What is the role of incisional vacuum therapy in challenging spinal wounds? A single centre experience

2021 ◽  
Vol 30 (6) ◽  
pp. 476-481
Author(s):  
Marwan S Hajjar ◽  
Georgio M Atallah ◽  
Ahmad Oneissi ◽  
Paul Beaineh ◽  
Ghassan S Abu-Sittah
Keyword(s):  
Spinal Surgery ◽  
Wound Care ◽  
Data Entry ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Vacuum Therapy ◽  
Medical Chart Review

Objective: A surgical approach to the treatment of spinal defects and disorders has become more common because of the medical and technological advancements achieved in the last decade. This rising trend in spinal surgeries is associated with adverse events, most notably wound complications. From its introduction, negative pressure wound therapy (NPWT) has proved to be essential in the management of complex wounds and in speeding up wound recovery. The aim of this study is to investigate the use of incisional NPWT in patients undergoing spinal surgery and its role in the prevention of wound complications. Method: This study is a retrospective medical chart review conducted on patients who underwent spinal surgery and received incisional vacuum therapy as part of their treatment. The apparatus was applied intraoperatively following the spinal surgery for all patients included in this study. All surgical procedures were conducted between September 2019 and May 2020. Data entry and analysis were performed between September and October 2020. Results: A total of five patients' records were reviewed. In our healthcare centre, three patients developed seroma, one developed haematoma, four required revision surgery and one patient required re-operation. There was no wound dehiscence and none of the wounds became infected. Mean length of hospital stay was 11.2 days (standard deviation (SD): 9.5 days) and mean operation time was 333 minutes (SD: 86.4 minutes). Conclusion: There is a scarcity of data on the role of incisional vacuum therapy in the prevention of wound complications associated with spine surgeries. Our study showed promising results for the use of incisional NPWT in the management of spinal wounds. Further research is required in order to enhance wound care by exploiting this potentially beneficial approach.

Classification and Management of Donor-Site Wound Complications in the Profunda Artery Perforator Flap for Breast Reconstruction

2019 ◽  
Vol 36 (02) ◽  
pp. 110-115
Author(s):  
Min-Jeong Cho ◽  
Sumeet S. Teotia ◽  
Nicholas T. Haddock
Keyword(s):  
Breast Reconstruction ◽  
Wound Care ◽  
Statistical Significance ◽  
Donor Site ◽  
Perforator Flap ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
P Value ◽  
Type I ◽  
Artery Perforator

Abstract Background Profunda artery perforator (PAP) flap breast reconstruction has emerged as a popular choice for patients who are not optimal candidates for autologous breast reconstruction using abdominal-based techniques such as the deep inferior epigastric perforator flap. Despite increased utilization of PAP flaps, there are no previous studies on the donor-site morbidity. In this study, we present risk factors, classification of thigh wounds, and our management of donor-site wounds. Methods Retrospective review of 69 patients who underwent PAP flap from 2013 to 2016 was performed. Demographic, patient characteristic, and flap data were collected. Postoperative photographs of donor sites were reviewed, and the wounds were classified into three types: type I—normal wound, type II—minor scab, and type III—dehiscence. Results Of the 69 patients (130 flaps), there were 13 patients (17 flaps) with wound dehiscence (13%), 8 patients with cellulitis (8.5%), 2 patients with seroma (3%), and 1 patient with hematoma (1.5%). The patients with wound dehiscence had statistically higher body mass index (BMI) (29.2 vs. 26.5) with p-value < 0.05 than the patients without wound complications. These patients had higher flap weight (514 vs. 439.7 g), were older (50.8 vs. 48.6 years old), and had a higher chance of being a diabetic (6 vs. 2%), but statistical significance was not achieved. The patients with dehiscence were managed with local wound care (63%), wound vacuum (26%), and operative intervention (11%). Conclusion Our study shows that BMI plays a significant role in the development of postoperative thigh wounds, and all wounds occurred at the medial thigh. However, the majority of the study population did not require any intervention, and revision of scar using the posterior thigh advancement flaps can be used to improve the gluteal aesthetics. We believe findings from our study can help plastic surgeons to counsel and assist patients who will undergo breast reconstruction with a PAP flap.

scholarly journals Role of postoperative antibiotics for prevention of infection after appendectomy in patients with complicated appendicitis

2016 ◽  
Vol 18 (3) ◽  
pp. 22 ◽  
Author(s):  
R Poudel
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
General Assumption ◽  
Complicated Appendicitis ◽  
Wound Complications ◽  
Inclusion Criteria ◽  
Medical Sciences

Background: Acute Appendicitis is the most common general surgical emergency. Despite improved asepsis and surgical techniques, postoperative complications are still common. The general assumption is that it is better to treat patients with complicated appendicitis (perforated or gangrenous) with antibiotics, in contrast to patients with simple appendicitis. Aim of this study was to compare outcomes of patients treated with antibiotics after appendectomy in complicated appendicitis with those of patients who were not treated with antibiotics.Methods: This was a retrospective study carried out in Universal College of Medical Sciences, Bhairawha, Nepal. Patients who underwent emergency appendectomy in 2 years period were included in the study. Patients with complicated appendicitis were analyzed on the basis of whether they received postoperative antibiotics or not. Main outcome measured were wound complications and length of hospital stay.Results: During the 2-year study period, a total of 203 patients met inclusion criteria. Complicated appendicitis was identified in 71 patients (34.97%). Postoperative antibiotics were administered to 42 (59.2%). On Univariate and multivariate analyses Postoperative antibiotics were not associated with decrease in wound infection. But it is associated with increase in length of hospital stay (p <0.01, 95% confidence interval 2.68-6.05).Conclusion: Use of Postoperative antibiotics does not decrease the rate of wound infection in patient with complicated appendicitis but result in increase length of hospital stay.

scholarly journals Prophylactic Wound Vacuum Therapy after Cesarean Section to Prevent Wound Complications in the Obese Population: A Randomized Controlled Trial (the ProVac Study)

2017 ◽  
Vol 34 (11) ◽  
pp. 1125-1130 ◽  
Author(s):  
Kelly Ruhstaller ◽  
Katheryne Downes ◽  
Suchitra Chandrasekaran ◽  
Sindhu Srinivas ◽  
Celeste Durnwald
Keyword(s):  
Cesarean Delivery ◽  
Controlled Trial ◽  
Wound Dehiscence ◽  
Feasibility Trial ◽  
Categorical Variables ◽  
Wound Complications ◽  
Vacuum Therapy ◽  
Continuous Variables ◽  
Obese Women ◽  
Randomized Controlled

Objective The objective of this study was to perform a randomized controlled feasibility trial investigating negative pressure wound therapy (NPWT) system versus a standard postcesarean wound care (WC) on the development of a postoperative surgical site infection (SSI) and/or a wound dehiscence in obese women. Study Design This is a randomized controlled feasibility trial of obese women undergoing an unscheduled cesarean delivery. Women with an initial body mass index ≥ 30 kg/m2 who were ≥ 4 cm dilated were included. Women were assigned to either a NPWT or standard WC. The primary outcome was a composite of wound morbidity at 4 weeks postpartum including SSI and/or wound opening (clinicaltrials.gov, NCT02128997). Continuous variables were analyzed with t-test and Wilcoxon rank-sum tests and categorical variables with Fisher's exact test. Results Of 136 women randomized, 67 received NPWT and 69 received standard WC. The 4-week follow-up rate was 88%. Maternal clinical and surgical characteristics were similar between the groups. The prevalence of the composite wound morbidity outcome was not different between those with NPWT and standard WC (4.9 vs. 6.9%; p = 0.71). Conclusion Routine clinical use of a NPWT system after cesarean delivery did not result in a significant reduction of wound morbidity over standard WC.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

Treatment of Pediatric Sternotomy Wound Complications: A Minimally Invasive Approach

2021 ◽  
Author(s):  
Taehee Jo ◽  
Joon Hur ◽  
Eun Key Kim
Keyword(s):  
Negative Pressure Wound Therapy ◽  
Wound Dehiscence ◽  
Surgical Debridement ◽  
Wound Complications ◽  
Approximation Technique ◽  
Invasive Approach ◽  
Nonsurgical Management ◽  
Single Use ◽  
Sternal Wound Infections ◽  
Deep Sternal Wound Infections

Abstract Background Pediatric sternal wound complications (SWCs) include sterile wound dehiscence (SWD) and superficial/deep sternal wound infections (SSWI/DSWI), and are generally managed by repetitive debridement and surgical wound approximation. Here, we report a novel nonsurgical management strategy of pediatric sternotomy wound complications, using serial noninvasive wound approximation technique combined with single-use negative pressure wound therapy (PICO) device. Methods Nine children with SWCs were managed by serial approximation with adhesive skin tapes and serial PICO device application. Thorough surgical debridement or surgical approximations were not performed. Results Three patients were clinically diagnosed as SWD, two patients as SSWI, and four patients as DSWI. None of the wounds demonstrated apparent mediastinitis or bone destructions. PICO device was applied at 16.1 days (range: 6–26 days) postoperatively, together with serial wound approximation by skin tapes. The average duration of PICO use was 16.9 days (range: 11–29 days) and the wound approximation was achieved in all patients. None of the patients underwent aggressive surgical debridement or invasive surgical approximation by sutures. Conclusion We report our successful management of selected pediatric SWCs, using serial noninvasive wound approximation technique combined with PICO device.

scholarly journals A triple combination of treatments on moderate COVID-19

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 769-772
Author(s):  
ChunMiao Bao ◽  
BinBin Li ◽  
YuFeng Zhou
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Smoking Status ◽  
Length Of Hospital Stay ◽  
Convincing Evidence ◽  
Triple Combination ◽  
Viral Shedding ◽  
Null Effect ◽  
Treatment Start

Abstract Objective A triple combination of interferon (IFN) α-2b, lopinavir tablets, and umifenovir was used to treat COVID-19 patients. It is important to explore whether the benefit of this therapy is time dependent. Methods A cohort of moderate COVID-19 patients (n = 54) was admitted for hospitalization. The demographic (age, gender, and smoking status) and clinical characteristics (epidemiological trace and comorbidity) were collected from the digital medical records. The length of hospital stay (LOS) and the viral shedding time (VST) were set as the outcomes for COVID-19 cases. Results After control for age, sex, epidemiological trace, smoking, and comorbidity, the time of treatment start had null effect on VST (IRR = 1.09; 95% CI = 0.91–1.30; p = 0.33) or LOS (IRR = 1.10; 95% CI = 0.94–1.28; p = 0.23). Conclusion There is no convincing evidence to support a pivotal role of the timing of the therapy in the prognosis of moderate COVID-19 cases.

scholarly journals Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongliang Yao ◽  
Tiegang Li ◽  
Weidong Chen ◽  
Sanlin Lei ◽  
Kuijie Liu ◽  
...  
Keyword(s):  
Colorectal Neoplasms ◽  
Average Distance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Safe Procedure ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction

AbstractNatural orifice specimen extraction surgery (NOSES) is especially suitable for colorectal surgery. Until now, most of the reports published were about laparoscopic NOSES, the reports about robotic NOSES are extremely rare. This study aims to explore the safety and feasibility of robotic NOSES for colorectal neoplasms. All patients underwent robotic NOSES from March 2016 to October 2019 in our hospital were enrolled for retrospective analysis. Clinicopathological data including patient characteristics, perioperative information and pathological information were collected and analyzed. According to the distance between tumor and anus or whether neoadjuvant chemoradiotherapy (nRCT) is performed, we grouped the cases and studied its influence on robotic NOSES. Also, we compared the previous reports on laparoscopic NOSES with our study and revealed advantages of robotic NOSES in terms of safety and feasibility. A total of 180 patients were enrolled. The average distance from the lower edge of the tumor to the anus was (8.64 ± 3.64) cm and maximum circumferential diameter (CDmax) of specimen was (3.5 ± 1.6) cm. In terms of safety, the average operation time, intraoperative blood loss, and postoperative hospital stay were (187.5 ± 78.3) min, (47.4 ± 34) mL, and (11.3 ± 7.5) days, respectively. In terms of feasibility, the average number of lymph node harvested was (14.8 ± 5). Robotic NOSES shows advantages in terms of safety and feasibility compared with laparoscopic NOSES. This procedure could not only be a safe procedure but also could achieve good oncological outcomes.

Engagement and Outcomes Associated with Contextual Annotation Features of a Digital Health Solution

2020 ◽  
pp. 193229682097640
Author(s):  
Michelle Dugas ◽  
Weiguang Wang ◽  
Kenyon Crowley ◽  
Anand K. Iyer ◽  
Malinda Peeples ◽  
...  
Keyword(s):  
Digital Health ◽  
Data Entry ◽  
Secondary Data ◽  
Well Being ◽  
Preliminary Evidence ◽  
Future Research ◽  
Note Taking ◽  
Potential Benefits

Background: Digital health solutions targeting diabetes self-care are popular and promising, but important questions remain about how these tools can most effectively help patients. Consistent with evidence of the salutary effects of note-taking in education, features that enable annotation of structured data entry might enhance the meaningfulness of the interaction, thereby promoting persistent use and benefits of a digital health solution. Method: To examine the potential benefits of note-taking, we explored how patients with type 2 diabetes used annotation features of a digital health solution and assessed the relationship between annotation and persistence in engagement as well as improvements in glycated hemoglobin (A1C). Secondary data from 3142 users of the BlueStar digital health solution collected between December 2013 and June 2017 were analyzed, with a subgroup of 372 reporting A1C lab values. Results: About a third of patients recorded annotations while using the platform. Annotation themes largely reflected self-management behaviors (diet, physical activity, medication adherence) and well-being (mood, health status). Early use of contextual annotations was associated with greater engagement over time and with greater improvements in A1C. Conclusions: Our research provides preliminary evidence of the benefits of annotation features in a digital health solution. Future research is needed to assess the causal impact of note-taking and the moderating role of thematic content reflected in notes.

scholarly journals Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Paolo Ceccarini ◽  
Rosario Petruccelli ◽  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Auro Caraffa
Keyword(s):  
Wound Dehiscence ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Bone Union ◽  
Wound Complications ◽  
Fisher Exact Test ◽  
Superficial Infection ◽  
Operative Care ◽  
Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

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