Vacuum-Assisted Wound Closure Therapy in Pediatric Lower Limb Trauma

Abstract BACKGROUND AND IMPORTANCE: Since the introduction of vacuum-assisted closure (VAC) in 1997, it has been used successfully in treating difficult wounds, including spinal wounds and wounds in pediatric patients. There are no reports on VAC therapy in pediatric patients on the scalp, especially with exposed dura. This report describes a 10-year-old boy with a chronic wound of the scalp with exposed dura after multiple neurosurgical interventions who was treated successfully with VAC. CLINICAL PRESENTATION: A 10-year-old mentally disabled boy with Apert syndrome suffered from a chronic wound with community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection after multiple neurosurgeon operations. For wound closure, VAC therapy was initiated on the bony defect with exposed dura. The wound healed successfully, and the MRSA disappeared. CONCLUSION: The aims of VAC therapy are formation of new granulation tissue, wound cleansing, and bacterial clearance. In this case, the VAC device was excellent for temporary coverage of the defect and for wound cleaning, and it allowed a thick bed of granulation tissue to form over the dura, even with minimal constant negative pressure. The application and management were feasible even in a mentally disabled child. With this experience, we are encouraged to use the VAC device in difficult wounds, even in the head and neck area in children, and to bring this treatment into the outpatient clinic.

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Differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00035 ◽

2018 ◽

Vol 6 (4_suppl2) ◽

pp. 2325967118S0003

Author(s):

Christopher Ull ◽

Dominik Seybold ◽

Matthias Königshausen ◽

Thomas Schildhauer ◽

Jan Geßmann

Keyword(s):

Soft Tissue ◽

Length Of Stay ◽

Compartment Syndrome ◽

Infection Rate ◽

Lower Limb ◽

Acute Compartment Syndrome ◽

Effective Procedure ◽

Definitive Treatment ◽

Primary Osteosynthesis ◽

Classification Type

To analyze the differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome (ACS). From our trauma database, we indentified a total number of 107 patients with 126 fractures of AO/OTA type 41 to 44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary osteosynthesis after compartment incision. 71 patients with 77 fractures of AO/OTA classification type 41 to 44 suffering ACS received primary osteosynthesis after compartment incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41 to 44 and ACS, who were treated by secondary osteosynthesis after compartment incision (SOCI). Patients with POCI showed a significantly shorter length of stay in the hospital with significantly less necessary surgeries for definitive treatment of the fractures and the soft tissue closure than SOCI patients (p < 0,001). The overall rate of infections in both groups were 13% without any difference between POCI and SOCI. The POCI of AO/OTA fractures type 41 to 44 with ACS is a safe and effective procedure for unilateral und single fractures of the lower limb without an increasing infection rate.

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Case Report: Pseudomonas can take a toll on a patient

F1000Research ◽

10.12688/f1000research.53424.1 ◽

2021 ◽

Vol 10 ◽

pp. 526

Author(s):

David K. Buchbinder ◽

Jasjit Singh ◽

Tuan Dao ◽

Aaron Sassoon ◽

Antonio Arrieta

Keyword(s):

Soft Tissue ◽

Immune Function ◽

Host Defense ◽

Pediatric Patients ◽

Germ Line ◽

Central Nervous System Infection ◽

Chronically Ill ◽

Definitive Treatment ◽

Inborn Errors ◽

Invasive Infections

Pseudomonas aeruginosa (P. aeruginosa) is an aerobic Gram-negative bacterium that is implicated in the development of severe systemic infections among pediatric patients. It is identified in hospitalized chronically ill pediatric patients in association with genitourinary, respiratory tract, and skin or soft tissue infections as well as severe and life-threating infection including sepsis. A variety of immunologic mechanisms play a vital role in the host defense mechanisms against invasive infections with P. aeruginosa. Rarely, specific inborn errors of immune function are implicated in deficiencies that predispose to invasive infections with P. aeruginosa. Innate immune function including germ-line encoded pattern recognition receptors such as toll-like receptors (TLRs) and their downstream signaling is vital in the host defense against P. aeruginosa through the generation of antimicrobial peptides, cytokines/chemokines, and shaping of adaptive immune responses. Herein, we describe a previously healthy two-year-old female with an invasive skin, soft tissue, and central nervous system infection secondary to P. aeruginosa. The invasive nature of this infection prompted a careful evaluation for an inborn error of immunity. Decreased cytokine response to agonists of TLRs was documented. Targeted sequencing of interleukin-1 receptor-associated kinase (IRAK)-4 documented a homozygous deletion of exons 8-13 consistent with IRAK-4 deficiency. This report provides a vital educative message in the existing scientific literature by underscoring the importance of considering inborn errors of immunity in all patients with severe P. aeruginosa infections. Functional assessments of immune function often in combination with sequencing can accurately assign a diagnosis in a timely fashion allowing for definitive treatment and the use of necessary supportive care.

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Case Report: Pseudomonas can take a toll on a patient

F1000Research ◽

10.12688/f1000research.53424.2 ◽

2021 ◽

Vol 10 ◽

pp. 526

Author(s):

David K. Buchbinder ◽

Jasjit Singh ◽

Tuan Dao ◽

Aaron Sassoon ◽

Antonio Arrieta

Keyword(s):

Soft Tissue ◽

Immune Function ◽

Host Defense ◽

Pediatric Patients ◽

Germ Line ◽

Central Nervous System Infection ◽

Chronically Ill ◽

Definitive Treatment ◽

Inborn Errors ◽

Invasive Infections

Pseudomonas aeruginosa (P. aeruginosa) is an aerobic Gram-negative bacterium that is implicated in the development of severe systemic infections among pediatric patients. It is identified in hospitalized chronically ill pediatric patients in association with genitourinary, respiratory tract, and skin or soft tissue infections as well as severe and life-threating infection including sepsis. A variety of immunologic mechanisms play a vital role in the host defense mechanisms against invasive infections with P. aeruginosa. Rarely, specific inborn errors of immune function are implicated in deficiencies that predispose to invasive infections with P. aeruginosa. Innate immune function including germ-line encoded pattern recognition receptors such as toll-like receptors (TLRs) and their downstream signaling is vital in the host defense against P. aeruginosa through the generation of antimicrobial peptides, cytokines/chemokines, and shaping of adaptive immune responses. Herein, we describe a previously healthy two-year-old female with an invasive skin, soft tissue, and central nervous system infection secondary to P. aeruginosa. The invasive nature of this infection prompted a careful evaluation for an inborn error of immunity. Decreased cytokine response to agonists of TLRs was documented. Targeted sequencing of interleukin-1 receptor-associated kinase (IRAK)-4 documented a homozygous deletion of exons 8-13 consistent with IRAK-4 deficiency. This report provides a vital educative message in the existing scientific literature by underscoring the importance of considering inborn errors of immunity in all patients with severe P. aeruginosa infections. Functional assessments of immune function often in combination with sequencing can accurately assign a diagnosis in a timely fashion allowing for definitive treatment and the use of necessary supportive care.

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Successful Treatment of Anterior Tracheal Necrosis after Total Thyroidectomy Using Vacuum-Assisted Closure Therapy

Critical Care Research and Practice ◽

10.1155/2012/252719 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Grégory Philippe ◽

Nicolas Pichon ◽

Justine Lerat ◽

Jean Bernard Amiel ◽

Marc Clavel ◽

...

Keyword(s):

Total Thyroidectomy ◽

Granulation Tissue ◽

Closure Device ◽

Vacuum Assisted Closure ◽

Good Opportunity ◽

Vac Therapy ◽

First Case ◽

Adjacent Structures ◽

Vacuum Assisted Closure Therapy ◽

Ongoing Infection

Total thyroidectomy involving the adjacent structures of the trachea can cause tracheal damage such as early tracheal necrosis. The authors describe the first case of anterior tracheal necrosis following total thyroidectomy treated using vacuum-assisted closure device. After two weeks of VAC therapy, there was no evidence of ongoing infection and the trachea was partially closed around a tracheotomy cannula, removed after 3 months. The use of a VAC therapy to reduce and close the tracheal rent and to create a rapid granulation tissue over tracheal structure appeared as a good opportunity after anterior tracheal necrosis.

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Lower limb landmine injuries

Prosthetics and Orthotics International ◽

10.3109/03093640409167923 ◽

2004 ◽

Vol 28 (1) ◽

pp. 37-43 ◽

Cited By ~ 8

Author(s):

S. Necmioglu ◽

M. Subasi ◽

C. Kayikci ◽

D. B. Young

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Tendon Repair ◽

Preoperative Assessment ◽

Traumatic Amputation ◽

Wound Debridement ◽

Group I ◽

Minimal Osteosynthesis ◽

Limb Injuries ◽

Group Ii

The medical records of 186 patients seeking treatment for landmine injuries in the authors' region between 1993 and 2001 were evaluated. Of these patients 13 died of accompanying complications. Ten (10) patients with general body trauma and upper limb trauma were excluded from the study. Of 163 patients with lower-limb injuries included in the study, 21 with traumatic amputation underwent surgical amputation at different levels. Patients without traumatic amputation were divided into 2 groups. There were 41 patients (29%) in Group I who were treated by limb salvage procedures. Treatments used in Group I including wound debridement, tendon repair, skin approximation, minimal osteosynthesis, external fixation of long bones and secondary wound coverage. In Group II, there were 101 patients (71%) with primary amputation. Trans-tibial amputation was performed in 52 cases (51.4%), ankle disarticulation in 24 (23.7%), trans-femoral amputation in 9 (8.9%), partial foot amputation in 8 (7.9%), knee disarticulation in 7 (6.9%) and hip disarticulation in 1 case. In Group I, there was infection in 21 patients (51.2%), revision in 27 (65.8%), and amputation in 15 (36.5%). In Group II, there was infection in 28 patients (27.7%), revision in 17 (16.8%), and amputation at a higher level in 8 (7%). In crush injuries such as those resulting from landmines, soft tissue, vascular, and neurological assessment must be performed with utmost care. Even so, the desired success in interventions intended to save a limb is complicated by a high infection rate, soft tissue complications, and high revision amputation rates. Therefore, a decision to amputate in the early term based on an accurate preoperative assessment is crucial

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Vacuum-Assisted Wound Closure (VAC Therapy) for the Management of Patients With High-Energy Soft Tissue Injuries

Journal of Orthopaedic Trauma ◽

10.1097/00005131-200311000-00004 ◽

2003 ◽

Vol 17 (10) ◽

pp. 683-688 ◽

Cited By ~ 167

Author(s):

Dolfi Herscovici, ◽

Roy W. Sanders ◽

Julia M. Scaduto ◽

Anthony Infante ◽

Thomas DiPasquale

Keyword(s):

Soft Tissue ◽

Wound Closure ◽

Soft Tissue Injuries ◽

High Energy ◽

Vac Therapy ◽

Tissue Injuries

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P60 Impact of Acute Knee Clinic in the West of Scotland

BJS Open ◽

10.1093/bjsopen/zrab032.059 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Saud Alfadhel ◽

Laith Sinan ◽

Simon Spencer ◽

Saud Alfadhel

Keyword(s):

Soft Tissue ◽

Clinical Outcomes ◽

Waiting Time ◽

Cruciate Ligament ◽

Adult Population ◽

Knee Injuries ◽

Definitive Treatment ◽

The West ◽

The Impact ◽

Acute Knee

Abstract Introduction Soft tissue knee injuries are a common presentation among the young and adult population, thus, we have performed this audit to investigate the impact of introducing a new acute knee clinic in the West of Scotland with regards to delay in treatment of such injuries and potential clinical outcomes. Methods We have collected data from over 100 random patients with anterior cruciate ligament (ACL) injuries pre and post- the introduction of acute knee clinic in the West of Scotland and calculated the median time taken for them to see a knee specialist following their initial injury. The data was collected using a standardised proforma and analysed using Microsoft Excel. All patients included were 18-years-old and above. Results The introduction of an acute knee clinic has led to over 65% reduction in waiting time to see a knee specialist following a knee injury. In addition, soft tissue co-injuries such as meniscal tears were more likely to occur in patients who waited longer to be treated and thus the introduction of the knee clinic had also led to a reduction in waiting time for a definitive treatment (i.e. surgery) of patients and subsequent reduction in associated co-injuries. Conclusion Acute knee clinics are effective in reducing patient waiting time to be seen by a knee specialist following an ACL tear. This is particularly important as the earlier intervention is more likely to prevent subsequent meniscal and chondral injuries which in turn can provide patients with better clinical outcomes and quality of life.

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