Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma

2013 ◽  
Vol 2013 ◽  
pp. 32-33
Author(s):  
J. Boehmler
Keyword(s):  
Soft Tissue ◽  
Patient Outcomes ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Soft Tissue Coverage ◽  
Wound Therapy ◽  
Limb Trauma ◽  
Lower Limb Trauma

Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma

Injury ◽  
2012 ◽  
Vol 43 (6) ◽  
pp. 772-778 ◽  
Author(s):  
David Shi Hao Liu ◽  
Foti Sofiadellis ◽  
Mark Ashton ◽  
Kirstie MacGill ◽  
Angela Webb
Keyword(s):  
Soft Tissue ◽  
Patient Outcomes ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Soft Tissue Coverage ◽  
Wound Therapy ◽  
Limb Trauma ◽  
Lower Limb Trauma

Negative-Pressure Wound Therapy and External Fixation for Infection and Hematoma After Hallux Abducto Valgus Surgery

2007 ◽  
Vol 97 (5) ◽  
pp. 410-414 ◽  
Author(s):  
Edward Ferdinando ◽  
Laura Guerin ◽  
Aluko O. Jervis ◽  
Henrietta Obidigbo
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Early Recognition ◽  
Metatarsophalangeal Joint ◽  
Postoperative Phase ◽  
Soft Tissue Coverage ◽  
Wound Therapy ◽  
First Metatarsophalangeal Joint

Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, pain, wound dehiscence, infection, and scarring of the surgical wound. We describe a 44-year-old woman who developed severe complications, including hematoma, abscess, failure of internal fixation, and loss of soft-tissue structures, after hallux abducto valgus surgery. Hospitalization was required for infection control, soft-tissue coverage through negative-pressure wound therapy, and first metatarsophalangeal joint stabilization through external fixation. Early recognition of the signs of infection and hematoma can help decrease the incidence of postoperative complications. (J Am Podiatr Med Assoc 97(5): 410–414, 2007)

scholarly journals Free Tissue Transfer in Pediatric Lower Limb Trauma

2019 ◽  
Vol 52 (01) ◽  
pp. 037-044 ◽  
Author(s):  
R. Srikanth
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Large Series ◽  
Soft Tissue Coverage ◽  
Wound Coverage ◽  
Tissue Transfer ◽  
Limb Trauma ◽  
Lower Limb Trauma

AbstractFree tissue transfer has become the standard in wound coverage and further refinements have given us newer flap donor sites or modifications of existing flaps to decrease morbidity; smaller vessels are being anastomosed, a direct spin-off following successful distal replantations. Younger children are presenting with traumatic defects similar to adults. Although there were apprehensions of free tissue transfer in children occasioned by smaller vessels, duration of procedure and concerns of growth following flap harvest, reports of small and large series have appeared in the literature with similar success. Pediatric-free tissue transfer is now an established entity. This article seeks to arrive at a consensus based on a review of the existing literature on free flaps for skin and soft-tissue coverage of lower limb trauma in children.

659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Soft Tissue ◽  
Cell Suspension ◽  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Case Series ◽  
Dermal Substitute ◽  
Wound Therapy ◽  
Skin Cell ◽  
Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

scholarly journals Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT

2020 ◽  
Vol 24 (38) ◽  
pp. 1-86
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Ruth Knight ◽  
May Ee Png ◽  
Julie Bruce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Site Infection ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Major Trauma ◽  
Site Infection ◽  
Wound Therapy ◽  
Deep Surgical Site Infection

Background Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. Objectives To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. Design A pragmatic, multicentre, randomised controlled trial. Setting Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. Participants A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. Interventions Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. Main outcome measures Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. Results A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. Conclusions The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. Future work Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. Trial registration Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.

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