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.

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.

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.

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.

Management of Complex Wounds with Dermal Substitute Assisted by a Negative Pressure System

Introduction: The standard treatment for complex wound care is autografting. The advent of dermal substitutes has provided a novel tool for the preparation of the bed to be grafted. However, most types of dermal matrices require the application of a skin graft a second time. Currently, other strategies have been developed to improve the vascularization process, such as negative pressure wound therapy (NPWT), which has been reported to reduce the time required for vascular growth and dermal matrix integration and thus achieve a shorter waiting period for autologous graft application. The present study aims to evaluate the effectiveness and safety of dermal matrix management associated with NPWT in the treatment of complex wounds. Methods: Seven patients with a diagnosis of complex wounds were enrolled in this study between July 1, 2015, and June 31, 2016. After debridement and having an adequate wound bed, patients who met the criteria for the application of combined therapy were treated with dermal substitutes and a negative pressure system. The percentage of graft integration into the wound bed, complications, length of hospital stay, and duration of therapy were analyzed. Results: The mean age was 42.5 ± 16 (39 - 54) years old;three women and four men were included in the study. The approximate size of skin loss was 120.7 ± 75 cm2 (25 - 250 cm2). The combined therapy of dermal matrix plus NPWT was instituted in all cases for a period of 14 days. There were no complications, with 100% graft integration in 6 of 7 cases. Patients were discharged after a mean hospital stay of 5.4 days. Conclusions: This study demonstrates that the utilization of combined dermal matrix plus NPWT therapy can be performed safely and effectively in patients with complex wounds with low complication rates and a short hospital stay.

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.

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.

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.

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.

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.

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.

Pre-placement of adhesive tape around wound sites can prevent air leakage in negative pressure wound therapy procedures

The introduction of negative pressure wound therapy has revolutionized the management of complicated wounds.However,the maintenance of an effective negative pressure environment is difficult in some instances,such as wounds in close proximity to an intestinal stoma or wounds surrounded by external fixations.We found that adhesive tape adheres more easily to itself than to wet skin or uneven surfaces.Therefore,we placed adhesive tape around surgical wounds prior to covering them with foam and sealing them with more tape.As a result of the strong adhesive force between pieces of tape,this method could provide a better environmental seal,even in situations where space is limited.Pre-placed adhesive tape around the wound site prior to foam placement could provide sufficient adhesion to maintain a continuous negative pressure environment during treatment.

Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS-Trial)

Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.

A Control System Design to Establish Dose-Response Relationships in Wound Healing Therapy

Advanced biophysical wound healing therapies can apply mechanical, electrical, or light energy to re-stimulate healing processes in chronic wounds. Despite the growing evidence of the clinical efficacy of these therapies, the optimal treatment stimulation parameters remain unknown and there are no standard treatment protocols. We introduce a closed-loop control design as an experimental system to study the dose-response of wound healing therapy treatment within a prescribed multidimensional and multimodal stimulation parameter space. Systems engineering approaches are applied to the control problem for estimation of a transfer function and model equations derived for use in optimal model-based control. The experimental control system design consisted of simultaneous application of biophysical energies inputted into a wound system. A study design set up including the use of negative pressure wound therapy, electrical stimulation therapy, and photobiomodulation device systems was described. Treatment stimulation parameters were selected from experimental ranges used in the scientific literature. Classical control methods and model-based control were suggested for model selection and evaluation and design of the overall control system. An experimental design for multimodal biophysical wound healing therapy control system is introduced to establish the dose-response interactions for development of therapeutic applications and device design.

负压伤口疗法治疗腹部手术切口愈合不良的临床效果

目的探讨负压伤口疗法治疗腹部手术切口愈合不良的临床效果。方法回顾性分析了2017年1月至2022年6月郑州大学第五附属医院70例腹部外科手术切口愈合不良患者的临床资料,按治疗方式分为常规治疗组和负压治疗组。通过t检验、χ^(2)检验、Fisher精确概率法或秩和检验分析两组患者一般资料、疼痛评分及切口愈合情况的差异。结果常规治疗组患者疼痛评分高于负压治疗组(t=2.189,P=0.032),负压治疗组肉芽生长情况优于常规治疗组(t=2.338,P=0.019),负压治疗组切口水肿消退时间(t=3.077,P=0.003)及二期处理时间(t=6.006,P<0.001)均短于常规治疗组。结论负压伤口疗法能够有效缓解患者切口愈合不良引起的疼痛,缩短切口水肿的消退时间,促进切口肉芽组织生长,加快腹部切口愈合。

负压引流辅助治疗骨与软组织感染的机制

背景:随着国内人口老龄化进程的加快,骨与软组织感染的发病率也随之升高。骨与软组织感染可累及包括骨膜、骨皮质、骨松质和骨髓在内的所有骨组织及周围软组织,如糖尿病足、骨髓炎、手术切口感染和关节假体周围感染等均属此范畴,由于其发病机制复杂且治疗困难,因而越来越受到临床关注。负压创面治疗技术是近年来用于伤口治疗的新兴技术,尤其在骨与软组织感染领域疗效显著。目的:综述近年国内外负压创面治疗技术治疗骨与软组织感染的研究进展。方法:检索1990-2022年在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词“negative pressure wound therapy,vacuum assisted closure,negative pressure,osteomyelitis,bone infection”;中文检索词“负压伤口疗法,局部负压疗法,负压包扎,负压封闭技术,机械力,骨髓炎,骨感染”。共检索到711篇相关文献,其中65篇文献符合纳入标准。结果与结论:①负压创面治疗技术作为一种创面辅助治疗方式,相对于单一作用的传统敷料,其稳定创面、减轻水肿、降低细菌载荷、刺激肉芽组织和血管生成、改善组织灌注、调控末梢神经、调节生物免疫、促进成骨细胞增殖和分化的多重作用机制,能够更好地管理骨与软组织感染等复杂创面;②现有的大量基础及临床研究结果表明负压创面治疗技术在辅助治疗骨与软组织感染中具有显著的安全性及有效性。

复方黄柏液负压滴灌联合局部氧疗在3、4期压力性损伤患者中的应用

目的 探讨复方黄柏液负压滴灌联合局部氧疗在3、4期压力性损伤创面中的治疗效果。方法 将98例3、4期压力性损伤患者随机分为两组,每组49例。对照组给予生理盐水负压滴灌治疗,观察组给予复方黄柏液负压滴灌联合局部氧疗。治疗前,治疗2周、4周时评估两组压力性损伤愈合量表得分、治疗效果、住院时间及血清炎性因子水平。结果 治疗2周、4周,观察组压力性损伤愈合计分、C-反应蛋白、白细胞介素-6及住院时间显著低于对照组(均P<0.05),治疗4周观察组治疗效果显著优于对照组(P<0.05)。结论 复方黄柏液负压滴灌联合局部氧疗,可有效降低炎性因子水平,提高3、4期压力性损伤创面的治愈率,缩短住院时间。

高负压引流瓶在颌面部肿物切除术后应用的回顾性研究

目的:本研究旨在对实施颌面部肿物切除术后患者使用高负压引流瓶或使用低负压引流鼓的并发症及经济效益进行回顾性分析。方法:回顾性分析了2021年12月1日~2022年5月31日就诊的颌面部肿物患者。根据治疗情况将123例患者分为高负压伤口治疗(high pressure negative pressure wound therapy,HP-NPWT)组(≤-15 kPa,n=79)和低负压伤口治疗(low pressure negative pressure wound therapy,LP-NPWT)组(≥5.2 kPa,n=44)。并分析了术后并发症、住院天数、手术及治疗费用以及临床结局数据。结果:44例低负压组患者中17例伤口感染患者,伤口感染率为38.64%;79例高负压引流组患者中3位伤口感染患者,伤口感染率为3.8%,差异具有统计学意义(P<0.001)。而在皮瓣移植中低负压组皮瓣坏死发生率为9.09%,而高负压组没有出现皮瓣坏死的情况,差异具有统计学意义(P<0.05)。结论:患者在颌面部肿物切除术后使用高负压吸引引流的并发症发生率较低负压吸引引流显著降低。

负压创面治疗技术联合削痂植皮术在深度烧伤创面修复中的应用

目的:探究负压创面治疗技术(Negative pressure wound therapy,NPWT)联合削痂植皮术修复深度烧伤后创面的疗效。方法:选取2020年1月-2023年1月笔者医院收治的112例深度烧伤患者,按随机数字表法分为实验组(56例)和对照组(56例)。对照组采用削痂植皮术治疗,实验组采用NPWT联合削痂植皮术进行治疗。统计比较两组患者临床疗效、创面愈合情况、疼痛评分[视觉模拟评分法(Visual analogue scale,VAS)]、外观满意度评分、炎症因子水平[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、并发症及瘢痕情况[温哥华瘢痕量表(Vancouver scar scale,VSS)]。结果:治疗后,实验组临床疗效优于对照组,创面愈合时间短于对照组,差异均有统计学意义(P<0.05);植皮术后7 d,实验组创面愈合率、皮片成活率、外观满意度评分均高于对照组(P<0.05),疼痛VAS评分、TNF-α和IL-6水平均低于对照组(P<0.05);治疗期间,实验组总并发症发生率低于对照组(P<0.05);植皮术后6个月,实验组VSS各评分及总分均低于对照组(P<0.05)。结论:NPWT联合削痂植皮术修复深度烧伤后创面疗效良好,可有效促进创面愈合,降低疼痛感,减少瘢痕形成,改善患者预后,值得临床应用。