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Tumor Recurrence after Negative Pressure Wound Therapy: An Alert Call  [PDF]
Patricio Andrades, Manuel Figueroa, Sergio Sepúlveda, Susana Benitez, Cristian Erazo, Stefan Danilla
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.36077
Abstract:

In this report, we present a 22-year-old patient with soft tissue sarcoma of the lower extremity that developed wound dehiscence after surgery. Biopsy demonstrated negative margins for cancer. He was treated with negative pressure wound therapy for 6 weeks and started to present increased wound exudates, local pain and proliferating tissue that was positive for tumor recurrence. Consequently he underwent lower extremity amputation with hip disarticulation by the orthopedic team. Although we cannot determine with certainty a full causative relationship, it seems prudent to advise cautious use of negative pressure wound therapy in oncologic related wound beds.

Negative Pressure Wound Therapy—An Effective, Minimally Invasive Therapeutic Modality in Burn Wound Management  [PDF]
Endre Nagy, István Juhász
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.65038
Abstract:
Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication; while sepsis remains the leading cause of death in severe burns. The research guided integration of new and effective techniques in burn wound management is mandatory. Negative pressure wound therapy (NPWT) is an effective and widely used technique in the management of problematic wounds. Previously existing indications include soft tissue traumas and chronic wounds such as diabetic, arterial, venous and pressure ulcers. The characteristics and challenges of these wounds have a lot in common with burns. Since the early 2000’s there are experiences with the use of NPWT for the healing of second degree burn wounds. Our clinical experience shows that it is a minimally invasive and effective way of improving burn wound management. In this article we give a review of the literature showing the mechanisms, unmapped future opportunities, financial issues, and possible adverse effects of NPWT in burn therapy.
Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq  [PDF]
Raghda Basil Ismael Alkhateeb, Asmaa Saleem Esmail Ah-Ghurabi, Laith Saleh Alkaaby, Abdulsalam Y. Taha
World Journal of Cardiovascular Surgery (WJCS) , 2022, DOI: 10.4236/wjcs.2022.127012
Abstract: Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m2. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks wh
The Effect of Ultrasound-Assisted Debridement Combined with Vacuum Pump Therapy in Deep Sternal Wound Infections
Ajay Moza,Andreas Goetzenich,Lachmandath Tewarie,Nikolay Chernigov,Rashad Zayat,Rüdiger Autschbach
- , 2018, DOI: 10.5761/atcs.oa.17-00244
Abstract:
Comparison of Vacuum-Assisted Closure Therapy and Conventional Dressing on Wound Healing in Patients with Diabetic Foot Ulcer: A Randomized Controlled Trial
Chellappa Vijayakumar,Chinnakali Palanivel,Naik Debasis,Sangma M D James,Sathasivam Sureshkumar,Thirthar P Elamurugan
- , 2019, DOI: 10.4103/njs.NJS_14_18
Abstract: Vacuum-assisted closure (VAC) therapy has been shown to be beneficial in a variety of wounds. However, evidence of its benefit in diabetic foot ulcers (DFUs), especially with respect to Indian population, is sparse
Versatile use of vacuum-assisted healing in fifty patients
Al Fadhli Ahmad,Alexander George,Kanjoor James
Indian Journal of Plastic Surgery , 2009,
Abstract: Context: Wound management can often be a challenging experience, especially in the presence of diabetes mellitus, vascular or immunological compromise. While no single technique can be considered by itself to be ideal, vacuum-assisted healing, which is a recent innovation, is fast becoming a necessary addition as adjuvant therapy to hasten wound healing. Aims: To determine the efficacy of vacuum-assisted healing. Settings and Design: Plastic surgery centre. Ministry of Health Hospital, Kuwait. Materials and Methods: Patients from Kuwait in a wide variety of clinical situations were chosen for study: Patients (n=50) were classified by diagnosis: Group 1: pressure sore- sacral (n= 3), trochanteric (n=6), ischial (n= 2); Group 2: ulcers (n= 11); Group 3: traumatic soft tissue wounds (n =15); Group 4: extensive tissue loss from the abdominal wall perineum, thigh and axilla (n =5); Group 5: sternal dehiscence wounds (n =4) and Group 6: wounds from flap necrosis (n =4). All wounds were subjected to vacuum by wall unit or portable unit, using pressure of 100-125 mm - continuous or intermittent. Closure of wounds, significant reduction in size and refusal by patient for continuation of vacuum-assisted closure therapy were end points of vacuum application. Results: Sixteen per cent of patients showed complete healing of the wound. Seventy per cent of patients showed 20-78% reduction in wound size. In 14% of patients treatment had to be discontinued. All patients showed improvement in granulation tissue and reduction in bacterial isolates and tissue oedema. Conclusions: The application of subatmospheric pressure or negative pressure promotes healing in a wide range of clinical settings and is an advanced wound healing therapy that can optimize patient care, promote rapid wound healing and help manage costs. It may be used in most instances in both hospital and community settings.
Uso de Terapia VAC？ en paciente pediátrico con exposición ósea postamputación tras púrpura fulminans
Navarro Cecilia,J.; León Llerena,C.; Luque López,C.;
Cirugía Plástica Ibero-Latinoamericana , 2011, DOI: 10.4321/S0376-78922011000500009
Abstract: meningococcal sepsis is associated with a high mortality rate. these patients may show severe disseminated intravascular coagulation (dic) and skin, subcutaneous tissue and muscle necrosis due to poor tissue perfusion. it is rare that early surgical intervention be required, as it is relatively difficult to determine the degree of tissue loss early on. once the patient is stable, debridement of all necrotic tissue is essential, and the goals are still to preserve as much tissue as possible, specially the joints. many children survive the disease, but suffer major morbidities such as extremities amputation, which may result of complications like bone exposure. there is very little published experience regarding the non-surgical treatment of this complication. we report a new possible application of the vacuum-assisted closure system (vac？) in very young patients with loss of tissue as a result of purpura fulminans secondary to meningococcemia.
Cost analysis of Topical Negative Pressure (TNP) Therapy for traumatic acquired wounds
Kolios, Leila,Kolios, Georg,Beyersdorff, Marius,Dumont, Clemens
GMS German Medical Science , 2010,
Abstract: Extended traumatic wounds require extended reconstructive operations and are accompanied by long hospitalizations and risks of infection, thrombosis and flap loss. In particular, the frequently used Topical Negative Pressure (TNP) Therapy is regarded as cost-intensive. The costs of TNP in the context of traumatic wounds is analyzed using the method of health economic evaluation.All patients (n=67: 45 male, 22 female; average age 54 y) with traumatically acquired wounds being treated with TNP at the university hospital of Goettingen in the period 01/01/2005–31/12/2007 comprise the basis for this analysis. The concept of activity-based costing based on clinical pathways according to InEK (National Institute for the Hospital Remuneration System) systematic calculations was chosen for cost accounting. In addition, a special module system adaptable for individual courses of disease was developed. The treated wounds were located on a lower extremity in 83.7% of cases (n=56) and on an upper extremity in 16.3% of cases (n=11). The average time of hospitalization of the patients was 54 days. Twenty-five patients (37.31%) exceeded the maximum length of stay“ of their associated DRG (Diagnosis Related Groups). The total PCCL (patient clinical complexity level = patient severity score) of 2.99 reflects the seriousness of disease. For the treatment of the 67 patients, total costs were $1,729,922.32 (1,249,176.91 €). The cost calculation showed a financial deficit of $–210,932.50 (–152,314.36 €). Within the entire treatment costs of $218,848.07 (158,030.19 €), 12.65% per case were created by TNP with material costs of $102,528.74 (74,036 €), representing 5.92% of entire costs. The cost of TNP per patient averaged $3,266.39 (2,358.66 €). The main portion of the costs was not – as is often expected – due to high material costs of TNP but instead to long-term treatments. Because of their complexity, the cases are insufficiently represented in the lump-sum calculation of the InEK. A differentiated integration of complex TNP-treatment in the DRG system (e.g., as an expanded DRG I98Z) would be a step towards cost recovery. In addition, the refunding of outpatient TNP-treatment would lead to enhanced quality of life for the patients and to a reduction of hospital costs and length of stay.
The Role of Wound Care in 2 Group A Streptococcal Outbreaks in a Chicago Skilled Nursing Facility, 2015？2016
Abimbola Ogundimu,Chris A Van Beneden,Jacob M Brandvold,Kasey E Diebold,Nimalie D Stone,Saadeh S Ewaidah,Sana S Ahmed,Stephanie Black,Zhongya Li
- , 2018, DOI: 10.1093/ofid/ofy145
Abstract: Two consecutive outbreaks of group A Streptococcus (GAS) infections occurred from 2015–2016 among residents of a Chicago skilled nursing facility. Evaluation of wound care practices proved crucial for identifying transmission factors and implementing prevention measures. We demonstrated shedding of GAS on settle plates during care of a colonized wound
Negative-pressure in treatment of persistent post-traumatic subcutaneous emphysema with respiratory failure: Case report and literature review
Ivan Ba？i？,Jakov Mihanovi？,Nina Sulen
- , 2018, DOI: 10.1016/j.tcr.2017.12.001
Abstract: Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published. We report on patient injured in a motor vehicle accident who had serial rib fractures and bilateral pneumothorax managed initially in another hospital. Due to respiratory deterioration, haemodynamic instability and renal failure patient was transferred to our Intensive Care Unit. Massive and persistent subcutaneous emphysema despite adequate thoracic drainage with respiratory deterioration and potentially injurious mechanical ventilation with high airway pressures was the indication for active surgical treatment. Negative-pressure wound therapy dressing was applied on typical blowhole incisions which resulted in swift emphysema regression and respiratory improvement. Negative pressure wound therapy for decompression of severe subcutaneous emphysema represents simple, effective and relatively unknown technique that deserves wider attention
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