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Katoumas K, Mitsopoulos G. Vacuum-assisted closure of a tissue deficit of the submental area in a patient with a necrotizing soft tissue odontogenic infection. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e119-e124. [PMID: 38155007 DOI: 10.1016/j.oooo.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 12/30/2023]
Abstract
Odontogenic infections can rarely progress to necrotizing soft tissue infections. Cervical necrotizing fasciitis (CNF) is a rare but fulminant infection that spreads along the fascial planes, including connective tissue, muscle, and subcutaneous fat, and is typified by necrosis of the skin and other adjacent tissues. This article aims to present the treatment of a patient with submental skin and soft tissue necrosis due to an odontogenic infection and the subsequent management of the tissue deficit with a vacuum-assisted closure (VAC) system. The patient presented with extensive skin necrosis in the submental area and was immediately hospitalized, and management of the odontogenic infection was performed. When the patients' infection had been sufficiently controlled, a wound VAC device was placed in the deficit. The VAC device was removed after 12 days, and the patient was discharged. In conclusion, VAC can be used to manage tissue deficits with good aesthetic results.
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Affiliation(s)
- Konstantinos Katoumas
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "Evaggelismos" and Dental School of the National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgios Mitsopoulos
- Department of Oral & Maxillofacial Surgery, 401 General Military Hospital of Athens, Athens, Greece
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2
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Werenski JO, Gonzalez MR, Fourman MS, Hung YP, Lozano-Calderón SA. Does Wound VAC Temporization Offer Patient-Reported Outcomes Similar to Single-Stage Excision Reconstruction After Myxofibrosarcoma Resection? Ann Surg Oncol 2024; 31:2757-2765. [PMID: 38197999 DOI: 10.1245/s10434-023-14839-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Vacuum-assisted closure (VAC) temporization is a promising technique to achieve local control in aggressive soft tissue sarcomas. Despite its previously reported efficacy, adoption of VAC temporization remains limited, primarily due to the scarce literature on patient-reported outcomes (PROs) supporting its efficacy. This study compared the postoperative PROs after VAC temporization or single-stage (SS) excision and reconstruction for patients undergoing surgical resection for myxofibrosarcoma management. METHODS A retrospective analysis of myxofibrosarcoma patients who underwent surgical resections at our institution from 2016 to 2022 was performed. Postoperative PROs collected prospectively for those treated with VAC temporization or SS excision/reconstruction were compared using a visual analog scale (VAS) for pain and three Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires: Global Health Short-Form Mental (SF Mental), Global Health Short-Form Physical (SF Physical), and Physical Function Short-Form 10a (SF 10a). Absolute and differential (postoperative minus preoperative) scores at the 1-month, 3-month, 6-month, 1-year, and 2-year time points were compared. RESULTS The analysis included 79 patients (47 treated with VAC temporization and 32 treated with SS excision/reconstruction). All outcomes were similar between the groups except for physical function 1 year after surgery, in which the differential PROMIS SF 10a scores were higher in the SS group (p = 0.001). All the remaining absolute and differential PROMIS and VAS pain scores were similar between the groups at all time points. Postoperative complications did not differ between the groups. CONCLUSION The PROs for physical and mental health, physical function, and pain were similar between the myxofibrosarcoma patients who had VAC temporization and those who had SS excision/reconstruction after surgical resection.
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Affiliation(s)
- Joseph O Werenski
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcos R Gonzalez
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell S Fourman
- Department of Orthopaedic Surgery, Montefiore-Einstein, New York, NY, USA
| | - Yin P Hung
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderón
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3
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The Application of Double-Layer-Vacuum-Assisted Closure Therapy With Flap Repair of Soft Tissue Defects Near the Eyes or EarDL-VAC Therapy. J Craniofac Surg 2023:00001665-990000000-00564. [PMID: 36843113 DOI: 10.1097/scs.0000000000009222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/21/2022] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE We aimed to introduce and evaluate the safety of double-layer-vacuum-assisted closure (DL-VAC) therapy with flap repair of the wound near the eyes or ears. METHODS This study is case reports of 2 patients who underwent DL-VAC therapy for tissue defects near the eyes or ears. The detailed process of the DL-VAC therapy is carefully described in this study. The postoperative wound healing process was closely observed. The biggest concern was the treatment outcome of DL-VAC therapy on the eyes and ears. RESULTS Two patients underwent DL-VAC therapy due to their soft tissue defects close to the eyes or ears. Both patients achieved primary wound healing and the flaps survived during the follow-up period, which ranged from 1 to 24 months. Patients did not receive any dressing change until the VAC device was removed on the 5th to 7th postoperative day. No severe complications appeared and the patients were satisfied with both appearance and function. CONCLUSIONS Double-layer-vacuum-assisted closure therapy is an effective and safe option for the treatment of wounds near the eyes and ears.
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Farré R, Rodríguez-Lázaro MA, Gonzalez-Martin J, Castro P, Hospital T, Compta Y, Solana G, Gozal D, Otero J. Device for Negative Pressure Wound Therapy in Low-Resource Regions: Open-Source Description and Bench Test Evaluation. J Clin Med 2022; 11:jcm11185417. [PMID: 36143070 PMCID: PMC9503864 DOI: 10.3390/jcm11185417] [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: 08/15/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Negative (vacuum) pressure therapy promotes wound healing. However, commercially available devices are unaffordable to most potential users in low- and middle-income countries (LMICs), limiting access to many patients who could benefit from this treatment. This study aimed to design and test a cheap and easy-to-build negative pressure device and provide its detailed open-source description, thereby enabling free replication. Methods: the negative pressure device was built using off-the-shelf materials available via e-commerce and was based on a small pump, a pressure transducer, and the simplest Arduino controller with a digital display (total retail cost ≤ 75 US$). The device allows the user to set any therapeutic range of intermittent negative pressure and has two independent safety mechanisms. The performance of the low-cost device was carefully tested on the bench using a phantom wound, producing a realistic exudate flow rate. Results: the device generates the pressure patterns set by the user (25–175 mmHg of vacuum pressure, 0–60 min periods) and can drain exudate flows within the clinical range (up to 1 L/h). Conclusions: a novel, low-cost, easy-to-build negative pressure device for wound healing displays excellent technical performance. The open-source hardware description provided here, which allows for free replication and use in LMICs, will facilitate the application and wider utilization of this therapy to patients.
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Affiliation(s)
- Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain
- Institut Investigacions Biomèdiques August Pi Sunyer, 08036 Barcelona, Spain
- Correspondence:
| | - Miguel A. Rodríguez-Lázaro
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Julian Gonzalez-Martin
- Microbiology Department-CDB, Hospital Clinic-ISGlobal-University of Barcelona, 08036 Barcelona, Spain
- CIBER of Infectiuos Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Castro
- Institut Investigacions Biomèdiques August Pi Sunyer, 08036 Barcelona, Spain
- Intensive Care Unit, Internal Medicine Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Teresa Hospital
- Intensive Care Unit, Internal Medicine Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Yaroslau Compta
- Institut Investigacions Biomèdiques August Pi Sunyer, 08036 Barcelona, Spain
- Institut de Neurociències, Service of Neurology, Parkinson’s Disease and Movement Disorders Unit, Hospital Clinic de Barcelona, 08036 Barcelona, Spain
- Institut de Neurociències, Maeztu Center, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Gorka Solana
- Faculdade de Engenharias e Tecnologias, Universidade Save, Maxixe, Mozambique
| | - David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Jorge Otero
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain
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Bilateral Inferiorly Based Labia Majora Flaps: A Simple Technique for Post Episiotomy Dehiscence Coverage. World J Plast Surg 2022; 11:78-83. [PMID: 36694685 PMCID: PMC9840771 DOI: 10.52547/wjps.11.3.78] [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: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 12/23/2022] Open
Abstract
Episiotomy dehiscence because of infection is a cause of major physical, psychological and social problems. Management depends on the degree of injury. The loco-regional flap can be considered in recurrent dehiscence with loss of tissue. We report a case of a 26-year-old female who presented with a post episiotomy wound in the perineal region extending from the posterior fourchette to the anal opening. She gave the history of resuturing of dehiscence twice but the result was the same. On examination, there was a loss of skin and subcutaneous tissue between vaginal and anal opening with pouting of the anal and vaginal mucosa. Per rectal examination, the anal tone was normal. Her wound was covered with bilateral inferiorly based labia majora flaps with a good outcome. So, an inferiorly based labia majora flap can be a useful option in coverage of recurrent perineal dehiscence.
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6
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Abeje BA, Bekele T, Getahun KA, Asrie AB. Evaluation of Wound Healing Activity of 80% Hydromethanolic Crude Extract and Solvent Fractions of the Leaves of Urtica simensis in Mice. J Exp Pharmacol 2022; 14:221-241. [PMID: 35875331 PMCID: PMC9304411 DOI: 10.2147/jep.s363676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Leaves of Urtica simensis (U. simensis) have been used traditionally for wound healing in different communities in Ethiopia. In spite of this, there were no scientific data documented regarding the wound healing activity of this plant. There is a need to investigate herbal remedies for the treatment of wounds in order to overcome the limitations of conventional drugs. Aim of the Study Aim of the study was to evaluate the wound healing activity of extract and solvent fractions of the leaves of U. simensis in mice. Methods Leaves of U. simensis were washed, dried under shade and ground into coarse powder and then extracted by 80% methanol with three consecutive macerations. Part of the extract was fractionated with n-hexane, chloroform and water. In excision and burn wounds, healing progress was measured by wound contraction, epithelialization period and histopathology investigation whereas incision wound healing was assessed by skin breaking strength. Results In excision wound model, the 5% and 10% crude extract ointments showed significant (p < 0.001) wound contractions during day 8 to day 16 evaluations. Similarly, in burn wound model, both 5% and 10% crude extract ointments produced significant (p < 0.001) wound contractions starting from day 12 and 10, respectively. In both models, the periods of epithelialization were also significantly reduced and favorable histopathologic changes were produced by the crude extract ointments. The solvent fractions of the crude extract as well produced significant wound contractions as evaluated in excision wound model. The fractions also significantly reduced the period of epithelialization in this model. The aqueous fraction found to be more active than either chloroform or n-hexane fraction in wound healing. Conclusion Results of this study indicated that methanol extract and aqueous fractions of the leaves of U. simensis possess dose-dependent wound healing activity, thus supporting traditional claims.
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Affiliation(s)
- Bezawit Alem Abeje
- Department of Pharmacology, School of Pharmacy, Jimma University, Jimma, Ethiopia
| | - Tiruzer Bekele
- Department of Pathology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Assefa Belay Asrie
- Department of Pharmacology, School of Pharmacy, University of Gondar, Gondar, Ethiopia
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Meng Z, Wang Y, Chao J, Ji Y, Sun Y, Zhu J, Gao T, Chen S, Wang S. Extensive necrotizing fasciitis of scrotum and abdominal wall: Report of two cases and a review of the literature. Front Surg 2022; 9:952042. [PMID: 35928030 PMCID: PMC9343677 DOI: 10.3389/fsurg.2022.952042] [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: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
The incidence rate of necrotizing fasciitis(NF) is low, but it has a high mortality rate. At present, it lacks experience in clinical treatment in municipal and county-level hospitals, insufficient awareness of disease risk, lack of experience in disease surgical intervention, and lack of a set of mature treatment norms and standards. Most patients have no time to transfer to a higher hospital for treatment. In January and April 2022, two cases of large-scale necrotizing fasciitis of the scrotum and abdominal wall were treated in the Department of Urology of Weifang people's Hospital respectively and were clinically cured after active surgical debridement combined with broad-spectrum antibiotics. Through the retrospective analysis of the diagnosis and treatment of two cases of necrotizing fasciitis, this paper analyzes and summarizes the scope of surgical debridement of NF, postoperative dressing changing skills, timing of multiple debridements, application and timing of vacuum sealing drainage(VSD), and the combined use of antibiotics. To provide experience for clinical diagnosis and treatment of necrotizing fasciitis.
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Affiliation(s)
- Zhe Meng
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Yanchen Wang
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Jun Chao
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Yongjian Ji
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Yaofei Sun
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Jiang Zhu
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Tongbin Gao
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Si Chen
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
| | - Shenyang Wang
- Yuhe Campus of Weifang Medical College, Weifang, China
- Department of Urology, Weifang people’s Hospital, Weifang, China
- Correspondence: Wang Shenyang
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Malinaric R, Mantica G, Balzarini F, Terrone C, Maffezzini M. Extraperitoneal cystectomy with ureterocutaneostomy derivation in fragile patients - should it be performed more often? Arch Ital Urol Androl 2022; 94:144-149. [PMID: 35775336 DOI: 10.4081/aiua.2022.2.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/16/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) continues to be standard of care for muscle-invasive bladder cancer and recurrent or refractory nonmuscle invasive bladder cancer. Unfortunately, it has high rates of perioperative morbidity and mortality. One of the most important predictors of postoperative outcomes is frailty, while the majority of complications are diversion related. The aim of our study was to evaluate safety of extraperitoneal cystectomy with ureterocutaneostomy in patients considered as frail. MATERIALS AND METHODS We retrospectively collected data of frail patients who underwent extraperitoneal cystectomy with ureterocutaneostomy from October 2018 to August 2020 in a single center. We evaluated frailty by assessing patients' age, body mass index (BMI), nutritional status by Malnutrition Universal Screening Tool, overall health by RAI (Risk Analysis Index) and ASA (American Society of Anaesthesiologists) score, and laboratory analyses. We observed intraoperative outcomes and rates of perioperative (within 30 days) and early postoperative (within 90 days) complications (Clavien-Dindo classification). We defined extraperitoneal cystectomy with ureterocutaneostomy as safe if patients did not develop Clavien Dindo IIIb, or worse, complication. RESULTS A total of 34 patients, 3 female and 31 male, were analyzed. The median age was 77, BMI 26, RAI 28, ASA 3 and the majority had preexisting renal insufficiency. Blood analyses revealed presence of severe preoperative hypoalbuminemia and anemia in half of our cohort. Intraoperative median blood loss was 250 cc, whilst operative time 245 min. During perioperative period 60% of our cohort developed Clavien Dindo II complication and during early postoperative period 32% of patients required readmission. One death occurred during early postoperative period (2.9%). After 12 months of follow-up, we observed stability of the renal function for most patients. CONCLUSIONS We believe that extraperitoneal cystectomy with ureterocutaneostomy could be considered as a treatment option for elderly and/or frail patients.
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Affiliation(s)
- Rafaela Malinaric
- Department of Urology, San Martino Hospital, University of Genoa, Genoa.
| | - Guglielmo Mantica
- Department of Urology, San Martino Hospital, University of Genoa, Genoa.
| | - Federica Balzarini
- Department of Urology, San Martino Hospital, University of Genoa, Genoa.
| | - Carlo Terrone
- Department of Urology, San Martino Hospital, University of Genoa, Genoa.
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Skin Preservation in the Debridement of Necrotizing Fasciitis: A Demonstrative Case Report. Plast Reconstr Surg Glob Open 2022; 10:e4227. [PMID: 35402126 PMCID: PMC8987216 DOI: 10.1097/gox.0000000000004227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
Necrotizing fasciitis (NF) is a rare yet potentially fatal soft-tissue, polymicrobial infection. Aggressive debridement of the fascia and overlying skin as well as antimicrobial coverage constitute the mainstay of management, often leaving large skin defects. However, we demonstrate in this paper a case of a young woman who developed NF after liposuction and was treated by fascial debridement with minimal skin excision. Skin preservation will reduce the morbidity and improve the final aesthetic outcome.
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Study on the Application of PRP Enriched with Hyaluronic Acid to Skin Wounds-Macroscopic Result. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:44-50. [PMID: 35911941 PMCID: PMC9289591 DOI: 10.12865/chsj.48.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
Tissue healing is a complex process of replacing damaged tissue structures, being a dynamic process with spatial and temporal involvement. In practice, there are three types of healing: primary, secondary and tertiary. Since even tertiary healing can cause different problems depending on the individual patient, the medical world has always strived for new, easier, more effective, faster, and low cost-effective methods to cover skin wounds. This experiment aims to find a method that is as efficient and fast as possible, with minimal costs, of native healing of skin wounds and the development of a protocol that is as reliable and safe as possible for the patient. The experiment was carried out within the animal facility of the University of Medicine and Pharmacy of Craiova, with the agreement of our institutional Ethics Committee. The experimental group consisted of 30 individuals (Wistar laboratory rats), clinically healthy, male and female, being divided into 3 sublots of 10 individuals each. Each sublot was sacrificed at different time intervals: 7, 14 and 21 days, respectively. The local evolution of each individual was monitored during the experimental days, as well as their general state of health. Before slaughter, the lesions were examined macroscopically, following their size, whether or not the infection was present and the presence of other self-inflicted lesions later. Macroscopically, a faster wound healing was found where PRP enriched with hyaluronic acid was applied from the 7th day, so we can say that at first glance the "free" healing period in the case of enhanced epithelialization was about 7 days shorten. This fact will be confirmed or refuted following histopathological examinations and immunohistochemistry.
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White AJ, Fiani B, Jarrah R, Momin AA, Rasouli J. Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery. Asian Spine J 2021; 16:451-461. [PMID: 34167274 PMCID: PMC9260408 DOI: 10.31616/asj.2020.0674] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
Surgical site infection (SSI) is a potentially devastating complication of spinal surgery that increases patient morbidity and healthcare costs. SSIs have complex and multifactorial etiologies; therefore, there are numerous opportunities for prevention and risk mitigation. The aim of this narrative review was to describe the incidence, risk factors, and outcomes of SSIs in spine surgery with an emphasis on postoperative wound care. We list and describe the preoperative, intraoperative, and postoperative evidence-based interventions that can be applied to potentially prevent SSI after spinal surgery.
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Affiliation(s)
- Alexandra J White
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Ryan Jarrah
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Arbaz A Momin
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan Rasouli
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
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12
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Sarkar S, Agrawal R, Barai B, De U. Vacuum-Assisted Closure (VAC) of Postoperative Pancreatic Fistula (POPF) Following Whipple’s Procedure. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Duan H, He Y, Zhang H, Wang F, Chen S, Wang J. Vacuum sealing drainage with instillation in the treatment of necrotising soft-tissue infection: a retrospective analysis. J Wound Care 2020; 29:510-517. [PMID: 32924816 DOI: 10.12968/jowc.2020.29.9.510] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Necrotising soft-tissue infection is a rare but life-threatening infectious disease with high morbidity and mortality. It is typically caused by toxin-producing bacteria and characterised clinically by a very rapid progression of the disease with significant local tissue destruction. In this study, we intend to explore effective wound management to control the invasive infection and to decrease the high mortality. Method: This retrospective analysis explored the wound management and mortality in patients with necrotising soft-tissue infection. Extensive debridement, vacuum sealing drainage (VSD) with normal saline instillation combined with broad-spectrum or sensitive antibiotics, and supportive therapies were used. Results: All 17 patients included in the analysis survived. The microbiology of 11 patients was found to be polymicrobial. Of the patients, 14 were discharged with completely healed wounds and three were transferred to a local hospital after the systemic and invasive wound infection was controlled. Conclusion: Our experiences revealed the outstanding effect of VSD with instillation in removing the debris of necrotising tissue on the wound bed, in the continual and complete drainage of wound exudates, and in prompting wound healing.
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Affiliation(s)
- Hongjie Duan
- Department of Burns and Traumatic Surgery, Hainan Branch of the PLA General Hospital, Sanya, China (572013)
| | - Yanqi He
- Department of Burns and Traumatic Surgery, Hainan Branch of the PLA General Hospital, Sanya, China (572013)
| | - Hengbo Zhang
- Department of Burns and Traumatic Surgery, Hainan Branch of the PLA General Hospital, Sanya, China (572013)
| | - Fang Wang
- Department of Burns and Traumatic Surgery, Hainan Branch of the PLA General Hospital, Sanya, China (572013)
| | - Shuai Chen
- Department of Burns and Traumatic Surgery, Hainan Branch of the PLA General Hospital, Sanya, China (572013)
| | - Jue Wang
- Department of Burns and Traumatic Surgery, Hainan Branch of the PLA General Hospital, Sanya, China (572013)
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14
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Vellingiri K, S NJ, Hongaiah D. Negative Pressure Wound Therapy With Flap Reconstruction for Extensive Soft Tissue Loss in the Foot: A Case Report. Cureus 2020; 12:e10116. [PMID: 33005533 PMCID: PMC7523747 DOI: 10.7759/cureus.10116] [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] [Indexed: 11/13/2022] Open
Abstract
Negative pressure wound therapy (NPWT) can create the healing granulation tissue that will form a wound bed for the skin graft, thereby reducing the volume of the soft tissue defect. The application of uniform negative pressure, which is delivered by vacuum-assisted closure (VAC) therapy, induces a physical response (macrostrain) and a biological response (microstrain). The patient in the current case report presented with an alleged history of a road traffic accident, sustaining a crush injury to his right heel pad, resulting in an open comminuted fracture of the right calcaneum with bone loss. A total of seven days of NPWT was allowed. Negative pressure sponge dressing was then applied in this region and adhesive drapes were sealed. Once sealed, suction was set at the continuous pressure of -125 mm Hg. The authors noted that the benefits significantly outweigh the costs of the VAC system, making it an essential treatment option for patients similar to the one presented in this case report.
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Affiliation(s)
- Kishore Vellingiri
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Nagakumar J S
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Deepak Hongaiah
- Plastic Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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15
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Katzengold R, Orlov A, Gefen A. A novel system for dynamic stretching of cell cultures reveals the mechanobiology for delivering better negative pressure wound therapy. Biomech Model Mechanobiol 2020; 20:193-204. [PMID: 32803464 DOI: 10.1007/s10237-020-01377-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
Serious wounds, both chronic and acute (e.g., surgical), are among the most common, expensive and difficult-to-treat health problems. Negative pressure wound therapy (NPWT) is considered a mainstream procedure for treating both wound types. Soft tissue deformation stimuli are the crux of NPWT, enhancing cell proliferation and migration from peri-wound tissues which contributes to healing. We developed a dynamic stretching device (DSD) contained in a miniature incubator for applying controlled deformations to fibroblast wound assays. Prior to the stretching experiments, fibroblasts were seeded in 6-well culture plates with elastic substrata and let to reach confluency. Squashing damage was then induced at the culture centers, and the DSD was activated to deliver stretching regimes that represented common clinical NPWT protocols at two peak strain levels, 0.5% and 3%. Analyses of the normalized maximal migration rate (MMR) data for the collective cell movement revealed that for the 3% strain level, the normalized MMR of cultures subjected to a 0.1 Hz stretch frequency regime was ~ 1.4 times and statistically significantly greater (p < 0.05) than that of the cultures subjected to no-stretch (control) or to static stretch (2nd control). Correspondingly, analysis of the time to gap closure data indicated that the closure time of the wound assays subjected to the 0.1 Hz regime was ~ 30% shorter than that of the cultures subjected to the control regimes (p < 0.05). Other simulated NPWT protocols did not emerge as superior to the controls. The present method and system are a powerful platform for further revealing the mechanobiology of NPWT and for improving this technology.
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Affiliation(s)
- Rona Katzengold
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Alexey Orlov
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, 6997801, Tel Aviv, Israel.
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Larsen BG, McLean JB, Brzostowski JT, Carter R, Allyn KJ, Hafner BJ, Garbini JL, Sanders JE. Does actively enlarging socket volume during resting facilitate residual limb fluid volume recovery in trans-tibial prosthesis users? Clin Biomech (Bristol, Avon) 2020; 78:105001. [PMID: 32619870 DOI: 10.1016/j.clinbiomech.2020.105001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Residual limb volume loss is a source of prosthetic socket fit problems in people with lower-limb amputation. The aim of this study was to investigate a novel volume recovery strategy for people with trans-tibial amputation. METHODS Test sockets for people with trans-tibial amputation were created that allowed panels of an adjustable socket and the underlying elastomeric liner to be pulled radially outward, using small motors mounted to the socket. One Control and one Intervention session were conducted with each participant. During Intervention sessions, panel-pull was executed during the sits of a multi-cycle sit/walk protocol. No panel-pull was executed during the Control sessions. Residual limb fluid volume was monitored in anterior and posterior regions using bioimpedance analysis. FINDINGS Results from 12 participants demonstrated that short-term (12 min after the intervention was applied) median posterior residual limb fluid volume change for Intervention (0.44%) was higher than that for Control (-0.02%) (P = .015). Long-term (40 min after the intervention was applied) median posterior residual limb fluid volume change for Intervention (0.95%) was higher than that for Control (-0.26%) (P = .002). INTERPRETATION If a panel-pull mechanism that was easy to assemble and operate could be created, then panel-pull may be an effective accommodation strategy to reduce daily limb volume loss in trans-tibial prosthesis users.
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Affiliation(s)
- Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Ryan Carter
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
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Patro BP, Khuntia S, Sahu NK, Das G, Patra SK. Negative Pressure Wound Therapy Assisted Closure: An Effective Mode of Management for Infected and Contaminated Wound With Non-Union Fracture Femur. Cureus 2020; 12:e9037. [PMID: 32782859 PMCID: PMC7410510 DOI: 10.7759/cureus.9037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
High-energy open fractures are often associated with significant soft tissue damage and can have contamination. Infection of a fracture can be the most detrimental factor for fracture union. Control of infection and soft tissue coverage over exposed bone plays a vital role in its overall outcome. Negative pressure wound therapy (NPWT) assisted closure has depicted encouraging results for helping control of infection and wound closure. NPWT assisted closure promotes reduction of bacterial load in the wound, facilitates removal of secretion from the wound, promotes the formation of granulation tissue, and decreases wound size. We present a case of open fracture femur with severe infection and exposed bone. Along with infection and comminution of fracture, there was collection of necrotic tissue at the fracture site. Infection settled with debridement of wound and application of NPWT. With the application of NPWT, there was formation of granulation tissue and a decrease in wound size. The wound healed completely following application of secondary sutures. Any form of plastic procedures, such as muscle pedicle graft and split-thickness skin grafting, was not required for wound closure. NPWT-assisted closure is a promising mode of wound management in grossly infected wounds and obviates the need for further plastic procedures. The effect can be extrapolated to all open wounds with infection but must follow a thorough debridement and lavage.
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Affiliation(s)
- Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Susanta Khuntia
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Nabin K Sahu
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Gurudip Das
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Saroj K Patra
- Trauma & Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
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Handaya AY, Fauzi AR, Werdana VAP. Tapering pressure of wall vacuum-assisted closure for the treatment of patients with pancreatic fistula in traumatic pancreatic injury: Report of two cases. Int J Surg Case Rep 2020; 68:158-161. [PMID: 32163905 PMCID: PMC7063329 DOI: 10.1016/j.ijscr.2020.02.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
Postoperative pancreatic fistula is a nightmare for digestive surgeons. Requires complex treatment and a long duration of hospitalization of patients with a large cost burden. VAC using wall suction with NPWT principle can be used to treat patients with complex wounds. A simple and easy procedure with good outcomes.
Introduction Traumatic injury to the pancreas is rare and difficult to diagnose, requiring immediate operative management. It also has high mortality and morbidity rates. Postoperative pancreatic fistula is one of the complications that is considered a nightmare for digestive surgeons. The prevalence of POPF is estimated at 13%–41%, with 28% of mortality rate and the most common cause of death is retroperitoneal sepsis and hemorrhage. It requires complex treatment and a long duration of hospitalization of patients with a large cost burden. Presentation of case Here we report 2 cases of POPF after pancreatic injury in abdominal trauma. The patients underwent emergency laparotomy. In the hospital ward, the patients developed wound dehiscence and a clear viscous pancreatic juice came out from the wound with high output. The installation of wall VAC using wall suction with pressure adjustments according to the number of products per day was performed. The patients showed good outcomes, the pancreatic juice output decreased and diminished, and the wound also narrowed and closed. Discussion VAC using wall suction is a device that applies the technique of NPWT and an emerging procedure used to treat patients with complex wounds. NPWT can reduce pooling of fluid, while reducing shear stress and tissue hypoxia at the wound edges, and stimulating the release of vascular endothelial growth factor in wound milieu. Conclusions Tapering pressure of VAC using wall suction for treatment of pancreatic fistula in post laparotomy pancreatic injury patients is a simple and easy procedure with good outcomes.
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Affiliation(s)
- Adeodatus Yuda Handaya
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Aditya Rifqi Fauzi
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Victor Agastya Pramudya Werdana
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
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Riese F, Meyerhoff N, Nessler J, Tipold A. Misery of insufficient treatment guidelines in post‐traumatic epilepsy. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Franziska Riese
- Department of Small Animal Medicine and SurgeryKlinik fuer Kleine HaustiereStiftung Tierarztliche Hochschule HannoverHannoverGermany
| | - Nina Meyerhoff
- Department of Small Animal Medicine and SurgeryKlinik fuer Kleine HaustiereStiftung Tierarztliche Hochschule HannoverHannoverGermany
| | - Jasmin Nessler
- Department of Small Animal Medicine and SurgeryKlinik fuer Kleine HaustiereStiftung Tierarztliche Hochschule HannoverHannoverGermany
| | - Andrea Tipold
- Department of Small Animal Medicine and SurgeryKlinik fuer Kleine HaustiereStiftung Tierarztliche Hochschule HannoverHannoverGermany
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Staged Treatment of Chest Wall Radiation-Induced Ulcer With Negative Pressure Wound Therapy and Latissimus Dorsi Myocutaneous Flap Transplantation. J Craniofac Surg 2019; 30:e450-e453. [DOI: 10.1097/scs.0000000000005514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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