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1.
Medicine (Baltimore) ; 99(11): e19040, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176031

RESUMEN

Traditional high ligation and stripping (THLS) is a routine operation for varicose veins. However, THLS is accompanied with postoperative subcutaneous ecchymosis and pain. In this current study, we aimed to explore the effect of tumescence solution (TS) combined with negative pressure wound therapy (NPWT) on the relief of subcutaneous ecchymosis and pain after THLS of great saphenous vein.A total of 180 patients receiving THLS were enrolled in group A, and 120 patients undergoing THLS and TS combined with NPWT were assigned into group B. The occurrences of subcutaneous ecchymosis and pain were recorded. Moreover, the total area of subcutaneous ecchymosis was estimated by the grid method. Visual analogue scale (VAS) score was used to assess the pain level of both groups.Preoperative characteristics were not significantly different between 2 groups. Postoperative ecchymosis occurred in 112 cases (62.2%) of group A and 41 cases (34.2%) of group B. The area of ecchymosis in group A (66.6 ±â€Š44.5) cm was larger than that in group B (25.2 ±â€Š19.9) cm. The number of patients without obvious pain in group A (57, 31.7%) was significantly less than that in group B (77, 64.2%) after operation. In addition, VAS score in group A (3.1 ±â€Š2.6) was higher than that in group B (2.2 ±â€Š1.9).In conclusion, the application of TS combined with NPWT in THLS can not only alleviate subcutaneous ecchymosis and pain, but also prevent the occurrence of subcutaneous ecchymosis and pain after operation. Therefore, it is conducive to postoperative recovery and is suitable for clinical application.


Asunto(s)
Equimosis/terapia , Epinefrina/uso terapéutico , Terapia de Presión Negativa para Heridas/métodos , Ropivacaína/uso terapéutico , Vena Safena/cirugía , Várices/cirugía , Adulto , Epinefrina/administración & dosificación , Femenino , Humanos , Masculino , Dolor Postoperatorio/terapia , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Ropivacaína/administración & dosificación
2.
Acta Cir Bras ; 34(9): e201900907, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800680

RESUMEN

PURPOSE: To describe a case report of FG associated with NPWT in the treatment of complex wound on the distal third of the lower limb with bone exposure. CASE REPORT: A 59-year-old patient with chronic left tibial osteomyelitis since childhood underwent extensive debridement of the distal tibial diaphysis (40% of bone thickness per 10 cm extension) and placement of bioactive glass S53P4. Distal necrosis occurred in the fasciocutaneous flap used as the primary bone coverage. After flap debridement, the case was resolved with FG, directly on the exposed bone and biomaterial, associated with NPWT. Three weeks after the first FG session over bony tissue, 100% granulation was achieved with NPWT. The closure was completed with thin laminated skin graft over the granulated wound area. DISCUSSION: The association of FG and NPWT is not known in the clinical practice. Except for the only one experimental study described by Kao et al.4, the theme was not addressed in the medical literature before. In this clinical case, the result obtained regarding the granulation tissue formation drew attention and prevented the use of more complex flaps such as the microsurgical ones. Accelerated granulation tissue formation was observed, filling an extensive and deep bone defect, even with infected bone and biomaterial. Low morbidity and no complications were observed with the use of FG associated with NPWT. When the grafted fat was compacted with the NPWT, it seemed to behave as a true autologous biological matrix with large amount of cells. To date, scientific studies on fat grafting have focused on the cellular aspect (adipocytes and mesenchymal cells), growth factors and fat differentiation in different tissues. The property of aspirated adipose tissue as a biological matrix seemed to be revealed by the application of NPWT in association with FG. This new roll for the aspirated fat tissue may represent a new research field in plastic surgery.


Asunto(s)
Tejido Adiposo/trasplante , Terapia de Presión Negativa para Heridas/métodos , Osteomielitis/cirugía , Cicatrización de Heridas , Vidrio , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos
3.
Medicine (Baltimore) ; 98(49): e18192, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804338

RESUMEN

RATIONALE: Tension-free repair of inguinal hernia with prosthetic materials in adults has become a routine surgical procedure. However, serious complications may arise such as mesh displacement, infection, and even enterocutaneous fistula (EF). The management of chronic mesh infection (CMI) complicated by an EF is very challenging. A simple treatment of infected mesh removal and negative pressure wound therapy (NPWT) may cure the patients with EF with CMI. PATIENT CONCERNS: A 75-year-old male patient underwent tension-free treatment for a bilateral inguinal hernia at a county hospital 10 years ago. Three months before admission, the right groin gradually formed a skin sinus with outflow of fetid thin pus, and it could not heal. DIAGNOSES: The patient was diagnosed preoperatively with mesh plug adhesion to the intestine, which resulted in low-flow EF combined with CMI. INTERVENTIONS: The patient received a simple treatment mode consisting of an incision made from the original incision, but the new incision did not penetrate the abdominal cavity; treatment included resection of the fistula, removal of the mesh, repair of the intestine and local tissue, and continuous irrigation of vacuum sealing drainage (VSD) devices for NPWT. OUTCOMES: The infected mesh was completely removed. Five VSD devices were utilized to treat the EF and wound. The time from intervention to wound healing was 35 days, and follow-up for 6 months revealed no infection and no hernia recurrence in the right groin. LESSONS: The NPWT is effective in treating CMI concomitant with EF and does not increase the risk of hernia recurrence.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Fístula Intestinal/cirugía , Infección de la Herida Quirúrgica/cirugía , Anciano , Remoción de Dispositivos , Herniorrafia/métodos , Humanos , Masculino , Terapia de Presión Negativa para Heridas/métodos , Mallas Quirúrgicas/microbiología
4.
Medicine (Baltimore) ; 98(44): e17786, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689851

RESUMEN

RATIONALE: Grade 4 diabetic foot (DF) is a severe infection that causes bone destruction, osteomyelitis, and osteoarticular damage, which, in turn, can lead to serious dry or wet gangrene, or amputation. DF is extremely difficult to treat. PATIENT CONCERNS: A 71-year-old female patient with long-term diabetes complicated with uremia, who undergoes regular hemodialysis 2 to 3 times per week, was admitted with grade 4 DF with Pseudomonas aeruginosa infection, and concomitant vascular occlusion of the lower extremities. The patient had a concurrent nutrition and electrolyte disorder. DIAGNOSES: The patient was diagnosed with type 2 diabetes, grade 4 DF, postamputation of the 2nd toe, vascular occlusion of the lower extremities, atherosclerosis, uremia, hypoproteinemia, and electrolyte disturbances. INTERVENTIONS: Treatment with antibiotics and comprehensive measures aimed at improving nutrition and microcirculation, controlling blood glucose, as well as balancing electrolytes were performed to ameliorate the general conditions. Nibbled debridement was used to remove devitalized tissues each time to maintain as much vital cells as possible. Open therapy was used for necrotic tissues, and dressings therapy was used simultaneously for the infected lesion. This combined treatment, involving open therapy with dressing, is referred to as "semiclosure wound therapy." Negative pressure wound therapy (NPWT) was used after a fistula formed. OUTCOMES: During the treatment procedure, the gangrene 3rd toe was spontaneously shed; the necrotic 1st toe was removed by surgery. The wound gradually healed after 3 months of open therapy combined with dressing. High location amputation was avoided. LESSONS: Semiclosure, which constitutes open therapy combined with the use of dressings, plus NPWT can preserve vital skin cells in the wound and control the aggravation of the infection. It is an effective and novel measure that prevents DF amputation in old patient and promotes wound union.


Asunto(s)
Desbridamiento/métodos , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/terapia , Terapia de Presión Negativa para Heridas/métodos , Enfermedades Vasculares Periféricas/terapia , Infecciones por Pseudomonas/terapia , Pseudomonas aeruginosa , Anciano , Antibacterianos/uso terapéutico , Vendajes , Terapia Combinada , Diabetes Mellitus Tipo 2/microbiología , Femenino , Humanos , Enfermedades Vasculares Periféricas/microbiología , Infecciones por Pseudomonas/microbiología
5.
Medicine (Baltimore) ; 98(46): e17928, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725645

RESUMEN

BACKGROUND: Research focusing on the efficacy of autologous platelet-rich gel (APRG) and continuous vacuum sealing drainage (CVSD) for diabetic foot ulcer (DFU) is increasing. Despite increasing knowledge on this theme, its results remain inconsistent. Thus, we will provide insight into the efficacy of APRG and CVSD for patients with DFU. METHODS: We will search electronic databases of MEDILINE, EMBASE, Cochrane Library, CINAHL, AMED, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to October 1, 2019. No language limitation is utilized to these databases. Two authors will independently perform study selection, data extraction, and risk of bias assessment. Disagreements between 2 authors will be solved through discussion with a third author. RESULTS: The efficacy and safety of APRG and CVSD for patients with DFU will be assessed by the time to complete healing, proportion of ulcers healed within trial period, change of size of ulcer, health-related quality of life, patient length of hospital stay, and adverse events. CONCLUSION: The results of this study will provide helpful evidence of APRG and CVSD for patients with DFU. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019153289.


Asunto(s)
Pie Diabético/terapia , Geles/uso terapéutico , Terapia de Presión Negativa para Heridas/métodos , Plasma Rico en Plaquetas , China , Drenaje , Geles/administración & dosificación , Geles/efectos adversos , Humanos , Tiempo de Internación , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Cicatrización de Heridas
6.
Medicine (Baltimore) ; 98(47): e18027, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764820

RESUMEN

Stress-induced injury is a common complication associated with patients with chronic critical illness (CCI). Skin-stretching device (SSD) and vacuum sealing drainage (VSD) technique are 2 approaches that can facilitate wound healing.In the present study, the effect of the concatenated application of the 2 techniques on the phases III and IV stress-induced injuries in aged patients with CCI was assessed. About 70 patients with CCI with stress-induced injuries were selected from February 2015 to October 2017. The treatment outcomes of the combined method and VSD method were assessed by comparing their clinicopathologic parameters.The results showed that the combined treatment shortened the average healing duration of wounds. Moreover, the total area of pressure sores, incidence of bleeding, bacteria amount, 28-day cure rate, peripheral C-reactive protein (CRP) level, and the hospitalization duration were all significantly improved in patients treated with SSD and VSD. The overall effective rate (97.14%) of patients treated with VSD and SSD was significantly higher than that (77.14%) in patients treated with VSD.The present study showed that the combined application of VSD and SSD improved the treatment outcomes of phases III and IV stress-induced injuries in aged patients with CCI.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Úlcera por Presión/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Enfermedad Crítica , Femenino , Humanos , Masculino , Terapia de Presión Negativa para Heridas/instrumentación , Úlcera por Presión/etiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estrés Mecánico , Resultado del Tratamiento
7.
Zhonghua Shao Shang Za Zhi ; 35(10): 720-725, 2019 Oct 20.
Artículo en Chino | MEDLINE | ID: mdl-31658542

RESUMEN

Objective: To preliminarily observe the effects of application of micro-negative pressure in children with small-area deep partial-thickness burn. Methods: From January 2016 to August 2018, 64 children with small-area deep partial-thickness burn who were admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University were recruited in this prospective randomized controlled study. According to the random number table, they were divided into negative pressure group [18 boys and 14 girls, aged (3.9±1.6) years with total burn area of (5.5±2.2)% total body surface area (TBSA)] and conventional group [20 boys and 12 girls, aged (3.8±1.7) years with total burn area of (5.8±1.6)% TBSA], with 32 patients in each group. After admission, simple debridement was performed in the patients of 2 groups. After that, the children in negative pressure group were treated with micro-negative pressure with negative pressure material replaced every 3 to 5 days. Children in conventional group were treated with silver sulfadiazine cream with dressing change every other day. On post injury day (PID) 14 and 21, general wound observation was performed, the wound healing rate was calculated, the exudates from the wounds were cultured and the positive detection rate was calculated. The number of patients requiring surgical skin grafting was recorded and the rate of surgical skin grafting was calculated, and the complete wound healing time was recorded in the patients of 2 groups. Scar formation was evaluated by the Vancouver Scar Scale (VSS) in 3, 6, and 12 months after wound healing. Data were processed with chi-square test, t test, Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) On PID 14, all the necrotic tissue in the wounds of patients in negative pressure group was removed, with few exudates, and most of the wounds had been epithelialized; most of necrotic tissue in the wounds of patients in conventional group was removed, with more exudates and smaller wound healing area than those in negative pressure group. On PID 21, most of the wounds of patients in negative pressure group were healed, and the exudates were rare, while the wound healing area of patients in conventional group was significantly smaller than that in negative pressure group with more exudates. (2) On PID 14 and 21, the wound healing rates [(49.8±3.3)% and (95.8±2.4)%] of patients in negative pressure group were significantly higher than those in conventional group [(40.0±3.2)% and (75.3±2.5)%, t=11.899, 33.461, P<0.01]. (3) On PID 14 and 21, the positive detection rates of wound bacteria of patients in negative pressure group were significantly lower than those in conventional group (χ(2)=6.275, 5.741, P<0.05). (4) The rate of surgical skin grafting of patients in negative pressure group was significantly lower than that in conventional group (χ(2)=5.333, P<0.05). (5) The complete wound healing time of patients in negative pressure group [(23.9±2.3) d] was significantly shorter than that in conventional group [(27.9±1.8) d, t=-7.806, P<0.01]. (6) In 3, 6, and 12 months after wound healing, the VSS scores [(6.9±1.8), (5.6±1.4), (3.4±1.5) points] of patients in negative pressure group were significantly lower than those in conventional group [(9.0±1.5), (7.4±2.0), (5.7±1.6) points, t=-4.987, -4.127, -5.988, P<0.01]. Conclusions: In comparison with routine dressing change, the treatment of application of micro-negative pressure in children with small-area deep partial-thickness burn can significantly improve the wound healing rate and rate of surgical skin grafting, decrease the wound infection rate, shorten the wound healing time, and improve the wound healing quality.


Asunto(s)
Quemaduras/terapia , Cicatriz/terapia , Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Quemaduras/complicaciones , Niño , Preescolar , Desbridamiento , Femenino , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Cicatrización de Heridas
8.
Zhonghua Shao Shang Za Zhi ; 35(10): 757-760, 2019 Oct 20.
Artículo en Chino | MEDLINE | ID: mdl-31658548

RESUMEN

Objective: To observe the clinical effects of sequential treatment with extensive lesion resection, vacuum sealing drainage (VSD) combined with irrigation of oxygen-loaded fluid, and tissue transplantation on hidradenitis suppurativa (HS) in buttocks which recurred after multiple surgeries. Methods: From January 2012 to March 2017, 15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley's stage Ⅲ HS in the buttocks recurred after 2-5 operations who met the inclusion criteria were enrolled in the prospective self pre- and post-control study. After extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid was given, with negative pressure of -16.7 kPa and flow rate of pure oxygen of 1.0 L/min. After 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid, the negative pressure device was removed and autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds. Six patients were performed with split-thickness skin grafting, 4 patients with local flap transplantation, and 5 patients with split-thickness skin grafting together with local flap transplantation. The donor sites of local flaps were sutured directly or transplanted with autologous posterior thigh split-thickness skin grafts, and the donor sites of split-thickness skin grafts with autologous thin split-thickness scalp. The wound tissue or wound granulation tissue was collected before lesion resection and 7 days after treatment with VSD combined with irrigation of oxygen-loaded fluid respectively for bacterial culture and detecting of the content of tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up. Data were processed with paired sample t test. Results: Bacterial culture result of wound tissue before lesion resection was positive in all patients, mainly Staphylococcus, Streptococcus, Proteus mirabilis, and anaerobic bacteria, etc., while that of wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was negative. The content of TNF-α in wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was (10.1±2.9) pg/L, significantly lower than (73.6±5.6) pg/L before lesion resection (t=33.47, P<0.01). The skin grafts and/or flaps of 15 patients survived post operation, and the wounds were healed. The patients were hospitalized for 17-31 days. During follow-up of 1 to 5 years, no recurrence of HS occurred in operative site of buttocks of 15 patients, but 1 patient had ulceration of healed perianal incision caused by high anal fistula and was healed after treatment. Conclusions: Sequential treatment with extensive resection, VSD combined with irrigation of oxygen-loaded fluid, and tissue transplantation can thoroughly remove HS lesions in the buttocks and improve the condition of wound bed for skin acceptance after debridement, which is conducive to the cure of HS in the buttocks which has undergone multiple operations but still recurs after operation.


Asunto(s)
Nalgas/microbiología , Colgajos Tisulares Libres/trasplante , Hidradenitis Supurativa/terapia , Terapia de Presión Negativa para Heridas/métodos , Traumatismos de los Tejidos Blandos/cirugía , Cicatrización de Heridas/fisiología , Adulto , Desbridamiento , Drenaje , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trasplante de Piel , Resultado del Tratamiento
9.
Wounds ; 31(8): E49-E53, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31483754

RESUMEN

INTRODUCTION: Patient nonadherence to wound care protocols may impact the efficacy of modalities, such as negative pressure wound therapy (NPWT). Recently, a remote therapy monitoring (RTM) system has been devised for use with NPWT for home care patients. OBJECTIVE: Three home care patients receiving NPWT are presented to examine the relationship between patients using the RTM system and Virtual Therapy Specialists (VTS). MATERIALS AND METHODS: Consent was secured from patients with either multiple comorbidities and/or wounds of varying complexity. Wounds were assessed as per their initial presentation, and all patients were discharged home with an RTM-equipped NPWT system to apply continuous subatmospheric pressure to their wound. Dressings were changed every 2 to 3 days. RESULTS: All 3 patients were women (age range, 53-72 years), who presented with the following wound types: recalcitrant abdominal wound, acute wound following ventral hernia repair, and dehisced wound following a hysterectomy. Patient 1 was treated with RTM-equipped NPWT for a duration of 88 days (6 nonadherent vs. 82 adherent days) and was adherent to the therapy 93.2% of the time. Patient 2 was treated with RTM-equipped NPWT for a duration of 57 days (8 nonadherent vs. 49 adherent days) and was adherent to the therapy 86.0% of the time. Patient 3 was treated with RTM-equipped NPWT for a duration of 16 days (2 nonadherent vs. 14 adherent days) and was adherent to the therapy 87.5% of the time. Each patient presented with a barrier to therapy adherence (eg, lack of access to residential clinical support, technical issues, or work demands) that was managed by VTS interactions. CONCLUSIONS: In these 3 cases, RTM-equipped NPWT and the patient-centric exchanges with the VTS through adherence calls helped promote consistent usage of RTM-equipped NPWT to address the patients' therapeutic needs and increase therapy adherence.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Cooperación del Paciente , Consulta Remota/métodos , Cicatrización de Heridas/fisiología , Técnicas de Cierre de Herida Abdominal/estadística & datos numéricos , Anciano , Femenino , Hernia Hiatal/terapia , Herniorrafia/efectos adversos , Servicios de Atención de Salud a Domicilio , Humanos , Histerectomía/efectos adversos , Persona de Mediana Edad , Monitoreo Ambulatorio/métodos , Atención Dirigida al Paciente/métodos , Dehiscencia de la Herida Operatoria/terapia , Infección de la Herida Quirúrgica/terapia , Resultado del Tratamiento
10.
Plast Reconstr Surg ; 144(3): 759-767, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31461042

RESUMEN

BACKGROUND: Marko Godina, in his landmark paper in 1986, established the principle of early flap coverage for reconstruction of traumatic lower extremity injuries. The aim of this study was to determine how timing influences outcomes in lower extremity traumatic free flap reconstruction based on Godina's original findings. METHODS: A retrospective review identified 358 soft-tissue free flaps from 1979 to 2016 for below knee trauma performed within 1 year of injury. Patients were stratified based on timing of coverage: 3 days or less (early), 4 to 90 days (delayed), and more than 90 days (late). The delayed group was further divided into two groups: 4 to 9 days and 10 to 90 days. Flap outcomes were examined based on timing of reconstruction. RESULTS: Flaps performed within 3 days after injury compared with between 4 to 90 days had decreased risk of major complications (OR, 0.40, p = 0.04). A receiver operating curve demonstrated day 10 to be the optimal day for predicting flap success. Flaps performed less than or equal to 3 days versus 4 to 9 days had no differences in any flap outcomes. In contrast, flaps performed within 4 to 9 days of injury compared to within 10 to 90 days were associated with significantly lower total flap failure rates (relative risk, 0.29, p = 0.025) and major complications (relative risk, 0.37, p = 0.002). CONCLUSIONS: Early free flap reconstruction performed within 3 days of injury had superior outcomes compared with the delayed (4 to 90 day) group, consistent with Godina's original findings. However, as an update to his paradigm, this ideal early period of reconstruction can be safely extended to within 10 days of injury without an adverse effect on outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Microcirugia/métodos , Terapia de Presión Negativa para Heridas/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Traumatismos de los Tejidos Blandos/terapia , Tiempo de Tratamiento , Adolescente , Adulto , Femenino , Colgajos Tisulares Libres/trasplante , Historia del Siglo XX , Humanos , Extremidad Inferior/lesiones , Masculino , Microcirugia/historia , Microcirugia/normas , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/historia , Terapia de Presión Negativa para Heridas/normas , Guías de Práctica Clínica como Asunto , Procedimientos Quirúrgicos Reconstructivos/historia , Procedimientos Quirúrgicos Reconstructivos/normas , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
11.
Wounds ; 31(8): 213-218, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31298660

RESUMEN

INTRODUCTION: Graft fixation is critical for the successful survival of a skin graft. Conventional mechanical fixation may induce inappropriate pressure and increase wound complications. Negative pressure wound therapy (NPWT) could be utilized to secure a skin graft and improve drainage. Limited quantitative data exist on the efficacy of NPWT for skin grafting. OBJECTIVE: This retrospective study compares the efficacy and complications between NPWT and conventional mechanical fixation in skin grafts. MATERIALS AND METHODS: Patients who underwent skin graft surgery from January 2015 to December 2016 at a large university hospital in southwest China were retrospectively analyzed. Characteristics, including wound pattern, skin graft type, surgical procedure, survival rate, and postoperative complication, were statistically analyzed by Pearson chi-square or Fisher's exact test. RESULTS: A total of 186 patients were included in the study; 72 received NPWT and 114 received conventional mechanical dressing fixation after skin grafting. Overall survival rate of full-thickness skin grafts was significantly higher in the NPWT group than the dressing group (P ⟨ .01). The NPWT group showed a higher survival rate than the dressing group for each anatomic site, but only patients who had skin grafts of the hand exhibited statistically significant results. CONCLUSIONS: This study reports a quantitative analysis of the efficacy of NPWT on skin graft fixation with NPWT providing consistent pressure and better drainage than conventional mechanical fixation. In addition, the use of NPWT also could increase graft take on the hand region.


Asunto(s)
Supervivencia de Injerto/fisiología , Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Cicatrización de Heridas/fisiología , Adulto , Traumatismos del Brazo/fisiopatología , Traumatismos del Brazo/cirugía , Cicatriz Hipertrófica/fisiopatología , Cicatriz Hipertrófica/cirugía , Contractura/fisiopatología , Contractura/cirugía , Fascitis Necrotizante/fisiopatología , Fascitis Necrotizante/cirugía , Femenino , Fracturas Óseas/fisiopatología , Fracturas Óseas/cirugía , Fracturas Múltiples/fisiopatología , Fracturas Múltiples/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
12.
Int J Low Extrem Wounds ; 18(3): 317-322, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31258007

RESUMEN

Although the importance of vacuum-assisted wound closure therapy has been well established as road to definitive treatment of trauma wound in the adult population, its use in pediatric patients is not well described in the literature. This study was conducted to evaluate the outcome of vacuum-assisted wound closure therapy in pediatric patients. Twenty-two patients were prospectively treated for soft tissue defect in lower limb using vacuum-assisted wound closure device, as these wounds were not amenable for primary closure. After wound evaluation, thorough wound debridement was done. Vacuum-assisted wound closure dressing was applied once hemostasis was achieved. Dressings were changed as per protocol. After the development of healthy granulation tissue, wound coverage was achieved with skin graft or flaps. Mean age of patients was 9.455 years, ranging from 4 to 14 years. Early, healthy granulation tissue had formed in all patients. The average number of vacuum-assisted closure (VAC) dressings required was 2.682. Average duration of VAC therapy was 8.045 days. The sizes of soft tissue defects reduced from an average 69.18 cm2 to 50.73 cm2 after VAC therapy with a mean decrease of 26.66%. There was no complication because of VAC therapy. Vacuum-assisted wound closure therapy accelerated the process of healthy granulation tissue formation, and thus shortened the healing time. VAC therapy lessens the morbidity and pain associated with large wounds in pediatric patients and brings cheer and smile in growing children.


Asunto(s)
Desbridamiento/métodos , Traumatismos de la Pierna/terapia , Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Traumatismos de los Tejidos Blandos/terapia , Cicatrización de Heridas , Vendajes , Niño , Terapia Combinada/métodos , Femenino , Humanos , India , Traumatismos de la Pierna/diagnóstico , Traumatismos de la Pierna/fisiopatología , Masculino , Estudios Prospectivos , Traumatismos de los Tejidos Blandos/diagnóstico , Traumatismos de los Tejidos Blandos/fisiopatología , Resultado del Tratamiento
13.
Med Sci Monit ; 25: 5343-5349, 2019 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-31320603

RESUMEN

BACKGROUND Chronic osteomyelitis is one of the currently refractory diseases. The aim of this study is to discuss the method and curative effects of vacuum sealing drainage (VSD) treatment combined with skin flap transplantation and antibiotic bone cement for chronic tibia osteomyelitis. MATERIAL AND METHODS For this study, 18 cases of open fracture secondary chronic tibia osteomyelitis were selected. After the granulation tissue of the wound surface became fresh and infection was controlled, the wound surface was repaired with a medial head of gastrocnemius transfer flap or a myofascial and cutaneous island pedicle flap with a collateral vessel nourished by the retrograde sural nerve. VSD combined with focus debridement and antibiotic bone cement filling was conducted. After inflammation was completely regulated, elective bone cement extraction, bone grafting, and internal fixation were performed. Within 2 to 3 years of follow-up post-surgery, the satisfaction and recurrence rates were evaluated. The patients' pre-operative and post-operative recovery of limb functions were compared according to the Enneking scoring system. RESULTS The patients did not suffer from osteomyelitis recurrence, with the exception of 1 case that manifested osteomyelitis recurrence and recovered through surgical treatment within the period of follow-up. The satisfaction and recurrence rates of these study cases post-surgery were 94.4% and 5.6%, respectively. The average functional recovery post-surgery was 81.5% of normal function. CONCLUSIONS Vacuum sealing drainage combined with skin flap transplantation and antibiotic bone cement is an effective treatment for chronic tibia osteomyelitis.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Osteomielitis/cirugía , Osteomielitis/terapia , Adolescente , Adulto , Antibacterianos , Cementos para Huesos , Trasplante Óseo , China , Desbridamiento/métodos , Drenaje/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Piel , Trasplante de Piel/métodos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/cirugía , Tibia/cirugía , Fracturas de la Tibia/cirugía , Resultado del Tratamiento , Cicatrización de Heridas
14.
Adv Skin Wound Care ; 32(8): 370-377, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31335434

RESUMEN

OBJECTIVE: To investigate the antibacterial efficacy of silver-impregnated negative-pressure wound therapy (NPWT) in lower-extremity acute traumatic wounds. METHODS: Open contaminated wounds caused by high-velocity trauma in the lower extremities were randomly allocated into two groups. The wounds in the control and experimental groups were treated with conventional NPWT (n = 31) and silver-impregnated NPWT (n = 35), respectively. MAIN OUTCOME MEASURES: Serial bacterial cultures were obtained from the participants' wounds, polyurethane foam, and suction tubes weekly during the 4-week follow-up to identify bacteria and follow their conversions. MAIN RESULTS: Bacterial colonization rates in the silver NPWT group were generally lower than those in the conventional NPWT group, and the difference increased with time. For methicillin-resistant Staphylococcus aureus colonization, wounds treated with silver-impregnated NPWT showed a significant reduction in bacterial load compared with those treated with conventional NPWT. CONCLUSIONS: Silver-impregnated NPWT effectively decreases bacterial load in open contaminated wounds of the lower extremities. It can be used as a temporizing measure to manage bacterial colonization while patients and wounds are being prepared for final wound reconstruction.


Asunto(s)
Traumatismos de la Pierna/terapia , Terapia de Presión Negativa para Heridas/métodos , Compuestos de Plata/uso terapéutico , Infección de Heridas/terapia , Adulto , Femenino , Humanos , Traumatismos de la Pierna/microbiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Cicatrización de Heridas , Infección de Heridas/microbiología
15.
J Wound Ostomy Continence Nurs ; 46(4): 337-342, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274868

RESUMEN

BACKGROUND: Repair of an enterocutaneous fistula (ECF) is challenging, particularly when complications occur. This case describes the use of negative pressure wound therapy (NPWT) and microadhesive dressings with polyabsorbent fibers and an acrylic core, with and without lipidocolloid and nano-oligosaccharide factors, in the management of a patient with a large abdominal wound and ECF. CASE: An 84-year-old woman underwent abdominoperineal resection with colostomy, hysterectomy, and subsequent chemotherapy and radiotherapy for colorectal cancer. She experienced complications, ultimately resulting in ECF of the jejunum. Initial management with NPWT was used to promote abdominal wound healing, while protecting exposed bowel loops proved challenging because of leakage of stoma effluent that impeded the formation of granulation tissue. In order to promote wound healing and prevent infection, we applied a microadhesive dressing composed of polyabsorbent fibers with an acrylic core and lipidocolloid and nano-oligosaccharide factors that facilitated autolytic debridement and healing. CONCLUSIONS: Use of NPWT with the microadhesive dressing proved successful in the management of this complex and challenging ECF.


Asunto(s)
Pared Abdominal/cirugía , Fístula Intestinal/cirugía , Pared Abdominal/anomalías , Pared Abdominal/fisiopatología , Técnicas de Cierre de Herida Abdominal , Anciano de 80 o más Años , Vendajes/efectos adversos , Vendajes/tendencias , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Fístula Intestinal/fisiopatología , Terapia de Presión Negativa para Heridas/métodos , Cicatrización de Heridas/efectos de los fármacos , Cicatrización de Heridas/fisiología
16.
Clin Microbiol Infect ; 25(11): 1328-1338, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31220604

RESUMEN

OBJECTIVES: Previous studies showed the effectiveness of negative pressure wound therapy (NPWT) in preventing surgical site infections (SSIs), but current guidelines do not recommend its routine use for surgical wounds. The aim was to compare the effectiveness and safety of NPWT with standard surgical dressing or conventional therapy for preventing SSIs. METHODS: Pubmed, Embase and the Cochrane Library were systematically searched on 10 April 2019. Also, we searched clinicaltrials.gov and references of relevant studies. Eligibility criteria were randomized controlled trials (RCTs) and adult surgical patients were included. The effectiveness of NPWT versus standard surgical dressing or conventional therapy was investigated. Relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were used to estimate the pooled effect of dichotomous outcomes and continuous outcomes respectively. The primary outcome was surgical site infections. The quality of included studies and the certainty of the evidence were assessed using the risk of bias tool and the GRADE approach. RESULTS: A total of 45 RCTs with 6624 surgical patients were included. NPWT reduced SSIs (RR 0.58; 95% CI 0.49-0.69) and wound dehiscence(17 RCTs; RR 0.80; 95% CI 0.65-1.00). NPWT did not increase the risk of hematoma (9 RCTs; RR 0.91; 95% CI 0.40-2.07) and hospital readmission(9 RCTs; RR 0.77; 95% CI 0.52-1.12) or prolong length of hospital stay(15 RCTs; MD -0.38; 95% CI, -0.78 to 0.02). NPWT significantly increased the risk of all adverse event-related outcomes (10 RCTs; RR 3.21; 95% CI, 1.17-8.78). The level of certainty was identified as low for the primary outcome and very low for all the secondary outcomes. CONCLUSIONS: Compared with standard wound care, NPWT may reduce the risk of SSIs. We are uncertain whether NPWT reduces or increases the risk of wound dehiscence, haematoma, hospital readmission and all adverse event-related outcomes or if it shortens or prolongs length of hospital stay.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Infección de la Herida Quirúrgica/prevención & control , Humanos , Infección de la Herida Quirúrgica/epidemiología , Resultado del Tratamiento
17.
BMC Surg ; 19(1): 65, 2019 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-31215452

RESUMEN

BACKGROUND: Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. METHODS: Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. RESULTS: The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. CONCLUSIONS: Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Cicatrización de Heridas , Adulto , Canal Anal/lesiones , Drenaje/métodos , Femenino , Humanos , Ileostomía/métodos , Masculino , Persona de Mediana Edad , Perineo/lesiones , Estudios Retrospectivos , Sacro/lesiones , Piel/patología , Infección de Heridas/epidemiología
18.
Med Sci Monit ; 25: 4495-4502, 2019 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-31204383

RESUMEN

BACKGROUND The aim of this study was to assess the effects of a new treatment strategy for envenomation that consists of multiple small incisions and negative-pressure wound therapy (NPWT) on injured limb swelling and systemic inflammatory reaction. MATERIAL AND METHODS This was a prospective randomized controlled trial on snakebite envenomation. The enrolled patients were randomly divided into 2 groups: an observation group and a control group. The traditional comprehensive treatment was administered in both groups, but the observation group also received combined treatment with multiple small incisions and NPWT. Reduction in limb swelling, mean admission duration, complication rate, and changes in the levels of relevant cytokines were recorded and compared between the 2 groups. RESULTS The mean duration of hospital stay was significantly lower in the observation group than in the control group (5.44±0.89 days vs. 7.71±1.70 days). The complication rate and IL-6 concentration were significantly lower in the observation group than in the control group. CONCLUSIONS Multiple small incisions combined with NPWT proved effective for controlling the release of inflammatory cytokines and accelerating the relief of systemic inflammatory reaction. As a consequence, the complication rate decreased. Therefore, our new treatment strategy is safe and effective.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Mordeduras de Serpientes/terapia , Adulto , Anciano , Animales , China , Venenos de Crotálidos , Crotalinae , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Herida Quirúrgica , Cicatrización de Heridas
19.
Wounds ; 31(5): E33-E36, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31184590

RESUMEN

INTRODUCTION: An early-stage decision clinicians often make in the management of complex wounds is which method of wound preparation will be appropriate for the patient. This decision can be affected by numerous wound and patient risk factors that present challenges and may make surgical debridement difficult in patients with complex wounds. Recently, negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a novel reticulated open-cell foam dressing with through holes (ROCF-CC) was shown to aid in the loosening and removal of thick exudate and nonviable tissue from wounds. OBJECTIVE: The authors present their experiences of using NPWTi-d with ROCF-CC, along with rationales for wound care decisions. MATERIALS AND METHODS: Patients received antibiotics and surgical debridement when appropriate. Therapy selection and parameters were based on a decision-tree model for wound care management that takes into consideration patient and wound information. Most patients received NPWTi-d with ROCF-CC for a duration of 5 to 8 days; however, 1 patient received NPWTi-d with ROCF-CC for more than 30 days due to the wound extent and severity. Therapy consisted of instilling saline or quarter-strength sodium hypochlorite solution with dwell times of 3 to 10 minutes, followed by 2 hours or 3.5 hours of NPWT either at -100 mm Hg or -125 mm Hg. RESULTS: There were 6 patients (3 men, 3 women; average age, 58.5 years) treated. Wound types included 3 pressure ulcers, 1 necrotizing soft tissue infection, 1 perianal abscess, and 1 large abdominal wound. Patient comorbidities included obesity, type 2 diabetes, and radiation therapy. In all cases, progression of wound healing was observed with no complications. This method produced viable granulation tissue and wound bed preparation; however, patients were not followed to closure or grafting. CONCLUSIONS: These cases help support the use of NPWTi-d with ROCF-CC as a viable option for wound care providers in the early-stage management of complex wounds.


Asunto(s)
Enfermedad Crítica/terapia , Terapia de Presión Negativa para Heridas/métodos , Cicatrización de Heridas/fisiología , Absceso Abdominal/fisiopatología , Absceso Abdominal/terapia , Enfermedades del Ano/fisiopatología , Enfermedades del Ano/terapia , Vendajes , Cuidados Críticos/métodos , Desinfectantes/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Úlcera por Presión/fisiopatología , Úlcera por Presión/terapia , Solución Salina/administración & dosificación , Hipoclorito de Sodio/administración & dosificación , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Resultado del Tratamiento
20.
J Coll Physicians Surg Pak ; 29(5): 476-477, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31036123

RESUMEN

Here, we present the management of a patient, developing severe peritonitis due to laceration of the jejunum, involving sutures applied to facial layers after anterior resection for adenocarcinoma of the sigmoid colon. The patient, an 83-year woman, was operated by anterior resection, and relaparotomy was performed because the small bowel contents leaked from the incision. A compulsory stoma on the top of the incision was performed. Bilateral fasciocutaneous advancement flaps were carried out to treat the patient with severe intraabdominal sepsis via vacuum-assisted closure. The patient, with Apache-II score 12, open abdomen Bjorck score 2C, and Mannheim peritonitis index score 28, was monitored in the intensive care unit. Based on our experience, open abdomen management with vacuum-assisted closure might be successful for patients with intraabdominal sepsis because of uncontrollable primer sources. We propose that the technique defined for this patient is an innovative technique for primary source control of open abdomen patients.


Asunto(s)
Cavidad Abdominal/cirugía , Yeyuno/cirugía , Laparotomía/efectos adversos , Terapia de Presión Negativa para Heridas/métodos , Sepsis/cirugía , Cicatrización de Heridas/fisiología , Adenocarcinoma/cirugía , Anciano de 80 o más Años , Colon Sigmoide , Femenino , Humanos , Peritonitis/complicaciones , Sepsis/complicaciones , Sepsis/diagnóstico , Neoplasias del Colon Sigmoide/cirugía , Resultado del Tratamiento , Técnicas de Cierre de Heridas
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