad Alharbi
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
- Clinical Sciences Department, Fakeeh College for Medical Sciences, P.O. Box 2537, Jeddah 21461, Saudi Arabia
- Correspondence:
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Uso de la terapia de presión negativa para fijar injertos cutáneos en úlceras secundarias a hematoma profundo disecante o a fascitis necrosante. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:540-542. [DOI: 10.1016/j.ad.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/12/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
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[Translated article] Negative Pressure for Securing Skin Grafts for Treating Ulcers due to Deep Dissecting Hematomas or Necrotizing Fasciitis. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2020.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, Stankiewicz M, Dumville JC. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2022; 4:CD009261. [PMID: 35471497 PMCID: PMC9040710 DOI: 10.1002/14651858.cd009261.pub7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS In January 2021, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane risk of bias tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Our primary outcomes were SSI, mortality, and wound dehiscence. MAIN RESULTS In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Eleven studies (6384 participants) which reported mortality were pooled. There is low-certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm; risk ratio (RR) 0.78 (95% CI 0.47 to 1.30; I2 = 0%). Fifty-four studies reported SSI; 44 studies (11,403 participants) were pooled. There is moderate-certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery; RR 0.73 (95% CI 0.63 to 0.85; I2 = 29%). Thirty studies reported wound dehiscence; 23 studies (8724 participants) were pooled. There is moderate-certainty evidence that there is probably little or no difference in dehiscence between people treated with NPWT (6.62%) and those treated with standard dressing (6.97%), although there is imprecision around the estimate that includes risk of benefit and harms; RR 0.97 (95% CI 0.82 to 1.16; I2 = 4%). Evidence was downgraded for imprecision, risk of bias, or a combination of these. Secondary outcomes There is low-certainty evidence for the outcomes of reoperation and seroma; in each case, confidence intervals included both benefit and harm. There may be a reduced risk of reoperation favouring the standard dressing arm, but this was imprecise: RR 1.13 (95% CI 0.91 to 1.41; I2 = 2%; 18 trials; 6272 participants). There may be a reduced risk of seroma for people treated with NPWT but this is imprecise: the RR was 0.82 (95% CI 0.65 to 1.05; I2 = 0%; 15 trials; 5436 participants). For skin blisters, there is low-certainty evidence that people treated with NPWT may be more likely to develop skin blisters compared with those treated with standard dressing (RR 3.55; 95% CI 1.43 to 8.77; I2 = 74%; 11 trials; 5015 participants). The effect of NPWT on haematoma is uncertain (RR 0.79; 95 % CI 0.48 to 1.30; I2 = 0%; 17 trials; 5909 participants; very low-certainty evidence). There is low-certainty evidence of little to no difference in reported pain between groups. Pain was measured in different ways and most studies could not be pooled; this GRADE assessment is based on all fourteen trials reporting pain; the pooled RR for the proportion of participants who experienced pain was 1.52 (95% CI 0.20, 11.31; I2 = 34%; two studies; 632 participants). Cost-effectiveness Six economic studies, based wholly or partially on trials in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in five indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty; coronary artery bypass grafts; and vascular surgery with inguinal incisions. They calculated quality-adjusted life-years or an equivalent, and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the evidence certainty varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS People with primary closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSIs than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate-certainty evidence). There may be a reduced risk of death after surgery for people treated with NPWT compared with standard dressings but there is uncertainty around this as confidence intervals include risk of benefit and harm (low-certainty evidence). People treated with NPWT may experience more instances of skin blistering compared with standard dressing treatment (low-certainty evidence). There are no clear differences in other secondary outcomes where most evidence is low or very low-certainty. Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Elizabeth Ma Murphy
- Ward 64, St. Mary's Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
| | - Laura Chiverton
- NIHR Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Monica Stankiewicz
- Chermside Community Health Centre, Community and Oral Health Directorate, Brisbane, Australia
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Review of History of Basic Principles of Burn Wound Management. Medicina (B Aires) 2022; 58:medicina58030400. [PMID: 35334576 PMCID: PMC8954035 DOI: 10.3390/medicina58030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/09/2023] Open
Abstract
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.
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10
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Dibbs RP, Depani M, Thornton JF. Technical Refinements with the Use of Biologic Healing Agents. Semin Plast Surg 2022; 36:8-16. [PMID: 35706558 PMCID: PMC9192159 DOI: 10.1055/s-0042-1742749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390
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Patel BJ, Asher CM, Bystrzonowski N, Healy C. Safeguarding Skin Grafts: An Evidence-Based Summary of Fixation Techniques. Ann Plast Surg 2021; 87:e180-e188. [PMID: 34117134 DOI: 10.1097/sap.0000000000002937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective skin graft fixation is vital in preventing sheering forces, seroma, and hematoma from compromising graft take. Yet, selecting the ideal technique for securing skin grafts remains a contentious subject, with significant variation in practice existing between surgeons. There is, therefore, benefit to be derived from assessing the literature for evidence-based recommendations to guide the decision-making process. METHODS A search of Medline and Embase was performed using appropriate key terms, yielding 419 articles. Reference lists were analyzed. Inclusion and exclusion criteria were composed. Level I to III studies, as defined by the Centre for Evidence-Based Medicine, that compared skin graft fixation methods were analyzed. Rayyan QCRI was used for abstract and title screening. After full text screening, 41 studies were included for qualitative analysis. All included randomized control trials (RCTs) were assessed for risk of bias using the Cochrane Risk-of-Bias 2 (ROB2) tool. RESULTS We identified 4 groups of fixation technique: "tie-over bolster" (TOB), "no TOB," "adhesive glues," and "negative pressure wound therapy" (NPWT). Twelve studies compared TOB with no TOB, with no difference in graft take demonstrated. Sixteen studies compared adhesive glues with traditional methods, with no difference in graft take demonstrated. Thirteen studies compared NPWT with traditional methods, with enhanced graft take demonstrated. Risk of bias was deemed low in 1 of 13 RCTs. CONCLUSIONS Based on the current evidence, only NPWT is associated with enhanced graft take. However, there is a scarcity of robust level I evidence comparing different fixation techniques, meaning that strong recommendations cannot be made. We propose examples of hypothesis-driven RCTs, in predetermined clinical settings, based on the theoretical benefits of the techniques that would add value to clinical practice.
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Affiliation(s)
- Benjamin J Patel
- From the Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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One-Stage Perifascial Areolar Tissue and Skin Grafting Combined with Negative Pressure Wound Therapy for a Refractory Wound with an Exposed Elbow Joint and Extensive Skin Defect. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Kuo CY, Kan JY, Kao CN, Ou-Yang F, Wu CC, Shiau JP, Li CL, Hou MF, Huang SH. Utilizing NPWT improving skin graft taking in reconstruction for extended breast skin defects following mastectomy. Clin Case Rep 2021; 9:e04716. [PMID: 34631060 PMCID: PMC8489387 DOI: 10.1002/ccr3.4716] [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: 11/05/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 12/02/2022] Open
Abstract
NPWT fulfill graft taking in complex breast wounds.
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Affiliation(s)
- Chia-Yu Kuo
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Jung-Yu Kan
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Chieh-Ni Kao
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Fu Ou-Yang
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Cheng-Che Wu
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Jun-Ping Shiau
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Chung-Liang Li
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - Ming-Feng Hou
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
- Regeneration Medicine and Cell Therapy Research Center Kaohsiung Medical University Kaohsiung Taiwan
| | - Shu-Hung Huang
- Division of Breast Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Surgery School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
- Division of Plastic Surgery, Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Regeneration Medicine and Cell Therapy Research Center Kaohsiung Medical University Kaohsiung Taiwan
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Nolff MC. Filling the vacuum: Role of negative pressure wound therapy in open wound management in cats. J Feline Med Surg 2021; 23:823-833. [PMID: 34428942 PMCID: PMC8392764 DOI: 10.1177/1098612x211037873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Practical relevance: Open wounds and their treatment present a common challenge in veterinary practice. Approaching 15 years ago negative pressure wound therapy (NPWT) started to be incorporated into clinical veterinary medicine, and its availability is becoming more widespread in Europe and the USA. Use of this therapy has the potential to significantly increase the healing rate of open wounds as well as free skin grafts in small animals, and it has been occasionally described for the management of feline wounds. Aim: This review describes the mechanisms of action of, and indications for, NPWT, and offers recommendations for NPWT specific to feline patients. Evidence base: The information presented is based on the current evidence and the author’s clinical experience of the technique gained over the past 12 years. Comparative studies of different treatment options are lacking and, since wound healing in cats and dogs differs, cat-specific studies are especially needed. Well-designed wound healing studies comparing different advanced techniques will improve open wound healing in cats in the future, and potentially allow better understanding of the role of NPWT in this setting.
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Affiliation(s)
- Mirja C Nolff
- Clinic for Small Animal Surgery, Tierspital Zürich, University of Zürich, Winterthurerstrasse 260, 8057 Zürich, Switzerland
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15
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Notorgiacomo G, Klug J, Rapp S, Boyce ST, Schutte SC. A bioreactor for studying negative pressure wound therapy on skin grafts. Int Wound J 2021; 19:633-642. [PMID: 34235863 PMCID: PMC8874041 DOI: 10.1111/iwj.13661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022] Open
Abstract
Negative pressure wound therapy (NPWT) has become the prevailing standard of care for treating complex soft tissue wounds and is now being considered for use in alternative applications including improving skin graft take. While it is generally agreed that negative pressure leads to improved wound healing, universal consensus on its optimal application is not supported in the literature. We describe the design and validation of a bioreactor to determine the prospective benefits of NPWT on skin grafts and engineered skin substitutes (ESS). Clinically relevant pressures were applied, and the native human skin was able to withstand greater negative pressures than the engineered substitutes. Both skin types were cultured under static, flow‐only, and −75 mm Hg conditions for 3 days. While it remained intact, there was damage to the epidermal‐dermal junction in the ESS after application of negative pressure. The normal skin remained viable under all culture conditions. The engineered skin underwent apoptosis in the flow‐only group; however, the application of negative pressure reduced apoptosis. Vascular endothelial growth factor levels were significantly higher in the normal flow‐only group, 152.0 ± 75.1 pg/mg protein, than the other culture conditions, 81.6 ± 35.5 pg/mg for the static and 103.6 ± pg/mg for the negative pressure conditions. The engineered skin had a similar trend but the differences were not significant. This bioreactor design can be used to evaluate the impacts of NPWT on the anatomy and physiology of skin to improve outcomes in wounds after grafting with normal or engineered skin.
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Affiliation(s)
| | - Justin Klug
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Scott Rapp
- Division of Plastic Surgery, Norton Children's Hospital, Louisville, Kentucky, USA.,Kentucky Center for Cosmetic and Reconstructive Surgery, Louisville, Kentucky, USA.,Research Department, Shriners Hospitals for Children-Cincinnati, Cincinnati, Ohio, USA
| | - Steven T Boyce
- Research Department, Shriners Hospitals for Children-Cincinnati, Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Stacey C Schutte
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA.,Research Department, Shriners Hospitals for Children-Cincinnati, Cincinnati, Ohio, USA
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16
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Rapp SJ, Dershem V, Zhang X, Schutte SC, Chariker ME. Varying Negative Pressure Wound Therapy Acute Effects on Human Split-Thickness Autografts. J Burn Care Res 2021; 41:104-112. [PMID: 31420676 DOI: 10.1093/jbcr/irz122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Over 6.5 million people in the United States suffer from traumatic, burn, acute, and chronic wounds yearly. When reconstruction is required, split and full-thickness autografts are a first line of treatment intervention. Negative pressure wound therapy (NPWT) is gaining traction as an adjunct modality to improve graft survival, yet the specifics on what settings to apply topically over the graft is unsubstantiated and associated with morbidities. This study was performed in an effort to understand initial changes in wound and graft healing with a long-term goal of surface pressure optimization. Excess skin from elective procedures from six human subjects was trimmed to 0.012 inch in order represent a split-thickness autografts. These grafts were treated continuously with either -75 mm Hg (n = 4), -125 mm Hg (n = 4), or no pressure (n = 4) for 3 hours. Six skin grafts were treated with no sponge or pressure control (n = 6). RNAseq was performed on all treatment groups and compared with no pressure control. Significant gene expression changes with a subset focusing on inflammatory, cellular/extracellular matrix proliferation and angiogenic mediators and having greater than 2-fold were confirmed with immunohistochemistry staining. There are 95 significant gene transcription differences among all treatment groups. NPWT leads to significantly increased gene expression of FGFR1, ET-1, and 22 Keratin proteins. Between -75 and -125 mm Hg groups, there are 19 significant gene changes. Proinflammatory genes S100A8 and Tenacin C (TNC) demonstrate an 8.8- and 9.1-fold change, respectively, and is upregulated in -125 mm Hg group and downregulated in -75 mm Hg group. Fibrinogen genes fibrinogen gamma chain and fibrinogen alpha chain had respective log2-fold changes of -7.9 and -7.4 change between treatment groups and were downregulated in -125 mm Hg group and upregulated in -75 mm Hg group. There are varying effects of surface pressures on human split-thickness autografts during the imbibition time period. NPWT may improve cellular migration, proliferation, and angiogenesis over controls. Human skin grafts respond differently to -125 and -75 mm Hg within 3 hours of NPWT treatment. The results suggest -75 mm Hg leads to less inflammation and increased fibrinogen production compared with the -125 mm Hg group, at least initially. Reducing "time to heal" with NPWT is critical to successful outcomes and quality of life within young patients who often experience pain/discomfort when treated at the current standard pump settings. The results from this study and continued investigation may quickly translate to the clinical setting by finding the ideal pressure setting utilized in an effort to reduce NPWT length of treatment, improve patient comfort, satisfaction, and psychosocial well-being.
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Affiliation(s)
- Scott J Rapp
- Division of Pediatric Plastic Surgery, Department of Research, Shriners Hospital for Children, Cincinnati, Ohio.,Department of Surgery, Division of Plastic Surgery, Norton Children's Hospital, Louisville, Kentucky.,Kentucky Center for Cosmetic and Reconstructive Surgery, Louisville, Kentucky
| | - Victoria Dershem
- Division of Pediatric Plastic Surgery, Department of Research, Shriners Hospital for Children, Cincinnati, Ohio
| | - Xiang Zhang
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Stacey C Schutte
- Division of Pediatric Plastic Surgery, Department of Research, Shriners Hospital for Children, Cincinnati, Ohio.,Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Mark E Chariker
- Department of Surgery, Division of Plastic Surgery, Norton Children's Hospital, Louisville, Kentucky.,Kentucky Center for Cosmetic and Reconstructive Surgery, Louisville, Kentucky
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17
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Nakamura Y, Ishitsuka Y, Sasaki K, Ishizuki S, Tanaka R, Okiyama N, Furuta J, Fujimoto M, Yamada T, Fujisawa Y. A prospective, phase II study on the safety and efficacy of negative pressure closure for the stabilization of split-thickness skin graft in large or muscle-exposing defects: The NPSG study. J Dermatol 2021; 48:1350-1356. [PMID: 34028872 DOI: 10.1111/1346-8138.15970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Several studies have demonstrated the usefulness of negative pressure closure (NPC) for the stabilization of skin grafts because it provides a uniform pressure to the graft. The results of our previous retrospective study also suggested the superiority of NPC over tie-over methods for the stabilization of split-thickness skin graft (STSG) in large or muscle-exposing defects. However, the usefulness of NPC for graft stabilization is yet to be fully established. This prospective, phase II clinical study was conducted to investigate the safety and efficacy of NPC for the stabilization of STSG in large or muscle-exposing defects. Patients who would require STSG for reconstruction of defects in the trunk and extremities other than hands and feet measuring >10 cm in the longest diameter or with muscle exposure were enrolled. NPC was applied for skin graft stabilization. Seven patients who had received wide excision of malignant tumors and resulted in muscle-exposed skin defects were included. All patients underwent meshed STSG. The mean size of the defect was 94.5 cm2 (range 63.6-164.9). The mean time from the skin graft harvesting to the NPC stabilization was 15.6 min (range 10.7-19.5). The mean survival rate of the skin graft at postoperative day 7 and 10 was 98.7% (range 97-100) and 96.5% (range 89.4-98.4), respectively. No adverse events associated with the procedure were observed. This prospective study provided further evidence of the safety and efficacy of NPC for STSG stabilization in patients with large or muscle-exposing skin defects.
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Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yosuke Ishitsuka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Katsuhito Sasaki
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shoichiro Ishizuki
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryota Tanaka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Junichi Furuta
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takeshi Yamada
- Tsukuba Clinical Research and Development Organization (T-CReDO), University of Tsukuba, Tsukuba, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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18
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Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis? Surg Technol Int 2021. [PMID: 33844240 DOI: 10.52198/21.sti.38.gs1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer's instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.
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19
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Zhou R, Qiu L, Xiao J, Mao X, Yuan X. Early wound repair versus later scar repair in children with treadmill hand friction burns. J Burn Care Res 2021; 43:269-276. [PMID: 34015124 DOI: 10.1093/jbcr/irab083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (9 patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (P>0.05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (P<0.05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.
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Affiliation(s)
- Rong Zhou
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Lin Qiu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Jun Xiao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Xiaobo Mao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Xingang Yuan
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
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20
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Poteet SJ, Schulz SA, Povoski SP, Chao AH. Negative pressure wound therapy: device design, indications, and the evidence supporting its use. Expert Rev Med Devices 2021; 18:151-160. [PMID: 33496626 DOI: 10.1080/17434440.2021.1882301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Negative pressure wound therapy (NPWT) has become a mainstay in the armamentarium for wound care. Since the initial commercial vacuum-assisted closure device became available in 1995, subsequent research has confirmed the positive physiological effects of negative pressure on wound healing. Traditionally, NPWT has been used to improve healing of open nonsurgical wounds by secondary intention. However, the clinical applications of NPWT have significantly broadened, and now also include use in open surgical wounds, closed surgical incisions, and skin graft surgery. In addition, devices have evolved and now include functionality and features such as instillation, antimicrobial sponges, and portability.Areas covered: This article reviews the history, background, and physiology underlying NPWT, as well as the most commonly used devices. In addition, an evidence-based discussion of the current clinical applications of NPWT is presented, with a focus on those with high levels of evidence.Expert opinion: Future directions for device development include modifications to increase ease of use by patients and to allow its use in a broader array of anatomic areas. Lastly, more research with high levels of evidence is needed to better define the outcomes associated with NPWT, including in relation to specific clinical applications and cost.
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Affiliation(s)
- Stephen J Poteet
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Steven A Schulz
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, Ohio State University, Columbus, OH, USA
| | - Albert H Chao
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
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21
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Jiang ZY, Yu XT, Liao XC, Liu MZ, Fu ZH, Min DH, Guo GH. Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials. Burns 2021; 47:747-755. [PMID: 33814213 DOI: 10.1016/j.burns.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Although skin grafts are widely used in reconstruction of large skin defect and complex wounds, many factors lead to suboptimal graft take. Negative-pressure wound therapy (NPWT) reportedly increases the graft take rates when added to skin grafting, but a summary analysis of the data of randomized controlled trials has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to compare the effectiveness and safety of NPWT and non-NPWT for patients with skin grafts. METHODS We searched PubMed, Embase, Cochrane Library, and CNKI for relevant trials based on predetermined eligibility criteria from database establishment to February 2020. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heterogeneity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis. RESULTS Ten randomized controlled trials with 488 patients who underwent NPWT or non-NPWT were included. Compared with non-NPWT, NPWT yielded an improved the percentage of graft take, a reduction in days from grafting to discharge, with lower relative risk of re-operation, and no increased relative risk of adverse event. Further, the subgroup analysis showed an improved the percentage of graft take in negative pressure of 80 mmHg, and no improved the percentage of graft take in negative pressure of 125 mmHg. CONCLUSION NPWT is more effective than non-NPWT for the integration of skin grafts, and the negative pressure of 80 mmHg can be recommended. Data on adverse events and negative pressure are, however, limited. A better understanding of complications after NPWT and the ideal negative pressure for the integration of skin grafts is imperative.
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Affiliation(s)
- Zheng-Ying Jiang
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Xiao-Ting Yu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Xin-Cheng Liao
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Ming-Zhuo Liu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Zhong-Hua Fu
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Ding-Hong Min
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China
| | - Guang-Hua Guo
- The Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Street, Nanchang 330006, Jiangxi, PR China.
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22
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Hermeto LC, DeRossi R, Oliveira RJ, Gomes FG, Ferreira WR, Galhardo JA, Möck TBM, Basaglia WVS, Fernandes DM. The efficacy of topical insulin application on rat model with burn wounds treated with adipose-derived stem cells. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:296-306. [PMID: 33500841 PMCID: PMC7811940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
Overall, major burn wounds may require special care and long-term hospitalization as they not only bring complications from the wound itself, but may also compromise the immune system, or even other organs. Previous studies have indicated that topical insulin cream shortened wound closure time in second-degree burns in rats. Transplanted adipose-derived stem cells (AD-MSCs) have been developed as an alternative to treat burns and to accelerate the healing process. The aim of the present study is to investigate the effect of topical insulin gel, associated with AD-MSCs intradermal administration to heal second-degree burn wounds in rat models who were subjected to second-degree dorsal burns. The models were divided into four groups (n = 10 per group): placebo gel (C), topical insulin gel (TI), topical insulin gel and adipose-derived mesenchymal stem cells (TIMSCs) and placebo gel and adipose-derived mesenchymal stem cells (CMSCs). Wounds were assessed on a daily basis and histological evaluations were made on 5 animals from each group on the seventh and fourteenth day. There was a significant macroscopic decrease in burn wound areas in the Control (P = 0.0083), TIMSCs and CMSCs (P = 0.042) groups between the seventh and fourteenth days. The TI treatment did not show any significant change (P > 0.05) throughout this same period. The histological analysis showed significant granulation tissue formation in CMSCs and TIMSCs (P = 0.02235) treatments during the experimental period. According to the results, intradermal administration of allogenic AD-MSCs in experimental second-degree burns for short periods of time in the rat model has contributed to reducing the inflammatory phase duration, improving wound re-epithelialization, tissue granulation and wound contraction, as well as increasing collagen deposition.
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Affiliation(s)
- Larissa C Hermeto
- Veterinary Medicine-Surgery and Anesthesiology Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
- Stem Cell Studies, Cell Therapy and Toxicological Genetics Centre, Medical School, Federal University of Mato Grosso do SulBrazil
| | - Rafael DeRossi
- Veterinary Medicine-Surgery and Anesthesiology Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
| | - Rodrigo J Oliveira
- Stem Cell Studies, Cell Therapy and Toxicological Genetics Centre, Medical School, Federal University of Mato Grosso do SulBrazil
| | - Felipe G Gomes
- Veterinary Medicine Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
| | - Wallison R Ferreira
- Veterinary Medicine Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
| | - Juliana A Galhardo
- Veterinary Medicine Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
| | - Tessie BM Möck
- Veterinary Medicine Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
| | - William VS Basaglia
- Veterinary Medicine Department, Veterinary Medicine and Animal Science School, Federal University of Mato Grosso do SulCampo Grande, Brazil
| | - Diogo M Fernandes
- Veterinary Science Graduate Program, Federal University of Mato Grosso do SulCampo Grande, Brazil
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23
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Zens Y, Barth M, Bucher HC, Dreck K, Felsch M, Groß W, Jaschinski T, Kölsch H, Kromp M, Overesch I, Sauerland S, Gregor S. Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials. Syst Rev 2020; 9:238. [PMID: 33038929 PMCID: PMC7548038 DOI: 10.1186/s13643-020-01476-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/07/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention. METHODS We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm). RESULTS We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD - 4.78, 95% CI - 7.79 to - 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events. CONCLUSIONS In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.
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Affiliation(s)
- Yvonne Zens
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Michael Barth
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
- Düsseldorf, Germany
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Katrin Dreck
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Moritz Felsch
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Wolfram Groß
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Thomas Jaschinski
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Heike Kölsch
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Mandy Kromp
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Inga Overesch
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Stefan Sauerland
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
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24
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Cheng Y, Zhou Z, Hu H, Li W, Liu Y, Xia Z, Deng C, Mao G, Yi L, Liu X, Yang S, Zheng J, Guo F. An Application of a Negative-Pressure Wound Dressing for Partial- or Full-Thickness Burn Wounds. INT J LOW EXTR WOUND 2020; 20:257-262. [PMID: 32594807 DOI: 10.1177/1534734620933439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Negative-pressure wound therapy is widely used in burn populations. Traditionally, negative-pressure devices use persistent vacuum suction, requiring a longer hospital stay. In this study, we applied a novel negative-pressure wound dressing for burn wounds, which eliminates the hospital stay. The medical records of 39 patients with partial-/full-thickness burns treated by negative-pressure wound dressing were retrospectively analyzed. The average burn area, burn degree, healing duration, cost, and incidents during treatment were determined and compared with previous data for conventional therapies. In conclusion, for patients diagnosed with partial-thickness or full-thickness burns and a burn area <34.6 ± 2.21 cm2, the negative-pressure wound dressing is a reliable option, especially for burnt children. Moreover, the negative-pressure wound dressing treatment was not only much cheaper than conventional therapies, but also eliminated hospital stay in patients with small-area deep burn wounds.
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Affiliation(s)
- Yulong Cheng
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Zengding Zhou
- Rui Jin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huan Hu
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Wenbo Li
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Liu
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Zihuan Xia
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Chenliang Deng
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Guangyu Mao
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Yi
- Rui Jin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiangdong Liu
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Songlin Yang
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Jianghong Zheng
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Guo
- Affiliated Sixth People’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
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Norman G, Goh EL, Dumville JC, Shi C, Liu Z, Chiverton L, Stankiewicz M, Reid A. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2020; 6:CD009261. [PMID: 32542647 PMCID: PMC7389520 DOI: 10.1002/14651858.cd009261.pub6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS In June 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another type of NPWT. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. MAIN RESULTS In this third update, we added 15 new randomised controlled trials (RCTs) and three new economic studies, resulting in a total of 44 RCTs (7447 included participants) and five economic studies. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Four studies (2107 participants) reported mortality. There is low-certainty evidence (downgraded twice for imprecision) showing no clear difference in the risk of death after surgery for people treated with NPWT (2.3%) compared with standard dressings (2.7%) (risk ratio (RR) 0.86; 95% confidence interval (CI) 0.50 to 1.47; I2 = 0%). Thirty-nine studies reported SSI; 31 of these (6204 participants), were included in meta-analysis. There is moderate-certainty evidence (downgraded once for risk of bias) that NPWT probably results in fewer SSI (8.8% of participants) than treatment with standard dressings (13.0% of participants) after surgery; RR 0.66 (95% CI 0.55 to 0.80 ; I2 = 23%). Eighteen studies reported dehiscence; 14 of these (3809 participants) were included in meta-analysis. There is low-certainty evidence (downgraded once for risk of bias and once for imprecision) showing no clear difference in the risk of dehiscence after surgery for NPWT (5.3% of participants) compared with standard dressings (6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13; I2 = 0%). Secondary outcomes There is low-certainty evidence showing no clear difference between NPWT and standard treatment for the outcomes of reoperation and incidence of seroma. For reoperation, the RR was 1.04 (95% CI 0.78 to 1.41; I2 = 13%; 12 trials; 3523 participants); for seroma, the RR was 0.72 (95% CI 0.50 to 1.05; I2 = 0%; seven trials; 729 participants). The effect of NPWT on occurrence of haematoma or skin blisters is uncertain (very low-certainty evidence); for haematoma, the RR was 0.67 (95% CI 0.28 to 1.59; I2 = 0%; nine trials; 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65 to 10.68; I2 = 69%; seven trials; 796 participants). The overall effect of NPWT on pain is uncertain (very low-certainty evidence from seven trials (2218 participants) which reported disparate measures of pain); but moderate-certainty evidence suggests there is probably little difference between the groups in pain after three or six months following surgery for lower limb fracture (one trial, 1549 participants). There is also moderate-certainty evidence for women undergoing caesarean sections (one trial, 876 participants) and people having surgery for lower limb fractures (one trial, 1549 participants) that there is probably little difference in quality of life scores at 30 days or 3 or 6 months, respectively. Cost-effectiveness Five economic studies, based wholly or partially on trials included in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in four indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty and coronary artery bypass graft surgery. They calculated quality-adjusted life-years for treatment groups and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the grade of the evidence varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS People experiencing primary wound closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSI than people treated with standard dressings (moderate-certainty evidence). There is no clear difference in number of deaths or wound dehiscence between people treated with NPWT and standard dressings (low-certainty evidence). There are also no clear differences in secondary outcomes where all evidence was low or very low-certainty. In caesarean section in obese women and surgery for lower limb fracture, there is probably little difference in quality of life scores (moderate-certainty evidence). Most evidence on pain is very low-certainty, but there is probably no difference in pain between NPWT and standard dressings after surgery for lower limb fracture (moderate-certainty evidence). Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Laura Chiverton
- NIHR Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Monica Stankiewicz
- Chermside Community Health Centre, Community and Oral Health Directorate, Brisbane, Australia
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
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26
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Norman G, Goh EL, Dumville JC, Shi C, Liu Z, Chiverton L, Stankiewicz M, Reid A. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2020; 5:CD009261. [PMID: 32356396 PMCID: PMC7192856 DOI: 10.1002/14651858.cd009261.pub5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS In June 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another type of NPWT. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. MAIN RESULTS In this third update, we added 15 new randomised controlled trials (RCTs) and three new economic studies, resulting in a total of 44 RCTs (7447 included participants) and five economic studies. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Four studies (2107 participants) reported mortality. There is low-certainty evidence (downgraded twice for imprecision) showing no clear difference in the risk of death after surgery for people treated with NPWT (2.3%) compared with standard dressings (2.7%) (risk ratio (RR) 0.86; 95% confidence interval (CI) 0.50 to 1.47; I2 = 0%). Thirty-nine studies reported SSI; 31 of these (6204 participants), were included in meta-analysis. There is moderate-certainty evidence (downgraded once for risk of bias) that NPWT probably results in fewer SSI (8.8% of participants) than treatment with standard dressings (13.0% of participants) after surgery; RR 0.66 (95% CI 0.55 to 0.80 ; I2 = 23%). Eighteen studies reported dehiscence; 14 of these (3809 participants) were included in meta-analysis. There is low-certainty evidence (downgraded once for risk of bias and once for imprecision) showing no clear difference in the risk of dehiscence after surgery for NPWT (5.3% of participants) compared with standard dressings (6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13; I2 = 0%). Secondary outcomes There is low-certainty evidence showing no clear difference between NPWT and standard treatment for the outcomes of reoperation and incidence of seroma. For reoperation, the RR was 1.04 (95% CI 0.78 to 1.41; I2 = 13%; 12 trials; 3523 participants); for seroma, the RR was 0.72 (95% CI 0.50 to 1.05; I2 = 0%; seven trials; 729 participants). The effect of NPWT on occurrence of haematoma or skin blisters is uncertain (very low-certainty evidence); for haematoma, the RR was 0.67 (95% CI 0.28 to 1.59; I2 = 0%; nine trials; 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65 to 10.68; I2 = 69%; seven trials; 796 participants). The overall effect of NPWT on pain is uncertain (very low-certainty evidence from seven trials (2218 participants) which reported disparate measures of pain); but moderate-certainty evidence suggests there is probably little difference between the groups in pain after three or six months following surgery for lower limb fracture (one trial, 1549 participants). There is also moderate-certainty evidence for women undergoing caesarean sections (one trial, 876 participants) and people having surgery for lower limb fractures (one trial, 1549 participants) that there is probably little difference in quality of life scores at 30 days or 3 or 6 months, respectively. Cost-effectiveness Five economic studies, based wholly or partially on trials included in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in four indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty and coronary artery bypass graft surgery. They calculated quality-adjusted life-years for treatment groups and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the grade of the evidence varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS People experiencing primary wound closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSI than people treated with standard dressings (moderate-certainty evidence). There is no clear difference in number of deaths or wound dehiscence between people treated with NPWT and standard dressings (low-certainty evidence). There are also no clear differences in secondary outcomes where all evidence was low or very low-certainty. In caesarean section in obese women and surgery for lower limb fracture, there is probably little difference in quality of life scores (moderate-certainty evidence). Most evidence on pain is very low-certainty, but there is probably no difference in pain between NPWT and standard dressings after surgery for lower limb fracture (moderate-certainty evidence). Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Laura Chiverton
- NIHR Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Monica Stankiewicz
- Chermside Community Health Centre, Community and Oral Health Directorate, Brisbane, Australia
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
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27
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Inatomi Y, Kadota H, Kamizono K, Hanada M, Yoshida S. Securing split-thickness skin grafts using negative-pressure wound therapy without suture fixation. J Wound Care 2020; 28:S16-S21. [PMID: 31393782 DOI: 10.12968/jowc.2019.28.sup8.s16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Negative-pressure wound therapy (NPWT) is generally applied as a bolster for split-thickness skin grafts (STSG) after the graft has been secured with sutures or skin staples. In this study, NPWT was applied to secure STSGs without any sutures or staples. Surgical outcomes of using NPWT without sutures was compared with a control group. METHODS Patients with STSGs were divided into two groups: a 'no suture' group using only NPWT, and a control group using conventional fixings. In the no suture group, the grafts were covered with meshed wound dressing and ointment. The NPWT foam was placed over the STSG and negative pressure applied. In the control group, grafts were fixed in place using tie-over bolster, securing with fibrin glue, or NPWT after sutures. RESULTS A total of 30 patients with 35 graft sites participated in the study. The mean rate of graft take in the no suture group was 95.1%, compared with 93.3% in the control group, with no significant difference between them. No graft shearing occurred in the no suture group. Although the difference did not reach statistical significance, mean surgical time in the no suture group (31.5 minutes) tended to be shorter than that in the control group (55.7 minutes). CONCLUSION By eliminating sutures, the operation time tended to be shorter, suturing was avoided and suture removal was not required meaning that patients could avoid the pain associated with this procedure. Furthermore, the potential for staple retention and its associated complications was avoided, making this method potentially beneficial for both medical staff and patients.
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Affiliation(s)
- Yusuke Inatomi
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Kenichi Kamizono
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Masuo Hanada
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
| | - Sei Yoshida
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Higashiku, Japan
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28
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Nilforoushzadeh MA, Kazemikhoo N, Mokmeli S, Zare S, Dahmardehei M, Vaghar Doost R, Momeni M, Ansari F. An Open-Label Study of Low-Level Laser Therapy Followed by Autologous Fibroblast Transplantation for Healing Grade 3 Burn Wounds in Diabetic Patients. J Lasers Med Sci 2019; 10:S7-S12. [PMID: 32021666 DOI: 10.15171/jlms.2019.s2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Low-level laser therapy (LLLT) has been used as an effective therapeutic modality since the mid-1960s. Although there have been several clinical studies using LLLT in wound healing, especially diabetic, pressure and venous ulcers, there are few reports of using this technique in burn ulcers. Autologous fibroblast transplantation is a novel treatment for patients with burns or venous ulcers. In this study for the first time, we used LLLT along with autologous fibroblast skin transplantation to treat grade 3 burn ulcers in diabetic patients. This case series describes the successful management of grade 3 burn ulcers in 10 diabetic patients using autologous fibroblast transplantation along with LLLT. Methods: After the approval of the Tehran University Ethics Committee (IR.TUMS.REC.1394.1683) and the Iran Registry of Clinical Trials (IRCT2016050226069N3), 10 diabetic patients with 10 grade 3 burn ulcers, who were a candidate for skin graft surgery, entered the study. Donor skin was biopsied using a 3 mm punch. Fibroblasts were extracted and cultured in vitro in the GMP Technique laboratory. The patients were treated using LLLT in 3-4 weeks during the time that fibroblast cultures became ready to use. Laser irradiation was done using red light, 650 nm, 150 mW, 1 J/cm2 for the bed of the ulcer and infra-red light 808 nm, 200 mW, 6 J/cm2 for the margins every other day for 10 sessions. Results: The mean wound size before treatment was 16.28 cm2 . All patients' burn wounds healed completely after 10-12 weeks. Conclusion: We conclude that this method can be used as an effective method for treating large wounds, especially in complicated patients including the diabetics.
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Affiliation(s)
| | - Nooshafarin Kazemikhoo
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, St. George Hospital, UNSW, Sydney, Australia
| | | | - Sona Zare
- Skin and Stem Cell Research Center,Tehran University of Medical Sciences, Tehran, Iran.,Department of Biology, Faculty of Science, Islamic Azad University, Hamedan Branch, Hamedan, Iran
| | - Mostafa Dahmardehei
- Burn Research Centre, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Vaghar Doost
- Burn Research Centre, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Burn Research Centre, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ansari
- Research Centre for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group
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29
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Cocjin HGB, Jingco JKP, Tumaneng FDC, Coruña JMR. Wound-Healing Following Negative-Pressure Wound Therapy with Use of a Locally Developed AquaVac System as Compared with the Vacuum-Assisted Closure (VAC) System. J Bone Joint Surg Am 2019; 101:1990-1998. [PMID: 31764361 DOI: 10.2106/jbjs.19.00125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Negative-pressure wound therapy (NPWT) gained widespread clinical use after its introduction in the 1990s because of its many beneficial effects on the wound environment. However, high treatment costs have limited its use in third-world countries. The present study compares a low-cost, locally developed NPWT system with a commercially available system in terms of efficacy, reliability, ease of application, and safety. METHODS This prospective, randomized controlled trial involved 36 patients who were managed with NPWT with either a low-cost, locally developed system (AquaVac) or a commercially available Vacuum-Assisted Closure Advanced Therapy System (VAC ATS; KCI). The low-cost NPWT system described consists of a converted aquarium pump as a reusable vacuum source and a dressing system that can be found in the hospital supply room: food plastic wrap as an occlusive drape, surgical gauze as wound filler, nasogastric tubes as tubing, and used intravenous (IV) bottles as effluent canisters. The purpose of the study was to compare the 2 systems in terms of (1) time to apply the dressing, (2) exudate levels, (3) amount of granulation tissue, (4) wound size reduction, (5) average cost of treatment, (6) visual analog scale (VAS) pain scores, and (7) complications. RESULTS The experimental low-cost system had a small but statistically insignificant advantage over the commercially available system in terms of application time, pain during dressing changes, and wound contraction percentage. The 2 systems were comparable in terms of the amount of exudate, granulation tissue coverage, and VAS scores during the course of treatment. No wound or periwound complications were observed. The systems were significantly different in terms of cost, with the AquaVac system being 7 times less expensive than the VAC ATS system ($63.75 compared with $491.38 USD). CONCLUSIONS The low-cost AquaVac system was shown to be comparable with the commercial VAC ATS system, suggesting that it is an effective and safe alternative method for NPWT in resource-challenged settings. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hansel Gould B Cocjin
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Jair Kimri P Jingco
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Franklin Delano C Tumaneng
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Jose Maria R Coruña
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
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30
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Melandri D, Marongiu F, Carboni A, Rubino C, Razzano S, Purpura V, Minghetti P, Bondioli E. A New Human-Derived Acellular Dermal Matrix for 1-Stage Coverage of Exposed Tendons in the Foot. INT J LOW EXTR WOUND 2019; 19:78-85. [DOI: 10.1177/1534734619884422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The closure of wounds associated with soft tissue defects is surgically challenging, frequently requiring extensive plastic surgery and free flaps. The combination of ADM and STSG is an innovative method used to cover such wounds. The human-derived ADMs (H-ADMs) are the most described in the literature but according to European legislations, Companies H-ADMs outside the EC are not allowed to commercialize them in Europe, H-ADMs being “human products” and not “medical devices”, so being ruled by European legislations on transplants. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of the first human cadaver-donor derived ADM from the Italian National Transplant Center and National Health Institute, we called with the Italian acronym M.O.D.A. (Matrice Omologa Dermica Acellulata). We present here the first use of a new H-ADM for treatment of distal lower extremity wounds with exposed tendons managed in one-stage pocedure with STSG. The excellent performance suggests that in cases where autologous tissue is unavailable or undesirable, the use of M.O.D.A. in one-stage procedure represents a promising alternative for covering wounds associated with tendons exposition.
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Pilot Study to Assess Safety and Usability of the Kyron NPWT System. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2334. [PMID: 31592014 PMCID: PMC6756643 DOI: 10.1097/gox.0000000000002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/03/2019] [Indexed: 12/02/2022]
Abstract
There is an evident need for Negative Pressure Wound Therapy (NPWT) systems specifically designed for use in resource-constrained settings to aid in the treatment of open wounds.
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32
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Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: Negative Pressure Wound Therapy. J Wound Care 2019; 26:S1-S154. [PMID: 28345371 DOI: 10.12968/jowc.2017.26.sup3.s1] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14 The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19 with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
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Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden
| | - Christian Willy
- Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden
| | - Marco Fraccalvieri
- Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy
| | - Astrid Probst
- Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany
| | - Peter Vowden
- Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
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Mohsin M, Zargar HR, Wani AH, Zaroo MI, Baba PUF, Bashir SA, Rasool A, Bijli AH. Role of customised negative-pressure wound therapy in the integration of split-thickness skin grafts: A randomised control study. Indian J Plast Surg 2019; 50:43-49. [PMID: 28615809 PMCID: PMC5469234 DOI: 10.4103/ijps.ijps_196_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Split-thickness skin grafting (STSG) is a time-tested technique in wound cover, but many factors lead to suboptimal graft take. Role of custom-made negative-pressure wound therapy (NPWT) is compared with conventional dress in the integration of STSG and its cost is compared with widely used commercially available NPWT. Materials and Methods: This is a parallel group randomised control study. Block randomisation of 100 patients into one of the two groups (NPWT vs. non-NPWT; 50 patients each) was done. Graft take/loss, length of hospital stay post-grafting, need for regrafting and cost of custom-made negative pressure wound therapy (NPWT) dressings as compared to widely used commercially available NPWT were assessed. Results: Mean graft take in the NPWT group was 99.74% ± 0.73% compared to 88.52% ± 9.47% in the non-NPWT group (P = 0.004). None of the patients in the NPWT group required second coverage procedure as opposed to six cases in the non-NPWT group (P = 0.035). All the patients in the NPWT group were discharged within 4–9 days from the day of grafting. No major complication was encountered with the use of custom-made NPWT. Custom-made NPWT dressings were found to be 22 times cheaper than the widely used commercially available NPWT. Conclusions: Custom-made NPWT is a safe, simple and effective technique in the integration of STSG as compared to the conventional dressings. We have been able to reduce the financial burden on the patients as well as the hospital significantly while achieving results at par with other studies which have used commercially available NPWT.
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Affiliation(s)
- Mir Mohsin
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Haroon Rashid Zargar
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Adil Hafeez Wani
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Mohammad Inam Zaroo
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | | | - Sheikh Adil Bashir
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Altaf Rasool
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Akram Hussain Bijli
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
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Collins J. Surgical intervention and customised dressings in an extremity wound caused by necrotising fasciitis: a case study. J Wound Care 2019; 28:S21-S27. [PMID: 31067168 DOI: 10.12968/jowc.2019.28.sup5.s21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Necrotising fasciitis can result in extensive loss of soft tissue and limb function. Therefore, surgical intervention requires a balance between extensive tissue removal and saving the limb. A 56-year-old male presented with necrotising fasciitis of the upper extremity. Debridement resulted in a full-thickness wound of the forearm and upper arm, an exposed olecranon and two proximally-based skin flaps. Reconstruction required multiple debridements to optimise the wound for skin grafting and to obtain flap adherence to underlying tissues of the upper arm. Conventional dressings over the flaps proved unsuccessful. Therefore, a customised versatile dressing to address each area of the wound was developed. Negative pressure wound therapy (NPWT) was applied over the exposed muscle (no exposed bone or tendon) of the lower arm and anterior upper arm; a hydropolymer foam dressing covered the elbow region. Closed incision negative pressure wound therapy (ciNPT) was applied over the incision on the posterior upper arm. Ultimately, complete wound closure was achieved, with normal/near-normal range of motion for all joints of the affected limb. There was complete take of skin grafts on the wrist, lower arm and anterior upper arm. ciNPT was effective in holding the incision together and promoting healing of the posterior upper arm, and the hydropolymer foam dressing aided with healing and coverage of the elbow region. In this case, healing of a large, complex upper extremity wound and restored limb function were achieved following use of a combination of surgical techniques and customisation of wound therapy modalities.
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Affiliation(s)
- Jessica Collins
- Plastic & Reconstructive Surgery, OasisMD Lifestyle Healthcare, San Diego, CA, US
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Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2019; 3:CD009261. [PMID: 30912582 PMCID: PMC6434581 DOI: 10.1002/14651858.cd009261.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). While existing evidence for the effectiveness of NPWT remains uncertain, new trials necessitated an updated review of the evidence for the effects of NPWT on postoperative wounds healing by primary closure. OBJECTIVES To assess the effects of negative pressure wound therapy for preventing surgical site infection in wounds healing through primary closure. SEARCH METHODS We searched the Cochrane Wounds Specialised Register, CENTRAL, Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus in February 2018. We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions on language, publication date, or setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another type of NPWT. DATA COLLECTION AND ANALYSIS Four review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to GRADE methodology. MAIN RESULTS In this second update we added 25 intervention trials, resulting in a total of 30 intervention trials (2957 participants), and two economic studies nested in trials. Surgeries included abdominal and colorectal (n = 5); caesarean section (n = 5); knee or hip arthroplasties (n = 5); groin surgery (n = 5); fractures (n = 5); laparotomy (n = 1); vascular surgery (n = 1); sternotomy (n = 1); breast reduction mammoplasty (n = 1); and mixed (n = 1). In three key domains four studies were at low risk of bias; six studies were at high risk of bias; and 20 studies were at unclear risk of bias. We judged the evidence to be of low or very low certainty for all outcomes, downgrading the level of the evidence on the basis of risk of bias and imprecision.Primary outcomesThree studies reported mortality (416 participants; follow-up 30 to 90 days or unspecified). It is uncertain whether NPWT has an impact on risk of death compared with standard dressings (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.25 to 1.56; very low-certainty evidence, downgraded once for serious risk of bias and twice for very serious imprecision).Twenty-five studies reported on SSI. The evidence from 23 studies (2533 participants; 2547 wounds; follow-up 30 days to 12 months or unspecified) showed that NPWT may reduce the rate of SSIs (RR 0.67, 95% CI 0.53 to 0.85; low-certainty evidence, downgraded twice for very serious risk of bias).Fourteen studies reported dehiscence. We combined results from 12 studies (1507 wounds; 1475 participants; follow-up 30 days to an average of 113 days or unspecified) that compared NPWT with standard dressings. It is uncertain whether NPWT reduces the risk of wound dehiscence compared with standard dressings (RR 0.80, 95% CI 0.55 to 1.18; very low-certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision).Secondary outcomesWe are uncertain whether NPWT increases or decreases reoperation rates when compared with a standard dressing (RR 1.09, 95% CI 0.73 to 1.63; 6 trials; 1021 participants; very low-certainty evidence, downgraded for very serious risk of bias and serious imprecision) or if there is any clinical benefit associated with NPWT for reducing wound-related readmission to hospital within 30 days (RR 0.86, 95% CI 0.47 to 1.57; 7 studies; 1271 participants; very low-certainty evidence, downgraded for very serious risk of bias and serious imprecision). It is also uncertain whether NPWT reduces incidence of seroma compared with standard dressings (RR 0.67, 95% CI 0.45 to 1.00; 6 studies; 568 participants; very low-certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision). It is uncertain if NPWT reduces or increases the risk of haematoma when compared with a standard dressing (RR 1.05, 95% CI 0.32 to 3.42; 6 trials; 831 participants; very low-certainty evidence, downgraded twice for very serious risk of bias and twice for very serious imprecision. It is uncertain if there is a higher risk of developing blisters when NPWT is compared with a standard dressing (RR 6.64, 95% CI 3.16 to 13.95; 6 studies; 597 participants; very low-certainty evidence, downgraded twice for very serious risk of bias and twice for very serious imprecision).Quality of life was not reported separately by group but was used in two economic evaluations to calculate quality-adjusted life years (QALYs). There was no clear difference in incremental QALYs for NPWT relative to standard dressing when results from the two trials were combined (mean difference 0.00, 95% CI -0.00 to 0.00; moderate-certainty evidence).One trial concluded that NPWT may be more cost-effective than standard care, estimating an incremental cost-effectiveness ratio (ICER) value of GBP 20.65 per QALY gained. A second cost-effectiveness study estimated that when compared with standard dressings NPWT was cost saving and improved QALYs. We rated the overall quality of the reports as very good; we did not grade the evidence beyond this as it was based on modelling assumptions. AUTHORS' CONCLUSIONS Despite the addition of 25 trials, results are consistent with our earlier review, with the evidence judged to be of low or very low certainty for all outcomes. Consequently, uncertainty remains about whether NPWT compared with a standard dressing reduces or increases the incidence of important outcomes such as mortality, dehiscence, seroma, or if it increases costs. Given the cost and widespread use of NPWT for SSI prophylaxis, there is an urgent need for larger, well-designed and well-conducted trials to evaluate the effects of newer NPWT products designed for use on clean, closed surgical incisions. Such trials should initially focus on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.
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Affiliation(s)
- Joan Webster
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
- The University of QueenslandSchool of Nursing and MidwiferyBrisbaneQueenslandAustralia
- Royal Brisbane and Women's HospitalNursing and Midwifery Research CentreButterfield StreetHerstonQueenslandAustralia4029
| | - Zhenmi Liu
- West China Hospital, Sichuan UniversityWest China School of Public HealthChengduSichuanChina610041
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Laura Chiverton
- St Mary's Hospital, Manchester University NHS Foundation TrustNeonatal Intensive Care UnitManchesterUK
| | | | - Monica Stankiewicz
- Haut Dermatology201 Wickham Terrace BrisbaneSpring HillBrisbaneQueenslandAustralia4000
| | - Wendy P Chaboyer
- Griffith UniversitySchool of Nursing and MidwiferyBrisbaneQueenslandAustralia
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Ker H, Al-Murrani A, Rolfe G, Martin R. WOUND Study: A Cost-Utility Analysis of Negative Pressure Wound Therapy After Split-Skin Grafting for Lower Limb Skin Cancer. J Surg Res 2019; 235:308-314. [DOI: 10.1016/j.jss.2018.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/01/2018] [Accepted: 10/08/2018] [Indexed: 11/16/2022]
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Frear CC, Griffin B, Cuttle L, McPhail SM, Kimble R. Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial. Trials 2019; 20:130. [PMID: 30760332 PMCID: PMC6374905 DOI: 10.1186/s13063-019-3223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone. METHODS/DESIGN A total of 104 children will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present to the participating children's hospital within 7 days of their injury with a thermal burn covering <5% of their total body surface area. Facial and trivial burns will be excluded. Following a randomised controlled parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™. The intervention arm will be treated with silver-impregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants' dressings will be changed every 3 to 5 days until their wounds are fully re-epithelialised. Time to re-epithelialisation will be studied as the primary outcome. Secondary outcomes will include pain, pruritus, wound progression, health-care-resource use (and costs), ease of management, treatment satisfaction and adverse events. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. DISCUSSION The study will be the first randomised controlled trial to explore the clinical effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618000256279 . Registered on 16 February 2018.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, Level 7, Children's Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia. .,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD, 4101, Australia. .,The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD, 4006, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Level 7, Children's Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia.,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD, 4101, Australia.,The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD, 4006, Australia
| | - Leila Cuttle
- Institute of Health and Biomedical Innovation, Centre for Children's Burns and Trauma Research, Lvl 8, Children's Health Research Centre, Queensland University of Technology, South Brisbane, QLD, 4101, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, QLD, 4102, Australia.,School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Level 7, Children's Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia.,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD, 4101, Australia.,The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD, 4006, Australia
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Kanapathy M, Mosahebi A. Comparative study on the donor site aesthetic outcome between epidermal graft and split-thickness skin graft. Int Wound J 2018; 16:354-359. [PMID: 30440106 DOI: 10.1111/iwj.13039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
Abstract
Donor site aesthetic outcomes of epidermal graft (EG) vs split-thickness skin graft (SSG) have yet to be objectively compared. Here, we evaluate donor site healing using a validated scar assessment tool and digital colorimetric technique, which compares colour in a consistent and objective manner. Ten patients (SSG (n = 5) and EG (n = 5)) were included. Donor site scarring was evaluated using the Vancouver Scar Scale (VSS) at Week 6 and Month 3. Colorimetric measurement was performed at Weeks 3 and 6 and Month 3. The mean donor site healing time for EG was significantly shorter (EG: 4.6 days (95% c.i. 3.8-5.3), SSG: 16.8 days (95% c.i. 13.3-20.1) (P = 0.003)). The VSS scores of the EG donor site were lower at Week 6 and Month 3(P < 0.001). The colour match between the donor site and surrounding skin for EG was better compared with SSG at all time points and was almost identical to their surrounding healthy skin at Month 3. This study is the first to objectively measure the clinical appearance of the EG donor site against SSG. EG donor site has faster healing with excellent scarring and good colour match with its surrounding normal skin at all time points compared with SSG.
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Affiliation(s)
- Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
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Zeng R, Lin C, Lin Z, Chen H, Lu W, Lin C, Li H. Approaches to cutaneous wound healing: basics and future directions. Cell Tissue Res 2018; 374:217-232. [PMID: 29637308 DOI: 10.1007/s00441-018-2830-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/09/2018] [Indexed: 02/05/2023]
Abstract
The skin provides essential functions, such as thermoregulation, hydration, excretion and synthesis of vitamin D. Major disruptions of the skin cause impairment of critical functions, resulting in high morbidity and death, or leave one with life-changing cosmetic damage. Due to the complexity of the skin, diverse approaches are needed, including both traditional and advanced, to improve cutaneous wound healing. Cutaneous wounds undergo four phases of healing. Traditional management, including skin grafts and wound dressings, is still commonly used in current practice but in combination with newer technology, such as using engineered skin substitutes in skin grafts or combining traditional cotton gauze with anti-bacterial nanoparticles. Various upcoming methods, such as vacuum-assisted wound closure, engineered skin substitutes, stem cell therapy, growth factors and cytokine therapy, have emerged in recent years and are being used to assist wound healing, or even to replace traditional methods. However, many of these methods still lack assessment by large-scale studies and/or extensive application. Conceptual changes, for example, precision medicine and the rapid advancement of science and technology, such as RNA interference and 3D printing, offer tremendous potential. In this review, we focus on the basics of wound treatment and summarize recent developments involving both traditional and hi-tech therapeutic methods that lead to both rapid healing and better cosmetic results. Future studies should explore a more cost-effective, convenient and efficient approach to cutaneous wound healing. Graphical abstract Combination of various materials to create advanced wound dressings.
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Affiliation(s)
- Ruijie Zeng
- Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China
| | - Chuangqiang Lin
- Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China
| | - Zehuo Lin
- Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China
| | - Hong Chen
- Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China
| | - Weiye Lu
- Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China
| | - Changmin Lin
- Department of Histology and Embryology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China.
| | - Haihong Li
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Shantou University Medical College, North Dongxia Road, Shantou, 515041, Guangdong Province, China.
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40
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Toyoshima Y, Maeda T, Kijima T, Namiki O, Nemoto T, Inagaki K. Therapeutic failure and eventual solution for skin necrosis and exposed tendon of the dorsum of the foot: A case report. Clin Case Rep 2018; 6:1600-1603. [PMID: 30147913 PMCID: PMC6099008 DOI: 10.1002/ccr3.1697] [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: 04/19/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
For the treatment of skin necrosis with exposed tendons in rheumatoid arthritis (RA) foot, we should perform microvascular free flap surgery at an early stage without conservative treatment considering the increased risk of infection and the decreased physical activity.
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Affiliation(s)
- Yoichi Toyoshima
- Department of Orthopaedic SurgeryShowa University School of MedicineShinagawa‐ku, TokyoJapan
| | - Toshio Maeda
- Department of Orthopaedic SurgeryShowa University School of MedicineShinagawa‐ku, TokyoJapan
| | - Takeshi Kijima
- Department of Orthopaedic SurgeryShowa University School of MedicineShinagawa‐ku, TokyoJapan
| | - Osamu Namiki
- Department of Orthopaedic SurgeryShowa University School of MedicineShinagawa‐ku, TokyoJapan
| | - Tetsuya Nemoto
- Department of Orthopaedic SurgeryShowa University School of MedicineShinagawa‐ku, TokyoJapan
| | - Katsunori Inagaki
- Department of Orthopaedic SurgeryShowa University School of MedicineShinagawa‐ku, TokyoJapan
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Tanaydin V, Beugels J, Andriessen A, Sawor JH, van der Hulst RRWJ. Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality. Aesthetic Plast Surg 2018; 42:927-935. [PMID: 29442143 PMCID: PMC6097780 DOI: 10.1007/s00266-018-1095-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast. METHODS The primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips. The secondary outcome was aesthetic appearance and quality of scarring using questionnaires [visual analogue scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS)] scored at day 42-, 90-, 180- and 365-day follow-up using additional scar measurement modalities, such as viscoelasticity. RESULTS For the 32 included patients, the number of wound complications was significantly lower (p < 0.004) for the NPWT treated sites compared to fixation strips. POSAS and VAS scores at 42 and 90 days revealed a significantly better quality of scarring in the NPWT treatment breasts than in fixation strips. At 180-day follow-up, there was a significant improvement in total VAS scores, as well as a comparable improvement in POSAS scores. No consistent significant improvement in scar quality was demonstrated with the assays that were used. CONCLUSIONS Our study showed less complications and a significant improvement in quality of scarring in favor of the NPWT-treated sites. The results indicate NPWT to be an attractive option for these patients. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- V Tanaydin
- Maastricht University Medical Center, Maastricht, The Netherlands.
| | - J Beugels
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Andriessen
- Andriessen Consultants, Malden, The Netherlands
- UMC St Radboud Nijmegen, Nijmegen, The Netherlands
| | - J H Sawor
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
| | - R R W J van der Hulst
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
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42
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Nakamura Y, Fujisawa Y, Ishitsuka Y, Tanaka R, Maruyama H, Okiyama N, Watanabe R, Fujimoto M. Negative-pressure closure was superior to tie-over technique for stabilization of split-thickness skin graft in large or muscle-exposing defects: A retrospective study. J Dermatol 2018; 45:1207-1210. [DOI: 10.1111/1346-8138.14536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yosuke Ishitsuka
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Ryota Tanaka
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Hiroshi Maruyama
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Naoko Okiyama
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Rei Watanabe
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Manabu Fujimoto
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
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Abstract
OPINION STATEMENT Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.
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Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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44
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Hollén L, Greenwood R, Kandiyali R, Ingram J, Foy C, George S, Mulligan S, Spickett-Jones F, Booth S, Sack A, Emond A, Dunn K, Young A. The SILKIE (Skin graftIng Low friKtIon Environment) study: a non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns. BMJ Open 2018; 8:e021886. [PMID: 29903799 PMCID: PMC6009614 DOI: 10.1136/bmjopen-2018-021886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. DESIGN Proof of concept before and after study with feasibility of delivering the intervention. SETTING Three burns services within two UK hospital trusts. PARTICIPANTS Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. INTERVENTION Introduction of LF sheets and pillowcases during a 15-month period. OUTCOME MEASURES For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. RESULTS 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was £-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. CONCLUSIONS LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified. TRIAL REGISTRATION NUMBER ISRCTN82599687.
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Affiliation(s)
- Linda Hollén
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosemary Greenwood
- Department of Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rebecca Kandiyali
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny Ingram
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Foy
- Gloucestershire Research Support Service, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Susan George
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sandra Mulligan
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Francesca Spickett-Jones
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Simon Booth
- McIndoe Burn Centre, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Anthony Sack
- Adult Burns Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alan Emond
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ken Dunn
- Department of Burns and Plastic surgery, The Manchester University NHS Foundation Trust, Manchester, UK
| | - Amber Young
- The Scar Free Foundation Centre for Children’s Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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45
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Abstract
Wound complications and surgical site infections after orthopaedic procedures result in substantial morbidity and costs. Traditional postoperative wound care consists of applying sterile, dry gauze and abdominal pads to the surgical site, with more frequent dressing changes performed in cases in which wound drainage is excessive. Persistent incisional drainage is of particular concern because it increases the risk of deep infection. The use of closed incision negative-pressure wound therapy (ciNPWT) to manage delayed wound healing was first reported a decade ago, and the benefits of this treatment modality include wound contraction with diminished tensile forces, stabilization of the wound environment, decreased edema and improved removal of exudate, and increased blood and lymphatic flow. Numerous trauma, plastic surgery, and general surgery studies have demonstrated that ciNPWT improves wound healing. In orthopaedic surgery, ciNPWT has been shown to be clinically effective for incisions at high risk for perioperative complications. However, specific indications for ciNPWT continue to be defined.
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46
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Kazemikhoo N, Vaghardoost R, Dahmardehei M, Mokmeli S, Momeni M, Nilforoushzadeh MA, Ansari F, Razagi MR, Razagi Z, Amirkhani MA, Masjedi MR. Evaluation of the Effects of Low Level Laser Therapy on the Healing Process After Skin Graft Surgery in Burned Patients (A Randomized Clinical Trial). J Lasers Med Sci 2018; 9:139-143. [PMID: 30026900 PMCID: PMC6046389 DOI: 10.15171/jlms.2018.26] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: Skin graft is the standard therapeutic technique in patients with deep ulcers, but like every surgical procedure, it may present some complications. Although several modern dressings are available to enhance comfort of donor site, the use of techniques that accelerate wound healing may enhance patient's satisfaction. Low level laser therapy (LLLT) has been used in several medical fields, especially for wound healing, but it may take several months for large ulcers treated with laser to heal completely. Methods: Nine patients with bilateral similar grade 3 burn ulcers in both hands or both feet were selected as candidates for split-thickness skin graft (STSG). One side was selected for laser irradiation and the other side as control, randomly. Laser was irradiated every day for 7 days with red 655 nm light, 150 mW, 2 J/cm2 at the bed of the ulcer and with infra-red 808 nm light, 200 mW for the margins. Results: The rate of wound dehiscence after skin graft surgery was significantly lower in laser treated group in comparison to control group which received only classic dressing (P=0.019). Conclusion: The results showed LLLT to be a safe effective method which improves graft survival and wound healing process and decreases the rate of wound dehiscence in patients with deep burn ulcers.
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Affiliation(s)
| | - Reza Vaghardoost
- Burn Research Center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Burn Research Center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahnoush Momeni
- Burn Research Center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fereshteh Ansari
- Skin Diseases and Leshmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Razagi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Razagi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Masjedi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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47
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Yin Y, Zhang R, Li S, Guo J, Hou Z, Zhang Y. Negative-pressure therapy versus conventional therapy on split-thickness skin graft: A systematic review and meta-analysis. Int J Surg 2018; 50:43-48. [DOI: 10.1016/j.ijsu.2017.12.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/04/2017] [Accepted: 12/20/2017] [Indexed: 11/26/2022]
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48
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Stapling technique through transparent dressing to fix skin grafts. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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49
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Negative pressure wound therapy in modern orthopaedic practice. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Meyer-Lindenberg A, Nolff MC. Vakuumassistierte Wundbehandlung (Negative Pressure Wound Therapy, NPWT) in der Kleintiermedizin. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2017; 44:26-37; quiz 38. [DOI: 10.15654/tpk-150957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/13/2016] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDie Behandlung offener Wunden gehört zu den alltäglichen Herausforderungen in der Tiermedizin. In den letzten Jahren hat sich mit der vakuumassistierten Wundbehandlung (Negative Pressure Wound Therapy, NPWT) eine neue Therapieform entwickelt. Durch ihren Einsatz lassen sich die Heilung offener Wunden und die Einheilungsrate freier Hauttransplantate beim Kleintier signifikant verbessern. In diesem Überblick werden Wirkweise, Indikationen sowie Komplikationen der Negative Pressure Wound Therapy dargestellt.
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