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The British Journal of Ophthalmology Mar 1982Four young male patients with keratoconus had traumatic dehiscence of the surgical wound after penetrating keratoplasty. Two were rendered aphakic by the trauma, and in...
Four young male patients with keratoconus had traumatic dehiscence of the surgical wound after penetrating keratoplasty. Two were rendered aphakic by the trauma, and in one patient the lens was dislocated posteriorly. In each case the dehiscence was repaired by resuturing the original corneal graft. Despite marked corneal oedema in the immediate postoperative period all four grafts deturgesced and subsequently cleared. The follow-up has been a minimum of 23 months. We recommend therefore primary resuturing of traumatic wound dehiscence after keratoplasty, anterior vitrectomy if the lens dislodged, and prophylactic antibiotics postoperatively. The clearing of the initially oedematous grafts in each case illustrates the resilience of the corneal endothelium.
Topics: Adult; Corneal Transplantation; Eye Injuries; Humans; Male; Surgical Wound Dehiscence; Time Factors; Wounds, Penetrating
PubMed: 7039665
DOI: 10.1136/bjo.66.3.174 -
Japanese Journal of Ophthalmology 2007
Topics: Accidental Falls; Aged; Aged, 80 and over; Bicycling; Corneal Injuries; Eye Injuries; Female; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Retrospective Studies; Surgical Wound Dehiscence
PubMed: 17401627
DOI: 10.1007/s10384-006-0414-1 -
Plastic and Reconstructive Surgery Nov 2011Several randomized controlled trials comparing negative-pressure therapy to standard wound care for chronic wounds have been published. Although these studies suggest a... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Several randomized controlled trials comparing negative-pressure therapy to standard wound care for chronic wounds have been published. Although these studies suggest a benefit for negative-pressure therapy, the majority of the review articles on the topic conclude that the studies are inconclusive. The authors conducted a quantitative meta-analysis of the effectiveness of negative-pressure therapy for the management of chronic wounds.
METHODS
The MEDLINE, EMBASE, and Cochrane databases were searched from 1993 to March of 2010 for randomized controlled trials comparing negative-pressure therapy to standard wound care for chronic wounds. Measures of wound size and time to healing, along with the corresponding p values, were extracted from the randomized controlled trials. Relative change ratios of wound size and ratios of median time to healing were combined using a random effects model for meta-analysis.
RESULTS
Ten trials of negative-pressure therapy versus standard wound care were found. In the negative-pressure therapy group, wound size had decreased significantly more than in the standard wound care group (relative change ratio, 0.77; 95 percent confidence interval, 0.63 to 0.96). Time to healing was significantly shorter in the negative-pressure therapy group in comparison with the standard wound care group (ratio of median time to healing, 0.74; 95 percent confidence interval, 0.70 to 0.78).
CONCLUSIONS
This quantitative meta-analysis of randomized trials suggests that negative-pressure therapy appears to be an effective treatment for chronic wounds. An effect of publication bias cannot be ruled out.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, II.
Topics: Anti-Bacterial Agents; Bandages; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Male; Negative-Pressure Wound Therapy; Pressure Ulcer; Prognosis; Randomized Controlled Trials as Topic; Severity of Illness Index; Skin Care; Surgical Wound Dehiscence; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 22030509
DOI: 10.1097/PRS.0b013e31822b675c -
Trials Nov 2013A decision of the Federal Joint Committee Germany in 2008 stated that negative pressure wound therapy is not accepted as a standard therapy for full reimbursement by the... (Randomized Controlled Trial)
Randomized Controlled Trial
Treatment of subcutaneous abdominal wound healing impairment after surgery without fascial dehiscence by vacuum assisted closure™ (SAWHI-V.A.C.®-study) versus standard conventional wound therapy: study protocol for a randomized controlled trial.
BACKGROUND
A decision of the Federal Joint Committee Germany in 2008 stated that negative pressure wound therapy is not accepted as a standard therapy for full reimbursement by the health insurance companies in Germany. This decision is based on the final report of the Institute for Quality and Efficiency in Health Care in 2006, which demonstrated through systematic reviews and meta-analysis of previous study projects, that an insufficient state of evidence regarding the use of negative pressure wound therapy for the treatment of acute and chronic wounds exists. Further studies were therefore indicated.
METHODS/DESIGN
The study is designed as a multinational, multicenter, prospective randomized controlled, adaptive design, clinical superiority trial, with blinded photographic analysis of the primary endpoint. Efficacy and effectiveness of negative pressure wound therapy for wounds in both medical sectors (in- and outpatient care) will be evaluated. The trial compares the treatment outcome of the application of a technical medical device which is based on the principle of negative pressure wound therapy (intervention group) and standard conventional wound therapy (control group) in the treatment of subcutaneous abdominal wounds after surgery. The aim of the SAWHI-VAC® study is to compare the clinical, safety and economic results of both treatment arms.
DISCUSSION
The study project is designed and conducted with the aim of providing solid evidence regarding the efficacy of negative pressure wound therapy. Study results will be provided until the end of 2014 to contribute to the final decision of the Federal Joint Committee Germany regarding the general admission of negative pressure wound therapy as a standard of performance within both medical sectors.
TRIAL REGISTRATION
Clinical Trials.gov NCT01528033German Clinical Trials Register DRKS00000648.
Topics: Clinical Protocols; Humans; Negative-Pressure Wound Therapy; Patient Outcome Assessment; Prospective Studies; Sample Size; Wound Healing; Wounds and Injuries
PubMed: 24252551
DOI: 10.1186/1745-6215-14-394 -
The American Surgeon Sep 2002It is unknown whether leaving the skin wound open to heal by secondary intention is associated with a lower rate of wound infections compared with primary skin-wound... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
It is unknown whether leaving the skin wound open to heal by secondary intention is associated with a lower rate of wound infections compared with primary skin-wound closure after operations for colon injuries. From June 1998 to December 2000 at our Level I academic trauma center 48 patients entered into a randomized controlled trial (RCT) and were randomized to have their skin wound primarily closed (CLOSED-RCT) or left open (OPEN-RCT). At the same time patients not included in the RCT were followed prospectively. At the discretion of the surgeon their skin wounds were managed by primary closure (CLOSED-nonRCT) or were left open (OPEN-nonRCT). Univariate and multivariate analysis was done to identify independent risk factors of wound infection, wound dehiscence, and necrotizing soft tissue infection. Wound infection developed in 65 per cent of CLOSED-RCT and 36 per cent of OPEN-RCT patients (P = 0.04) and wound dehiscence in 31 per cent and 14 per cent respectively (P = 0.18). No remarkable differences were noted in any other variable including length of hospital stay. Wound infection developed in 29 per cent of CLOSED-nonRCT and 15 per cent of OPEN-nonRCT patients (P = 0.46). There were three independent risk factors of wound infection: primary wound closure [odds ratio (OR) = 5.5, 95% confidence interval (CI) = 1.8-19.4], colectomy (OR = 3.4, 95% CI = 1.2-10.4), and intraabdominal infection (OR = 5.3, 95% CI = 1.3-24.2). There were two independent risk factors for wound dehiscence and/or necrotizing soft tissue infection: wound infection (OR = 20.9, 95% CI = 4.9-152.3) and intra-abdominal infection (OR = 19.3, 95% CI = 4.0-146.9). Primary closure of the wound almost doubles the rate of wound infection compared with leaving the wound open in operations for colon injuries. Primary wound closure is a risk factor for wound infection and wound infection is a risk factor for wound dehiscence or necrotizing soft tissue infection. Because of the complexity of evaluating the real clinical significance of superficial wound infection larger studies on trauma patients are required.
Topics: Adult; Bandages; Colon; Digestive System Surgical Procedures; Humans; Logistic Models; Los Angeles; Prospective Studies; Risk Factors; Statistics, Nonparametric; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures; Wound Healing; Wounds, Gunshot; Wounds, Stab
PubMed: 12356153
DOI: No ID Found -
British Journal of Neurosurgery Jun 2023Spinal surgical wound infection can lead to tissue voids between the spine and skin that can be difficult to reconstruct. Previously described techniques include...
INTRODUCTION
Spinal surgical wound infection can lead to tissue voids between the spine and skin that can be difficult to reconstruct. Previously described techniques include myocutaneous flaps or perforator based fasciocutaneous flaps. However, these procedures can be time-consuming and surgically challenging.
AIMS
This study aimed to assess the effectiveness of a novel technique employing a buried island transposition (BIT) flap, for the repair of non-irradiated dehisced spinal wounds.
METHODS
Fifteen patients with failed conservative management of infected midline posterior spinal wounds, underwent wound repair using a local buried islanded de-epithelialized double-breasted fasciocutaneous transposition flap, performed by joint input from the neurosurgical and plastic surgical teams.
RESULTS
Mean age was 58 years (range, 31-76 years) with male-to-female ratio of 8:7. The BIT flap was used to repair four wounds in the cervical spine with underlying fixation; four wounds in the thoracic spine with underlying fixation; and seven wounds in the lumbar-sacral spine, of which three had underlying fixation. Pre-operatively, each of the wounds were either dehiscent with exposed hardware, or had large defects unsuitable for primary closure following debridement. There was no procedure-related mortality. All patients demonstrated good wound healing with no subsequent repeat surgery or removal of spinal fixation at mean 24-month follow-up.
CONCLUSION
We successfully used a novel buried island transposition flap that has not previously been described in repair of spinal wounds. This technique, which led in all cases to good wound healing and prevented removal of metalwork, has comparable efficacy but increased ease of use compared to traditional techniques. It requires redundant skin at the wound site.
Topics: Humans; Male; Female; Middle Aged; Retrospective Studies; Treatment Outcome; Surgical Flaps; Plastic Surgery Procedures; Spine; Spinal Injuries
PubMed: 31875723
DOI: 10.1080/02688697.2019.1704220 -
The Cochrane Database of Systematic... Oct 2014Indications for the use of negative pressure wound therapy (NPWT) are broadening with a range of systems now available on the market, including those designed for use on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Indications for the use of negative pressure wound therapy (NPWT) are broadening with a range of systems now available on the market, including those designed for use on clean, closed incisions and skin grafts. Reviews have concluded that the evidence for the effectiveness of NPWT remains uncertain, however, it is a rapidly evolving therapy. Consequently, an updated systematic review of the evidence for the effects of NPWT on postoperative wounds expected to heal by primary intention is required.
OBJECTIVES
To assess the effects of NPWT on surgical wounds (primary closure, skin grafting or flap closure) that are expected to heal by primary intention.
SEARCH METHODS
We searched the following electronic databases to identify reports of relevant randomised clinical trials: the Cochrane Wounds Group Specialised Register (searched 28 January 2014); the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, issue 12); Database of Abstracts of Reviews of Effects (2013, issue 12); Ovid MEDLINE (2011 to January 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 24 January 2014); Ovid EMBASE (2011 to January 2014 Week 44); and EBSCO CINAHL (2011 to January 2014). We conducted a separate search to identify economic evaluations.
SELECTION CRITERIA
We included trials if they allocated patients to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with a different type of NPWT.
DATA COLLECTION AND ANALYSIS
We assessed trials for their appropriateness for inclusion and for their quality. This was done by three review authors working independently, using pre-determined inclusion and quality criteria.
MAIN RESULTS
In this first update, we included an additional four trials, taking the total number of trials included to nine (785 participants). Three trials involved skin grafts, four included orthopaedic patients and two included general surgery and trauma surgery patients; all the included trials had unclear or high risk of bias for one or more of the quality indicators we assessed. Seven trials compared NPWT with a standard dressing (two of these were 'home-made' NPWT devices), one trial compared one 'home-made' NPWT with a commercially available device. In trials where the individual was the unit of randomisation, there were no differences in the incidence of surgical site infections (SSI); wound dehiscence, re-operation (in incisional wounds); seroma/haematoma; or failed skin grafts. Lower re-operation rates were observed among skin graft patients in the 'home-made' NPWT group (7/65; 10.8%) compared to the standard dressing group (17/66; 25.8%) (risk ratio (RR) 0.42; 95% CI 0.19 to 0.92). The mean cost to supply equipment for VAC® therapy was USD 96.51/day compared to USD 4.22/day for one of the 'home-made' devices (P value 0.01); labour costs for dressing changes were similar for both treatments. Pain intensity score was also reported to be lower in the 'home-made' group when compared with the VAC® group (P value 0.02). One of the trials in orthopaedic patients was stopped early because of a high incidence of fracture blisters in the NPWT group (15/24; 62.5%) compared with the standard dressing group (3/36; 8.3%) (RR 7.50; 95% CI 2.43 to 23.14).
AUTHORS' CONCLUSIONS
Evidence for the effects of negative pressure wound therapy (NPWT) for reducing SSI and wound dehiscence remains unclear, as does the effect of NPWT on time to complete healing. Rates of graft loss may be lower when NPWT is used, but hospital-designed and built products are as effective in this area as commercial applications. There are clear cost benefits when non-commercial systems are used to create the negative pressure required for wound therapy, with no evidence of a negative effect on clinical outcome. In one study, pain levels were also rated lower when a 'home-made' system was compared with a commercial counterpart. The high incidence of blisters occurring when NPWT is used following orthopaedic surgery suggests that the therapy should be limited until safety in this population is established. Given the cost and widespread use of NPWT, there is an urgent need for suitably powered, high-quality trials to evaluate the effects of the newer NPWT products that are designed for use on clean, closed surgical incisions. Such trials should focus initially on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.
Topics: Bandages; Humans; Negative-Pressure Wound Therapy; Orthopedic Procedures; Randomized Controlled Trials as Topic; Skin Transplantation; Surgical Procedures, Operative; Surgical Wound Dehiscence; Wound Healing; Wounds and Injuries
PubMed: 25287701
DOI: 10.1002/14651858.CD009261.pub3 -
The Journal of Emergency Medicine Mar 2021
Topics: Corneal Transplantation; Eye Injuries; Humans; Keratoplasty, Penetrating; Retrospective Studies; Surgical Wound Dehiscence; Wounds, Nonpenetrating
PubMed: 33288352
DOI: 10.1016/j.jemermed.2020.10.027 -
British Journal of Nursing (Mark Allen... Mar 2001Good nutritional status is essential for wound healing to take place. Ignoring nutritional status may compromise the patient's ability to heal and subsequently prolong... (Review)
Review
Good nutritional status is essential for wound healing to take place. Ignoring nutritional status may compromise the patient's ability to heal and subsequently prolong the stages of wound healing. Glucose provides the body with its power source for wound healing and this give energy for angiogenesis and the deposition of new tissue. Therefore, it is vital that the body receives adequate amounts of glucose to provide additional energy for wound healing. Fatty acids are essential for cell structure and have an important role in the inflammatory process. Wound healing is dependent on good nutrition and the presence of suitable polyunsaturated fatty acids in the diet. Protein deficiency has been demonstrated to contribute to poor healing rates with reduced collagen formation and wound dehiscence. High exudate loss can result in a deficit of as much as 100g of protein in one day. This subsequently needs to be replaced with a high protein diet. Vitamins are also important in wound healing. Vitamin C deficiency contributes to fragile granulation tissue. There is a correlation between low serum albumin and body mass index (BMI) and the development of pressure ulcers. Also, low serum albumin and high Waterlow score have a positive association. The body automatically renews tissue while we are asleep but this does not mean that protein synthesis does not take place during our wakeful hours. Holistic assessment of nutrition and early detection of malnutrition are essential to promote effective wound healing.
Topics: Body Mass Index; Deficiency Diseases; Dietary Fats; Dietary Proteins; Exudates and Transudates; Fatty Acids; Geriatric Assessment; Humans; Inflammation; Nursing Assessment; Nutrition Assessment; Nutritional Requirements; Nutritional Status; Trace Elements; Vitamins; Wound Healing; Wounds and Injuries
PubMed: 12070399
DOI: 10.12968/bjon.2001.10.Sup1.5336 -
World Journal of Gastroenterology May 2006This paper reviews the negative impact of diabetes mellitus or hypothyroidism on wound healing, both in experimental and clinical settings. Since both are metabolic... (Review)
Review
This paper reviews the negative impact of diabetes mellitus or hypothyroidism on wound healing, both in experimental and clinical settings. Since both are metabolic disorders of great clinical importance, special attention is given, not only to their pathophysiology, but also to their biochemical and histological effects on tissue integrity and regeneration. Also, special focus is awarded on wound healing of the gastrointestinal tract, i.e. in intestinal anastomosis, and how these disorders can lead to wound dehiscence. Since diabetes mellitus and hypothyroidism can coexist in clinical settings, more research must be directed on their influence on wound healing, considering them as one clinical entity.
Topics: Blood Glucose; Collagen; Diabetes Complications; Diabetes Mellitus; Gastrointestinal Tract; Growth Substances; Humans; Hypothyroidism; Sutures; Wound Healing; Wounds and Injuries
PubMed: 16718759
DOI: 10.3748/wjg.v12.i17.2721