Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

2021 ◽  
Vol 23 (3) ◽  
pp. 157-164
Author(s):  
Valery V. Semenov ◽  
Sofya А. Prudyeva ◽  
Alexander A. Kurygin
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Treatment Strategies ◽  
Repeated Administration ◽  
Early Postoperative Period ◽  
Diagnosis And Treatment ◽  
Wound Therapy ◽  
Active Growth ◽  
Surgical Interventions ◽  
Ventral Hernias

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

scholarly journals Conference Proceedings of the Third International Vivano Conference held from 19th – 21st March 2014 in Nuremberg, Germany

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Vivano Conference
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Cost Benefit ◽  
Wound Therapy ◽  
Fourth Degree ◽  
Surgical Interventions ◽  
The Third ◽  
Cost Benefit Ratio ◽  
The Cost

During a two-day conference international speakers presented their experiences with negative pressure wound therapy in chronic wounds but also in cases of third- and fourth-degree burns, in complex surgical interventions of the abdominal region, in open fractures as well as in thoracic and cardiac surgery. The this year’s conference focused on questions whether negative pressure wound therapy (NPWT) resulted in wound healing more often and more quickly than standard wound therapy, for which indications can NPWT be used and how should the cost-benefit ratio be evaluated.

scholarly journals Salvaging collateral damage by COVID-19 pandemic in form of exposed silicone ear framework in 33-year post reconstructed ear

2021 ◽  
Vol 9 (8) ◽  
pp. 2468
Author(s):  
Vinay Kumar Tiwari ◽  
Deepak Nanda ◽  
Raman Tandon ◽  
Rohit Babu Mula
Keyword(s):  
Twentieth Century ◽  
Postoperative Period ◽  
Negative Pressure ◽  
Skin Necrosis ◽  
Negative Pressure Wound Therapy ◽  
Early Postoperative Period ◽  
Ear Reconstruction ◽  
Collateral Damage ◽  
Wound Therapy

Total ear reconstruction is being practiced by different techniques. Ready to use Silicone ear framework (Silastic ear framework by Dow corning) was being used frequently by Plastic surgeons in the eighties and nineties of the twentieth century. Framework exposure, either due to skin necrosis or due to infection used to be the commonest complication in the early postoperative period. A follow-up case of a 50 year old male patient, our 33 years follow up case of Total ear reconstruction by silicone ear framework implantation presented to us with exposed silicone framework and infection. Due to constant use of facemask with elastic ear loop for support during COVID-19 pandemic. The exposed infected implant successfully salvaged using negative pressure wound therapy. In all cases of autologous or alloplastic ear reconstruction, we strictly recommend not to use facemasks with elastic ear loops. If a facemask has to be used it should have a head loop or to be used with an ear protector.  

scholarly journals Short and long-term outcomes of surgical intervention for empyema in the post-fibrinolytic era

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Caitlin J. Cain ◽  
Marc Margolis ◽  
John F. Lazar ◽  
Hayley Henderson ◽  
Margaret Hamm ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bronchopleural Fistula ◽  
Retrospective Chart Review ◽  
Fibrinolytic Therapy ◽  
Wound Therapy ◽  
Surgical Interventions ◽  
Trapped Lung ◽  
Poor Outcomes

Abstract Background Open window thoracostomy (OWT) is indicated for patients with bronchopleural fistula (BPF) or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of OWT in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy. Methods A retrospective chart review of all patients who underwent OWT at a single institution from 2010 to 2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for OWT. Results Eighteen patients were identified for the study. The most common indication for OWT was post-resectional BPF (n = 9). Prior to OWT, n = 11 patients failed other surgical or minimally invasive interventions. Patient comorbidities were quantified with the Charlson Comorbidity index (n = 11 score ≥ 5, 10-year survival ≤21%). Three (16.7%) patients died < 30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.5 ± 1.2 (range 1–6) with one patient having 6 ribs removed. Patients were managed with negative pressure wound therapy (n = 9) or Kerlix packing (n = 9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions Our study illustrates the significant comorbidities of patients undergoing OWT, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however, OWT procedures continue to be extremely morbid.

scholarly journals Negative-Pressure Wound Therapy Versus Standard Treatment of Adult Patients With Conflict-Related Extremity Wounds: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Andreas Älgå ◽  
Sidney Wong ◽  
Rawand Haweizy ◽  
Kalle Conneryd Lundgren ◽  
Johan von Schreeb ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Standard Treatment ◽  
Controlled Trial ◽  
Treatment Strategies ◽  
Wound Complications ◽  
Wound Therapy ◽  
Intention To Treat ◽  
Randomized Controlled

BACKGROUND In armed conflict, injuries commonly affect the extremities and contamination with foreign material often increases the risk of infection. The use of negative-pressure wound therapy has been described in the treatment of acute conflict-related wounds, but reports are retrospective and with limited follow-up. OBJECTIVE The objective of this study is to investigate the effectiveness and safety of negative-pressure wound therapy use in the treatment of patients with conflict-related extremity wounds. METHODS This is a multisite, superiority, pragmatic randomized controlled trial. We are considering for inclusion patients 18 years of age and older who are presenting with a conflict-related extremity wound within 72 hours after injury. Patients are block randomly assigned to either negative-pressure wound therapy or standard treatment in a 1:1 ratio. The primary end point is wound closure by day 5. Secondary end points include length of stay, wound infection, sepsis, wound complications, death, and health-related quality of life. We will explore economic outcomes, including direct health care costs and cost effectiveness, in a substudy. Data are collected at baseline and at each dressing change, and participants are followed for up to 3 months. We will base the primary statistical analysis on intention-to-treat. RESULTS The trial is ongoing. Patient enrollment started in June 2015. We expect to publish findings from the trial by the end of 2019. CONCLUSIONS To the best of our knowledge, there has been no randomized trial of negative-pressure wound therapy in this context. We expect that our findings will increase the knowledge to establish best-treatment strategies. CLINICALTRIAL ClinicalTrials.gov NCT02444598; http://clinicaltrials.gov/ct2/show/NCT02444598 (Archived by WebCite at http://www.webcitation.org/72hjI2XNX) INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12334

scholarly journals Delayed Closure of Open Abdomen in Septic Patients Treated With Negative Pressure Vacuum Therapy and Dynamic Sutures: A 10-Years Follow-Up on Long-Term Complications

2021 ◽  
Vol 7 ◽  
Author(s):  
Anna Theresa Hofmann ◽  
Christopher May ◽  
Karl Glaser ◽  
René H. Fortelny
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fascial Closure ◽  
Wound Therapy ◽  
Surgical Interventions ◽  
Incisional Hernias ◽  
Operating Field

Introduction: Patients with open abdomen after surgical interventions associated with the complication of secondary peritonitis are successfully treated with negative pressure wound therapy. The use of dynamic fascial sutures reduces fascial lateralization and increases successful delayed fascial closure after open abdomen treatment.Methods: In 2017 we published the follow-up results of 38 survivors out of 87 open abdomen patients treated with negative pressure wound therapy and dynamic fascial sutures between 2007 and 2012. In our current study we present the 10-years follow-up results regarding long-term complications with the focus on incisional hernias and pain. Since 2017 seven more patients have died, hence 31 patients were included in the current study. The patients were asked to answer questions about specific long-term complications of OA treatment including pain, the presence of incisional hernias and subsequent surgical interventions. Demographic data and data regarding fascial closure after open abdomen treatment were collected. All results were analyzed quantitatively. The follow-up period was 8–13 years.Results: The median age was 69 (30–90) years, and 15 (48.4%) were females. Twenty-four patients (77.4%) responded to the questionnaire: Three patients (12.5%) suffered from pain in the original operating field, all three at rest but not during exercise. None of the patients required analgesic treatment. Eleven patients (45.8%) were found to have incisional hernias. Five out of 11 hernias (45.5%) were treated by surgery and did not declare any pain in the operating field. Among the patients with incisional hernias lower MPI (Mannheimer Peritonitis Index) at the time of primary surgery but more reoperations and treatment days were found. The technique of fascial closure was heterogenic and no differences in the occurrence of incisional hernia could be detected.Conclusion: The incidence of incisional hernias after open abdomen treatment is still high, but are associated with little pain in the original operating field. Further studies are required to investigate methods for fascial closure techniques after OA treatment.

scholarly journals Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

2021 ◽  
Author(s):  
Caitlin J. Cain ◽  
Marc Margolis ◽  
John F. Lazar ◽  
Hayley R. Henderson ◽  
Margaret E. Hamm ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bronchopleural Fistula ◽  
Retrospective Chart Review ◽  
Fibrinolytic Therapy ◽  
Wound Therapy ◽  
Surgical Interventions ◽  
Open Window ◽  
Open Window Thoracostomy ◽  
Trapped Lung

Abstract Background: Open window thoracostomy is indicated for patients with bronchopleural fistulae or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of open window thoracostomy in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy.Methods: A retrospective chart review of all patients who underwent open window thoracostomy at a single institution from 2010-2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for open window thoracostomy.Results: Eighteen patients were identified for the study. The most common indication for open window thoracostomy was post-resectional bronchopleural fistula (n=8). Patient comorbidities were quantified with the Charleston Comorbidity index (n=11 score≥5, 10-year survival ≤21%). Three (16.7%) patients died <30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.6 ± 1.2 (range 1-6). Patients were managed with negative pressure wound therapy (n=9) or Kerlix packing (n=9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions: Our study illustrates the significant comorbidities of patients undergoing open window thoracostomy, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however open window thoracostomy procedures continue to be extremely morbid.

scholarly journals Negative-pressure wound therapy is effective for peritoneal dialysis catheter exit-site management in the early postoperative period

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Haruna Fukuzaki ◽  
Junichiro Nakata ◽  
Shuko Nojiri ◽  
Yuki Shimizu ◽  
Toshiki Kano ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Postoperative Period ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Site Formation ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Wound Therapy

AbstractPeritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential because it has an open wound that is always adjacent to a PD catheter tube. This study aimed to examine the effectiveness of negative-pressure wound therapy (NPWT) for postoperative PD catheter exit sites. Thirty patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day was lower in the NPWT group than in the non-NPWT group (p = 0.0049). Analysis of variance F statistic for the effect of NPWT over 180 days was highly significant (11.482595, p = 0.007). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period.

scholarly journals Negative-Pressure Wound Therapy is Effective for Peritoneal Dialysis Catheter Exit-Site Management in The Early Postoperative Period

2021 ◽  
Author(s):  
Haruna Fukuzaki ◽  
Junichiro Nakata ◽  
Shuko Nojiri ◽  
Yuki Shimizu ◽  
Toshiki Kano ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Postoperative Period ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Site Formation ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Wound Therapy

Abstract Peritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential due to its susceptibility to slow healing and infection. Despite the recent use of negative-pressure wound therapy (NPWT) for a wide variety of wounds, few studies have investigated the effectiveness of NPWT for PD catheter exit sites. In this study, 30 patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day and over 180 days were lower in the NPWT group than in the non-NPWT group (p = 0.0049 and p = 0.007, respectively). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period.

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