scholarly journals EXPERIENCE OF USING NPWT-THERAPY IN THE TREATMENT OF COMBAT INJURIES OF SOFT TISSUES OF THE LIMBS AND BODY

2021 ◽  
pp. 56-60
Author(s):  
Ya. I. Haida ◽  
K. R. Muradian ◽  
S. V. Petrushenko ◽  
O. S. Herasymenko ◽  
A. V. Okolets
Keyword(s):  
Soft Tissue ◽  
Granulation Tissue ◽  
Negative Pressure ◽  
Soft Tissues ◽  
Variable Pressure ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
Soft Tissue Defects ◽  
Combat Injuries ◽  
Tissue Defects

Summary. Aim. NPWT-therapy (Negative-pressure wound therapy) or VAC-therapy (Vacuum Assisted Clousur) - a modern method of wound healing, which significantly improves the course of all stages of the wound process and is relevant today due to the large number of wounded during hostilities in eastern Ukraine. Often these injuries are combined and lead to the formation of large soft tissue defects. The aim of the study. Improving the results of treatment of the wounded with extensive defects of the soft tissues of the torso and extremities through the use of NPWT therapy. Materials and methods. Under our supervision in the period from 2017 to 2020 there were 60 wounded who were hospitalized in the surgical departments of the Military Medical Clinical Center of the Southern Region, who received vacuum therapy in the treatment of wounds. 38 (63.3%) had gunshot wounds to the extremities, and 22 (36.7%) had soft tissue injuries to the torso. The age of the wounded ranged from 19 to 58 years, among them young people under 30 years of age. Before installing the device, it was necessary to perform surgical treatment with excision of necrotic tissue and removal of fibrin layers. Negative pressure was set at -125 mm Hg. Art. in the non-stop mode for soft tissue defects of the extremities and variable pressure in the -40 mm Hg mode. Art. -70 mm Hg Art. for wounds of the anterior abdominal wall. The duration of treatment with NPWT therapy was from 5 to 25 days. The systems were replaced at least once every 3-5 days. Criteria for discontinuation of NPWT therapy were: cleansing the wound of necrotized tissues and fibrin, improving clinical performance, filling the wound defect with granulation tissue. Results and discussion. The use of this method of treatment allowed to close wound defects by autodermoplasty in 21 patients (35%), primary-delayed sutures in 11 (18%), secondary sutures in 15 (25%) and local tissue plastics in 13 (22%). Complications after NPWT therapy in the form of re-suppuration of the wound, bleeding or perforation of hollow organs and large vessels were not observed. Conclusions. The use of NPWT therapy can significantly increase the effectiveness of comprehensive treatment of the wounded with damage to the soft tissues of the torso and extremities. It allows you to quickly clean the wound surface, fill the wound defect with granulation tissue and prepare the wound for plastic closure.

scholarly journals A META-ANALYSIS OF THE SOFT TISSUE DEFECTS CLASSIFICATION AND JUSTIFICATION OF THE OPTIMAL SURGICAL RECONSTRUCTION METHOD

2021 ◽  
Vol 121 (1) ◽  
pp. 112-123
Author(s):  
Sergiy Tertyshnyi ◽  
Igor Khomenko ◽  
Кostyantyn Gumenyuk ◽  
Sergiy Korol ◽  
Yevgen Tsema ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Meta Analysis ◽  
Surgical Reconstruction ◽  
Reconstruction Method ◽  
Soft Tissue Defects ◽  
Military Conflict ◽  
Preoperative Training ◽  
Defects Classification ◽  
Tissue Defects

During the military conflict in the East of Ukraine, considerable experience in providing medical assistance to wounded and injured with soft tissue defects has been accumulated. Taking into account the considerable diversity of defects of soft tissues on numerous a number of signs, which involves the application in the process of treatment of fundamentally different algorithms of preoperative training, planning of reconstructive intervention and method of surgical reconstruction there was a need to systematize the accumulated knowledge by developing the integral classification of soft tissue defects.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

scholarly journals Negative Pressure Wound Therapy with Surgical Gloves to Repair Soft Tissue Defects in Hands

2015 ◽  
Vol 37 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Teruaki FUJITANI ◽  
Yukichi ZENKE ◽  
Michitaka SHINONE ◽  
Kunitaka MENUKI ◽  
Keizo FUKUMOTO ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Soft Tissue Defects ◽  
Wound Therapy ◽  
Surgical Gloves ◽  
Tissue Defects

Negative Pressure Wound Therapy for Traumatic Soft Tissue Defects

2006 ◽  
Vol 19 (1) ◽  
pp. 67 ◽  
Author(s):  
Keun Bae Lee ◽  
Jin Choi ◽  
Eun Sun Moon ◽  
Taek Rim Yoon ◽  
Keun Young Lim
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Soft Tissue Defects ◽  
Wound Therapy ◽  
Tissue Defects

Extracellular matrix graft for reconstruction over exposed structures: a pilot case series

2020 ◽  
Vol 29 (12) ◽  
pp. 742-749
Author(s):  
Gregory A Bohn ◽  
Abigail E Chaffin
Keyword(s):  
Extracellular Matrix ◽  
Soft Tissue ◽  
Skin Graft ◽  
Granulation Tissue ◽  
Case Series ◽  
Skin Grafting ◽  
Soft Tissue Defects ◽  
Dermal Matrix ◽  
Dermal Matrices ◽  
Tissue Defects

Objective: Soft tissue defects, especially those involving exposed vital structures, present a reconstructive challenge because poor vascularity of such defects typically makes immediate skin grafting unviable. Where flap procedures are inappropriate or not possible, dermal matrices represent an alternative reconstructive option for defects with denuded vital structures. With dermal matrices becoming increasingly available and technologically advanced, we evaluated an ovine-derived extracellular matrix graft in the reconstruction of complex soft tissue defects involving exposed vital structures. Method: Six cases of soft tissue defects exhibiting denuded vital structures underwent reconstruction using an ovine forestomach matrix graft as a dermal matrix. Grafts were fixed directly into defects for immediate coverage and subsequently temporised defects via granulation tissue formation for later skin graft or secondary closure. Defect granulation and epithelialisation were monitored until closure and the final aesthetic and functional outcomes were evaluated. Results: Complete healing was achieved in all cases, with defect granulation becoming observable within one to two weeks and complete granulation occurring within one to six weeks. Granulation tissue resulting from the graft was suitable for skin grafting, with 100% take of skin grafts after one week and complete re-epithelialisation in two to three weeks in the four cases that received a skin graft. Good cosmetic, functional and patient satisfaction outcomes were achieved in all cases. Conclusion: The present series demonstrates our initial use of an extracellular matrix-based dermal matrix in reconstructing defects with exposed vital structures. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible.

scholarly journals Immediate application of negative pressure wound therapy following lower extremity flap reconstruction in sixteen patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chun-Yu Chen ◽  
Shyh-Ming Kuo ◽  
Yih-Wen Tarng ◽  
Kai-Cheng Lin
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Muscle Flap ◽  
Lower Leg ◽  
Tissue Loss ◽  
Soft Tissue Defects ◽  
Wound Therapy ◽  
Flap Coverage ◽  
Tissue Defects

AbstractNegative pressure wound therapy (NPWT) is usually applied in wound management and soft-tissue salvage after the development of complications. However, immediate postoperative application of NPWT over the flap coverage is seldom reported. We evaluate the effectiveness of immediate postoperative application of NPWT following fasciocutaneous or muscle flap coverage for lower leg reconstruction. A retrospective review of patients who underwent either fasciocutaneous or muscle flap coverage of lower leg soft-tissue defects applied with NPWT immediately after surgery was conducted in a level I trauma center. Sixteen patients, with an average age of 51.2 years, were included in the study. Nine patients had trauma-related soft-tissue loss, six had subsequent soft-tissue defects after debridement, and one had burn injury. Two patients had been treated with free anterolateral thigh flaps, 11 with pedicle flaps, and three with muscle flaps. All flaps survived except for those in two patients with venous congestion on postoperative day 1, which needed further debridement and skin grafting. Therefore, the use of immediate incisional NPWT is an alternative for wound care following flap coverage. The U-shaped design allows easy flap observation and temperature check. Furthermore, this method eliminates any concerns of vascular pedicle compression under negative pressure.

Hindfoot Containment Orthosis for Management of Bone and Soft-Tissue Defects of the Heel

2005 ◽  
Vol 26 (3) ◽  
pp. 198-203 ◽  
Author(s):  
Jeffrey E. Johnson ◽  
Jonas R. Rudzki ◽  
Erick Janisse ◽  
Dennis J. Janisse ◽  
Ray R. Valdez ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Soft Tissue Defects ◽  
Heel Pad ◽  
Periodic Monitoring ◽  
Growth Change ◽  
Tissue Defects

Background: Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. Methods: Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. Results: Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. Conclusions: The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.

Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction

2017 ◽  
Vol 16 (4) ◽  
pp. 296-301
Author(s):  
Sujin Bahk ◽  
GyeongHyeon Doh ◽  
Ki Yong Hong ◽  
SooA Lim ◽  
SuRak Eo
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Reverse Flow ◽  
Donor Site ◽  
Skin Grafting ◽  
Soft Tissue Defects ◽  
Satisfactory Outcome ◽  
Split Thickness Skin Grafting ◽  
Foot Reconstruction ◽  
Tissue Defects

Reconstruction of soft tissue defects in the foot remains a challenge due to its specialized tissue for weightbearing and ambulation. Considering the principle of replacing “like with like,” adjacent soft tissues would be a best option for a donor site. Although several kinds of reverse-flow island flaps for the lower leg have been well described, intrinsic foot reverse flow flaps have been rarely reported. We describe 3 kinds of reverse-flow intrinsic fasciocutaneous flaps (RIFFs) for foot reconstruction. From September 2012 to August 2015, a retrospective study was done on case notes of all patients who had a RIFF for coverage of soft tissue defects within the foot following trauma or tumor ablation. A total of 7 patients were included in this study, with an average of 5 × 3.5 cm sized defects in the forefoot, second and third web space, and sole, which were reconstructed with RIFF. All flaps were well perfused and recovered excellent function of the foot with satisfactory aesthetics and minimal limitations in range of motion. However, one case showed a complication of venous congestion, due to remnant scar tissues, which resolved after medical leech application. Donor defects healed completely with split thickness skin grafting in all cases. Soft tissue defects within the foot were repaired successfully by RIFF. In spite of its technical challenges, it is a reliable one-stage procedure requiring no microsurgical anastomosis. Precise vascular evaluation of the reverse inflow has to be preceded for satisfactory outcome of RIFF.

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