A Cost and Metric Comparison of Disposable Negative-Pressure Wound Therapy Systems.

BACKGROUND: Disposable NPWT (dNPWT), a form of negative-pressure wound therapy, has been shown to be both outcome- and cost-effective for small to medium-sized wounds or closed incisions compared to traditional NPWT systems. When choosing a dNPWT system, multiple factors should be evaluated, including the wound size, wound type, estimated exudate production, and required days of therapy. If the device is not optimized for use in a particular patient, a much higher overall cost can be expected. METHODS: A web-based search, manufacturer website review and communication, and list price-based cost analysis was performed for currently available dNPWT systems. These systems differ with respect to cost, degree of negative pressure, canister size, number of dressings included, and recommended days of therapy. RESULTS: The results showed that 3M™ KCI devices (3M™ KCI, St. Paul, MN) cost about 6x more per day than non-KCI devices, and the V.A.C.® Via and Prevena™ Plus Customizable Incision Management System (both 3M KCI) cost over $180 per day of use. The no-canister Pico 14™ (Smith+Nephew, Watford, UK) is the most cost-effective dNPWT option, with an overall cost of $25.00 per day, but is limited to low exudate-producing wounds, such as closed incisions. At $25.67 per day, the UNO 15 (Genadyne Biotechnologies, Hicksville, NY) is the most cost-effective dNPWT option that still includes a replaceable canister system. CONCLUSION: We present a cost and metric comparison of currently available dNPWT systems. Despite significant differences in the cost of treatment with each dNPWT device, there has been limited research on their relative efficacies.

Knee Reconstruction following Sarcoma Resection Utilizing Pedicled Anterolateral Thigh Propeller Flap: A Case Series.

Coverage of knee wounds with exposure or violation of the joint capsule has long been a challenge to plastic surgeons. Wide resection and radiation treatment for soft-tissue sarcomas further this difficulty due to resultant diminished vascularity and soft tissue fibrosis. Traditional muscle flaps such as the gastrocnemius may be within the radiated field, limiting their arc of rotation to the knee. We present a series of exposed knee joint reconstructions using pedicled propeller flaps after sarcoma resection. Three patients diagnosed with soft tissue sarcomas underwent neoadjuvant radiation followed by wide local resection by orthopedic oncology. All patients had underlying knee joint exposure and underwent successful soft tissue reconstruction utilizing pedicled anterolateral thigh (ALT) propeller flaps. The ALT flap is widely used in plastic surgery for reconstruction of soft tissue defects due to its reliable vascularity, long pedicle, versatility, low donor-site morbidity, and large size. As a propeller flap, we demonstrate this is a viable alternative for reconstruction when the vascular plexus around the knee is unreliable after neoadjuvant radiation. Extending the ALT propeller flap with a large proximal skin paddle provides a nonmicrosurgical alternative to traditional muscle flaps at this location. The ALT propeller flap is an excellent option for reconstruction of large defects of the knee, especially in the setting of a radiated wound bed with unpredictable vascularity. In our case series, all three patients underwent successful reconstruction of exposed knee joints after resection of soft tissue sarcoma utilizing ALT propeller flaps.

Laparoscopic Free Omental Flap for Craniofacial Reconstruction: A Video Article Demonstrating Operative Technique and Surgical Applications.

The omental flap is a well described pedicled flap for surgical reconstruction of multiple body locations. As a laparoscopically harvested free flap, the omentum offers a minimally invasive solution to many reconstructive problems including extremity and head and neck wounds. This video article highlights the operative technique involved in flap harvest and inset for a cranial defect. An illustrative case involving a 23-year-old female's traumatic scalp degloving injury that was resurfaced by free omental flap and split-thickness skin graft is presented. This patient had stable long-term wound coverage for a very severe injury. Through video media we demonstrate that the laparoscopically harvested free omental flap is a minimally invasive, 2-team operation that provides soft tissue coverage of severe, remote wounds. This video demonstrates a safe operative technique and nuances specific to laparoscopic harvest of this flap.

Gold weight implantation and lateral tarsorrhaphy for upper eyelid paralysis.

BACKGROUND: Upper eyelid paralysis leads to lagophthalmos with the risk of exposure keratitis, corneal ulceration and blindness. METHODS: Consecutive patients undergoing gold weight implantation and/or lateral tarsorrhaphy were identified from our prospective database and reviewed. RESULTS: Sixty-three patients were identified, 36 of whom underwent immediate reanimation procedure either during cancer excision (n = 35) or repair of facial laceration (n = 1). Twenty-seven patients had a delayed procedure either following tumour excision (n = 21) or unresolved Bell's palsy (n = 3), or facial palsy due to complex craniofacial fracture (n = 3). Nine patients required revision to achieve optimal weight. Fifty-two patients had full eye closure. The remaining 11 patients had almost complete eye closure. CONCLUSIONS: Facial paralysis is devastating for the patient and immediate facial reanimation should be performed. We have demonstrated that gold weight implantation and lateral tarsorrhaphy are simple and effective in achieving eye closure.

Technology for the delivery of hyperthermic intraoperative intraperitoneal chemotherapy: a survey of techniques.

Peritoneal metastases are common sequelae of gastrointestinal malignancy. The treatment of peritoneal metastases through use of aggressive surgical cytoreduction including peritonectomy coupled with HIPEC has now been reported in several large single-institution series. The available literature suggests that in experienced hands and with appropriate patient selection cytoreduction and HIPEC can be an effective therapy, particularly when all macroscopic tumor deposits are removed. Different techniques involving the administration of intraperitoneal chemotherapy have been reported, including the closed intraoperative technique, the open or coliseum technique, and the open technique using a PCE device. All techniques have been associated with mortality and morbidity that is significant, but generally consistent with other major surgical procedures. In theory, the coliseum and PCE techniques may have less associated morbidity because of improved heat distribution; however, this remains to be definitively proven in a controlled clinical trial. Such controlled studies are critical to defining the best techniques for HIPEC administration and the appropriate role for this treatment regimen in patients with peritoneal metastases. The development of a program in cytoreductive surgery and HIPEC requires a comprehensive patient care team led by appropriately trained surgeons. Such teams are best suited to provide the highest-quality care to patients with peritoneal surface malignancy.