Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb

BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.

Impact of solution-focused brief therapy and vacuum sealing drainage on mental health of wound care patients

BACKGROUND Improving mental health is crucial for patients who require wound treatment.AIM To analyze the effects of solution-focused brief therapy(SFBT)combined with vacuum sealing drainage on the psychological health of patients undergoing wound treatment,providing a basis for selecting wound treatment protocols.METHODS A total of 102 patients undergoing wound treatment were included,with the study period from March 2020 to March 2024.Sex was not a factor,and patients were randomly assigned to two groups of 51 cases each.The control group received negative pressure wound therapy(NPWT),while the experimental group received NPWT plus SFBT.The recovery of wounds,granulation tissue scores,and psychological health levels were compared between the two groups.Statistical analysis was conducted using SPSS Windows software version 26.0 and GraphPad Prism 8.0.RESULTS Post-treatment,the levels of high-sensitivity C-reactive protein,white blood cell count,and lactate dehydrogenase in the experimental group were significantly lower than those in the control group(P<0.05).The two groups had no significant difference in granulation tissue scores(P<0.05).The psychological health level in the experimental group was significantly higher than in the control group(P<0.05).CONCLUSION The combination of SFBT and NPWT accelerates wound healing,promotes granulation tissue growth,and improves psychological well-being,making it a valuable approach for clinical application.

Consensus on the health education of home-based negative pressure wound therapy for patients with chronic wounds:a modified Delphi study

Background:The study aimed to develop consensus on the components of health education of home-based negative pressure wound therapy(NPWT)for patients with chronic wounds.Methods:A Delphi method was used to achieve consensus on the components of health education and 75%agreement and coefficient of variation(CV)<0.25 were used as cutoff.Sixteen experts were recruited purposefully to finish this study.Results:Two rounds of consultation were implemented.Consensus was achieved on 36 of the 42 statements.The final agreed list of statements represented three domains:health education before carrying out home-based NPWT,health education for the treatment day of NPWT at hospital and health education for NPWT at home.Conclusions:This study was the first attempt to develop consensus on the comprehensive components of health education of home-based NPWT for patients with chronic wounds.According to the established framework and components of health education,wound professionals can safely and effectively implement health education of home-based NPWT for patients with chronic wounds and improve their self-care ability and treatment experience at home.

Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic:A case report

BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.

慢性创面患者负压治疗居家管理质量评价指标体系构建的研究

目的对负压治疗居家管理质量评价指标体系进行初步研究。方法运用2轮德尔菲专家咨询法对20名专家进行咨询，初步确立质量评价指标体系。结果形成了负压治疗居家管理质量评价指标体系，包括一级指标4项，二级指标13项，三级指标30项。结论慢性创面患者负压治疗居家管理质量评价指标体系经评估，层次清晰，研究结果可信度高，为该项工作的客观评价、护理质量的持续改进提供了标准化的参考依据。