Novel foam dressing with through holes and negative pressure wound therapy with instillation and dwell time: a retrospective cohort study.

BACKGROUND: NPWTi-d of a topical wound solution has been shown to benefit healing in a variety of wound types. This therapy has traditionally been applied via a standard ROCF-V. In 2017, a new ROCF-CC was introduced at the practice of the authors of the current manuscript for adjunctive management of patients with wounds with thick exudate and/or nonviable tissue and in cases in which surgical debridement is not available or not appropriate. OBJECTIVE: To compare the efficacy of NPWTi-d with ROCF-CC dressing (treatment) vs NPWTi-d with ROCF-V dressing (control). MATERIALS AND METHODS: An observational retrospective cohort study of hospital records of patients with VLUs treated with NPWTi-d who received ROCF-CC dressings (n = 11) vs standard ROCF-V dressings (n = 11) was conducted. NPWTi-d was chosen to promote wound healing in VLUs that were not fully responsive to advanced dressings and/or compression bandage. Solution dwell time was 10 minutes, followed by 2.5-hour NPWT cycles at -125 mm Hg. Dressings were changed every 72 hours. RESULTS: Overall, mean ± SD duration of therapy and hospital length of stay were shorter in the treatment group vs the control group (duration of therapy, 8.63 days ± 7.05 vs 11.72 days ± 17.41, respectively; P = .05, and length of stay, 9.9 days ± 2.98 vs 12.81 days ± 4.26, respectively; P = .08), but these differences were not statistically significant. Mean wound area reduction was greater in the treatment group than in the control group (14.63 cm2 ± 13.24 and 10.72 cm2 ± 14.06, respectively; P = .51), but this was not significant. CONCLUSION: ROCF-CC dressings were a useful tool in assisting wound bed preparation and reducing time to skin graft closure in this series of complex VLUs.

Management of Acute and Chronic Wounds Using Negative Pressure Wound Therapy With Instillation and Dwell Time: A Retrospective Review of a 100-Patient Cohort in Padova, Italy.

INTRODUCTION: The presence of debris covering a wound surface significantly impedes progression toward closure. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) of topical wound solutions is a versatile tool that can be applied to various wound types to promote wound healing. At the University Hospital of Padova in Padova, Italy, NPWTi-d has been incorporated into wound management plans that include debridement and antibiotic therapy, as necessary, for a diverse population of patients with open wounds, including acute, chronic, and infected wounds. OBJECTIVE: A retrospective analysis of 100 patients (53 male, 47 female; age range, 22-95 years) who underwent NPWTi-d was performed, and key healing outcomes observed in subgroups differentiated by sex, wound etiology, initial wound size, and topical instillation solution were reported. MATERIALS AND METHODS: Wound types included vascular ulcers, surgical wounds, dehiscences, and trauma; anatomic location of the wounds varied. Negative pressure wound therapy with instillation (0.05% sodium hypochlorite, normal saline, or 0.25% acetic acid) was implemented with a dwell time of 3 minutes to 10 minutes, followed by a negative pressure cycle length of 2 hours to 3.5 hours at -75 mm Hg to -125 mm Hg. Dressings were changed approximately every 3 days. RESULTS: After a median of 11 days (range, 1-35 days), the wound surface area significantly decreased (P <.0001), percentage of infected wounds declined from 72% to 46%, and wound closure was attained in 91% of cases. A significant reduction in wound surface area was detected in both sexes, small- and medium-sized wounds, vascular ulcers, surgical wounds, dehiscences, trauma wounds, and pressure ulcers (P <.05). This effect was detected in wounds regardless of topical instillation solution (P <.0001). CONCLUSIONS: This study showed that NPWTi-d is a valuable treatment option in a variety of circumstances and can help the clinician achieve a range of therapy goals based on individual patient needs.

Combining traditional and microsurgical reconstruction after a complex hand trauma with multiple tissue defects. A case report.

Complex injuries involving bones, tendons and soft tissues of the hand still represent a difficult challenge for reconstructive surgeons. Hereby, we present a case of a man suffering from a complex crush injury of the right hand that led to a wide three-dimensional defect with loss of two metacarpal bones, extensor tendons and skin. For composite hand defects, the most common surgical approach provides for a one-stage composite reconstruction or for an early restoration of bone and skin, with delayed tendon grafts. For the peculiarity of the defect, a one-stage reconstruction was not feasible. Hence, we opted for a two-stage reconstruction but the usual surgical steps have been inverted. First we secured tendon and skin restoration through a composite teno-cutaneous radial free flap. A month later, we reconstructed the two metacarpals with a modified Masquelet technique using fibular cortical graft. This strategy allowed the patient to start an early rehabilitation program and obtain a satisfactory recovery of his dominant hand. KEY WORDS: Composite flap, Hand trauma, Hand reconstruction, Microsurgery.

Fluorescent Light Energy and Chronic Lesions: A Winning Association.

BACKGROUND: Chronic ulcers represent a challenge for healthcare professionals and a large expense for national health care systems for their difficulty in achieving complete healing and for their high incidence of recurrence. With the progressive aging of the general population, the incidence of these injuries will only increase, further affecting the public health budget, hence the need to find new strategies for their management. The purpose of this study was to share the experience of the Complex Operational Unit of Plastic Surgery of the University Hospital of Padua with fluorescent light energy therapy, outlining its role in the treatment of chronic ulcers in the daily use outside the previous EUREKA study. METHODS: In this case series study, we enrolled 15 patients with chronic ulcers of any etiology between January 2018 and July 2019 and we treated them using fluorescence light energy. We evaluated efficacy and safety endpoints reporting data in excel files completed by medical staff during the study. RESULTS: The study confirms the effectiveness of fluorescent light energy inducing chronic ulcer healing, regardless of etiology, or at least preparing the lesions for a skin graft closure surgery. The system showed a low rate of complications established by patient adherence to treatment. Patients also reported a reduction in pain both at home and during outpatient dressings. CONCLUSION: Based on our experience, fluorescent light energy shows an excellent safety and efficacy profile in chronic ulcers no more responsive to traditional dressings and/or surgery.

Persistent Sciatic Artery and its role in limb salvage in oncological surgery.

AIM: The Persistent Sciatic Artery (PSA) is a rare congenital anomaly due to missed involution of embryo-fetal sciatic artery, which is the main blood supply to lower limb during embryonic development until superficial femoral artery (SFA) is formed. The PSA is frequently related to complications in adults like aneurysm and embolism. Here we present a case in which the discovery of a complete PSA resulted limb saving. In case of oncologic or trauma surgery, when no other options are available, the PSA can help in management of reconstructive surgery. CASE REPORT: A case of PSA was discovered during management of a patient affected by a soft tissue sarcoma of the lower limb. Tumor resection needed the femoral neurovascular bundle demolition to ensure radical surgery and subsequent vascular reconstruction, which failed due to complications. RESULTS: Despite failure reconstruction, a misdiagnosed type IIa PSA, replacing the role of the SFA, saved the lower limb from ischemia and subsequent amputation. Functional reconstruction was thus achieved with almost total recovery of lower limb function. DISCUSSION AND CONCLUSIONS: In oncological and trauma surgery we recommend investigate the whole lower limb vascularization, from the pelvis to the foot, suspecting the PSA existence. Indeed, although it is always preferable to reconstruct the SFA system despite a complete PSA is present, due to its frequent complications, the PSA can represent a limb saving option. KEY WORDS: Computerized tomography angiography, Persistent sciatic artery, PSA, Superficial femoral artery, SFA fibromyxoid sarcoma.

Symmetrical peripheral gangrene reconstruction after lower limb amputation.

Symmetrical peripheral gangrene (SPG) is a complication of septicemia, characterized by progressive skin lesions, which can result in wide necrosis of all the extremities. Severe necrosis is often responsible of disfiguring consequences. It is important to limit the amputation and to provide a stable and functional soft tissue coverage of the stumps. Limited amputation and free flap reconstruction may help to prevent tissue loss and to provide an effective prosthetization and a prompt rehabilitation. We present a clinical case of a 60-year-old male admitted in our department for lower limbs necrosis due to SPG after a pneumococcal infection. The patient underwent bilateral forefeet amputation and microsurgical reconstruction with antero-lateral thigh flap was performed on the left stump. Vascular complications determined a progressive necrosis of the flap and the failure of the reconstruction. A careful analysis of the local and systemic inflammatory vascular and coagulative issues following the SPG has been performed to explain the failure of the microsurgery. Although the opinion of several authors is divided about the use of free tissue transfer, we believe that microsurgical reconstruction remains the first choice of treatment due to the reduced morbidity and early rehabilitation it provides. KEY WORDS: Amputation, Free flaps, Free tissue transfer, Limb salvage, Microsurgery salvage, Prosthesis, Sepsis, Septicaemia, Symmetrical peripheral gangrene.

Transfer of the anterior branch of the obturator nerve for femoral nerve reconstruction and preservation of motor function: A case report.

INTRODUCTION: Femoral nerve lesions are uncommon but severely disrupting at the functional level, because of the inability to walk, run, and passing from sitting to standing position. Reconstruction via local nerve transfer (neurotization) is a relatively new yet promising procedure. PRESENTATION OF CASE: We describe a case of successful restoration of rectus femoris' function after a malignant process by transfer of the anterior branch of the obturator nerve at the thigh level. At present, only few similar reports are present in the literature. Nerve gap after surgery was considerable (10 cm) and nerve grafting could have been unsatisfactory in terms of reinnervation. Therefore, reconstruction was managed with nerve isolation and transfer to the rectus femoris motor branch. The functional result was satisfactory at 1-year follow up with margins for further improvement. DISCUSSION: This case reported favorable outcomes of neurotization of the anterior branch of the obturator nerve for femoral nerve lesion. Reports of success with this procedure are still limited, but the promising results in terms of functional recovery suggest it should be offered to patients as a viable therapeutic option. CONCLUSION: Advantages of neurotization compared to grafts are several, including: limiting suturing sites and scarring; shortening the recovery time by decreasing the required regeneration distance; and allowing for faster muscle reinnervation. The choice to transfer the anterior branch of the obturator nerve specifically allows to preserve part of the adductor functionality in the thigh without affecting the stability of the knee joint.