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Polski Przeglad Chirurgiczny Apr 2022<b>Introduction:</b> Negative pressure wound therapy (NPWT) has been suggested as a gold standard for managing complex wounds and to reduce the time of...
<b>Introduction:</b> Negative pressure wound therapy (NPWT) has been suggested as a gold standard for managing complex wounds and to reduce the time of healing and overall morbidity and mortality of the patient. </br></br> <b>Aim:</b> We have done a retrospective study to observe the outcome in patients managed with negative pressure wound therapy for varied etiologies. </br></br> <b> Methods:</b> Patients with complicated wounds including lower limb wounds post-debridement, upper limb wounds post-debridement, postoperative abdominal wound dehiscence, abdominal and chest abscess wounds post-debridement and amputation stumps, managed with negative pressure wound therapy were studied on the basis of wound outcome, total hospital stay, days of NPWT application and pressure and mode of NPWT. </br></br> <b>Results:</b> A total of 42 patients with complicated wounds were included in the study. Mean hospital stay was 16.2 days and mean NPWT application time was 8.29 days with NPWT being applied on average for 3.91 days post-procedure like debridement or amputation or after wound dehiscence in which debridement was not done. As many as 41.5% of wounds were closed with suturing, 48.8% healed by secondary intention and 9.8% were covered with split-thickness skin grafts. A significant observation was made for lower pressure being used for abdominal wound dehiscence (75 mmHg) compared to other wounds on limbs (mean 98.33 mmHg) (P < 0.001). Re-debridement after the 1st cycle of NPWT was needed in 40% of wounds managed with intermittent mode compared to 6.2% in continuous mode (P = 0.028). </br></br> <b>Conclusion:</b> NPWT can reduce and manage wound complications with improvement in the quality of life of patients when used at an appropriate time with knowledge of its mechanism and functionality.
Topics: Humans; Negative-Pressure Wound Therapy; Quality of Life; Retrospective Studies; Neurosurgical Procedures; Postoperative Complications; India
PubMed: 36806166
DOI: 10.5604/01.3001.0015.8170 -
North American Spine Society Journal Oct 2020Wound complications, including dehiscence and surgical site infections, following spinal surgery have the potential to be devastating both to the patient and to the...
BACKGROUND
Wound complications, including dehiscence and surgical site infections, following spinal surgery have the potential to be devastating both to the patient and to the hospital system. Complications can occur in a wide range of patients including diabetics, those of low or high BMI and those of old age. Obese patients and those with increased subcutaneous fat are at particularly high risk for wound complications, which may be mitigated through use of local flap reconstruction by a Plastic Surgeon.
CASE DESCRIPTION
A 28 year-old female with morbid obesity presents with multiple lumbar transverse process fractures and complex sacral and pelvic fractures requiring closed reduction and percutaneous fixation of the pelvic ring followed by posterior spinal fusion. The patient was closed tension-free by the neurosurgery team and ultimately dehisced requiring consultation and management by Plastic Surgery.
OUTCOME
The patient underwent debridement and reconstruction with a gluteus maximus myocutaneous flap advancement without complication.
CONCLUSIONS
Wound management after spinal surgery is a complex problem, which may be prophylaxed through early identification of high-risk patients and preoperative consultation of Plastic Surgery. Patients with increased thickness of subcutaneous fat are at particularly high risk for postoperative complications, including infection and dehiscence, secondary to increased tissue manipulation and necrosis.
PubMed: 35141597
DOI: 10.1016/j.xnsj.2020.100029 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Aug 2023Lower extremity defects may occur due to many etiological causes such as trauma, peripheral arterial disease, diabetic foot infections, tumor resection, gunshot... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Lower extremity defects may occur due to many etiological causes such as trauma, peripheral arterial disease, diabetic foot infections, tumor resection, gunshot injuries, and burns. Lower extremity defects show a wide clinical presentation ac-cording to the affected anatomical localization, amount of tissue, and tissue content. In this study, it is aimed to present the use of bipedicled flaps as a simple and reliable salvage method in cases where microsurgical repairs such as free flaps are not possible.
METHODS
Patients with soft-tissue defect in their lower extremities between March 2018 and September 2021 were scanned retrospectively over the file. Among these patients, patients who were repaired with a bipedicle flap were included in the study. The patients were followed up regularly for at least 12 months. During the follow-ups, the patients were photographed, a physical examination was performed in terms of flap viability, wound dehiscence, and soft-tissue infection, and the data were recorded.
RESULTS
In this study, 23 patients with a defect in the lower extremity who were repaired with randomized bipedicled flap were retrospectively analyzed. In four patients, the location of the defect was located in the middle 1/3 of the leg, while in 19 patients, it was located in the distal 1/3 of the leg. The flap design was done vertically in 22 patients, and the flap design was done transversely in one patient. One bipedicled flap was used for defect repair in 14 patients, and two bipedicled flaps were used for defect repair in nine patients. While skin grafts were used for donor site repairs in 16 patients, the donor site was primarily repaired in seven patients. In the post-operative period, local soft-tissue infection was detected in five patients and dehiscence at the wound site in three patients, and uneventful healing was achieved with antibiotic therapy, resuturation, and appropriate wound care. No major complications such as flap or graft loss were experienced in any of the patients.
CONCLUSION
Randomized bipediculated flaps are a very reliable option for the reconstruction of middle and distal lower extremity defects. We think that it is a reconstruction option that can be safely applied in small and medium-sized defects of the lower extremity, since it can be used even in patients with comorbidities such as diabetes mellitus and peripheral arterial disease that adversely affect wound healing.
Topics: Humans; Free Tissue Flaps; Lower Extremity; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome
PubMed: 37563895
DOI: 10.14744/tjtes.2023.96633 -
International Wound Journal Oct 2022The application of negative pressure wound therapy (NPWT) in cancer surgical wounds is still controversial, despite its promising usage, because of the risks of... (Meta-Analysis)
Meta-Analysis
The application of negative pressure wound therapy (NPWT) in cancer surgical wounds is still controversial, despite its promising usage, because of the risks of increased tumorigenesis and metastasis. This study aimed to review the risks and benefits of NPWT in surgical wounds with the underlying malignant disease compared with conventional wound care (CWC). The first outcome was wound complications, divided into surgical site infection (SSI), seroma, hematoma, and wound dehiscence. The secondary outcome was hospital readmission. We performed a separate meta-analysis of observational studies and randomised controlled trials (RCTs) with CI 95%. Thirteen observational studies with 1923 patients and seven RCTs with 1091 patients were included. NPWT group showed significant decrease in the risk of SSI (RR = 0.45) and seroma (RR = 0.61) in observational studies with P value <0.05, as well as RCTs but were not significant (RR = 0.88 and RR = 0.68). Wound dehiscence (RR = 0.74 and RR = 1.15) and hospital readmission (RR = 0.90 and RR = 0.62) showed lower risks in NPWT group but were not significant. Hematoma (RR = 1.08 and RR = 0.87) showed no significant difference. NPWT is not contraindicated in cancer surgical wounds and can be considered a beneficial palliative treatment to promote wound healing.
Topics: Hematoma; Humans; Negative-Pressure Wound Therapy; Neoplasms; Randomized Controlled Trials as Topic; Seroma; Surgical Wound; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 35112467
DOI: 10.1111/iwj.13756 -
The Iowa Orthopaedic Journal Jun 2022Femoral fragility fractures are one of the most common injuries managed by orthopedic surgeons. Malnutrition influences the poor outcomes observed in this population....
BACKGROUND
Femoral fragility fractures are one of the most common injuries managed by orthopedic surgeons. Malnutrition influences the poor outcomes observed in this population. Our purpose was to assess the annual trends of malnutrition diagnosis and determine risk factors for malnutrition and complications in patients 65 years and older presenting with femoral fragility fractures. We hypothesized that malnutrition would increase the risk of postoperative wound infection, wound dehiscence, non-union, and mortality.
METHODS
The PearlDiver database was reviewed from 2010 to 2020. Patients ≥ 65-years-old with femur fractures treated with operative fixation were identified by CPT code. A preoperative diagnosis of malnourished state was defined by ICD-9 and ICD-10 codes and patients were divided into malnourished and non-malnourished cohorts. Patients were tracked for one year following operative fixation of a femoral fragility fracture for the occurrence of infection, wound dehiscence, nonunion and mortality. The rates of these complications were compared between malnourished and nonmalnourished cohorts.
RESULTS
There were 178,283 total femoral fragility fractures identified in patients aged 65-years or older. The overall prevalence of malnutrition diagnosis in this geriatric population was 12.8%. Documented malnutrition in femoral fragility fractures increased from 1.6% to 32.9% from 2010-2020 (P<0.0001). Compared to patients without malnutrition, patients with malnutrition are at increased risk of mortality (OR 1.31, 95% CI 1.2558 - 1.3752, p < 0.0001), are more likely to develop a wound infection (OR 1.49; 95% CI 1.252 - 1.7626; p < 0.0001), more likely to have a wound dehiscence (OR 1.55; 95% CI 1.3416 - 1.7949; p < 0.0001), and more likely to develop non-union (1.89; 95% CI 1.6946 - 2.1095; p < 0.0001). Multiple demographic variables were associated with malnutrition diagnosis including higher age, higher Charlson Comorbidity Index, female sex, dementia, and institutionalization. Parkinson's disease, feeding difficulty and institutionalization demographic variables had the highest risk of malnutrition.
CONCLUSION
The current study found that malnutrition diagnosis significantly increases the risk of adverse medical events in elderly adults with femoral fragility fractures. The rates of malnutrition increased steadily from 2010-2020. This trend is likely a result of increased awareness and testing for malnutrition, not reflecting an actual increased prevalence of malnutrition. Multiple expected demographic variables are associated with diagnosis of malnutrition. .
Topics: Aged; Female; Femoral Fractures; Humans; Malnutrition; Prevalence; Risk Factors
PubMed: 35821930
DOI: No ID Found -
The British Journal of Surgery Oct 2022Tissue adhesive, adhesive tape, and sutures are used to close surgical incisions. However, it is unclear which produces the best results in children, and whether... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tissue adhesive, adhesive tape, and sutures are used to close surgical incisions. However, it is unclear which produces the best results in children, and whether combination wound closure is better than sutures alone.
METHODS
In this parallel randomised controlled trial (ANZCTR: ACTRN12617000158369), children (aged 18 years or less) undergoing elective general surgical or urological procedures were randomized to skin closure with sutures alone, sutures and adhesive tape, or sutures and tissue adhesive. Participants were assessed 2 weeks, 6 weeks, and more than 6 months after operation. Outcomes included wound cosmesis (clinician- and parent-rated) assessed using four validated scales, parental satisfaction, and wound complication rates.
RESULTS
295 patients (333 wounds) were recruited and 277 patients (314 wounds) were included in the analysis. Tissue adhesive wounds had poorer cosmesis at 6 weeks: median 10-point VAS score 7.7 with sutures alone, 7.5 with adhesive tape, and 7.0 with tissue adhesive (P = 0.014). Respective median scores on a 100-point VAS were 80.0, 77.2, and 73.8 (P = 0.010). This difference was not sustained at over 6 months. There was no difference in parent-rated wound cosmesis at 6 weeks (P = 0.690) and more than 6 months (P = 0.167): median score 9.0 with sutures alone, 10.0 with adhesive tape, and 10.0 with tissue adhesive at both stages. Parental satisfaction was similar at all points, with a median score of 5 (very satisfied) for all groups. There was one instance of wound dehiscence in the tissue adhesive group and no wound infections.
CONCLUSION
Short-term wound cosmesis was poorer with tissue adhesive although it is unclear whether this difference is sustained in the long-term. There were no differences between techniques for the study outcomes.
REGISTRATION NUMBER
ACTRN12617000158369 (ANZCTR) (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372177&isReview=true).
Topics: Child; Humans; Prospective Studies; Surgical Wound; Suture Techniques; Sutures; Tissue Adhesives; Wound Healing
PubMed: 35913888
DOI: 10.1093/bjs/znac254 -
Journal of Vascular Surgery Jun 2022A previous meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of closed incision negative pressure wound therapy (ciNPWT) on vascular surgery... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A previous meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of closed incision negative pressure wound therapy (ciNPWT) on vascular surgery groin wounds reported a reduction in surgical site infections (SSIs). Our aim was to perform a comprehensive, updated meta-analysis after the largest multicenter RCT on the subject to date reported no benefits from ciNPWT.
METHODS
A systematic review identified RCTs that had compared the primary outcome of the incidence of postoperative SSIs of groin incisions treated with ciNPWT or standard dressings. The secondary outcomes included wound dehiscence, a composite incidence of seroma, lymph leakage, and hematoma, the need for reoperation, in-hospital mortality, the need for readmission, and the hospital length of stay. The odds ratios (ORs) were compared across the studies using a random effects meta-analysis. The risk of bias was assessed using the Cochrane risk of bias tool, Harbord test, and trim-and-fill analysis.
RESULTS
Eight RCTs with 1125 incisions (ciNPWT, n = 555 [49.3%]; control, n = 570 [50.7%]) were included. The RCTs included three studies inside and five outside the United States. ciNPWT was associated with a significant reduction in the rate of SSIs (OR, 0.39; 95% confidence interval [CI], 0.24-0.63; P < .001). No significant differences were found in the rate of wound dehiscence (OR, 1.11; 95% CI, 0.67-1.83; P = .68), composite incidence of seroma, lymph leak, or hematoma (OR, 0.49; 95% CI, 0.13-1.76; P = .27), need for reoperation (OR, 0.68; 95% CI, 0.40-1.16; P = .16), or need for readmission (OR, 0.60; 95% CI, 0.30-1.21; P = .15). It was not possible to quantitatively evaluate in-hospital mortality or the hospital length of stay. The risk of bias assessment identified a high risk of bias for participant blinding in all eight studies, a low risk for randomization and outcome reporting, and variability between studies for the other methods. We found no evidence of publication bias.
CONCLUSIONS
Our meta-analysis of pooled data has suggested that prophylactic use of ciNPWT for vascular groin incisions will be associated with reduced rates of SSIs. The greatest benefits were seen in the trials with higher baseline rates of SSIs in the control group.
Topics: Groin; Hematoma; Humans; Multicenter Studies as Topic; Negative-Pressure Wound Therapy; Seroma; Surgical Wound; Surgical Wound Infection; Vascular Surgical Procedures
PubMed: 34999218
DOI: 10.1016/j.jvs.2021.12.070 -
International Journal of Colorectal... Jan 2021Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or... (Review)
Review
The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review.
BACKGROUND
Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR.
METHODS
Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds.
RESULTS
Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25-30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls.
CONCLUSION
The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation.
Topics: Humans; Negative-Pressure Wound Therapy; Perineum; Proctectomy; Rectal Neoplasms; Surgical Wound Infection; Wound Healing
PubMed: 32886194
DOI: 10.1007/s00384-020-03732-6 -
Arquivos Brasileiros de Oftalmologia 2015To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty.
PURPOSE
To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty.
METHODS
Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of WD from January 1, 2004 to December 31, 2012 at Hospital Oftalmologico de Brasilia.
RESULTS
Eight (72.7%) patients were men and three were women. Six (54.5%) patients had deep anterior lamellar keratoplasty (DALK) and 5 had penetrating keratoplasty. The mean age at trauma was 31.1 years. The mean time from corneal keratoplasty to WD was 12.82 months (range, 3-33 months). The mean best-corrected visual acuity of patients before trauma was 20/60 (0.48 logMAR) and after final treatment was 20/160 (0.90 logMAR) (P=0.15). In one case, visual acuity decreased to no light perception because of retinal detachment and phthisis bulbi. Accidental blunt trauma and fall were the most common causes of WD.
CONCLUSION
Patients who undergo corneal keratoplasty have a life-long risk of WD. The full-thickness rupture at the graft-host junction in our study suggests that the junction remains vulnerable, even following DALK, and can rupture with trauma. In our series, depending upon the severity of the trauma, postkeratoplastic WD can be associated with a good visual prognosis.
Topics: Adolescent; Adult; Corneal Transplantation; Eye Injuries; Female; Humans; Male; Retinal Detachment; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Surgical Wound Dehiscence; Sutures; Time Factors; Visual Acuity; Wounds, Nonpenetrating; Young Adult
PubMed: 26466231
DOI: 10.5935/0004-2749.20150081 -
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