Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure

2007 ◽  
Vol 6 (5) ◽  
pp. 407-411 ◽  
Author(s):  
G. Alexander Jones ◽  
John Butler ◽  
Isador Lieberman ◽  
Richard Schlenk
Keyword(s):  
Blood Loss ◽  
Antibiotic Therapy ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bleeding Complications ◽  
Vacuum Assisted Closure ◽  
Wound Therapy ◽  
Intravenous Antibiotic ◽  
Spinal Infections

Object Deep infections of the spine are a significant cause of morbidity and death. Such infections complicate 0.7 to 11.9% of spinal procedures. Management includes intravenous antibiotic therapy, debridement and irrigation with primary closure, placement of drains, use of irrigation systems, and/or healing through secondary intention with wound packing. Vacuum-assisted closure (VAC) is a new alternative for treatment of patients with complex postoperative spinal infections. The aim of this study was to investigate the safety of this treatment method in this patient population. Methods The authors reviewed the charts of 16 consecutive patients treated with negative-pressure wound therapy at their institution between 2002 and 2006. All had deep infections of the spine and were treated with surgical debridement and placement of VAC dressings. All infections were postoperative. Members of the infectious disease service were involved in the care of all patients, and all patients received intravenous antibiotic therapy. The authors reviewed operative notes, discharge summaries, and notes from follow-up visits and assessed outcome on the basis of the same records. Three patients were lost to follow up, leaving a group of 13 with follow up of at least 90 days. Two patients experienced bleeding complications related to the continuous negative pressure of the VAC device. In two cases, the infections persisted and required reoperation. In one case, a skin graft was required because of nonhealing granulation tissue. One of the patients with bleeding complications died as a result of delayed complications related to intraoperative blood loss, blood loss via the VAC system, and refusal of a blood transfusion on religious grounds. Conclusions Negative-pressure wound therapy has been employed as a treatment strategy for patients with complex postoperative spinal infections, but little is known of the complications associated with VAC in the spinal surgery patient population. Serious complications, including death, may be associated with use of the VAC system.

scholarly journals Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

2021 ◽  
Author(s):  
Selina Summers ◽  
Natasha Faye Daniels ◽  
Azeem Thahir ◽  
Matija Krkovic
Keyword(s):  
Antibiotic Therapy ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Senior Author ◽  
Skin Closure ◽  
Modified Technique ◽  
Wound Therapy ◽  
Implant Retention ◽  
Effective Adjunct

Abstract Purpose Infected orthopaedic metalwork is challenging to treat. Negative pressure wound therapy (NPWT) with irrigation is an emerging therapy for infected wounds as an adjunct to antibiotic therapy. The senior author had devised a modified technique to augment its efficacy, utilising high-flow rate irrigation and skin closure over the standard NPWT dressing. This novel technique was originally evaluated in a different centre and produced 100% success in metalwork retention. The present study is a reproducibility test of the same technique. Methods A retrospective review was performed on 24 patients with infected orthopaedic metalwork, including 3 upper limb and 21 lower limb cases, for outcomes relating to implant retention and infection resolution. Patients underwent a modified NPWT technique as an adjunct to antibiotic therapy and surgical debridement. Detailed medical and microbiology information were obtained from the patient records. Results 23 of 24 (96%) patients had successful metalwork retainment with healed wounds and resolution of infection, allowing fracture union. 27 infective organisms were identified in this cohort, and the antibiotic regimens for each patient are provided. The average follow-up was 663 days. No adverse effects were observed. Conclusion This series supports the modified NPWT technique as a safe, reliable and effective adjunct therapy to resolve metalwork infection. The same results have been reproduced as the previous cohort in a different centre.

Comparative study between Negative Pressure Wound Therapy (NPWT) and Standard Moist Wound Dressing (SMWD) in management of diabetic non ischemic foot ulcers

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Kamal ◽  
A N Kamel ◽  
S M Elsayed
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Therapy ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background and Aims Diabetes is rapidly increasing in prevalence worldwide and surgery in patients with diabetic foot is becoming more common. Foot complications are a major cause of admissions in diabetic patients, and comprise a disproportionately high number of hospital days because of multiple surgical procedures and prolonged length of stay in hospital. Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. Foot disorders such as ulceration, infection and gangrene are the most common, complex and costly sequelae of diabetes mellitus. The optimal therapy for diabetic foot ulcers remains ill-defined. Saline-moistened gauze has been the standard method; however, it has been difficult to continuously maintain a moist wound environment with these dressings. This has led to the development of various hydrocolloid wound gels, which provided more consistent moisture retention. Refinements in topical ointments have resulted in the addition of various pharmacological agents including growth factors and enzymatic debridement compounds. Hyperbaric oxygen therapy and culture skin substitutes are other wound therapies that have been advocated. All these therapies are associated with significant expense and are being utilized in some situations without sufficient scientific evidence demonstrating their efficacy. Therefore, the search for an efficacious, convenient and cost-effective therapy continues. Negative Pressure Wound Therapy (NPWT) is a newer noninvasive adjunctive therapy system that uses controlled negative pressure using Vacuum-Assisted Closure device (VAC) to help promote wound healing by removing fluid from open wounds through a sealed dressing and tubing which is connected to a collection container. The use of sub-atmospheric pressure dressings, available commercially as a VAC device, has been shown to be an effective way to accelerate healing of various wounds. This was aimed to compare wound outcome, limb salvage, and cost effectiveness between Negative pressure wound therapy (NPWT) and Standard moist wound therapy (SMWT) in management of diabetic non ischemic foot ulcers. Methods we performed a cohort study involving 30 patients with active diabetic foot ulcers, in a high volume tertiary referral vascular center. They were divided into 2 groups: 15 patients (group A) were prescribed NPWT and the other 15 patients (group B) received SMWD. During follow up visits, progress of healing was evaluated and documented in the form of change in wound diameter, depth, up or down scaling along UTWC, wound status at 2, 4, 8, and 12 weeks and 4 weekly thereafter till complete epithelialization. Results As regard to ulcer depth there were statistically significant difference between the 2 groups during follow up duration of the study after 4 weeks with group A showing faster decrease in ulcer depth than group B denoting faster formation of granulation tissue. As regard to complete granulation of ulcer there were statistically significant difference between the 2 groups during follow up duration of the study markedly shown after 6 weeks with group A showing complete ulcer granulation faster than group B, with statistically significant difference as regard to number of days on dressing and follow up duration in weeks between the 2 groups with group A showing lesser number of days on dressing and shorter follow up duration in weeks than group B. Conclusion NPWT has a definitive role in promotion of proliferation of granulation tissue, reduction in the wound size, by and rapid clearing of bacterial load. Our data demonstrates that negative pressure wound dressings decrease the wound size more effectively than saline gauze dressings over the first 4 weeks of therapy. It is suggested that NPWT is a cost-effective, easy to use and patient-friendly method of treating diabetic foot ulcers which helps in early closure of wounds, preventing complications and hence promising a better outcome.

scholarly journals The role of intermittent negative pressure wound therapy combined with a mesh incision in the salvage of perforator flap with venous congestion, a case report

2020 ◽  
Author(s):  
Zhaoyue Li ◽  
Kun Xie ◽  
Rui He ◽  
Qiang Li ◽  
Changqing Zhou ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Perforator Flap ◽  
Venous Congestion ◽  
Continuous Mode ◽  
Perforator Flaps ◽  
Wound Therapy ◽  
Improve Wound Healing

Abstract Background: The application of perforator flap is becoming wide. The most common postoperative complication is venous congestion but traditional treatments’ effect is limited. A new method called negative pressure wound therapy(NPWT) was introduced to improve wound healing. Many scholars have tried this method with continuous mode and achieved good outcomes. In this paper, we tried a different mode(intermittent) of negative pressure wound therapy on congested perforator flaps after a mesh incision, and we expected this paper could provide information for follow-up clinical research.Case presentation: A retrospective research of 6 patients (6 perforator flaps) who had been suffered from venous congestion from June, 2016 to June, 2019 was performed. All flaps were treated by intermittent negative pressure wound therapy after a mesh incision. Among 6 flaps, 4 of them were totally survived while the other 2 of them were mostly survived.Conclusions: Intermittent negative pressure wound therapy combined with a mesh incision can be a safe option to rescue perforator flaps with venous congestion. This technique has a certain success rate and clinical application value.

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