New experimental model to evaluate the effect of negative pressure wound therapy and viscosity exudates in foam dressings using confocal microscopy.

Negative pressure wound therapy is currently one of the most popular treatment approaches that provide a series of benefits to facilitate healing, including increased local blood perfusion with reduced localized oedema and control of wound exudate. The porous foam dressing is a critical element in the application of this therapy and its choice is based on its ability to manage exudate. Industry standards often employ aqueous solutions devoid of proteins to assess dressing performance. However, such standardized tests fail to capture the intricate dynamics of real wounds, oversimplifying the evaluation process. This study aims to evaluate the technical characteristics of two different commercial polyurethane foam dressings during negative pressure wound therapy. We introduce an innovative experimental model designed to evaluate the effects of this therapy on foam dressings in the presence of viscous exudates. Our findings reveal a proportional increase in dressing fibre occupancy as pressure intensifies, leading to a reduction in dressing pore size. The tests underscore the pressure system's diminished efficacy in fluid extraction with increasing fluid viscosity. Our discussion points to the need of establishing standardized guidelines for foam dressing selection based on pore size and the necessity of incorporating real biological exudates into industrial standards.

Application of PREVENA (Surgical Incision Protection System) in reducing surgical site infections following reversal of ileostomy or colostomy: the PRIC study protocol.

AIM: There is a current lack of evidence in the literature to support the routine use of negative pressure wound therapy (NPWT) to reduce the risk of surgical site infections (SSI) in the setting of ileostomy or colostomy reversal. The aim of this study is to examine whether routine NPWT confers a lower rate of SSI than conventional dressings following reversal of ileostomy or colostomy. METHODS: The PRIC study is a randomized, controlled, open-label, multi-centre superiority trial to assess whether routine NPWT following wound closure confers a lower rate of SSI following reversal of ileostomy or colostomy when compared to conventional dressings. Participants will be consecutively identified and recruited. Eligible participants will be randomized in a 1:1 allocation ratio, to receive either the NPWT (PREVENA) dressings or conventional dressings which will be applied immediately upon completion of surgery. PREVENA dressings will remain applied for a duration of 7 days. Surgical wounds will then be examined on post-operative day seven as well as during follow-up appointments in OPD for any evidence of SSI. In the interim, public health nurses (PHN) will provide out-patient support services incorporating wound assessment and care as part of a routine basis. Study investigators will liaise with PHN to gather the relevant data in relation to the time to wound healing. Our primary endpoint is the incidence of SSI within 30 days of stoma reversal. Secondary endpoints include measuring time to wound healing, evaluating wound healing and aesthetics and assessing patient satisfaction. CONCLUSION: The PRIC study will assess whether routine NPWT following wound closure is superior to conventional dressings in the reduction of SSI following reversal of ileostomy or colostomy and ascertain whether routine NPWT should be considered the new standard of care.

The use of negative pressure wound therapy in the primary setting for high-risk head and neck surgery.

BACKGROUND: In head and neck surgery, dead space is typically managed by transferring a secondary pedicled flap or harvesting a larger composite flap with a muscular component. We demonstrate the novel use of prophylactic negative pressure wound therapy (NPWT) to obliterate dead space and reduce possible communication between the upper aerodigestive tract and the contents of the neck. METHODS: We present a single-institutional case series of five patients with high-risk head and neck cancer treated with NPWT after ablative and reconstructive surgery to eliminate dead space following surgical resection. RESULTS: All patients achieved successful wound closure following NPWT, which was applied in the secondary setting to combat infection in one patient and the primary setting to prophylactically eliminate dead space in four patients. CONCLUSION: NPWT can be used to treat unfilled dead space in the primary setting of head and neck ablative and reconstructive surgery and help to avoid wound healing problems as well as the need for secondary flap transfers.

[Axillary hidradenitis suppurativa: a single-stage surgical treatment]. / Hidrosadénite axillaire : une stratégie thérapeutique en un temps.

INTRODUCTION: Hidradenitis suppurativa is a chronic inflammatory disease, particularly incapacitating. Wide surgical excision of the whole affected skin is the only radical and successful treatment that can be offered. Coverage of the defect is then generally obtained with a split-thickness skin graft after a period of granulation. We expose a single-stage procedure which reduces the number of surgical times and the period of recovery. PATIENTS AND METHODS: We have documented a series of five patients who underwent uni- (three cases) or bilateral (two cases) axillary hidradenitis suppurativa, between December 2008 and December 2009. Surgical procedure included excision of the lesions and coverage with a split-thickness skin graft. The graft was meshed in a ratio of 1.5:1, and secured with a negative-pressure dressing. This dressing, which provided a continuous subatmospheric pressure of -75 mmHg, was removed after five days. Then, complete healing was obtained with conventional vaseline gauze dressings. RESULTS: After removal of the negative-pressure dressings, the graft take was 90% on average (80-100%). Complete healing was obtained within an average of 34 days (20-43 days), with a good quality of scar tissue, no retraction and no limitation of arm's abduction. CONCLUSION: This technique, enabled by negative-pressure dressings, provides a quick and good quality healing, with only one surgical stage. It has many advantages: reduced morbidity, faster healing, higher level of patient's comfort, and lower costs.

Negative Pressure Dressings (PICOTM) on Laparotomy Wounds Do Not Reduce Risk of Surgical Site Infection.

Background: Surgical site infection is a common cause of post-operative morbidity. Although a number of studies on negative pressure dressings including PICOTM (Smith & Nephew, St. Petersburg, PL) have shown reduced rates of surgical site infections (SSI), more evidence is required. This study sought to determine if PICO dressings reduce surgical site infections or other surgical site complications in primarily closed laparotomy incisions after clean-contaminated surgery in moderate-risk patients. Methods: Patients undergoing laparotomy and bowel resection were randomly assigned to PICO or conventional dressings. The incision was assessed one-week post-operatively for any infection. Patient notes including outpatient appointments were later examined for any delayed infection during the same or subsequent admissions or in the outpatient setting. Patient characteristics such as body mass index (BMI), incision depth, and comorbidities were noted to identify any group who may show more benefit from the negative pressure dressings. Results: From March 1, 2015 until September 30, 2017, 217 patients consented to participate in the trial. Twenty-nine were subsequently excluded, leaving 188 patients with 96 receiving PICO and 92 receiving a standard dressing. Twenty-seven (14%) patients developed a surgical site infection; 13 received a PICO dressing and 14 received standard dressing (p = 0.73), indicating no difference in surgical site infections between the two types of dressing (odds ratio [OR] 1.1). Thirty-one (16.5%) patients developed other surgical site complications. Eleven of these patients received a PICO dressing and 20 received the standard dressing (p = 0.06, OR 2.1). Conclusion: This study does not support the routine use of PICO dressings on uncomplicated laparotomy incisions in moderate-risk patients.

Evaluating the effects of immediate application of negative pressure therapy after decompression from abdominal compartment syndrome in an experimental porcine model.

PURPOSE: The purpose of this large-animal study was to assess the safety and effects of negative pressure therapy (NPT) when used as temporary abdominal closure in the immediate post-decompression period after abdominal compartment syndrome (ACS). METHODS: Using a hemorrhagic shock/resuscitation and mesenteric venous pressure elevation model, ACS was physiologically induced in 12 female Yorkshire swine. At decompression, animals were allocated to either NPT (n = 6) or Bogota bag (n = 6) as temporary abdominal closure and studied for a period of 48 h or until death. Outcomes measured included morbidity and mortality, as well as hemodynamic parameters, ventilator-related measurements, blood gases, coagulation factors, and organ (liver, kidney, lung, and intestinal) edema and histology at the time of death/sacrifice. RESULTS: All animals developed ACS. Early application of NPT was associated with decreases in mesenteric venous and central venous pressure, and significantly increased drainage of peritoneal fluid. In addition, there was no increase in the incidence of mortality, recurrent intra-abdominal hypertension/ACS, or any deleterious effects on markers of organ injury. CONCLUSIONS: Early application of NPT in this porcine ACS model is safe and does not appear to be associated with an increased risk of recurrent intra-abdominal hypertension. The results of this animal study suggest that the application of NPT following decompression from ACS results in greater peritoneal fluid removal and may translate into augmented intestinal edema resolution secondary to more favorable fluid flux profiles.

Enterostomal therapy and wound care of the enterocutaneous fistula patient.

Enterocutaneous fistulas represent a challenging situation with respect to wound care and stoma therapy. An understanding of the principles of wound care and the various techniques and materials that are available is of vital importance to enhance patient comfort and recovery as well as facilitate fistula healing. Skin barriers, adhesives, dressings, pouches, and negative pressure dressings are all materials that are available in the armamentarium of the enterostomal therapist. Proper utilization of these items and appropriate modifications to their application requires an intimate knowledge of the characteristics of the fistula being treated. Wound care management is a key element in the overall care and healing of the enterocutaneous fistula.