scholarly journals Closed-incision negative-pressure wound management in surgery—literature review and recommendations

2020 ◽  
Vol 52 (6) ◽  
pp. 249-267
Author(s):  
Maria A. Smolle ◽  
Sebastian P. Nischwitz ◽  
Martin Hutan ◽  
Primoz Trunk ◽  
David Lumenta ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cardiac Surgery ◽  
Literature Review ◽  
General Surgery ◽  
Negative Pressure ◽  
Wound Complications ◽  
Postoperative Wound ◽  
Positive Effects ◽  
Pubmed Database ◽  
Tensile Forces

Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

2018 ◽  
Vol 12 (5) ◽  
pp. 409-417 ◽  
Author(s):  
Hesham Saleh ◽  
Sanjit Konda ◽  
Adam Driesman ◽  
John Stranix ◽  
Catherine Ly ◽  
...  
Keyword(s):  
Wound Healing ◽  
Ankle Fracture ◽  
Wound Complications ◽  
Management Options ◽  
Original Cohort ◽  
Surgical Interventions ◽  
Postoperative Wound ◽  
Trimalleolar Fractures ◽  
Medical Histories ◽  
Fracture Surgery

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

scholarly journals A Study of Wound Healing in 402 Calcaneus Fracture Cases Using Precise Extensive L-Shaped Incision

2021 ◽  
Author(s):  
Fushan Hou ◽  
Xiao Liang ◽  
Kun Xi ◽  
Feng Zhao ◽  
Bin Wang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Skin Necrosis ◽  
Wound Complications ◽  
Postoperative Wound ◽  
Calcaneus Fracture ◽  
Heel Bone ◽  
Dressing Change ◽  
Medical University ◽  
Would Healing

Abstract Background: To investigate wound healing in 402 calcaneus fracture cases using precise extensive L-shaped incision.Method: We retrospectively analyzed 402 calcaneus fracture cases, involving patients who underwent heel bone reduction and internal fixation, using precise extensive L-shaped incision, at the second hospital of Shanxi medical university between January 2018 and December 2020. Postoperative would healing was evaluated using a self-designed skin margin grading system. Results: The patients experienced osseous healing after the surgery. A Maryland foot score of ≥90% was considered excellent. The skin margins from Grade I, II, III injuries healed spontaneously after dressing change. However, Grade IV injuries healed after debridement or removal of internal fixation.Conclusions: The precise extensive L-shaped incision, used in this study, allowed for fewer postoperative wound complications and lower incidence of skin necrosis.

Effect of selective intestinal decontamination on the incidence of postoperative wound complications and anastomosis insufficiency in colorectal surgery (literature review)

2020 ◽  
pp. 56-64
Author(s):  
I. V. Mikhin I. V. Mikhin ◽  
O. F. Vorontsov ◽  
C. Graeb C. Graeb ◽  
V. V. Tolochyk ◽  
I. G. Natroshvili ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Colorectal Surgery ◽  
Literature Review ◽  
Wound Complications ◽  
Bacterial Strains ◽  
Intravenous Antibiotic ◽  
Postoperative Wound ◽  
Intestinal Decontamination ◽  
Colon And Rectum ◽  
Oral Decontamination

The article provides a literary review of the fundamentals, role in clinical practice, and possibilities of selective perioperative intestinal decontamination. Aspects of prevention of postoperative wound complications and anastomosis insufficiency in colorectal surgery are analyzed. The key point is to reduce the number of certain bacterial strains that contribute to the development of exponential inflammation in the anastomosis zone. Modern schemes for the use of oral decontamination and their combination with intravenous antibiotic prophylaxis for the failure of anastomoses of the left half of the colon and rectum are considered.

scholarly journals The Utility of Disposable Negative Pressure Wound Therapy (PICO) in Wound Healing of Latissimus Dorsi Musculocutaneous Flap Donor Sites

2020 ◽  
Vol 16 (1) ◽  
pp. 21-25
Author(s):  
Jeoung Hyun Nam ◽  
Eun Soo Park ◽  
Seok Hwan Kim
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Latissimus Dorsi ◽  
Negative Pressure Wound Therapy ◽  
Musculocutaneous Flap ◽  
Wound Complications ◽  
Control Group ◽  
Dressing Method ◽  
Wound Therapy ◽  
Latissimus Dorsi Musculocutaneous Flap

Background: Among treatments aiming to solve surgical wound complications, negative pressure wound therapy (NPWT) is considered an innovative method. NPWT can promote wound healing, protect the wound from infection and reduce the tension on suture sites. At the same time, the large machine required in the therapy led to some inconvenience. The PICO system has recently been developed as a simple pocket-sized NPWT device. By comparing the time required for healing of the wound, incidence of wound complications, duration of hospital stays, and dressing costs, we attempted to confirm the utility of PICO for managing latissimus dorsi musculocutaneous flap donor sites.Methods: PICO was used on nine donor sites of patients who had undergone breast reconstruction using latissimus dorsi musculocutaneous flaps. PICO was applied immediately after operation and removed on the 9th day. In the control group, daily conventional dressings were administered commensurate with the condition of the wounds. We defined the wound healing time to the point when no more dressing was needed. For the costs of dressing, only costs incurred on the donor sites were included.Results: Wound healing was proven to be faster in the PICO group (P=0.035) versus the control group, and no complications were observed in the PICO group. Also, the cost of PICO was lower compared to the costs incurred by the conventional dressing method (P<0.001).Conclusion: We suggest that PICO can reduce wound complications on areas where anatomical movement could lead to tension, while also reducing dressing costs.

The use of autologous platelet gel (APG) for high-risk patients in cardiac surgery — is it beneficial?

Perfusion ◽  
2009 ◽  
Vol 24 (6) ◽  
pp. 381-387 ◽  
Author(s):  
Jens Litmathe ◽  
Christian Philipp ◽  
Muhammed Kurt ◽  
Udo Boeken ◽  
Emmeran Gams ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cardiac Surgery ◽  
High Risk ◽  
Wound Complications ◽  
Control Group ◽  
Study Group ◽  
Platelet Gel ◽  
High Risk Patients ◽  
Risk Patients ◽  
Autologous Platelet

Background: Wound healing in cardiac surgery has become a major problem due to the impaired risk profile of many patients. The aim of this study was to prove the influence of autologous platelet gel (APG) on wound healing in a special group of high-risk patients undergoing coronary surgery. Patients and Methods: We performed a prospective, double-blind study in 44 patients with a special risk constellation relating to wound complications (obesity, diabetes, smoker, New York Heart Association (NYHA) III-IV and peripheral vascular disease). The study group was treated with APG, prepared using the Magellan© platelet separator, the control group underwent conventional wound treatment. Results: The incidence of major and minor wound complications at the thoracotomy, as well as in the area of saphenous vein harvesting, was not pronounced in either of the groups. Blood loss and pain sensations did not differ significantly either. Stay in the intensive care unit (ICU) and the in-hospital mortality were also comparable. The duration of the entire operation and the time until removing the chest-tubes were prolonged in the study group. Conclusion: Despite promising results in other fields of surgery, APG shows no beneficial effect in high-risk patients undergoing cardiac surgery. Probably, it depends on different types of microcirculation in atherosclerotic patients, which are quite different from those of other surgical areas. This factor may offset the existing beneficial platelet effects which could be observed, for example, in maxillo-facial surgery.

scholarly journals Use of Intraoperative Tranexamic Acid and Wound Complications in Spine Surgery: A Retrospective Cohort Study

2020 ◽  
Vol 14 (5) ◽  
pp. 639-646 ◽  
Author(s):  
Moti Kramer ◽  
Michael Drexler ◽  
Amir Herman ◽  
Tal Kalimian ◽  
Yuri Klassov ◽  
...  
Keyword(s):  
Wound Healing ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Retrospective Cohort ◽  
Wound Dehiscence ◽  
Multivariate Regression Analysis ◽  
Wound Complications ◽  
Factors Affecting ◽  
Postoperative Wound ◽  
Academic Center

Study Design: A retrospective cohort study.Purpose: This study aims to examine the effect of tranexamic acid (TXA) on postoperative wound healing in spine surgery.Overview of Literature: TXA (Cyklokapron, Hexakapron) is a widely used anti-fibrinolytic drug that is shown to be effective in mitigating hemorrhage during and after surgery by competitively blocking plasminogen in fibrinolytic cascade. Plasminogen also plays a role in inflammatory and infectious diseases. The modulation of this role by TXA may influence the development of postoperative infectious complications.Methods: We collected and reviewed the charts of 110 patients who underwent spine surgery at our academic center. We used multivariate regression analysis to assess the factors affecting surgical site infection (SSI).Results: Of the 110 patients included in this study, 21 patients (19%) were categorized as having postoperative wound complications, 16 patients (14%) had deep or superficial wound infection, and five patients (4%) had wound dehiscence. Patients with a higher surgical invasiveness index score, longer surgeries, and older patients were found to be at risk for wound complications. TXA was determined not to be a direct risk factor for wound healing complications and SSIs.Conclusions: We found no risk of wound healing complications and SSI directly attributable to preoperative and intraoperative treatment with TXA in spine surgeries.

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