Open-wound treatment for gunshot to the brain

2012 ◽  
Vol 10 (1) ◽  
pp. 64-66 ◽  
Author(s):  
Pepijn van den Munckhof ◽  
Vincent G. Geukers ◽  
Fonnet E. Bleeker ◽  
Celia E. Allison ◽  
W. Peter Vandertop
Keyword(s):  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Gunshot Wound ◽  
Wound Treatment ◽  
Elevated Intracranial Pressure ◽  
Open Wound ◽  
Functional Level ◽  
Open Wound Treatment ◽  
The Brain

The authors report a case of a gunshot wound to the brain in a 2.5-year-old girl. To treat the uncontrollably elevated intracranial pressure, the patient underwent bilateral decompressive craniectomy and experimental open-wound treatment. She recovered to a good functional level.

scholarly journals Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

2021 ◽  
Author(s):  
Johanna C. Wagner ◽  
Anja Wetz ◽  
Armin Wiegering ◽  
Johan F. Lock ◽  
Stefan Löb ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Wound Complications ◽  
Skin Closure ◽  
Wound Treatment ◽  
Open Wound ◽  
Wound Therapy ◽  
Significant Difference ◽  
Open Wound Treatment

Abstract Purpose Traditionally, previous wound infection was considered a contraindication to secondary skin closure; however, several case reports describe successful secondary wound closure of wounds “preconditioned” with negative pressure wound therapy (NPWT). Although this has been increasingly applied in daily practice, a systematic analysis of its feasibility has not been published thus far. The aim of this study was to evaluate secondary skin closure in previously infected abdominal wounds following treatment with NPWT. Methods Single-center retrospective analysis of patients with infected abdominal wounds treated with NPWT followed by either secondary skin closure referenced to a group receiving open wound therapy. Endpoints were wound closure rate, wound complications (such as recurrent infection or hernia), and perioperative data (such as duration of NPWT or hospitalization parameters). Results One hundred ninety-eight patients during 2013–2016 received a secondary skin closure after NPWT and were analyzed and referenced to 67 patients in the same period with open wound treatment after NPWT. No significant difference in BMI, chronic immunosuppressive medication, or tobacco use was found between both groups. The mean duration of hospital stay was 30 days with a comparable duration in both patient groups (29 versus 33 days, p = 0.35). Interestingly, only 7.7% of patients after secondary skin closure developed recurrent surgical site infection and in over 80% of patients were discharged with closed wounds requiring only minimal outpatient wound care. Conclusion Surgical skin closure following NPWT of infected abdominal wounds is a good and safe alternative to open wound treatment. It prevents lengthy outpatient wound therapy and is expected to result in a higher quality of life for patients and reduce health care costs.

scholarly journals Decompressive Craniectomy for Elevated Intracranial Pressure and Its Effect on the Cumulative Ischemic Burden and Therapeutic Intensity Levels After Severe Traumatic Brain Injury

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1111-1119 ◽  
Author(s):  
Gregory M. Weiner ◽  
Michelle R. Lacey ◽  
Larami Mackenzie ◽  
Darshak P. Shah ◽  
Suzanne G. Frangos ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Intensity Level ◽  
Before And After ◽  
Severe Tbi ◽  
Therapeutic Intensity ◽  
The Brain

Abstract BACKGROUND Increased intracranial pressure (ICP) can cause brain ischemia and compromised brain oxygen (PbtO2 ≤ 20 mm Hg) after severe traumatic brain injury (TBI). OBJECTIVE We examined whether decompressive craniectomy (DC) to treat elevated ICP reduces the cumulative ischemic burden (CIB) of the brain and therapeutic intensity level (TIL). METHODS Ten severe TBI patients (mean age, 31.4 ± 14.2 years) who had continuous PbtO2 monitoring before and after delayed DC were retrospectively identified. Patients were managed according to the guidelines for the management of severe TBI. The CIB was measured as the total time spent between a PbtO2 of 15 to 20, 10 to 15, and 0 to 10 mm Hg. The TIL was calculated every 12 hours. Mixed-effects models were used to estimate changes associated with DC. RESULTS DC was performed on average 2.8 days after admission. DC was found to immediately reduce ICP (mean [SEM] decrease was 7.86 mm Hg [2.4 mm Hg]; P = .005). TIL, which was positively correlated with ICP (r = 0.46, P ≤ .001), was reduced within 12 hours after surgery and continued to improve within the postsurgical monitoring period (P ≤ .001). The duration and severity of CIB were significantly reduced as an effect of DC in this group. The overall mortality rate in the group of 10 patients was lower than predicted at the time of admission (P = .015). CONCLUSION These results suggest that a DC for increased ICP can reduce the CIB of the brain after severe TBI. We suggest that DC be considered early in a patient's clinical course, particularly when the TIL and ICP are increased.

scholarly journals Cortical Pressure Injury: A Hypothesis to Explain the Incongruity of Clinical and Radiologic Improvement in Decompressive Craniectomy

2019 ◽  
Vol 08 (03) ◽  
pp. 188-190
Author(s):  
Sudip Kumar Sengupta ◽  
Harjinder Singh Bhatoe
Keyword(s):  
Intracranial Pressure ◽  
Clinical Outcome ◽  
Decompressive Craniectomy ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Anatomy And Physiology ◽  
Pressure Injury ◽  
The Brain ◽  
Shared Problem

AbstractIt has astonished neuroscientists since the advent of decompressive craniectomy as to why a seemingly successfully achieved goal of reduction in intracranial pressure (ICP), by removing a portion of the cranial vault and the resultant intracranial volume augmentation, fails to give the desired beneficial clinical outcome in every case and in fact, at times, proves to be deleterious in some conditions with a shared problem of refractory raised ICP. The authors propose a hypothesis based on the understanding of the anatomy and physiology of the brain that can explain the fallacy.

scholarly journals Evaluation of Systemic Effects of Negative Pressure Wound Therapy in Open Wound Treatment in Dogs

VCOT Open ◽  
2019 ◽  
Vol 02 (02) ◽  
pp. e1-e8
Author(s):  
Rebecca Albert ◽  
Sven Reese ◽  
Mirja C. Nolff ◽  
Andrea Meyer-Lindenberg
Keyword(s):  
Negative Pressure ◽  
Total Protein ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Systemic Effects ◽  
Wound Treatment ◽  
Characteristic Analysis ◽  
Open Wound ◽  
Wound Therapy ◽  
Open Wound Treatment

Objectives The aim of this study was to evaluate the systemic effect of negative pressure wound therapy (NPWT) on the treatment of complicated wounds in dogs. Materials and Methods Dogs undergoing open wound treatment were randomly assigned to one of two groups: NPWT (n = 11) or polyurethane foam dressing (n = 11). Rectal temperature, heart rate as well as haematocrit, thrombocytes, leucocyte count, band neutrophils, C-reactive protein (CrP), total protein and albumin were recorded daily from the beginning of therapy (day 0) until day 5, as well as on day 10. The effect of treatment on systemic parameters was evaluated as well as the prognostic power of the individual parameters with regard to successful wound closure. Results A more profound systemic decrease was found in total protein under NPWT. This difference was non-significant. Patients with non-successful closure displayed a non-significant trend towards lower initial leukocyte and thrombocyte counts and significantly higher CrP values on days 4, 5 and 10 (p < 0.05) compared with successfully treated patients. Receiver operating characteristic analysis revealed an optimal cutoff value of 70.2 mg/L at day 4 (sensitivity 80; specificity of 85.7). Conclusion There might be an increased loss of protein in NPWT-treated patients, which does not affect albumin levels, otherwise no systemic effects were detected compared with the control treatment. The parameter with the best sensitivity and specificity to detect serious complications (no wound closure achieved) was CrP at day 4.

scholarly journals Retrospective comparison of negative pressure wound therapy and silver-coated foam dressings in open-wound treatment in cats

2016 ◽  
Vol 19 (6) ◽  
pp. 624-630 ◽  
Author(s):  
Mirja Christine Nolff ◽  
Michael Fehr ◽  
Sven Reese ◽  
Andrea E Meyer-Lindenberg
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Previous Treatment ◽  
Wound Treatment ◽  
Open Wound ◽  
Wound Therapy ◽  
Antiseptic Treatment ◽  
Group A ◽  
Group B ◽  
Open Wound Treatment

Objectives The objective of this study was to evaluate negative pressure wound therapy (NPWT) for the treatment of complicated wounds in cats. Methods Twenty cats undergoing open-wound treatment in two clinics were classed according to treatment method: NPWT (group A, n = 10) and polyurethane foam dressing (group B, n = 10). Pairs of patients from each group were matched based on wound conformation, localisation and underlying cause. Cats from both groups were compared in terms of duration of previous treatment, time to closure and complications. Results Signalment, duration of previous treatment, antibiotic and antiseptic treatment, and bacterial status were comparable between groups. Total time to wound closure was significantly shorter ( P = 0.046, strong effect size; Cohen d = 0.8) in group A (25.8 days, range 11.0–57.0 days) compared with group B (39.5 days, range 28.0–75.0 days). NPWT-treated wounds suffered fewer complications and became septic less frequently during treatment compared with wounds treated with a foam dressing. The progression of fat tissue necrosis was particularly well controlled under NPWT, resulting in fewer deaths due to this condition in this group. However, although a strong effect of NPWT on the progression of infection, fever and sepsis was detected (Cramer-V 0.5), this difference was not significant. Conclusions and relevance This study demonstrated that time to healing was considerably shorter, and complication rate lower, in NPWT-treated animals compared with foam dressing-treated cats. In particular, the effective management of infection by NPWT emphasises the value of NPWT in the treatment of cats suffering from infected wounds.

Negative pressure wound therapy, silver coated foam dressing and conventional bandages in open wound treatment in dogs

2015 ◽  
Vol 28 (01) ◽  
pp. 30-38 ◽  
Author(s):  
M. Fehr ◽  
A. Bolling ◽  
R. Dening ◽  
S. Kramer ◽  
S. Reese ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Previous Treatment ◽  
Wound Treatment ◽  
Open Wound ◽  
Wound Therapy ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Open Wound Treatment

SummaryObjectives: To evaluate negative pressure wound therapy (NPWT) for treatment of complicated wounds in dogs.Study type: Retrospective multicentre study.Materials and methods: Dogs (n = 50) undergoing open wound treatment were classified according to treatment method used: bandage (Group A, n = 7), NPWT (Group B, n = 18), and foam dressing (Group C, n = 25). Pairs of patients matched based on wound conformation, localization, and underlying cause were compared between Group A and C (n = 7 pairs) and between groups B and C (n = 18 pairs) in terms of duration of previous treatment, time to closure, and complications.Results: Signalment, antibiotic medications, antiseptic treatment, and bacterial status of wounds were comparable between groups. The duration of previous treatment was significantly higher in patients assigned to Group B (p = 0.04) compared to Group C, while no significant difference was found between groups A and B. Total time to wound closure was significantly shorter in Group C compared to Group A (p = 0.02) and in Group B compared to Group C (p = 0.003). Wounds treated with NPWT suffered significantly less complications (p = 0.008) and were significantly less septic during treatment (p = 0.016) than wounds treated with a foam dressing.Conclusion: This study shows that time to healing was halved in NPWT treated patients compared to foam dressing treated patients, which in turn healed faster than patients treated with conventional bandage, underlining the value of NPWT therapy for the treatment of complicated wounds.

Comparison of Negative Pressure Wound Therapy and Silver-Coated Foam Dressings in Open Wound Treatment in Dogs: A Prospective Controlled Clinical Trial

2018 ◽  
Vol 31 (04) ◽  
pp. 229-238 ◽  
Author(s):  
Sven Reese ◽  
Andrea Meyer-Lindenberg ◽  
Mirja Nolff ◽  
Rebecca Albert
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Treatment ◽  
Open Wound ◽  
Wound Therapy ◽  
Randomized Clinical Study ◽  
Days Of Therapy ◽  
Group A ◽  
Group B ◽  
Open Wound Treatment

Objectives To evaluate negative pressure wound therapy (NPWT) for treatment of complicated wounds in dogs. Study Type Prospective randomized clinical study Materials and Methods Dogs (n = 26) undergoing open-wound treatment were randomly assigned to one of two groups: Group A (n = 13) NPWT; Group B (n = 13) silver-coated foam dressing. Pairs of patients were matched based on wound conformation, localization, and underlying cause and compared in terms of duration of previous treatment, development of wound size (wound planimetry), time to closure, bacterial bio-burden and complications. Wound dressing changes were performed every 3 days during the first 9 days of therapy for both groups. Statistical analysis was performed. Results Pre-treatment signalment and bacterial status were comparable between groups. Total time to closure was significantly (p = 0.018) shorter in Group A (14.2 days) compared with Group B (28.6 days), and wound planimetry on days 3, 6 and 9 showed significant greater reduction in total wound area for Group A at all-time points (p < 0.05). Furthermore, wounds in Group A showed less progression of local infection than did wounds in Group B (p = 0.01). Conclusion NPWT-treated wounds showed faster closure, improved macro-deformation and less local signs of infection.

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