Rotation flap closure of pressure injuries following negative pressure wound therapy with instillation for wound cleansing.

INTRODUCTION: Wound cleansing is integral during early-stage wound management and affords the transition to modalities promoting granulation tissue formation and reepithelialization, or preparation for wound coverage/closure. NPWTi-d includes periodic instillation of topical wound cleansing solutions and negative pressure for infectious material removal. MATERIALS AND METHODS: This was a retrospective study of 5 patients who were admitted to an acute care hospital and treated for PI. After initial wound debridement, NPWTi-d instilled normal saline or HOCl solution (40 mL-80 mL) onto the wound for a dwell time of 20 minutes followed by 2 hours of subatmospheric pressure (-125 mm Hg). NPWTi-d duration was 3 to 6 days with 48-hour dressing changes. RESULTS: NPWTi-d helped cleanse 10 PIs in 5 patients (age, 39-89 years) with comorbidities to facilitate primary closure using rotation flaps. In 4 patients, rotation flap closures were performed without immediate postoperative complications, followed by hospital discharge within 72 hours. In one patient, closure was preempted due to an unrelated medical issue. A stoma was created to prevent further contamination. The patient returned for flap coverage post colostomy. CONCLUSION: The findings herein support the use of NPWTi-d in the cleansing of complex wounds and suggest that it may facilitate an expedited transition to rotation flap closure for this wound type.

Increased long-term health risks attributable to select volatile organic compounds in residential indoor air in southeast Louisiana.

Volatile organic compounds (VOCs) represent a broad class of chemicals, many of which can be found in indoor air including residential indoor air. VOCs derive from a variety of sources including cleaning products, cooking practices, fragrances and fresheners, hobbies and at-home work behaviors. This study examined residential indoor air in homes (n = 99) in southeast Louisiana using passive organic vapor monitors and gas chromatography/mass spectrometry to determine if select VOCs were present, at what concentrations, and if those posed any potential long-term health risks. Twenty-nine VOCs were targeted in cross-sectional analyses using a 48-h sampling period. Twelve VOCs were detected in most of the homes sampled including xylenes, pinenes, benzene, toluene, ethylbenzene, hexane, pentane, chloroform, and carbon tetrachloride. Concentrations of alkanes and BTEX compounds were highly correlated (Spearman's r > 0.63, p < 0.0001). Using health risk measures (i.e. reference concentrations [RfCs] and inhalation unit risks [IURs]) available from the USEPA non-cancer risk assessments and cancer risk assessments were developed for some of these VOCs. Alkanes and BTEX compounds likely come from the same indoor source(s). Using existing health standards published by the USEPA, no unacceptable non-cancer risks were evident except under extremely high concentrations. Lifetime cancer risks, on the other hand, may well be considered unacceptable for chloroform and benzene (upper IUR) and for the combination of chloroform, benzene, and carbon tetrachloride. These exceeded a 1 in 10,000 cancer risk threshold in 35-50% of our simulations. Further study of residential indoor air in low-income women's homes in this area is needed. Including a larger number of VOCs may reveal yet more potential health risks.

All Hands on Deck! A Challenging Case with a Multidisciplinary Team Using Negative-pressure Wound Therapy as the Cornerstone for Treatment.

The use of negative-pressure wound therapy (NPWT) has become the new standard of care for complex wounds. NPWT with instillation (NPWTi) has been shown to assist wound progression in a variety of wound types in an acute hospital setting with increased progression toward healing.  We present the case of a 70-year-old male with Crohn's disease, who had post-operative life-threatening complications following hernia repair. His complex abdominal wound and a high-output fistula required the assistance of an entire clinical team. The multidisciplinary team's approach toward the patient was equivalent to the team's approach to the complex wound: "All Hands On Deck!" The cornerstone of our management was NPWT, specifically NPWTi. Instillation therapy was initiated. Complex foam application and innovative strategies to keep a grossly contaminated wound from becoming the final straw to a patient's demise appeared our greatest challenge. NPWTi was utilized and optimized, where every type of foam, bridge, and securement was needed to gain success. This patient's progress could be wholly attributed to the commitment and experience of a group of care providers who were led by their knowledge and experience in NPWT in the most challenging circumstances.