STUDI KASUS: OBSERVASI PERBAIKAN LUKA PADA PASIEN WOUND DEHISCENCE DENGAN NEGATIVE PRESSURE WOUND THERAPY (NPWT) DI RUANG KEMUNING V RSUP Dr. HASAN SADIKIN BANDUNG

Abstract Background Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR. Methods Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds. Results Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25–30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls. Conclusion The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation.

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Negative Pressure Wound Therapy Compared to Petrolatum Gauze and a Bogota Bag to Manage Postoperative Midline Abdominal Wound Dehiscence: A Pilot, Nonrandomized Controlled Trial

Wound Management & Prevention ◽

10.25270/wmp.2020.5.3845 ◽

2020 ◽

Vol 66 (5) ◽

pp. 38-45

Author(s):

Vihari Chandrasekhar ◽

Sathasivam Sureshkumar ◽

Ali S Manwar ◽

TP Elamurugan ◽

Thirugnanasambandam Nelson ◽

...

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Controlled Trial ◽

Wound Dehiscence ◽

Abdominal Wound ◽

Wound Therapy ◽

Abdominal Wound Dehiscence

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Abdominal Cavity Eventration Treated by Means of the „Open Abdomen” Technique Using the Negative Pressure Therapy System – Case Report and Literature Review

Polish Journal of Surgery ◽

10.1515/pjs-2016-0008 ◽

2015 ◽

Vol 87 (11) ◽

Cited By ~ 1

Author(s):

Piotr W. Trzeciak ◽

Joanna Porzeżyńska ◽

Karolina Ptasińska ◽

Dominik A. Walczak

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Surgical Complication ◽

Abdominal Cavity ◽

Wound Dehiscence ◽

Serous Fluid ◽

Wound Therapy ◽

Pressure Therapy ◽

Acute Respiratory Insufficiency ◽

Surgical Suture

AbstractWound dehiscence is a surgical complication in which the wound ruptures along the surgical suture with abdominal cavity bowel displacement. It is observed in 0.2-6% of operated patients. The extensive wound is a gateway for infection. Moreover, increased secretion of serous fluid induces a hygienic problem and may lead to secondary skin infections or bedsores. The negative pressure wound therapy (NPWT) system is an innovative therapeutic method. It perfectly executes the TIME strategy, receiving more and more recognition.The study presented a case of a 62-year old male patient after several consecutive wound dehiscence episodes who was primarily treated for rectal cancer by means of low anterior resection of the rectum. Due to acute respiratory insufficiency after several operations, wound necrosis with dehiscence was observed. Considering the high risk of perioperative death we abandoned surgical treatment and introduced conservative management using negative pressure wound therapy until the patient’s health improved. Literature regarding the above-mentioned issue was also reviewed.

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Managing Wound Dehiscence With Mechanical Negative Pressure Wound Therapy: A Case Report

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/2021.e7578 ◽

2021 ◽

Vol 33 (12) ◽

pp. E75-E78

Author(s):

Robert Klein

Keyword(s):

Negative Pressure ◽

Diabetic Foot ◽

Negative Pressure Wound Therapy ◽

Wound Care ◽

Single Case ◽

Wound Dehiscence ◽

Metatarsal Head ◽

Outpatient Setting ◽

Wound Therapy ◽

Surgical Wounds

Mechanical negative pressure wound therapy (mNPWT) is commonly used in the management of a variety of wounds, including diabetic foot ulcerations, surgical wounds, venous ulcerations, and wound dehiscence. This mechanically powered, disposable modality can be used to manage wounds in the outpatient setting and has been shown to be an effective wound care option when transitioning patients from the inpatient to outpatient setting and continuing NPWT for wound care. Mechanical NPWT helps promote wound healing by decreasing edema and via removal of tissue debris and exudate. Traditional NPWT is bulky, is often noisy, and requires a power source. A mechanically powered, disposable, easily applied, off-the-shelf mNPWT device is available for patients with small- to medium-sized wounds with mild to moderate exudate. The disposable mNPWT device provides −125 mm Hg pressure, is silent and small, can be worn under clothes, and allows the patient to be fully ambulatory, thus, more mobile. The mNPWT device tubing can be cut to fit to enable safer ambulation than the powered system and to enable the patient to work and enjoy social activities without a medical device showing. This single case study of a patient with chronic diabetic foot ulcerations of the medial first metatarsal head and dorsal proximal interphalangeal joints of the second and third toes of the left foot, which had not been successfully treated with conservative care and had been present for more than 1 year.

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Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1709528 ◽

2020 ◽

Vol 53 (01) ◽

pp. 090-096

Author(s):

Ravikiran Naalla ◽

Smriti Bhushan ◽

Minhaj Ul Abedin ◽

Ashish Dhanraj Bichpuriya ◽

Maneesh Singhal

Keyword(s):

Dead Space ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Care ◽

Wound Dehiscence ◽

Suture Line ◽

Wound Therapy ◽

Flap Coverage ◽

The Mean ◽

Complex Wounds

Abstract Background Persistent dead space following flap cover is a frequently encountered challenge following the reconstruction of complex wounds. It may lead to a hematoma, seroma, wound infection, and wound dehiscence. Wound dehiscence could be a devastating complication. Closed incisional negative pressure wound therapy (ciNPWT) over the surgical incisions was found to reduce surgical site infection (SSI) and wound dehiscence. We applied this principle at the closed flap suture line and through this article, we share the indications, technique, and outcomes. Methods A retrospective analysis (January 2018–June 2019), in which selected high-risk patients who underwent ciNPWT at the flap suture following complex reconstruction (pedicled or free flap) were included in the study. The indications include deep incisional/organ SSI after debridement and flap coverage, persistent dead space following flap coverage, chronic osteomyelitis. Patients were analyzed in the follow-up period in terms of complications, wound healing. Results Nine patients underwent ciNPWT over the flap suture line. The mean age was 32.2 years (range: 10–48 years). The mean duration of the NPWT application was 7.3 days (range: 3–21 days). Three of the nine patients had flap-related minor complications. One patient had marginal flap necrosis and required skin grafting, one patient had minor wound dehiscence (1 cm) which required secondary skin suturing and one patient had chronic discharging sinus related to osteomyelitis of ischium, which subsequently healed with antibiotics and local wound care. None of the patients had NPWT-related complications. Conclusion Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.

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Surgical Site Infections Complicating the Use of Negative Pressure Wound Therapy in Renal Transplant Recipients

Case Reports in Transplantation ◽

10.1155/2019/2452857 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Susanna Lam ◽

Ngee-Soon Lau ◽

Jerome Martin Laurence ◽

Deborah Jean Verran

Keyword(s):

Renal Transplant ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Case Series ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Wound Therapy ◽

Transplant Patients

Surgical site infections (SSI) of the abdominal wall in renal transplant recipients can on occasion require management with negative pressure wound therapy (NPWT). This is often successful, with a low risk of further complications. However, we describe three cases in which persistent or recurrent surgical site sepsis occurred, whilst NPWT was being deployed in adults with either wound dehiscence or initial SSI. This type of complication in the setting of NPWT has not been previously described in renal transplant recipients. Our case series demonstrates that in immunosuppressed transplant recipients, there may be ineffective microbial or bacterial bioburden clearance associated with the NPWT, which can lead to further infections. Hence recognition for infections in renal transplant patients undergoing treatment with NPWT is vital; furthermore, aggressive management of sepsis control with early debridement, antimicrobial use, and reassessment of the use of wound dressing is necessary to reduce the morbidity associated with surgical site infections and NPWT.

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Successful treatment of postoperative, radiation-associated wound dehiscence around tracheostomy with negative pressure wound therapy.

Negative Pressure Wound Therapy Journal ◽

10.18487/npwtj.v5i2.40 ◽

2018 ◽

Vol 5 (2) ◽

pp. 14-16

Author(s):

Ewa Migacz ◽

Dominik Walczak ◽

Adam Maciejewski ◽

Wojciech Kukwa

Keyword(s):

Negative Pressure ◽

Total Laryngectomy ◽

Negative Pressure Wound Therapy ◽

Wound Dehiscence ◽

Wound Therapy ◽

Present Case Report ◽

Postoperative Wound ◽

Second Procedure ◽

Technical Solutions ◽

Pressure Dressing

We present case report of 62-year-old man who underwent total laryngectomy, bilateral neck dissection and radiotherapy due to laryngeal cancer. After 11 months he was reoperated because of a local recurrence. The second procedure was complicated with postoperative wound dehiscence in tracheostomy site which was successfully treated with negative pressure wound therapy. We indicate the difficulties and point technical solutions for negative pressure dressing around the airway.

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