Hard-to-heal peripheral wounds infected with Corynebacterium striatum: a prospective study.

OBJECTIVE: To investigate Corynebacterium striatum as a nosocomial pathogen infecting hard-to-heal peripheral wounds, such as skin wounds, soft tissue abscesses and osteomyelitis. As of 2023, the medical community were alerted against the risk of emerging systemic and central infections; on the other hand literature on peripheral cutaneous regions is still scarce. METHOD: In this study, two groups of patients with similar lesions which were infected were compared: one group with the presence of the coryneform rod, the other without. RESULTS: In total, Corynebacterium striatum was cultured from 62 patients and 131 samples. Corynebacterium striatum infection correlated well with the presence of: foot ulcer; venous leg ulcer; altered ambulation and/or altered foot loading; peripheral vascular and arterial disease; hospitalisation; malignancy; spinal cord injury; and recent administration of antibiotics (p<0.05 for all associations). Patients with Corynebacterium striatum had a lower overall survival rate compared to patients in the non-Corynebacterium striatum group (28.6 versus 31.6 months, respectively; p=0.0285). Multivariate analysis revealed that Corynebacterium striatum infection was an independent factor for poor prognosis (p<0.0001). CONCLUSION: In view of the findings of our study, Corynebacterium striatum appears to be an important opportunistic pathogen infecting peripheral tissues and complicating wound healing. Given its numerous and worrying virulence factors (such as multidrug resistance and biofilm production), particular attention should be given to this pathogen by professional wound care providers in nosocomial and outpatient environments.

Low-vacuum negative pressure wound therapy protocol for complex wounds with exposed vessels.

OBJECTIVE: Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. METHOD: The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (-80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72-96 hours. RESULTS: This protocol was followed in five male patients (aged 23-68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20-61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. CONCLUSION: The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.

Surgical Endoscopic Vacuum-assisted Closure Therapy (EVAC) in Treating Anastomotic Leakages After Major Resective Surgery of Esophageal and Gastric Cancer.

BACKGROUND/AIM: Endoscopic vacuum-assisted closure therapy (EVAC) is a promising new technique for repairing upper gastrointestinal defects of different etiologies. As of 2018, however, no standardized recommendation exists. This article reviewed EVAC in treating anastomotic leakage following major resective surgery of esophageal (EC) and gastric cancer (GC). MATERIALS AND METHODS: Only English-language literature was investigated. Only studies or data on EC and GC were included. Seven popular search engines (PubMed, Web of Science, ScienceDirect, Scopus, Google Scholar, ResearchGate, PubFacts) were utilized. RESULTS: A total of 29 studies (17 retrospective, six prospective and six case reports) with a total of 209 patients. Range of anastomotic leakage closure was 66.7-100%. Anastomotic stricture was the most frequent long-term related complication (18 cases). CONCLUSION: EVAC appears to be an extremely useful treatment for postsurgical anastomotic leakage in patients with EC/GC. Almost all kinds of anastomotic leakage (silent to symptomatic, small to large) seem to be amenable to this technique.

[Quality of life and social support for women with breast cancer: research study]. / La qualità di vita e il supporto sociale nelle donne con carcinoma mammario: uno studio.

The expression "quality of life" was used for the first time by Pigou in 1920 in a textbook on economy and welfare , but was only regarded seriously in social terms in the 1960's before becoming a medical issue. Although it is difficult to define, the WHO has stated that "the quality of life is how an individual perceives his own life, in the light of the cultural context and values of his/her environment ,and his/her aims, expectations and worries. According to the Outcome Research the quality of life becomes a mere quantification of some health aspects described ty the patient using standardized tools. The theoretical model adopted was the concept of social support as a determining element in improving the quality of life, devised by J.E Ware , that emphasizes how the quality of life in oncological patients is positively influenced by strong social support. The aim of the study is to evaluate the existence of a positive relationship between the perception of family support and the quality of life in young women who have survived breast cancer.