scholarly journals Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Sven Richter ◽  
Stefan Dold ◽  
Johannes P. Doberauer ◽  
Peter Mai ◽  
Jochen Schuld
Keyword(s):  
Risk Factors ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fistula Formation ◽  
Temporary Abdominal Closure ◽  
Wound Therapy ◽  
Predisposing Factor ◽  
Intestinal Fistulas ◽  
The Impact

Introduction.The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas.Methods.The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients’ demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded.Results.Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during () or after NPWT (). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas.Conclusion.The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation.

scholarly journals Successful Use of Negative Pressure Wound Therapy for Abdominal Wall Necrosis Caused by a Perforated Ascending Colon Using the ABThera System

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kouki Imaoka ◽  
Takuya Yano ◽  
Yasuhiro Choda ◽  
Ko Oshita ◽  
Yuma Tani ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Anterolateral Thigh Flap ◽  
Temporary Abdominal Closure ◽  
Ascending Colon ◽  
Wound Therapy ◽  
Pressure Therapy ◽  
New Device

Background. The practice of leaving the abdomen open after an emergency laparotomy has gained increasing popularity recently. Negative pressure wound therapy (NPWT) is known as an effective technique in the management of an open abdomen (OA). A new device, the ABThera™ Open Abdomen Negative Pressure Therapy System (KCI USA, San Antonio, TX, USA), was specifically designed to achieve a temporary abdominal closure (TAC) in the management of an OA. This study was aimed at presenting a successful experience of treating a case of abdominal wall necrosis caused by a perforated ascending colon using the ABThera System. Case Presentation. A 66-year-old man was admitted to our hospital with complaints of severe pain in the abdomen. On admission, abdominal contrast-enhanced computed tomography (CT) showed fluid collection, an air pocket in the subcutaneous fat layer of the abdominal wall, and edematous changes in the adipose tissue in the peritoneum and abdominal wall. Based on a diagnosis of peritonitis resulting from a perforated ascending colon, emergency surgery was performed. A right hemicolectomy, ileostomy construction, and debridement of the necrotic tissues were performed. However, necrotizing fasciitis rapidly spread; therefore, more necrotic tissue was debrided in a second operation. The abdominal wall defect was left open, and the ABThera System was used in the management of the OA; this device promoted wound healing. A reduction was observed in the size of the open wound with visible granulation tissue. The defect was finally covered with a mesh split-thickness skin graft and anterolateral thigh flap. Conclusions. In the management of a case of a massive wound with infection, it can be of great benefit to treat the wound with NPWT initially to decrease its size. The ABThera System could facilitate early and safe management of an OA by surgeons.

scholarly journals Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Martin Hutan ◽  
Christian Bartko ◽  
Augustin Prochotsky ◽  
Jaroslav Sekac ◽  
Jan Skultety ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fascial Closure ◽  
High Morbidity ◽  
Temporary Abdominal Closure ◽  
Wound Therapy ◽  
Mortality And Morbidity ◽  
Prospective Assessment ◽  
Sequential Closure

Open abdomen (OA) is a surgical approach, that emerged in last 15 years, with its management being complicated, timely and financially demanding, burdened with high morbidity and mortality. In recent years, several publications proved superiority of usage of negative pressure wound therapy (NPWT) over usage of conventional temporary abdominal closure techniques in treatment of open abdomen. Different aspects of treatment of OA with NPWT remain to be assessed and stated.Authors of the paper prospectively assessed group of 48 patients with OA, managed by one surgeon with NPWT between 2006-2014, assessing mortality and morbidity in the group stratified by indication for OA, type of sequential closure of OA, presence and management of concomitant enteroatmospheric fistula (EAF), maximal values of C-reactive protein (CRP) and Procalcitonine (PCT), and initial body mass index (BMI). Mortality of the whole group was 35.41%, rate of fascial closure 45.83% and rate of the wound closure 83.33%. Incidence of the fistula was 37.5%, of these 66.67% were successfully locally managed. Incidence of fascial closure without use of sequential closure was significantly lower as opposed to use of different techniques of sequential closure.Unsuccessful local management of EAF is significant predictor of mortality. All other data were not found to be statistically significant. Identifying specific aspects of treatment of OA by NPWT, significantly improving outcomes, and adhering to these aspects in clinical practice will further ameliorate outcomes.

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

2021 ◽  
Author(s):  
Marcus Rickert ◽  
Michael Rauschmann ◽  
Nizar Latif-Richter ◽  
Mohammad Arabmotlagh ◽  
Tamin Rahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Negative Pressure Wound Therapy ◽  
Wound Infections ◽  
Wound Therapy ◽  
Postoperative Wound ◽  
Deep Wound ◽  
The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

The Impact of Negative-Pressure Wound Therapy with Instillation Compared with Standard Negative-Pressure Wound Therapy

2014 ◽  
Vol 133 (3) ◽  
pp. 709-716 ◽  
Author(s):  
Paul J. Kim ◽  
Christopher E. Attinger ◽  
John S. Steinberg ◽  
Karen K. Evans ◽  
Kelly A. Powers ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
The Impact

The Use Of Negative Pressure Wound Therapy (NPWT) In The Management Of Enteroatmospheric Fistula – Case Report And Literature Review

2015 ◽  
Vol 87 (10) ◽  
Author(s):  
Rajmund Jaguścik ◽  
Dominik A. Walczak ◽  
Joanna Porzeżyńska ◽  
Piotr W. Trzeciak
Keyword(s):  
Negative Pressure ◽  
Metabolic Disorders ◽  
Multidisciplinary Approach ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Oral Intake ◽  
Surgical Team ◽  
Wound Therapy ◽  
Necrotic Pancreatitis ◽  
Enteroatmospheric Fistula

AbstractAn enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions.We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.

scholarly journals Negative pressure therapy for management of patients with enterocutaneous fistulas

2020 ◽  
pp. 90-92
Author(s):  
A. E. Demko ◽  
I. M. Batyrshin ◽  
J. S. Ostroumova ◽  
D. S. Sklizkov ◽  
D. V. Fomin
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Negative Pressure Therapy ◽  
Wound Therapy ◽  
Comparable Group ◽  
Pressure Therapy ◽  
Saint Petersburg ◽  
Early Closure ◽  
Surgical Tactics ◽  
Intestinal Fistulas

Objective: To assess the benefits of negative pressure wound therapy (NPWT) in complex therapy of patients with enterocuta‑ neous fistulas.Methods: From 2014 to 2019 in Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 24 patients were managed with vacuum assisted techniques. For comparison, a comparable group of 23 observations (control) was formed retrospectively based on an analysis of medical records.Results: When using NPWT, the terms of wound cleansing and the formation of a laparostomy were reduced, and conditions were created for its early closure. With a small laparostomy, the use of NPWT contributed to self-epithelialization of the wound around the fistula.Conclusions: The use of NPWT more than halves the time of formation of a laparostomy, shortens the time for cleansing the wound and creates the conditions for its closure. Surgical tactics using NPWT can more than three times reduce the number of local complications in patients with unformed intestinal fistulas and less often change the combination of antibacterial drugs. 

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