The Potential of Bacteriophage Therapy as an Alternative Treatment Approach for Antibiotic-Resistant Infections.

OBJECTIVE: This study aimed to provide a comprehensive overview of the current state of the literature on the therapeutical application of bacteriophages. METHODS: First, a bibliometric analysis was performed using the database Web of Science to determine annual number of publications and citations. Second, a systematic literature review was conducted on randomized-controlled trials (RCTs) of phage therapy in PubMed. RESULTS: Over the past decade, the number of publications on bacteriophage therapy increased more than fourfold with 212 articles in 2011 and 739 in 2022. The systematic search in PubMed yielded 7 RCTs eligible for inclusion, reporting on a total of 418 participants. Identified indications in this study included bacterial diarrhea, urinary tract infections, infected burn wounds, chronic otitis, chronic venous leg ulcers, and chronic rhinosinusitis. In three studies, mild to moderate adverse events were reported in 10/195 participants (5.1%). Three of the studies reported a statistically significant difference in outcomes comparing phage therapy with standard of care or placebo. CONCLUSION: Phage therapy has gained increasing interest over the years. RCTs on different indications suggest the safety of phage therapy; however, reasons why phage therapy is not yet well accepted are limitations in the study designs. For a successful translation into clinical practice researchers and clinicians should learn from the earlier experiences and consider issues such as the quality of phage preparation, sensitivity testing, titer and dosages, as well as access to the infection site and stability for standardized protocols and future trials.

E-scooter incidents in Berlin: an evaluation of risk factors and injury patterns.

BACKGROUND: E-scooters have emerged as a frequently used vehicle in German cities due to their high availability and easy access. However, investigations about the causes and mechanisms of E-scooter incidents and their trauma-specific consequences are rare. METHODS: We analysed all patients involved in E-scooter incidents from June to December 2019 who presented to four inner-city EDs in Berlin. The prospective data included patient-related and incident-related data, information on injury patterns and therapy, responses in a voluntary questionnaire concerning E-scooter use and general traffic experience. RESULTS: 248 patients (129 males; median age 29 years (5-81)) were included: 41% were tourists and 4% were children. Most incidents (71%) occurred between July and September 2019, the majority occurring at weekends (58%). The injury pattern was mostly multifocal, affecting the lower (42%) and upper limbs (37%) and the head (40%). Traumatic brain injury was associated with alcohol consumption. Inpatient admission was recorded in 25%, surgery in 23%. CONCLUSION: This study has defined the incidence of injury related to E-scooter use in a major European city. Stricter laws governing the use of E-scooters, the wearing of helmets and technical modifications to the E-scooter platforms might decrease E-scooter-associated incidents and resulting injuries in the future. TRIAL REGISTRATION NUMBER: German Clinical Trials Registry (DRKS00018061).

[Explosion trauma part 1 : Physical principles and pathophysiology]. / Explosionstrauma Teil 1 : Physikalische Grundlagen und Pathophysiologie.

After explosions, various injury mechanisms lead to multiple injuries that can affect the entire body. While high pressure peaks and exposure to heat, especially in the vicinity of a detonation, can cause severe injuries and organ damage, fragments also pose a considerable threat to explosion victims even over long distances. The recognition and treatment of life-threatening disorders and the assessment of the severity of the injury are just as challenging for the entire treatment team as long-term operative management, reconstruction strategies and rehabilitation of the complex injuries. Knowledge of the injury mechanics and the pathophysiology of blast injuries should help the interdisciplinary team to master this challenge.

[Blast injuries part 2 : Principles of medical treatment]. / Explosionstrauma Teil 2 : Medizinische Behandlungsprinzipien.

Explosions can cause severe injuries, which affect multiple organ systems and leave extensive soft tissue defects. In unstable patients, damage control surgery initially focuses exclusively on controlling bleeding and contamination with the aim of preserving life and limbs. The excision of all necrotic tissue, extensive wound irrigation with antiseptic solutions and a calculated antibiotic prophylaxis, which is subsequently adapted to the microbiological findings, are the basis for sufficient infection control. As the tissue damage caused by the pressure surge can regenerate over time as well as become secondarily necrotic (developing wounds), several revision operations are often necessary to assess the viability of tissue in the sense of serial debridement. In the case of extensive soft tissue injuries temporary vacuum-assisted closure (VAC) techniques can bridge the time to the earliest possible definitive plastic surgical wound closure; however, this must not delay the closure of the defect.

[Funnel Chest Corrective Surgery with the Aid of a 3D Reconstruction of the Bony Thorax for Preoperative Adjustment of the Metal Bar]. / Trichterbrust-Korrektur-OP unter Zuhilfenahme einer 3-D-Rekonstruktion des Thorax zur präoperativen Anpassung des Korrekturstabes.

BACKGROUND: Funnel chest is a congenital deformity of the thorax in which the sternum and the adjacent ribs form a funnel towards the spine. As the pathogenesis has not yet been clearly clarified, there are different therapeutic approaches. These range from conservative measures and minimally invasive surgery to open corrective surgery. The patients suffer from aesthetic impairment, as well as cardiopulmonary restrictions due to the narrowing of the mediastinal space. The indication for funnel chest correction surgery is therefore justified by functional and aesthetic reasons. PATIENTS: We report a 23-year-old male patient who presented with subjectively impairing and objectively moderate funnel chest. A chest CT scan was performed preoperatively. The sternovertebral distance was 8 cm, the transverse thoracic diameter 28,9 cm (Haller's index 3.6). The preoperative pulmonary function test showed a slight restriction, the otherwise healthy patient described shortness of breath with greater exertion. The indication for funnel chest correction surgery was made. The operation was performed using a combined surgical technique: sternotomy and cartilage wedge resection according to Brunner/Grob and implantation of a metal bar without lateral antirotation plate. The most time-consuming step of the operation is the intraoperative adjustment of the metal bar. Therefore, in advance of the operation, we used a 3D printer to prepare a 3D reconstruction of the bony thorax with the help of the thorax CT scan. The metal bar was then bent and fitted to the thorax print and implanted during surgery. This allowed us to shorten the operation time by at least 15 min. RESULTS: The postoperative follow-up examinations showed a clearly erect funnel and a satisfactory aesthetic result. The metal bar explantation took place, as planned, 7 months after implantation. The postoperative CT scan now showed a Haller's index of 3.25, the pulmonary function test showed improved results. Subjectively, the patient was always symptom-free. CONCLUSION: The preparation of medical implants with 3D patient models as templates helps to save operation time. The practicability has not yet been established, as the creation of a 3D model of the bony thorax is associated with a different approach. With the increasing digitisation of the medical world, however, it is conceivable that the creation of digital and real 3D models will become easier and cheaper in the future.

Can a Balance Wristband Influence Postural Control?

Eichhorn, S, Foerster, S, Friemert, B, Willy, C, Riesner, H-J, and Palm, H-G. Can a balance wristband influence postural control? J Strength Cond Res 34(12): 3416-3422, 2020-Top sports performances cannot be achieved without a high level of postural control. Balance wristbands purport to improve the mental and physical balance of the wearer. It is still unclear, however, whether these wristbands can indeed enhance postural control. Our aim was to ascertain through computerized dynamic posturography whether balance wristbands can improve postural stability. In this randomized controlled single-blind clinical study, posturography was used to assess postural control in 179 healthy subjects with or without a balance wristband. Tests were also performed with the subjects blinded to whether they were wearing an intact or a defective wristband. Analysis of variance (ANOVA) was used to detect significant differences (p ≤ 0.05). Stability indexes did not reveal significant differences in postural control between wearing and not wearing a wristband. Our study did not provide evidence of an improvement in postural stability. Because the single-blind trials too revealed no significant differences, a placebo effect could be ruled out.

[Simulation techniques in surgical training programs to become an orthopedic and trauma surgeon : Introduction to the topic]. / Simulationstechniken in der Weiterbildung zum Orthopäden und Unfallchirurgen : Einführung zum Thema.

Numerous professional and societal developments nowadays fundamentally reduce the possibility of mastering all officially prescribed surgical training contents in sufficient quantities and in a target-oriented manner with sufficient operative internal clinical experience from the surgical daily routine. In order to learn key competences, modern simulation technology will have to be integrated into surgical training programs. A meaningful implementation requires a structured procedure for the users, individual clinics or surgical training networks. Financially, simulation is an expensive investment in training quality. The implementation of simulation technology can be a further impulse to design the structure of the continuing training landscape within the framework of a coordinated national or EU-wide overall training concept in such a way that the infrastructural, personnel and financial expenditure can be borne.

[3D printing in orthopedic and trauma surgery education and training : Possibilities and fields of application]. / 3D-Druck in der unfallchirurgischen Fort- und Weiterbildung : Möglichkeiten und Anwendungsbereiche.

The 3D printing technology enables precise fracture models to be generated from volumetric digital imaging and communications in medicine (DICOM) computed tomography (CT) data. Apart from patient treatment, in the future this technology could potentially play a significant role in education and training in the field of orthopedic and trauma surgery. Preliminary results show that the understanding and classification of fractures can be improved when teaching medical students. The use of life-size and haptic models of real fractures for education is particularly interesting. Even experienced surgeons show an improved classification and treatment planning with the help of 3D printed models when compared to plain CT data. Especially for complex articular fractures, such as those of the acetabulum and tibial plateau, initial evidence shows patient benefits in terms of reduced surgery time and blood loss with the help of 3D models. The use of 3D printing on-site at the hospital is of particular interest in orthopedic and trauma surgery as it promises to provide products within a short time. The low investment and running costs and the increasing availability of convenient software solutions will spur increasing dissemination of this technology in the coming years.

[Human patient simulators for training in emergency surgery : Needs, status quo and potential]. / Technische Trainingsmodelle für die notfallchirurgische Ausbildung : Bedarf, Status quo und Potenzial.

Surgical providers must maintain currency and competency for low-volume high-risk procedures for optimal outcomes. There are currently a number of methods available to train for these rare but vital skills, ranging from simple to complex and inexpensive to expensive. Traditionally, these skills have been taught using human cadaveric and animal models, which are limited by availability (cadavers) and social acceptability (animals). As such, there is a need to utilize advances in educational and simulation technologies to refine and develop consensus-based, validated, tissue-realistic, anatomically correct and cost-effective training tools to teach these vital skills. Partially perfused human cadavers have recently been shown to be an important adjunct to established trauma training. Human patient simulators (HPS) and the associated technology is rapidly expanding, but currently lack consistent realism to be used for competence training, when compared to traditional models and are currently cost-prohibitive. It will be important for surgical trainers and trainees to remain engaged and facilitate the development of realistic cost-effective training tools.

Consensus on Wound Antisepsis: Update 2018.

Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

[Use of Negative Pressure Wound Therapy with Instillation and Dwell Time for Wound Treatment - Results of an Expert Consensus Conference]. / Einsatz der Vakuuminstillationstherapie für die Wundbehandlung ­ Ergebnis einer Expertenkonsensuskonferenz.

Rinsing wounds with wound cleansing solutions has long been a recognised cornerstone in wound management as a means of removing cell debris and surface pathogens in wound exudates. In combination with surgical debridement and topical negative pressure wound therapy (NPWT), this can facilitate the intended progression from the inflammatory to the proliferative phase of wound healing. Procedures of topical negative pressure wound therapy with instillation and a defined exposure/dwell-time of topical solutions under cyclic compression and decompression with foam dressings (NPWTi-d) can remove cellular remnants and debris that may inhibit the healing process. At the same time, it can aid in reducing the bacterial load in contaminated or infected wounds. Since this newer technique is now commercially available and increasingly widespread, recommendations for the proper use and clinical indications were developed by a panel of interdisciplinary experts in the course of a consensus meeting. Although the level of evidence from expert opinions is low, general guidelines for a safe and effective use of NPWTi-d can be worked out that can be of assistance to the clinician. The consensus recommendations derived from this meeting include the objectives of the treatment, the administration modalities of NPWTi-d, the indications for various wounds, including their contraindications, therapy settings, as well as the use of topical instillation solutions, volume and duration (dwell time) based on current scientific data, optimal treatment duration and future developments of the NPWTi-d.

Closed-incision negative pressure therapy to reduce groin wound infections in vascular surgery: a randomised controlled trial.

Groin wound infections pose a major problem in vascular surgery. Closed-incision negative pressure therapy (ciNPT) was especially designed for the management of incisions at risk of surgical site infections. The aim of this study was to investigate whether ciNPT is able to reduce the incidence of wound infections after vascular surgery. Data on 132 consecutive patients, scheduled for vascular surgery with a longitudinal femoral cutdown, were collected prospectively. All patients were randomised either to the ciNPT group (n = 64) or the control group (n = 68) with conventional dressing. In the ciNPT group, the foam dressing was applied intraoperatively and removed after 5 days. The control group received an absorbent dressing. All wounds were evaluated after 5 and 42 days. Infections were graded according the Szilagyi classification (I-III°). There were no significant differences between both groups considering patient characteristics. Indications for surgery were peripheral arterial disease in 95% (125/132) and aneurysm in 5% (7/132). The overall infection rates were 14% (9/64) in the ciNPT group and 28% (19/68) in the control group (P = 0·055). Early infections were observed in 6% (4/64) of the ciNPT group and 15% (10/68) of the control group (P = 0·125). ciNPT did not reduce infection rates associated with different risk factors for infection. While the experiences with the ciNPT device were encouraging, the study fails to provide evidence of the efficacy of the device to reduce groin wound infections after vascular surgery. It illustrates far more that larger multicentre studies are required and appear promising to provide further evidence for the use of ciNPT.

EWMA Document: Negative Pressure Wound Therapy.

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.

[Transcutaneous osseointegrated prosthesis (TOP) after limb amputation : Status quo and perspectives]. / Transkutane osseointegrierte Prothesensysteme (TOPS) nach Extremitätenamputation : Status quo und Ausblick.

The majority of transfemoral and transtibial amputees can be functionally fitted with conventional suspension sockets; however, due to socket problems using conventional stump care, 60% of the patients have limited function and even in younger patients approximately one sixth are unable to wear the prosthesis daily. After the introduction of transcutaneous osseointegrated prostheses (TOP) the inherent problems of socket-stump care can be avoided for these patients. Against this background this article reviews the recent clinical development of TOP in Sweden, Germany, the Netherlands, Australia and USA currently in nine centers. Unanimously, all groups show that TOP enables physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback and better control of the artificial limb. Likewise, there is agreement that as a rule that there is a clinically less relevant superficial contamination of the stoma. Furthermore, TOP is nowadays also used for transhumeral amputees and after thumb amputation and the development of the indications for this technique are increasing. Future aspects include novel treatment options using implanted intramedullary electrodes allowing permanent and unlimited bidirectional communication with the human body (osseointegrated human-machine gateway). This could possibly realize an innovative form of prosthesis control as well as the combination of TOP and targeted muscle reinnervation (TMR) surgery to create more advanced prosthesis systems for upper and lower extremity amputees.

[Antibiotic stewardship : A programmatic approach to improved antimicrobial management]. / "Antibiotic Stewardship" : Programmatischer Ansatz zum optimierten Antibiotikamanagement.

Due to the increasing selection and prevalence of multidrug-resistant gram-negative bacteria and the insufficient development of novel antibiotics, the responsible and prudent use of the available antimicrobial drugs is of major importance. In Germany the rational use of anti-infectives considering the local antimicrobial resistance situation is defined in the infection protection act of 2011. An important tool to follow legal regulations and to improve the treatment of bacterial infections is the antimicrobial stewardship (AMS) concept. Hospitals implementing an AMS program charge a multidisciplinary team of experts to develop and monitor treatment standards and to establish a system of regular consultations and ward rounds. Objectives of this set of measures are the optimization of the individual treatment outcome and on a longer range the improvement of the epidemiological situation. AMS programs include all clinical disciplines that use antimicrobials. Trauma surgery is also affected in a special way as soon as complicated infections and those with multidrug-resistant bacteria are treated.

[Prevention of postoperative infections : Risk factors and the current WHO guidelines in musculoskeletal surgery]. / Prävention postoperativer Infektionen : Risikofaktoren und aktuelle WHO-Guidelines in der muskuloskelettalen Chirurgie.

BACKGROUND: Despite the many scientific and technological advances postoperative infection continues to be a large problem for trauma and orthopedic surgeons. Based on a review of the current literature, this study provides a comprehensive overview of the risk factors (RF) and possible preventive measures to control surgical site infections. METHODS: Medline search and analysis from 1968-2017 (as of 01 March 2017). Selection of trauma and orthopedic relevant RFs and comparison with WHO recommendations (global guidelines for the prevention of surgical site infection, Nov. 2016). RESULTS: Identification of 858 relevant articles from the last 50 years (1968-2017). Pooled postoperative rate of infection is 0.3% (hand surgery) and 19% (3rd degree open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RF from three areas (patient-dependent RF, organizational and procedural RF, trauma- and surgery-dependent RF). The five most important RFs are body mass index over 35 kg/m2, increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period also in the case of nondiabetic patients, and errors in the perioperative antibiotic prophylaxis. DISCUSSION: Inconsistent definition of "infection", interaction of the RF and the different follow-up duration limit the meaningfulness of the study. CONCLUSION: In the future, considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high-risk patients.

[Importance of wound irrigation solutions and fluids with antiseptic effects in therapy and prophylaxis : Update 2017]. / Bedeutung von Wundspüllösungen und Flüssigkeiten mit antiseptischer Wirkung in Therapie und Prophylaxe : Update 2017.

INTRODUCTION: Despite the use of modern antibiotics as well as complex perioperative, intraoperative and postoperative prophylactic measures, the rate of surgical site infections (SSI) could not be significantly reduced. The introduction of biocompatible antiseptic drugs with a high microbiocidal effect provided a successful alternative for infection prevention and therapy, particularly in a time of increasing occurrence of multi-drug resistant pathogens. Hence, questions about the risk-benefit ratio of antiseptic wound irrigation solutions, the prophylactic use of wound irrigation solutions for the reduction of SSI and the effect of negative pressure wound therapy combined with instillation (NPWTi) need to be answered. METHOD: Against the background of our own experiences with the use of antiseptic wound irrigation solutions, a literature analysis (e.g. computer-supported MEDLINE, EMBASE and Cochrane database research as of April 2017) was performed. RESULTS: Antiseptic fluids can be used both prophylactically and therapeutically, in acute and chronic, clean, contaminated and infected wounds to reduce the posttraumatic and postoperative wound infection rates. The antiseptic solutions that are commonly used in orthopedic and trauma surgery (e.g. PVP-iodine, octenidine, polyhexanide, sodium hypochlorite/hypochlorous acid and acetic acid), have in common that no development of resistance has so far been shown and that when the contraindications are taken into account, the antiseptic effect can develop without any clinically significant local and systemic side effects. As a rule the biocompatibility index is higher than 1 for the substances mentioned. In addition, they show an antiseptic effect against biofilms and multi-drug resistant pathogens. These antiseptic solutions can also be used for NPWTi with some limitations for octenidine. CONCLUSION: As the basic equipment in trauma surgery, a selection of three different antiseptic wound irrigation solutions for the reduction of the rates of posttraumatic and SSI can be recommended. The use of antiseptics should be reviewed on an ongoing basis in the daily clinical routine and particular attention should be paid to unwanted effects in the course of the healing process. After application of 7-14 days, the indications for continuing the use of the antiseptic solutions must be carefully re-evaluated.

Closed incision negative pressure therapy: international multidisciplinary consensus recommendations.

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m2 ); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.

Testing of antibiotic releasing implant coatings to fight bacteria in combat-associated osteomyelitis - an in-vitro study.

PURPOSE: Surgical procedures to prevent osteomyelitis after trauma can be supported by local application of antibiotics. This in-vitro study investigated the release and impact of antibiotics from implant coatings against bacteria associated with combat-related osteomyelitis. METHODS: K-wires were coated with poly(D,L-lactide) and ciprofloxacin, gentamicin, colistin, daptomycin or cefoxitin in different concentrations. The release was quantified and antimicrobial activity tested for different gram-positive or gram-negative bacteria, alone and in combination. To exclude toxic effects, primary osteoblast-like cells were exposed to antibiotic coating concentrations. RESULTS: All antibiotics alone and in combination showed an initial burst release with dose dependent antimicrobial activity and no negative effects on osteoblast-like cells, except for cefoxitin. CONCLUSIONS: Implant coatings can be customized with single or double antibiotic coatings to effectively fight different bacteria and also mixed infections in the treatment of a combat-acquired osteomyelitis. However, optimal drug load and degradation behaviour of individual antibiotics have to be considered.