Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage—Clinical Outcome of 34 Patients

2021 ◽  
pp. 153473462110320
Author(s):  
Yaojun Wu ◽  
Liang Chen ◽  
Xinliang Mao ◽  
Zhengliang Ru ◽  
Liying Yu ◽  
...  
Keyword(s):  
Vacuum Sealing ◽  
Day Range ◽  
Skin Stretching ◽  
Group A ◽  
Group B ◽  
Vacuum Sealing Drainage ◽  
Real Challenge ◽  
Safe Approach ◽  
Large Skin ◽  
Complex Wounds

Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length ( W/ L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables ( P < .05 Kruskal–Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A ( W/ L ＞ 0.5) were more difficult to close than in group B ( W/ L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.

scholarly journals Preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid of foot and ankle wounds improves outcome of reconstructive skin flap surgery

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xu Gao ◽  
Hailei Yin ◽  
Jixia Sun
Keyword(s):  
Inflammatory Response ◽  
Skin Flap ◽  
Foot And Ankle ◽  
Flap Surgery ◽  
Local Inflammatory Response ◽  
Drainage Fluid ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Vacuum Sealing Drainage

Abstract Objectives By observing the infection and soft tissue defect on the wound surface of the foot and ankle, this paper attempts to explore the effect of preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid (abPI-VSD) on the bacterial quantity and the local inflammatory response at the flap, and further to provide a basis for applying this technique before a reconstructive skin flap surgery of foot and ankle wounds. Methods Seventy-five patients were randomly divided into two groups, and all surgeries were done by one physician. The flap reconstructions were done to 31 cases with the abPI-VSD being used (group A); the flap reconstructions were done to the rest 44 cases after wound cleaning using antibiotic irrigation solution without the use of the abPI-VSD (group B). Quantitative bacteriology was made to group A before and after the use of abPI-VSD; quantitative bacteriology was made to group B before and after wound cleaning. Then, the reconstructive skin flap surgery was done. After the surgeries, the time of local inflammatory response at the flap in both groups were recorded. The measured bacterial quantity was evaluated in logarithm and by t test. Results The bacterial quantity was 3.2 ± 1.9 × 107 cfu/g in group A before the use of abPI-VSD and 2.3 ± 2.0 × 107 in group B (P > 0.05) before debridement. The bacterial quantity was 1.2 ± 2.0 × 104 cfu/g in group A after abPI-VSD and was 2.9 ± 4.0 × 106 in group B after wound cleaning (P < 0.05). The time of postoperative inflammatory response in the flap was 8 ± 2.5 days in group A and 13 ± 3.4 days in group B (P < 0.05). Conclusions abPI-VSD can distinctly reduce the bacterial quantity on the surface of the wound, provide a good condition of tissue bed for the flap reconstruction, and effectively control the local inflammatory response at the flap and hence improve the survival quality of the flap.

The relationship between naldemedine administration and the maximum dose of oral opioids.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 818-818
Author(s):  
Shinya Kajiura ◽  
Shingo Chikaoka ◽  
Ayaka Kadota ◽  
Sakie Fukai ◽  
Takako Matsushita ◽  
...  
Keyword(s):  
Maximum Dose ◽  
Median Dose ◽  
Patients With Cancer ◽  
Day Range ◽  
Opioid Receptor Antagonists ◽  
Significant Difference ◽  
Group A ◽  
Starting Date ◽  
Group B ◽  
The Relationship

818 Background: Opioid-induced constipation (OIC) is the most common side effect of opioid therapy. Laxatives are usually used as a first-line treatment for OIC. Treatment options for OIC are switching to other opioids associated with less frequent OIC, such as Fentanyl. Naldemedine is an orally active peripherally acting µ-opioid receptor antagonists that was approved in Japan from 2017 for management of cancer-related OIC. The aim of this study is to investigate the relationship between Naldemedine administration and the maximum dose of oral Oxycodone which is the most frequently used oral opioids at our hospital. Methods: During June 2017 and December 2018, a total of 217 patients with cancer-related pain received Oxycodone at our institution. The first group of the patients concurrently received Naldemedine 0.2 mg daily (group A, n = 101), and the second group didn’t receive it (group B, n = 116) for cancer-related OIC reduction. We compared the maximum Oxycodone dose between two groups by medical record retrospectively. Results: The median age of group A was 69 y.o. (range 20-87 y.o.), and the median age of group B was 67 y.o. (range 27-88y.o.). There was no significant difference in common patient background between group A and B. The median dose of maximum Oxycodone dose of group A was 40 mg/day (range 10-480 mg/day), and that of group B was 20 mg/day (range 10-320 mg/day). There was a significant difference in the median dose of maximum Oxycodone between group A and B (Mann-Whitney U test, P < 0.0001). In Group A, the administration was started in 31 patient Naldemedine and Oxycodone at the same time. As for 70 remaining patients, the administration was started when they had constipation after oxycodone was administrated. In those patients, the median days was 19 days from the Oxycodone administration starting date to the Naldemedine administration starting date. Conclusions: Naldemedine administration in patients with cancer-related OIC may increase the maximum dose of oral Oxycodone.

scholarly journals Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yaojun Wu ◽  
Liang Chen ◽  
Shaokun Wu ◽  
Liying Yu ◽  
Mimi Chen ◽  
...  
Keyword(s):  
Median Time ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Defect Size ◽  
Wound Therapy ◽  
Skin Stretching ◽  
Safe Approach ◽  
Large Skin

AbstractThe management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

2021 ◽  
Author(s):  
Yaojun Wu ◽  
Liang Chen ◽  
Shaokun Wu ◽  
Liying Yu ◽  
Mimi Chen ◽  
...  
Keyword(s):  
Median Time ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Defect Size ◽  
Wound Therapy ◽  
Skin Stretching ◽  
Safe Approach ◽  
Large Skin

Abstract Management of complex diabetic foot wounds with large skin defects poses a challenge for surgeon. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 to October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm² (range: 4.71 -66.76 cm²).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 days to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm² per day, ranging from 0.29 cm² per day to 8.35 cm² per day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistically difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach for complex diabetic foot wounds. Nevertheless, more attentions should be paid for the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

An ultrastructural study of sertoli cells in two geographically isolated populations of Aphanius dispar

1992 ◽  
Vol 50 (1) ◽  
pp. 548-549
Author(s):  
Taber A. Ba-Omar ◽  
Philip F. Prentis
Keyword(s):  
Ultrastructural Level ◽  
Uranyl Acetate ◽  
Freshwater Teleost ◽  
Isolated Populations ◽  
En Bloc ◽  
The North ◽  
Group A ◽  
Ultrathin Sections ◽  
Group B ◽  
Geographically Isolated

We have recently carried out a study of spermiogenic differentiation in two geographically isolated populations of Aphanius dispar (freshwater teleost), with a view to ascertaining variation at the ultrastructural level. The sampling areas were the Jebel Al Akhdar in the north (Group A) and the Dhofar region (Group B) in the south. Specimens from each group were collected, the testes removed, fixed in Karnovsky solution, post fixed in OsO, en bloc stained with uranyl acetate and then routinely processed to Agar 100 resin, semi and ultrathin sections were prepared for study.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

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