Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery:A case report

BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.

Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

Application of negative pressure wound therapy after skin grafting in the treatment of skin cancer:A case report

BACKGROUND Skin cancer is a common malignant tumor in dermatology.A large area must be excised to ensure a negative incisal margin on huge frontotemporal skin cancer,and it is difficult to treat the wound.In the past,treatment with skin grafting and pressure dressing was easy to cause complications such as wound infections,subcutaneous effusion,skin necrosis,and contracture.Negative pressure wound therapy(NPWT)has been applied to treat huge frontotemporal skin cancer.CASE SUMMARY Herein,we report the case of a 92-year-old woman with huge frontotemporal skin cancer.The patient presented to the surgery department complaining of ruptured bleeding and pain in a right frontal mass.The tumor was pathologically diagnosed as highly differentiated squamous cell carcinoma.The patient underwent skin cancer surgery and skin grafting,after which NPWT was used.She did not experience a relapse during the three-year follow-up period.CONCLUSION NPWT is of great clinical value in the postoperative treatment of skin cancer.It is not only inexpensive but also can effectively reduce the risk of surgical effusion,infection,and flap necrosis.

Effectiveness of topical oxygen therapy in wound healing for patients with diabetic foot ulcer

Objectives:Non-healing wounds have been one of the major challenges in health care because of increased morbidity,especially for those who have diabetes mellitus.Numerous regimens are being innovated to produce an evidence-based practice that would minimize complications and promote healing.Topical oxygen therapy is an innovation in wound care that has been considered influential in the wound healing process.This intervention aims to increase the oxygen concentration in the affected limb to promote wound healing.Methods:This research applied an experimental design that targeted a total of 60 adult patients aged 45–64 years with diabetic foot ulcers.A randomized systematic sampling technique was used to allow equal chances and prevent bias.In total,30 patients in the control group received usual care for diabetic foot ulcers,and the remaining 30 patients in the experimental group received topical oxygen therapy together with standard care for diabetic foot ulcers.Subjects were assessed using the Wagner-Meggitt Wound Classification System.Results:The result proved that there was a significant difference in the wound grade of patients in the experimental group after the application of the usual wound care plus the topical oxygen therapy using Friedman's test.The control and experimental groups were compared using Mann–Whitney statistical analyses,and the results showed that there was a significant difference between the control and experimental groups after the application of topical oxygen therapy.Conclusions:Topical oxygen therapy was demonstrated to be effective to aid in the wound healing process of patients with diabetic foot ulcers.Fur ther research was recommended to improve the application of topical oxygen therapy to patients with chronic wounds and promote the wound healing process.

Biological scaffold as potential platforms for stem cells:Current development and applications in wound healing

Wound repair is a complex challenge for both clinical practitioners and researchers.Conventional approaches for wound repair have several limitations.Stem cell-based therapy has emerged as a novel strategy to address this issue,exhibiting significant potential for enhancing wound healing rates,improving wound quality,and promoting skin regeneration.However,the use of stem cells in skin regeneration presents several challenges.Recently,stem cells and biomaterials have been identified as crucial components of the wound-healing process.Combination therapy involving the development of biocompatible scaffolds,accompanying cells,multiple biological factors,and structures resembling the natural extracellular matrix(ECM)has gained considerable attention.Biological scaffolds encompass a range of biomaterials that serve as platforms for seeding stem cells,providing them with an environment conducive to growth,similar to that of the ECM.These scaffolds facilitate the delivery and application of stem cells for tissue regeneration and wound healing.This article provides a comprehensive review of the current developments and applications of biological scaffolds for stem cells in wound healing,emphasizing their capacity to facilitate stem cell adhesion,proliferation,differentiation,and paracrine functions.Additionally,we identify the pivotal characteristics of the scaffolds that contribute to enhanced cellular activity.

Non-Hodgkin's lymphoma involving chronic difficult-to-heal wounds:A case report

BACKGROUND Non-Hodgkin's lymphoma(NHL)is a malignant tumor that originates from the lymphoid tissues and can potentially affect numerous organs within the body.Among these,the skin stands out as one of the primary sites affected by NHL,often presenting with multiple extra-nodal manifestations.In this report,we present an unusual case of NHL involving chronic wounds in the lower extremities that were difficult to heal.The scars were successfully treated using radiotherapy in combination with extended excision debridement and peroneal artery perforator flap grafting,resulting in satisfactory outcomes.CASE SUMMARY A 19-year-old male patient presented with ulceration of the skin on the left calf near the ankle accompanied by purulent discharge.Subsequent pathologic biopsy confirmed a diagnosis of NHL(extranodal NK/T-cell lymphoma,nasal type).Initial treatment comprised local radiotherapy and wound care;however,the wound exhibited prolonged non-healing.Consequently,the patient underwent a series of interventions including radiotherapy,wound enlargement excision debridement,and peroneal artery perforator flap grafting.Ultimately,successful healing was achieved with favorable postoperative outcomes characterized by good texture of the flap without any signs of rupture or infection.CONCLUSION The combination of radiotherapy,wound enlargement excision debridement,and peroneal artery perforator flap grafting may present a favorable treatment modality for chronic non-healing lower leg wounds resulting from NHL.

Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

Diabetic foot(DF) is a common complication of diabetes and the first cause of hospital admission in diabetic patients. In recent years several guidelines have been proposed to reinforce the the management of DF with a notable increase in diabetes knowledge and an overall reduction of amputations. Significant improvements have been reached in the treatment of diabetic foot ulcers(DFUs) and nowadays clinicians have several advanced medications to apply for the best local therapy. Among these, negative pressure wound therapy(NPWT) is a useful adjunct in the management of chronic and complex wounds to promote healing and wound bed preparation for surgical procedures such as skin grafts and flap surgery. NPWT has shown remarkable results although its mechanisms of action are not completely understood. In this paper, we offer a complete overview of this medication and its implication in the clinical setting. We have examined literature related to NPWT concerning human, animal and in vitro studies, and we have summarized why, when and how we can use NPWT to treat DFUs. Further we have associated our clinical experience to scientific evidence in the field of diabetic foot to identify a defined strategy that could guide clinician in the use of NPWT approaching to DFUs.

Role of negative pressure wound therapy in total hip and knee arthroplasty

Negative-pressure wound therapy(NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trialsincluding single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections.

Role of stem cell therapies in treating chronic wounds:A systematic review

BACKGROUND The impairment of cutaneous wound healing results in chronic,non-healing wounds that are caused by altered wound environment oxygenation,tissue injury,and permissive microbial growth.Current modalities for the treatment of these wounds inadequately address the complex changes involved in chronic wound pathogenesis.Consequently,stem cell therapies have emerged as a potential therapeutic modality to promote cutaneous regeneration through trophic and paracrine activity.AIM To investigate current literature regarding use of stem cell therapies for the clinical treatment of chronic,non-healing wounds.METHODS PubMed,EMBASE,Cochrane Library,Web of Science,and Scopus were queried with combinations of the search terms“mesenchymal stem cells,”“adult stem cells,”“embryonic stem cells,”“erythroid precursor cells,”“stem cell therapies,”and“chronic wounds”in order to find relevant articles published between the years of 2000 and 2019 to review a 20-year experience.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(reviews,case reports/series,retrospective/prospective studies,and clinical trials)were evaluated by the authors for their depiction of clinical stem cell therapy use.Data were extracted from the articles using a standardized collection tool.RESULTS A total of 43 articles describing the use of stem cell therapies for the treatment of chronic wounds were included in this review.While stem cell therapies have been explored in in vitro and in vivo applications in the past,recent efforts are geared towards assessing their clinical role.A review of the literature revealed that adipose-derived stem cells,bone marrow-derived stem cells,bone marrowderived mononuclear cells,epidermally-derived mesenchymal stem cells,fibroblast stem cells,keratinocyte stem cells,placental mesenchymal stem cells,and umbilical cord mesenchymal stem cells have all been employed in the treatment of chronic wounds of various etiologies.Most recently,embryonic stem cells have emerged as a novel stem cell therapy with the capacity for multifaceted germ cell layer differentiation.With the capacity for self-renewal and differentiation,stem cells can enrich existing cell populations in chronic wounds in order to overcome barriers impeding the progression of wound healing.Further,stem cell therapies can be utilized to augment cell engraftment,signaling and activity,and resultant patient outcomes.CONCLUSION Assessing observed clinical outcomes,potential for stem cell use,and relevant therapeutic challenges allows wound care stakeholders to make informed decisions regarding optimal treatment approaches for their patients’chronic wounds.

Hyperbaric oxygen therapy and chemokine administration - a combination with potential therapeutic value for treating diabetic wounds

Non-healing wounds impart serious medical problems to people with diabetes.Amongst 15%of diabetic patients,the incidence of foot ulcer is the most prevailing,which confers a significant risk of limb amputation,mainly due to hypoxia and impairment in cell signaling.Alteration in the expression of chemokines and the related factors in diabetic conditions delays the recruitment of different cell types,including fibroblasts,keratinocytes,and immune cells such as macrophages to the site of injury,further impairing neovasculogenesis,reepithelialization,and extracellular matrix formation.Thus,proper activation of effector cells through an accurate signal pathway is necessary for better therapeutic application.Hyperbaric oxygen therapy(HBOT)is the current treatment prescribed by medical practitioners,shown to have increased the wound healing rate by reducing the need for significant amputation among the diabetic population.However,the risk of morbidity associated with HBOT needs complete attention through rigorous research to avoid adverse outcomes.Altering the level of pro-angiogenic chemokines may regulate the inflammatory response,further promote vascularization,and enhance the complete healing of wounds in diabetic patients.Thus,a combination of better therapeutic approaches could pave the way for developing a successful treatment for diabetic foot and wound healing.

Evidence based review of negative pressure wound therapy

Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy(NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms(macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms(including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.

Systematic review of the negative pressure wound therapy in kidney transplant recipients

AIM To review negative pressure wound therapy(NPWT) as animportant addition to the conventional methods of wound management.METHODS A systematic review, performed by searching the PubM ed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation(KT) patients(range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.RESULTS No complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.CONCLUSION Negative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

Effect of hydrogen intervention on refractory wounds after radiotherapy:A case report

BACKGROUND Patients with keloids who receive radiotherapy(RT)after surgery can develop refractory wounds that cannot be healed by the patient's own repair system.Such chronic wounds are uneven and complex due to persistent abscess and ulceration.Without external intervention,they can easily result in local tissue necrosis or,in severe cases,large area tissue resection,amputation,and even death.CASE SUMMARY This article describes the use of hydrogen to treat a 42-year-old female patient with a chronic wound on her left shoulder.The patient had a skin graft that involved implanting a dilator under the skin of her left shoulder,and then transferring excess skin from her shoulder onto scar tissue on her chest.The skin grafting was followed by two rounds of RT,after which the shoulder wound had difficulty healing.For six months,the patient was treated with 2 h of hydrogen inhalation(HI)therapy per day,in addition to application of sterile gauze on the wound and periodic debridement.We also performed one deep,large,sharp debridement to enlarge the wound area.The wound healed completely within 6 mo of beginning the HI treatment.CONCLUSION After HI therapy,the patient showed superior progress in reepithelialization and wound repair,with eventual wound closure in 6 mo,in comparison with the previous failures of hyperbaric oxygen and recombinant bovine basic fibroblast growth factor therapies.Our work showed that HI therapy could be a new strategy for wound healing that is cleaner,more convenient,and less expensive than other therapies,as well as easily accessible for further application in clinical wound care.

Combination therapy of hydrogel and stem cells for diabetic wound healing

Diabetic wounds(DWs)are a common complication of diabetes mellitus;DWs have a low cure rate and likely recurrence,thus affecting the quality of patients’lives.As traditional therapy cannot effectively improve DW closure,DW has become a severe clinical medical problem worldwide.Unlike routine wound healing,DW is difficult to heal because of its chronically arrested inflammatory phase.Although mesenchymal stem cells and their secreted cytokines can alleviate oxidative stress and stimulate angiogenesis in wounds,thereby promoting wound healing,the biological activity of mesenchymal stem cells is compromised by direct injection,which hinders their therapeutic effect.Hydrogels form a three-dimensional network that mimics the extracellular matrix,which can provide shelter for stem cells in the inflammatory microenvironment with reactive oxygen species in DW,and maintains the survival and viability of stem cells.This review summarizes the mechanisms and applications of stem cells and hydrogels in treating DW;additionally,it focuses on the different applications of therapy combining hydrogel and stem cells for DW treatment.

Methodologies of Biophysical Wound Healing Therapies

Purpose: To evaluate the effects of methodological variation of biophysical therapies on wound healing outcomes, as a preliminary study to develop a composite wound healing device. Methods: A literature search was focused on the variable devices, sys-tem configurations, input parameters, and treatment durations of negative pressure wound therapy (NPWT), electrical stimulation (ES), and low-level light therapy (LLLT) from 2011 to July 2016. Results: In NPWT, lower vacuum pressures of ?50 and ?80 mmHg achieved similar tissue perfusion outcomes as earlier recommendations of ?125 mmHg, while there is no established regimen with respect to continuous, square wave, or triangular NP waveform due to inconsistent results. Use of wound filler may contribute to improved tissue granulation when compared to topical NP. An ES configuration of high-voltage pulsed current with the stimulation electrode placed in the wound bed best resembles the endogenous skin current, which guides cellular migration. However, no studies have established optimal stimulation parameters. For LLLT, laser and LED proved similarly effective. Although red light has been almost exclusively used in human pressure ulcer treatment, studies comparing blue, green, and red wavelengths more consistently show biological effects using green light. Conclu-sions: Variation in the application of mechanical, electrical, and radiant energies may be used to modulate wound healing pathways. To 2012, no studies have examined use of these biophysical modalities in combination. Further methodological studies with a systems approach would help define optimal treatment protocols for improved wound healing outcomes in clinical practice.

Therapeutic role of growth factors in treating diabetic wound

Wounds in diabetic patients,especially diabetic foot ulcers,are more difficult to heal compared with normal wounds and can easily deteriorate,leading to amputation.Common treatments cannot heal diabetic wounds or control their many complications.Growth factors are found to play important roles in regulating complex diabetic wound healing.Different growth factors such as transforming growth factor beta 1,insulin-like growth factor,and vascular endothelial growth factor play different roles in diabetic wound healing.This implies that a therapeutic modality modulating different growth factors to suit wound healing can significantly improve the treatment of diabetic wounds.Further,some current treatments have been shown to promote the healing of diabetic wounds by modulating specific growth factors.The purpose of this study was to discuss the role played by each growth factor in therapeutic approaches so as to stimulate further therapeutic thinking.

Effectiveness of Laser Therapy (AlGaInP) on Cicatrization of Experimental Cutaneous Wound in Rats

The use of laser therapy is one of the most effective tools in the prevention and treatment of skin ulcers. It is an effective treatment choice because it potentiates the trophic regenerative, anti inflammatory, and painkiller effects. This study aimed to assess the effectiveness of low level laser therapy in treating induced cutaneous ulcers in rats. An experimental study using 12 female Wistar rats (Rattus novergicus), weighing between 150 and 250 g, from the room of animal husbandry at the Center of Health Sciences of UNIFOR. Rats underwent surgery to induce cutaneous ulcer. Subsequently, the animals were divided into two randomized groups: 1) Control group;and 2) Experimental group. They received nine applications of AlGaInP laser treatment (power of 30 mW) with an intensity of 4 J/cm2, using the scan method, for 15 seconds over the entire ulcer. The cicatrization process was evaluated from the 1st to 19th postoperative (PO) day, but on alternate days. The results showed that animals treated with laser had less area of cutaneous wound than the control group from the 7th until the 17th postoperative day, highlighting the 7th and the 9th PO with a significant reduction in wound area of 28.8% (p = 0.00) and 23,5% (p = 0.01), respectively. Treatment with the AlGaInP laser was effective in the repair of cutaneous wound when compared to the control group—particularly on the 7th postoperative day.

Negative Pressure Wound Therapy—An Effective, Minimally Invasive Therapeutic Modality in Burn Wound Management

Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication;while sepsis remains the leading cause of death in severe burns. The research guided integration of new and effective techniques in burn wound management is mandatory. Negative pressure wound therapy (NPWT) is an effective and widely used technique in the management of problematic wounds. Previously existing indications include soft tissue traumas and chronic wounds such as diabetic, arterial, venous and pressure ulcers. The characteristics and challenges of these wounds have a lot in common with burns. Since the early 2000’s there are experiences with the use of NPWT for the healing of second degree burn wounds. Our clinical experience shows that it is a minimally invasive and effective way of improving burn wound management. In this article we give a review of the literature showing the mechanisms, unmapped future opportunities, financial issues, and possible adverse effects of NPWT in burn therapy.

Tumor Recurrence after Negative Pressure Wound Therapy: An Alert Call

In this report, we present a 22-year-old patient with soft tissue sarcoma of the lower extremity that developed wound dehiscence after surgery. Biopsy demonstrated negative margins for cancer. He was treated with negative pressure wound therapy for 6 weeks and started to present increased wound exudates, local pain and proliferating tissue that was positive for tumor recurrence. Consequently he underwent lower extremity amputation with hip disarticulation by the orthopedic team. Although we cannot determine with certainty a full causative relationship, it seems prudent to advise cautious use of negative pressure wound therapy in oncologic related wound beds.

Negative Pressure Wound Therapy with Multiple Drainage Holes for the Treatment of Pressure Ulcer with Undermining: Case Reports

Noninvasive treatment of pressure ulcers with undermining is often difficult. To decrease the risk of bleeding in such conditions, negative pressure wound therapy (NPWT) has been applied. We treated a pressure ulcer with wide undermining using NPWT after opening drainage holes in the undermined area. This method can reduce the risk of bleeding and promote the rapid closure of the undermined area.