Comparison between Vacuum-Assisted Closure Technique and Conventional Approach in Patients with Mediastinitis After Isolated Coronary Artery Bypass Graft Surgery

ABSTRACT Introduction: Median sternotomy is the most preferred approach in heart surgery. Post-sternotomy mediastinitis is a catastrophic and potentially life-threatening complication with an incidence rate of 0.15% to 5%, and its overall mortality rate reaches 47%. In this study, we aimed to compare the results of vacuum-assisted closure technique and the conventional methods on the management of mediastinitis following isolated coronary artery bypass graft surgery. Methods: Between February 2001 and July 2013, 32,106 patients who underwent cardiac operations were evaluated retrospectively. One hundred and fourteen patients who developed post-sternotomy mediastinitis were included in this study. The patients were divided into two groups and compared - vacuum-assisted closure group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%). Results: There were no differences between the two groups according to the patients' characteristics, surgical data, and mediastinal cultures. However, we found that total treatment duration for post-sternotomy mediastinitis, time interval from diagnosis to negative culture, hospitalization time, and in-hospital mortality were statistically significantly lower in the vacuum-assisted closure group than in the conventional treatment group (P<0.001, P<0.001, P<0.001, and P=0.03, respectively). Conclusion: This study demonstrates that the vacuum-assisted closure technique improves the medical outcome of patients with post-sternotomy mediastinitis compared with the conventional treatment. The vacuum-assisted closure is a safe and more effective treatment modality for patients with post-sternotomy mediastinitis after cardiac surgery with reasonable morbidity and mortality.

NEGATIVE PRESSURE WOUND THERAPY (NPWT): OUR EXPERIENCE USING HOSPITAL WALL SUCTION

Study Design: Prospective case series Delayed wound healing is a significant concern, particularly in Introduction: complex wounds and the elderly with co-morbidities. It leads to pain, morbidity, prolonged treatment, and requires major reconstructive surgery, which imposes an enormous social and financial burden. Negative Pressure Wound Therapy (NPWT) was used to cover large wounds, decubitus ulcers, and open fractures that cannot be closed either primarily or secondarily and often require a complex reconstructive procedure to protect the injury. NPWT is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. We applied NPWT on pa Materials and Methodology: tients with open fractures, decubitus ulcers, neglected wounds, fasciotomies, and large wounds. Compared to the patented VAC system, ours include pre-sterilized PVA foam, cling drape (Surgiwear TM), nasogastric tube or an infant feeding tube, and a hospital wall suction. There Results: were three cases of soft tissue injury of the foot with wound defect, one case of fasciotomy for compartment syndrome, one case of the decubitus ulcer, one case of open fractures, and three cases of degloving injuries of the foot. In our study, the NPWT was changed every five days, the average number of NPWT changes was 3-4, length of time NPWT applied before the closure was 14-21 days. The most frequent coverage mode is Split Thickness Skin Graft obviating the need for more complex flaps and microvascular reconstructive procedures. Negative Conclusion: pressure therapy stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis. NPWT appears to be simple and more effective than conventional dressings for managing complex wounds, reducing wound volume, depth, treatment duration, and cost.

Proficiency of topical platelet-rich plasma with vacuum-assisted closure over platelet-rich plasma alone in diabetic foot ulcers - A clinical prospective comparative study

Background: Type 2 Diabetes Mellitus is usually associated with peripheral neuropathy, peripheral vascular disease with consequential limb ischemia, and eventually diabetic foot ulcers (DFU). The healing process is slow due to microangiopathy and wound is easily infected with microbials leading to superficial infection, progressing to deep infection and eventually landing in amputation most of the times. Plate rich plasma (PRP) is very cost-effective, readily available blood derivative and has the capability to stimulate cell proliferation and differentiation. It improves tissue healing and regeneration and exhibits potent activities against a number of pathogens. Vacuum assisted closure (VAC), on the other hand, is a new novel way to treat DFU by having negative pressure wound healing. The present study focused on the advantage of (PRP+VAC) dressing over (topical PRP application with its peripheral injection) alone for aiding and enhancing the process of wound healing in DFU. Aims and Objectives: To appraise the advantage of (PRP+VAC) dressing over (topical PRP application with its peripheral injection) alone for aiding and enhancing the process of wound healing in DFU. Materials and Methods: This was a prospective comparative study of 100 cases to compare the outcomes of wound healing by (topical PRP application with its peripheral injection. Results: Mean time taken for appearance of granulation tissue, 100% granulation tissue, average reduction in wound surface area, showed significant (P => 0.005) differences between the (PRP+VAC) and the (topical PRP application with its peripheral injection) dressing groups. Conclusion: (PRP+VAC) dressings are more effective than conventional (topical PRP application with its peripheral injection) dressings in wound healing of DFU.

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determinethe advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods:The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results:In the study sample 10% patients were less than 40 years,76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions:VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

Role of vacuum assisted closure in wound healing among patients attending a tertiary care hospital

Background: Vacuum assisted closure is procedure to aid in improved wound healing. This negative pressure wound therapy can be used in cases of both acute and chronic wounds. Objectives: To find out pattern of wound healing while using vacuum assisted closure for healing chronic non healing ulcers. Materials and methods: It was a prospective study conducted among patients admitted to the Department of General Surgery. Participant included had chronic non healing ulcer due to various etiologies. The study period was from October 2021 to December 2021. 50 participants were enrolled into the study. The data was compiled and analyzed using SPSS version 26. Results: The wound healing was better after day 3. There was significant positive change in wound healing with P value of less than 0.05 over the follow up period. No other factor was found to influence wound healing. Conclusion: Vacuum assisted closure would enhance wound healing among those suffering from chronic non-healing ulcer.

Comparison of Topical Oxygen with Vacuum Assisted Closure in Wound Healing in a Low Resource Setting

The aim of this pilot study is to obtain preliminary results comparing topical oxygen therapy (TOT) and vacuum assisted closure (VAC) in terms of its ability to accelerate wound healing. METHODS: This non-randomised prospective study included patients with age 16-50 years, wound size ≥ 16cm2 and present below knee joint within seven days of occurrence. Bates-Jensen wound assessment tool (BWAT) was used for evaluation at 8-day interval along with percent area reduction at final follow up. RESULTS: Mean number of cycles required in VAC and TOT group were 1.97 (range 1-3) and 2.1 (range 1-3) (each cycle of 5 days) per patient respectively. Percent area reduction was significantly higher in the VAC group (34±9.7%) than TOT (11.3±3.8%) group at final follow up (p<0.05). TOT patients had better improvement in epithelialization compared to VAC at last follow up. More extensive debridement was needed in patients of TOT than VAC. There was no significant difference between final score in both groups. CONCLUSION: TOT appears to be comparable to well-established VAC in treatment of fresh traumatic wounds below the knee joint. Further large scale, multicentric and randomised studies comparing both these modalities of treatment should be the way forward

Research progress of endoscopic vacuum-assisted closure therapy for esophageal fistulas / 中国胸心血管外科临床杂志

@#How to effectively repair esophageal fistulas, caused by esophageal perforation, rupture and anastomotic leakage after esophagectomy has always been a key problem for the digestive surgeon. Although there are many clinical treatment methods, the therapeutic effect is still completely unsatisfactory, especially when severe mediastinal purulent cavity infection is associated with the esophageal fistula. In recent years, foreign centers have promoted a new minimally invasive endoscopic treatment technology to repair the esophageal fistula, endoscopic vacuum-assisted closure therapy, with significantly curative effect. In this article, we will review the specific operation, advantages and disadvantages, as well as the clinical efficacy of endoscopic vacuum-assisted closure therapy in treating the esophageal fistulas, to provide a new therapeutic technique for esophageal fistulas and expand the new field of minimally invasive endoscopic therapy.

A Comparative Study between Indigenous Low Cost Negative Pressure Wound Therapy with Added Local Oxygen versus Conventional Negative Pressure Wound Therapy

@#Introduction: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT. Materials and Methods: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT. Results: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations. Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

Use of vacuum-assisted closure in massive puerperal genital hematoma

Puerperal genital hematomas are rare but life-threatening complications of obstetric emergencies. A pregnant patient (39 weeks) underwent a mediolateral episiotomy during a vaginal delivery. An afterbirth hematoma (approximately 20 cm in diameter) was evacuated, but the use of a vacuum-assisted wound closure system was applied after the sutures opened on the 7th postoperative day. On the 10th day of the vacuum-assisted closure (VAC) application, the wound was completely closed. VAC is an alternative treatment modality that can drain an infection and increase the proportion of granulation tissue in humid and irregular surfaces such as the perineum.

Advances in the clinical application of negative pressure wound therapy in the field of surgery / 中华整形外科杂志

The new method of negative pressure wound therapy not only greatly improves the level of treatment on hard healing wounds in plastic surgery, but also widely used in the field of major surgery. The clinical efficacy of this technique in prevention of surgical incision complications, treatment of postoperative wound infection and fissure, treatment of postoperative infection and exposure of various implants, treatment of special burn wounds, and temporary closure of abdominal cavity after open abdominal surgery were reviewed. The impact of negative pressure wound therapy with instillation for infected wounds and the application of endoscope assisted negative pressure therapy in the treatment of complications after hollow viscera anastomosis were also reviewed. This review provides a new idea for the treatment of various refractory wounds and wound complications.

Continuous peritoneal lavage with vacuum peritoneostomy: an experimental study

OBJECTIVE: Despite advances in diffuse peritonitis treatment protocols, some cases develop unfavorably. With the advent of vacuum therapy, the use of laparostomy to treat peritonitis has gained traction. Another treatment modality is continuous peritoneal lavage. However, maintaining this technique is difficult and has been associated with controversial results. We propose a new model of continuous peritoneal lavage that takes advantage of the features and benefits of vacuum laparostomy. METHOD: Pigs (Landrace and Large White) under general anesthesia were submitted to laparostomy through which a multiperforated tube was placed along each flank and exteriorized in the left and lower right quadrants. A vacuum dressing was applied, and intermittent negative pressure was maintained. Peritoneal dialysis solution (PDS) was then infused through the tubes for 36 hours. The stability of peritoneostomy with intermittent infusion of fluids, the system resistance to obstruction and leakage, water balance, hemodynamic and biochemical parameters were evaluated. Fluid disposition in the abdominal cavity was analyzed through CT. RESULTS: Even when negative pressure was not applied, the dressing maintained the integrity of the system, and there were no leaks or blockage of the catheters during the procedure. The aspirated volume by vacuum laparostomy was similar to the infused volume (9073.5±1496.35 mL versus 10165±235.73 mL, p=0.25), and there were no major changes in hemodynamic or biochemical analysis. According to CT images, 60 ml/kg PDS was sufficient to occupy all intra-abdominal spaces. CONCLUSION: Continuous peritoneal lavage with negative pressure proved to be technically possible and may be an option in the treatment of diffuse peritonitis.

Abdominal Vacuum-Assisted Closure for Secondary Abdominal Fascial Closure into Open Abdomen after Surgical Repair for Ruptured Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

Secondary abdominal fascial closure by abdominal vacuum-assisted closure (VAC) therapy is required for abdominal organ protection and prevention of infection due to abdominal compartment syndrome (ACS) developing after the surgery. In this paper, we present our experience with abdominal VAC therapy for two cases that required open abdominal management after surgical repair for ruptured abdominal aortic aneurysm, with favorable outcomes. Case 1 involved a 72-year-old man who underwent endovascular aortic repair for ruptured abdominal aortic aneurysm. Abdominal VAC therapy was started after decompression laparotomy because he developed ACS immediately after surgery. Secondary abdominal fascial closure was performed on day 4 postoperatively, and he had no complications. Case 2 involved a 71-year-old man who underwent emergency Y-graft replacement for ruptured abdominal aortic aneurysm. We considered secondary abdominal fascial closure necessary because of prominent intestinal edema and massive retroperitoneal hematoma, and performed abdominal VAC therapy. We changed the VAC system on day 4, postoperatively and performed secondary abdominal fascial closure on day 7, postoperatively. Abdominal VAC therapy is considered effective and safe for patients requiring secondary abdominal fascial closure after abdominal surgery.

Effect of vacuum-assisted closure on the circulating number of endothelia progenitor cell in diabetic patients with mild to moderate degrees of ischemic foot ulcer / 中华内分泌代谢杂志

Objective To investigate the effect of vacuum-assisted closure(VAC)on the circulating number of endothelia progenitor cell(EPCs)in diabetic patients with mild to moderate degrees of ischemic foot ulcer and their related factors. Methods A total of 84 diabetic patients with foot ulcer duration for at least 4 weeks and ankle brachial index(ABI)0.5~0.9 were selected and divided into and assigned to two groups according to 2: 1 randomization:vacuum-assisted closure(VAC)treatment group(n=56)and Non-VAC treatment group(n=28). The control group (NC) was composed of 18 patients who had normal glucose tolerance and lower extremity ulcer without arteriovenous disease. VAC was performed on the ulcer wound after debridement for 1 week in both VAC group and NC group,and the patients in Non-VAC group received conventional treatment process. The circulating number of EPCs was measured before and after various treatments and the influencing factors of their changes were analyzed. Results After VAC treatment,the circulating number of EPCs significantly increased in both VAC group and NC group[(85.3 ± 18.1)vs(34.1 ± 12.5)/106cells,(119.9 ± 14.4)vs(66.1 ± 10.6)/106cells,both P<0.05]. By contrast,the circulating number of EPCs had no significant change in Non-VAC group[(45.2 ± 19.4)vs(34.7 ± 16.8)/106cells, P>0.05]. In addition,the circulating levels of vascular endothelial growth factor(VEGF)and the protein expressions of VEGF and stromal cell-derived factor-1α(SDF-1α)in the granulation tissue also significantly increased after VAC treatment in both VAC group and NC group,but no significant change in Non-VAC group. Compared with Non-VAC group,the changes of VEGF and SDF-1α levels in the sera and granulation tissue were all significantly higher in both VAC group and NC group(P<0.05 or P<0.01). There were no significant differences in changes of the circulating number of EPCs, and VEGF and SDF-1α in the sera and granulation tissue between VAC group and NC group. Correlation analysis showed that the change of the circulating number of EPCs was correlated with the changes of VEGF and SDF-1α levels in the sera and granulation tissue of VAC group and NC group(P<0.05). Conclusion VAC treatment may increase the circulating number of EPCs in diabetic patients with mild to moderate ischemic foot ulcer as in non-diabetic controls,which may be attributed to the upregulation of systemic and local VEGF and SDF-1α levels.

Effect of vacuum-assisted closure in the treatment of diabetic foot / 中国综合临床

Objective To explore the effect of vacuum-assisted closure (VAC) in the treatment of diabetic foot.Methods Sixty-seven cases patients with diabetic foot in Chaoyang Central Hospital from January 2010 to January 2016 were recruited successively,according to wagner criteria for 2-5 diabetic foot classification.They were divided into VAC group with 34 cases and control group with 33 cases according to the different treatment methods.Both groups were given debridement treatment.After debridement,the patients in control group were given wound dressing every day or every other day.When fresh granulation tissue on wound surface became well-stacked,skingrafting or skin flap reparation was carried out.After debridement,patients in VAC group were given VAC treatment for 5 days.When fresh granulation tissue on wound surface became wellstacked,skingrafting or skin flap reparation was performed.The wound healing duration,healing rate and amputation rate were compared between the two groups.Results The wound healing time,healing rate and amputation rate of VAC group were (30.91 ± 15.61) d,97.1％ (33/34) and 3％ (1/34) respectively,of the control group were (58.86± 14.23) d,75.8％ (25/33) and 24.2％ (8/33) respectively.There were significant differences between the two groups(P＜0.05).Conclusion VAC treatment of diabetic foot ulcer has significant effect,can promote wound healing,improve the healing rate and reduce the risk of amputation(toe).

Deep Neck Infection with Mediastinal Abscess Treated by Modified Vacuum-Assisted Closure Application

Deep neck infection is a surgical emergency that can result in life threatening complications such as airway obstruction, aspiration, thrombosis of major vessels and mediastinitis by spread of infection along fascial planes. Although appropriate surgical intervention and prompt antibiotics are given, revision surgeries are often required. We report a patient with mediastinal abscess caused by a deep neck infection that was initially intractable with usual surgical drainage but was eventually successfully treated with the modified application of a vacuum-assisted closure (VAC) device (InfoV.A.C. Therapy Unit; Kinetic Concept Inc., USA). We inserted silastic drain tubes into paratracheal area. It was difficult to pack the VAC foams, so they were prone to fail, with complete debridement. With modified VAC therapy assisted by silastic drain tube, the deeply located mediastinal abscess that had been unresponsive to conventional surgical drainage was successfully treated.

Usefulness of Vacuum-Assisted Closure Therapy in the Treatment of Esophageal Perforation Following Thyroidectomy / 대한이비인후과학회지

Perforation of the cervical esophagus after thyroidectomy is a rare complication. Esophageal perforation is usually treated conservatively with simple surgical drainage and intravenous antibiotic therapy. If complicated by abscess, it needs aggressive surgery including resection and anastomosis. But the aggressive treatments mentioned have low success and high morbidity. Herein, we report a patient with complicated deep neck infection caused by esophageal perforation following thyroidectomy, which was successfully treated with multiple vacuum-assisted closure and intravenous antibiotic therapy after the failure of simple suture and simple drainage as conservative managements.

A comprehensive study on effectiveness of wound healing in vacuum assisted wound dressing

Background: Delayed wound healing is a significant health problem, particularly in older adults. In addition to the pain and suffering, failure of the wound to heal also imposes social and financial burdens. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimize conditions for wound healing and requires fewer painful dressing changes. Aim: To assess whether the management of non-healing wounds using VAC therapy will result in improved efficacy and safety outcomes compared with conventional methods. Materials and methods: Present prospective, time bound study was done for 1 year from January 2016 to December 2016 over 50 subjects (25 cases and 25 controls). Details of cases were recorded including history and wound characteristics. Routine investigations were done. Follow up with size of wound, appearance of granulation tissue after day 0, 3, 6, 9, 12 and so on dressings were done. Results: Patients managed with VAC had increased rate of r epithelialization and fewer patients required repeat split thickness skin graft to the same site. VAC was more effective at treating various chronic and complex wounds, as there was a significantly greater reduction in wound volume, depth and treatment duration. Conclusion: VAC results in better healing than standard methods, with few serious complications. More rigorous studies with larger sample sizes assessing the use of VAC therapy on different wound types are required

A Case of Retropharyngeal Abscess Treated by Vacuum-Assisted Closure Application / 대한이비인후과학회지

The incidence of retropharyngeal abscess has been decreased with the use of antibiotics, but it can cause critical complications such as airway obstruction, aspiration pneumonia, disseminated intravascular coagulation, mediastinitis, or sepsis. A vacuum-assisted closure (VAC) device is a surgical drain that can help prevent reaccumulation of purulent collections. We present one case of retropharyngeal abscess treated by VAC and highlight the utility of VAC in the management of retropharyngeal abscess.

Study on rifamycin combined with vacuum-assisted closure for promoting wound healing of ulcerative lymphoid tuberculosis / 重庆医学

Objective To investigate the effect of rifamycin combined vacuum-assisted closure for promoting the wound healing of ulcerative lymphoid tuberculosis .Methods 78 cases of ulcerative lymphoid tuberculosis were randomly divided into the observa-tion group and the control group .The observation group was given rifamycin combined vacuum-assisted closure for treating the wound surface ,while the control group was given rifamycin for dressing change .The area of wound surface was measured before treatment and on 0 ,10 ,20 ,25 ,30 d after treatment .Then the shrinkage rate of wound surface area was calculated .Results During intervention period ,the shrinkage rates of wound surface area at the given time points in the observation group were higher than those in the control group ,the difference showing statistical significance (P<0 .01) .The wound surface in the observation group reached the healing standard on 30 d .Conclusion Rifamycin combined with vacuum-assisted closure can significantly promote the wound healing of ulcerative lymphoid tuberculosis .

Study on negative pressure wound therapy combined with moist wound therapy for traffic crush injury / 医学研究生学报

Objective Negative pressure wound therapy (NPWT) and moist wound therapy (MWT) are two new methods for wound care .Whether the united is better than the single .The study was to observe and compare the effects of using negative pres-sure wound therapy ( NPWT) combined with moist wound therapy ( MWT) and simple MWT in the treatment of traffic crush injuries . Methods 32 cases were randomly divided into two groups:intervention group and control group , 16 cases for each group .In interven-tion group, wounds were first treated by NPWT for 21 days, followed by standardized MWT till healing .In control group, wounds were treated by standardized MWT till healing .Consensus methods were applied in the measurements before treatment , 7 days, 14 days and 21 days after treatment .The measurements were involved in wound size , depth, undermined edge and the ratio of granulation tissue covering wound bed .Calculation were made on the construction rates of wound size , depth, volume and undermined edge along with re-cords of the time 100%granulation tissue covering wound bed and healing .The database was set up and statistical analysis were done by SPSS 16.0 software. Results The healing rate was 100%for both groups.During 21 days of treatment, the construction rates of wound size, volume, depth and undermined edge of intervention group were better than those of control group (P<0.05).The time 100%granulation tissue covering wound bed of intervention group was shorter than that of control group ([25.00 ±5.77] d vs [41.25 ±18.32]d, P=0.000).The healing time of intervention group was about two weeks shorter than of control group , but with no significance([67.63 ±22.38]d vs [83.56 ±55.31]d, P=0.597). Conclusion NPWT is applicable to traffic crush injuries in combination with MWT , which could promote the growth of granulation tissue and help construct and heal the wounds .NPWT combined with MWT has prior effects to simple MWT .