Negative Pressure Wound Therapy applied to a cholecystoparietal fistula: How to treat a rare complication of a common condition - a case report

A cholecystoparietal fistula is an uncommon complication of gallstone disease as a result of neglected gallbladder disease).The subcutaneous abdominal wall abscess, derived from this condition, might be wide and hard to treat, especially in elderly and debilitated patients. The best management of cholecystoparietal fistula depends on its etiology and may require medical, surgical, or endoscopic treatment. Negative Pressure Wound Therapy (NPWT) is a valuable support therapy that can improve the prognosis of the disease and the patient’s outcome. We report the case of an 89-year-old female patient affected by a spontaneous cholecystoparietal fistula with a wide abdominal wall abscess treated by a one-stage surgical approach combined with NPWT over the resulting skin loss.

Use of ciNPWT in cardiac surgery: single center observational study

Surgical site infections and complications (SSI, SSC) are relatively rare but potentially devastating events; particularly in cardiac surgery because of the importance of the structures involved. In accordance with the main international guidelines, that recommend the use of negative pressure therapy in closed surgical wounds (ciNPWT) in high-risk patients, we selected a group of 112 patients at high risk of developing surgical site complications, presenting in the clinic from January 2018 to December 2019. We applied 165 single-use negative pressure dressings in our cohort and kept them for seven days ($\pm$ 1). All the wounds were closed by primary intention without edema or hematoma. Three cases of postoperative bleeding required us to pause the negative pressure therapy. After discharge, five patients at particularly high risk developed sternal wound dehiscence. In conclusion, the use of ciNPWT, applied following a dedicated algorithm, gave good results in the prevention of SSI or SSC. Some limitations in the results are determined by the specific requirements of cardiac surgery.

Severe deep neck infections successfully treated with negative pressure wound therapy with instillation - a case report

Background: Deep neck infection (DNI) is a life-threatening complication associated with significant mortality and morbidity rates. The most common causes of DNI are the tonsilitis, dentitis, salivary glands inflammation, malignancies, and foreign bodies. As a result of neck infection, patients are at high risk of potential secondary complications which include: descending mediastinitis, pleural empyema, septicemia, jugular vein thrombosis, pericarditis. We presented a case of successful management of DNI with the utility of negative pressure wound therapy with instillation (iNPWT). Method: A 37-year-old male with deep neck infection due to dentitis was qualified for iNPWT. Due to previous incisions and drainage of the neck abscesses, some undermined wounds drained towards each other’s were revealed with an excessive amount of purulent content. Standard NPWT dressing was placed and polyurethane foam was covered with contact layer dressing. Additionally, an inflow drain was placed within one of the wounds in regard to instill an antimicrobial solution. The wound was instilled four times daily. Results: The patient underwent a total of eight iNWPT sessions. Locally, a reduction in purulent content was achieved with a decrease of wounds’ dimensions and improvement of wound bed granulation. Moreover, improvement of the patient’s general condition and decrease of inflammatory markers was achieved. Conclusions: iNPWT may play an important role in the management of combined, complicated wounds due to DNI. The instilled antimicrobial solution facilitates dissolving and removing of the purulent content that impairs the wound healing.

Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group

Recent SARS-CoV-2 pandemic leading to a rapidly increasing number of hospitalizations enforced reevaluation of wound management strategies. The optimal treatment strategy for patients with chronic wounds and those recovering from emergency and urgent oncological surgery should aim to minimize the number of hospital admissions, as well as the number of surgical procedures and decrease the length of stay to disburden the hospital staff and to minimize viral infection risk. One of the potential solutions that could help to achieve these goals may be the extensive and early use of NPWT devices in the prevention of wound healing complications. Single-use NPWT devices are helpful in outpatient wound treatment and SSI prevention (ciNPWT) allowing to minimize in-person visits to the health care center while still providing the best possible wound-care. Stationary NPWT should be used in deep SSI and perioperative wound healing disorders as soon as possible. Patient’s education and telemedical support with visual wound healing monitoring and video conversations have the potential to minimize the number of unnecessary in-person visits in patients with wounds and therefore substantially increase the level of care.

Deferred anastomosis in severe secondary peritonitis using a temporary intestinal shunt – case report

Introduction: As part of the damage control surgery concept applied to the treatment of sepsis due to severe secondary peritonitis following intestinal perforation and/or in high-risk patients we describe the novel "temporary intestinal shunt" (TIS) technique with delayed intestinal anastomosis, as an alternative to primary anastomosis or enterostomy. Material and Methods: We present three patients in whom urgent laparotomy was performed due to intestinal perforation, with intestinal resection and TIS. Case reports:Case 1: A 39-year-old male presented with acute myeloid leukemia M3 and generalized peritonitis, sigmoid colon perforation and secondary jejunal loop involvement. In view of these findings, we performed 10 cm jejunal resection with TIS placement, sigmoid colon resection, and negative pressure therapy (NPT). Reoperation after 48 hours showed no evidence of peritonitis, so a manual jejuno-jejunal anastomosis and terminal colostomy were performed. Case 2: A 65-year-old woman treated with corticosteroids presented with a pneumoperitoneum secondary to a road traffic accident. Urgent laparotomy revealed a 2 cm jejunal perforation. Resection of the jejunal segment and TIS with NPT was performed. Exploration of the peritoneal cavity 96 hours later showed clinical improvement and a jejuno-ileal anastomosis was performed. Case 3: A 73-year-old male was admitted due to intestinal subocclusion. Clinical deterioration occurred rapidly and we performed an urgent laparotomy diagnosing jejunal perforation secondary to torsion and ischemia of the affected loop, and generalized peritonitis. Intestinal resection and TIS with NPT placement were thus decided. Anastomosis and closure of the abdominal appendage were deferred until 96 hours after the first surgery. Conclusion: Although the evidence we present is limited, we believe TIS to be an additional tool in damage control surgery. This staged management strategy allows definitive reconstruction with the patient in a more favorable physiological condition.

Novel, self-made and cost-ective technique for closed-incision negative pressure wound therapy

Background: It has been suggested that applying the negative pressure wound therapy (NPWT) to a closedsurgical incision may hasten the healing of the incision and decrease the incidence of wound healing complications. The goal of this study is to present the new idea of a simple, self-made, low-cost wound vacuum dressing for closed-incision NPWT that may become an alternative to currently manufactured medicalindustry products.Method: We designed a simple dressing for closed-incision NPWT from gauze pads, polyurethane adhesive film, stoma paste, and a drain tube. Negative pressure was created using a standard 50 ml syringe connected to the drain. First, the dressing was applied to the wound model and on the healthy volunteer. Finally, the dressing was applied to 10 patients after low anterior rectal resection. The vacuum dressing was left in place for 3 days, then changed and placed once more for the next 3 days.Results: We did not observe any adverse effects associatedwith the dressing. All postoperative wounds healed properly. 18 out of 20 dressings were still air-tight 72h post-placement.Conclusions: This simple, self-made dressing for NPWT is safe and effective and may decrease the wound infection rate. However future studies are needed to confirm that hypothesis.

Negative Pressure Wound Therapy (NPWT) in Breast Surgery

Background: The use of Negative Pressure Wound Dressing has been found to promote the wound healing process, therefore, reducing the risk of surgical site complications. The use of this technique amongst breast cancer patients, who have often encountered a distressing journey, may prove beneficial in making the post-operative process less eventful. Many of these patients have a limited time window to start adjuvant treatment. The use of a negative pressure device is recommended in both prophylactic and therapeutic scenarios. NPWT may also be used in patients who have undergone cosmetic breast surgery. We have evaluated the use of NPWT in breast surgery with an updated and systematic review of the available literature. Methods: The authors systematically searched the PubMed, Science Direct, and Wiley Online databases using the phrases “Negative Pressure Wound Therapy in Breast surgery” and “Vacuum-Assisted Closure in Breast Wound” and all publications, including relevant data were considered eligible for inclusion in the review. Results: We have found reports of 7 studies, 3 retrospective, 2 prospective, one randomized trial, and one case series. The complication rate in the NPWT group versus conventional dressing group has been reported in 5 papers. A statistically significant effect in favor of NPWT was documented in three trials. Conclusion: The current evidence supports the notion that NPWT systems are beneficial in enhancing the healing of complicated breast wounds. However, larger studies exploring the effectiveness of this technique would be of interest to breast surgeons.

The The role of Negative Pressure Wound Therapy in the management of orocutaneous fistulas in cancer patients - a case series

Background: Negative Pressure Wound Therapy (NPWT) is used in the treatment of various wounds. The study demonstrates a novel use of vessel patch as a sealant of mucosal orifice fistulas. Methods: The study included ten patients with orocutaneous fistulas in the course of treatment of oral malignancies. Patients were divided into treatment (NPWT) and control (conventional dressings) group. In four cases, the vessel patch was applied. We used the Hartmann Vivano system with 50 mmHg to 130 mmHg negative pressure values. Results: The median age of patients was 61.5 years (range: 31 -- 73 years). The median treatment time was 83 days (range: 14 -- 272 days). The median total treatment cost was 5.300 EUR (range: 2490 -- 7821 EUR) in the NPWT group and 12.000 EUR (range: 3.060 -- 22.745 EUR) in the control group. Conclusion: The use of NPWT is a cost-effective and reasonable method for the management of orocutaneous fistulas and other complications in maxillofacial surgery.

Negative pressure wound therapy as a „bridge” forthe final reconstruction of tissue defect following adegloving injury of the forearm – a case report

Degloving injuries are traumatic avulsions usually resulting in large areas of soft tissue defects. The injury involves separation of skin and subcutaneous tissue from fascia and muscles. The complex nature of these injuries requires a patient-oriented multidisciplinary surgical approach and a wide variety of therapeutic options. Negative pressure wound therapy can be of benefit at every stage of the long-lasting treatment. In this paper, we present a case of a 29-year-old male after an occupational accident with a conveyor belt leading to a degloving injury of the right forearm treated in the Department of Plastic Surgery of the Medical University in Gdańsk. The use of NPWT, hyperbaric oxygen therapy, dermal regeneration templates, skin grafting, and early rehabilitation resulted in an excellent functional and aesthetic outcome.

Single-use NPWT device with telemedical wound monitoring in the treatment of acne inversa in apregnant patient – case report

Acne inversa (AI) is a chronic inflammatory skindisease significantly impacting the patient’s quality of life.Management guidelines for acne inversa during pregnancy donot exist. We decided to use a single-use negative pressurewound therapy (PICO, Smith & Nephew) while managing apregnant patient with AI. Negative pressure wound therapy(NPWT) seemed to improve the patient’s condition, managingthe exudation, reducing edema, and improving local regeneration,as well as epithelialization. The method was also absolutelysafe for the fetus and feasible to conduct in the outpatientdepartment - what was of utmost importance for the patient.The telemedical monitoring of wound healing using mobiletechnologies seems to be gaining importance for patients andmedical practitioners. In the described case, we used the iWound(Polmedi, Poland) application in an outpatient setting.