Negative pressure wound therapy in infants and children: a single-institution experience.

BACKGROUND: Information regarding the use of negative pressure wound therapy (NPWT) in the pediatric population is limited. Because of adverse outcomes in adult patients, the Food and Drug Administration issued a warning in 2011 about the use of NPWT in infants and children. METHODS: We performed an institutional review board-approved, single-institution, retrospective review of pediatric patients who had undergone NPWT from 2007-2011. We collected the types of wounds for which NPWT was initiated, the NPWT outcomes, and the complications encountered. RESULTS: The data from 290 consecutive patients were reviewed. Their average age was 9.3 y (range 12 d to 18 y), and their average weight was 46.5 kg (range 1.1-177). Of the wounds, 66% were classified as acute, 10% as chronic, and 24% as traumatic. The two most common indications were surgical wound dehiscence (n = 47) and skin grafting (n = 41). NPWT was used in 15 wounds containing surgical hardware, with 2 devices requiring eventual removal. NPWT was used for a median of 9 d per patient (two dressing changes). Complications occurred in 5 patients (1.7%). Documentation problems were noted in 44 patients. After NPWT, about one-third of the patients (n = 95 patients) were able to undergo delayed primary closure. CONCLUSIONS: NPWT is an effective adjunct in wound healing and closure in the pediatric population, with no mortality ascribed to NPWT. Also, the complication rates were low.

La suplementación nutricional oral con micronutrientes y el tratamiento de heridas quirúrgicas / Oral micronutrient supplementation and surgical wound treatment

Objetivo: conocer el enfoque actual de la práctica de la suplementación nutricional oral (SON) con micronutrientes y su implicación en la cicatrización de heridas quirúrgicas de pacientes adultos en tratamiento de cirugía general curativa. Metodología: se llevó a cabo una revisión bibliográfica narrativa mediante una búsqueda estructurada de diversas fuentes en varias etapas, incluyendo libros, manuales, protocolos, monografías, guías de práctica clínica, enciclopedias, etc., revistas científicas, tesis doctorales y actas de congresos, utilizando diversas bases de datos y buscadores (Elsevier, Scielo, e-revist@, Google,Teseo, PubMed, MEDES, Cochrane Plus, Bio-Med Central, MedinePus, Google Académico y SCIRUS y Single Citation Matcher). Se empleó la combinación de operadores boleanos con los descriptores: "micronutrientes", "suplementos nutricionales", "cicatrización", "cirugía" y "antioxidantes". El periodo de búsqueda se acotó entre el 30 de junio de 2007 hasta el 30de junio de 2012. Resultados: se identificaron dos estudios recientes que se ajustan relativamente al objetivo de este estudio, ambos realizados con poblaciones heterogéneas de pacientes quirúrgicos, diferentes diseños metodológicos, distintas cantidades, composición y tiempo de administración de los SNO con micronutrientes, corto plazo de seguimiento, etc., obteniendo como resultado una mejora en el proceso de cicatrización y disminución del riesgo de infección de las heridas quirúrgicas, tras la administración conjunta de vitaminas y oligoelementos esenciales. Conclusiones: los micronutrientes son elementos terapéuticos que se asocian a buenos resultados en la cicatrización de las heridas, pero es necesario respaldar esta evidencia con adecuadas investigaciones científicas, profundizando y perfeccionando las grietas existentes en esta materia (AU)

Purpose: Ascertain the current approach to micronutrient-based oral nutritional supplementation (ONS) and the implication thereof on the healing of surgical wounds in adult patients undergoing general curative surgical treatment. Methodology: A narrative bibliographic review was conducted by way of a structured, multi-stage search of different sources including books, manuals, protocols, monographic studies, clinical practice guides, encyclopedias, etc., scientific journals, doctoral theses and conference proceedings, using different databases and search engines (Elsevier,Scielo, e-revist@, Google, Teseo, PubMed, MEDES, Cochrane Plus, Bio-Med Central, Medine Pus, Academic Google and SCIRUS and Single Citation Matcher). Boolean searches were run using the descriptors: "micronutrients", "nutritional supplements", "wound healing", "surgery"and "antioxidants". The search was confined to the June 30, 2007 - June 30, 2012 period. Results: Two recent studies were identified as being relatively in keeping with the purpose of this study, both of which were conducted on heterogeneous populations of surgical patients, different methodological designs, different quantities, composition and time of administering the micronutrient-based ONSs, short follow-up time, etc., having achieved as a result an improvement in the wound healing process and a lower risk of their infection following the combined administration of vitamins and essential trace elements. Conclusions: Micronutrients are treatment-related aspects associated with good results in wound healing, it however being necessary for this evidence to be backed with suitable scientific research by delving deeper into this subject and filling in the currently extant gaps (AU)

Oral glutamine in addition to parenteral nutrition improves mortality and the healing of high-output intestinal fistulas / Glutamina oral en adición a nutrición parenteral mejora la mortalidad y la cicatrización de fístulas intestinales de alto débito

Objective: Anastomotic leakage is one of the most important causes of morbidity and mortality in gastrointestinal surgery. We investigated the effect of oral glutamine on the healing of high-output intestinal fistula. Setting: A tertiary University Hospital of the University of Mato Grosso, Cuiaba, Brazil. Patients and methods: 28 patients (25 males and 3 females; median age = 45 [18-71] years old) admitted with high output post-operative small bowel fistulas (median volume in 24 h: 850 [600-2,200] mL) during a 4 years period were retrospectively studied. Interventions: In the first two years 19 (67.9%) patients received only TPN as the initial nutritional support. In the last two years however, due to a change in the protocol for the nutritional support in cases of intestinal fistula 9 patients (32.1%) received oral glutamine (0.3 g/kg/day; 150 mL/day) in addition to TPN. Endpoints of the study were mortality, resolution of the fistula, and length of hospital stay (LOS). Results: The overall mortality was 46.4% (13patients). Fistula closure was observed in all other 15patients (53.6%) that survived. In the subset of survived patients LOS was similar in those who received or not received glutamine. The multivariate regression analysis showed that resolution of the fistula was 13 times greater in patients that received oral glutamine (OR = 13.2 (95% CI = 1.1-160.5); p = 0.04) and 15 times greater in non-malnourished patients (OR = 15.4 [95% CI = 1.1- 215.5]; p = 0.04). Conclusions: We conclude that oral glutamine accelerated the healing and diminished the mortality in this series of patients with post-operative high-output intestinal fistula receiving TPN

Objetivo: La fístula anastomótica es una de las principales causas de morbilidad y mortalidad en cirugía general. Investigamos el efecto de la glutamina oral en la cicatrización de fístulas intestinales de alto débito. Ámbito: Una unidad terciaria de un Hospital Universitario de la Universidad Federal de Mato Grosso, Cuiabá, Brasil. Pacientes y métodos: 28 pacientes (25 M y 3 F; edad mediana = 45 [18-71] años) admitidos con fístulas pos-operatorias del intestino delgado de alto débito (volumen mediano en 24 h: 850 [600-2.200] mL) durante un período de 4 años fueron retrospectivamente estudiados. Intervenciones: En los dos primeros años 19 pacientes (67,3%) recibieron únicamente TPN como suporte nutricional. En los últimos dos años sin embargo, debido a un cambio del protocolo para el suporte nutricional en casos de la fístula intestinal 9 pacientes (32,1%) recibieron glutamina oral (0,3 g/kg/día; 150 mL/día) además de TPN. Las variables de resultado del estudio fueron la mortalidad, la resolución de la fístula, y el tiempo de hospitalización (LOS).Resultados: La mortalidad fue de 46,4% (13 pacientes). La cicatrización de la fístula fue observada en 15 pacientes (53,6%) que sobrevivieron. Entre los pacientes que sobrevivieron la permanencia hospitalaria fue similar en aquellos que recibieron o no recibieron glutamina. El análisis multivariante mostró que la resolución de la fístula fue 13 veces mayor en los pacientes que recibieron glutamina oral (OR = 13,2(95% CI = 1,1-160,5); p = 0,04) y 15 veces mayor entre los pacientes no desnutridos (OR = 15,4 [95% CI = 1,1-215,5]; p = 0,04). Conclusiones: La glutamina oral acelera la cicatrización y disminuyó la mortalidad en nuestros pacientes con fístula intestinal de alto débito que recibieron TPN

[Elemental diet and external fistulae of, the digestive system]. / Dieta elemental y fistulas externas del aparato digestivo

An elemental diet is a food which provides the basic needs in calories, proteins, vitamins and minerals with two advantages: it is predigested and leaves minimal or no residue to provide bulk. The care of 20 patients, with an elemental diet, presenting 20 external fistulas (75 per cent with low output and 25 per cent with high output) succeeded to obtain a spontaneous healing in 75 per cent of the cases, and an improvement of the general conditions of 15 per cent of the patients who were operated on because of fistula persistency. The death rate was 10 per cent. We think that the elemental diet is a useful tool in the treatment of external fistulas of patients who have preserved their bowel movements and an output smaller than 500 ml. in 24 hrs.