Colon perforation with severe peritonitis caused by erotic toy insertion and treated using vacuum-assisted closure:A case report

BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of rectal perforation.However,surgical site infections are the most common complications after colorectal surgery.CASE SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence.The perforation occurred as a result of the patient inserting a sex toy in his rectum.Severe peritonitis was attributable to delayed presentation.CONCLUSION Vacuum-assisted closure was performed to treat the wound,which healed well after therapy.No complications were noted.

New skin closure system facilitates wound healing after cardiovascular implantable electronic device surgery

The manuscript describes the efficacy of a new skin closure system(Zip Line?) for wound closure after pacemaker/implantable cardioverter defibrillator surgery. The system is particularly useful when wound healingis difficult with traditional methods and in patients at high risk for surgical site infections(SSIs). This skin closure option is easy and quick to apply and remove, and produces excellent cosmetic results. Although it is associated with a minimal expense upcharge, the benefits, including the potential for decrease in SSI, make it attractive and worth considering for skin closure in device patients, particularly those at increased risk of complications.

Clinical efficacy of endovascular revascularization combined with vacuum-assisted closure for the treatment of diabetic foot

BACKGROUND The diabetic foot is a common cause of disability and death,and comorbid foot infections usually lead to prolonged hospitalization,high healthcare costs,and a significant increase in amputation rates.And most diabetic foot trauma is complicated by lower extremity arteriopathy,which becomes an independent risk factor for major amputation in diabetic foot patients.AIM To establish the efficacy and safety of endovascular revascularization(ER)combined with vacuum-assisted closure(VAC)for the treatment of diabetic foot.METHODS Clinical data were collected from 40 patients with diabetic foot admitted to the Second Affiliated Hospital of Soochow University from April 2018 to April 2022.Diabetic foot lesions were graded according to Wagner’s classification,and blood flow to the lower extremity was evaluated using the ankle-brachial index test and computerized tomography angiography of the lower extremity arteries.Continuous subcutaneous insulin infusion pumps were used to achieve glycemic control.Lower limb revascularization was facilitated by percutaneous transluminal balloon angioplasty(BA)or stenting.Wounds were cleaned by nibbling debridement.Wound granulation tissue growth was induced by VAC,and wound repair was performed by skin grafting or skin flap transplantation.RESULTS Of the 35 cases treated with lower limb revascularization,34 were successful with a revascularization success rate of 97%.Of these,6 cases underwent stenting after BA of the superficial femoral artery,and 1 received popliteal artery stent implantation.In the 25 cases treated with infrapopliteal artery revascularization,39 arteries were reconstructed,7 of which were treated by drug-coated BA and the remaining 32 with plain old BA.VAC was performed in 32 wounds.Twenty-four cases of skin grafting and 2 cases of skin flap transplantation were performed.Two patients underwent major amputations,whereas 17 had minor amputations,accounting for a success limb salvage rate of 95%.CONCLUSION ER in combination with VAC is a safe and effective treatment for diabetic foot that can significantly improve limb salvage rates.The use of VAC after ER simplifies and facilitates wound repair.

Assessment of the effect of wound closure technique on postoperative sequaele and complications after impacted mandibular third molar extraction

Aims and Objectives: The aim of the study was to compare the effect of complete and partial wound closures on postoperative sequelae and complications after surgical removal of impacted mandibular third molars. Patients and Methods: One hundred and twenty patients who required 121 surgical extractions of mandibular impacted third molars were included in the study. Patients were randomly divided into 2 groups based on wound closure after surgery. In group 1 (complete wound closure, n1 = 60) patients had their extraction sockets completely closed by mucosal flap while in group 2 (partial wound closure, n2 = 60) patients had their extraction sockets partially closed. Data collected included maximum inter-incisal distance (MID) and facial width which were recorded both preoperatively and postoperatively. What also recorded were postoperative pain intensity and postoperative complications. Results: There were 50 (41.7%) males and 70 (58.3%) females (male to female ratio of 1:1.4);age range was 18-40 years and the mean was 26 ± 10 years. The mean ages of patients in both groups showed no significant difference (group 1 = 26.5 ± 7.2;group 2 = 27.1 ± 8.1). The pain was maximal at the first postoperative day review and it gradually reduced in intensity towards the preoperative values for both groups. The pain perceptionsin patients in group 2 were however significantly lower than those of group 1 on days 1 and 3 but not statistically different on day 7. The mean difference in the postoperative and preoperative MID was greatest on the 1st postoperative day and gradually became smaller on the subsequent review days. Comparison of this mean difference between the 2 groups however showed a significant difference in the 2 groups only on day 7. Maximal swelling was noted in both groups on the third postoperative day. A comparison of the mean facial width between the two groups showed no statistically significant difference on all the review days. The postoperative complication rate was 5% in both groups. Conclusions: The results of the study indicate that there was a comparative reduction in postoperative sequelae namely pain and trismus after impacted mandibular third molar surgery when a partial wound closure technique was done. However, there was no significant difference in the postoperative complication rate between the two groups.

Wound Closure on the Neonatal Rat Skin II. The Potential Ability of Epidermis to Close Small-Sized Wounds Independently of the Underlying Dermis

Reepithelialization of skin which comprises epidermis and dermis has not been fully elucidated due to the complexity of the participants as well as the interactions therein. In this study, the intrinsic roles and behaviors of epidermis itself during wound closure on neonatal rat skin were explored by developing and utilizing a novel in vivo wound model, termed “shallow incisional wound” in which the injury of dermis was minimized. The shallow wounds were closed by 12 h postwounding (PW) by the migration of the wound-marginal epidermal sheets in which activated myosin light chain (p-MLC) was predominantly detected at the lateral plasma membrane of individual cells. By local administration of Rho-associated protein kinase (ROCK) inhibitor Y27632, p-MLC disappeared at the wound margin and wounds were not closed by 12 h PW. Inhibition of Rac 1 by NSC23766 also resulted in hold of wound closure by 12 h PW, though NSC23766 somewhat slowly acted on p-MLC expression. These results suggest that, without joining of dermis, epidermal cells have a potential ability of closing wounds by active epithelial sheet movement integrated by Rho family small GTPases-dependent extension and contraction of the individual cell bodies.

Dermabond Protape (Prineo) for Wound Closure in Plastic Surgery

Dermabond Protape (2-octyl-cyanoacrylate and pressure sensitive adhesive mesh;Prineo, Closure Medical Corporation) is a topical mesh and skin adhesive that forms a strong polymeric bond across opposed wound edges allowing the normal healing process to occur. No published studies have already compared the use of a topical mesh en skin adhesive in wound closure. This study evaluated the possible applications of a combined mesh-adhesive system in 100 plastic surgery operations (14 different surgical procedures) with a mean follow-up of 85.5 days. The rate of allergic reaction, infection, wound dehiscence and hypertrophic scar formation were recorded in relation to patient co-morbidities, medication and tobacco consumption. No technical restrictions were found during the Dermabond Protape application. The average time for the topical mesh and skin adhesive application was 2 minutes. The Dermabond protape was removed 7 through 10 days after the operation. Three patients (3/100 or 3%) reported an allergic reaction without increased scar formation. Hyper-inflammation in one or more wound areas with a micro-abscess were noted in 11 different patients probably due to polyglactin 910 (vicryl) sutures at their scheduled follow-up visit 1 week after their operation. Increased tissue inflammation and scar formation were found in these patients with hypertrophic scars in 1 patient (1/11 or 9.1%). One upper leg wound dehiscence was seen in a diabetes mellitus patient using corticosteroids. Two patients (2/100 or 2%) with a history of tobacco abuse showed a partial wound dehiscence after an abdominoplasty and a partial areola dehiscence after mamma reduction respectively (Table 2).

Top-closure皮肤牵张器结合伤口床准备治疗感染性皮肤软组织缺损的疗效研究

目的探讨Top-closure皮肤牵张器结合伤口床准备治疗感染性皮肤软组织缺损的疗效。方法根据纳入和排除标准纳入皮肤软组织缺损伴感染的患者18例,皮肤软组织缺损面积为4.71~98.96 cm^(2),根据病情需要给予纠正营养、控制血糖等基础治疗,伤口做细菌培养及药敏实验,再根据细菌培养及药敏结果给予敏感抗生素治疗,同时给予TIME原则伤口床准备及Top-closure皮肤牵张器做皮肤牵张。结果18例患者中痊愈17例,有效1例,好转及无效0例,痊愈时间20~66 d,平均(33.22±10.81)d,有效的1例患者牵张及伤口床准备10 d后给予游离植皮,创面完全愈合时间为23 d。17例皮肤牵张痊愈的患者,伤口呈线性瘢痕愈合,愈合创面的皮肤的感觉、色泽、伸缩弹性和正常皮肤无明显差异。结论Top-closure皮肤牵张系统结合伤口床准备的精细化管理对感染性皮肤软组织缺损能起到很好的治疗效果。

Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure

AIM: To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection. METHODS: Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups: 90 patients were closed by needle-free incision suture closure, which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown; 79 patients were closed by butterfly bandage; another 54 patients were closed by traditional secondary suturing technique. Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision. RESULTS: Healing time in the needle-free incision suture closure group (24.2 +/- 7.2 d) was significantly shorter than that in the butterfly bandage group (33.3 +/- 11.2 d) and the traditional secondary suturing group (36.2 +/- 15.3 d) (P < 0.05). Healing time in the butterfly bandage group appeared to be slightly shorter than that in the secondary suture group, but the difference was not statistically significant (P > 0.05). CONCLUSION: Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change, thereby shortening the healing time. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Successful treatment of cervical esophageal leakage by endoscopic-vacuum assisted closure therapy

AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage. METHODS: Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker's diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week.RESULTS: The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy. CONCLUSION: E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.

Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence:A case report

BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Treating Tropical Pyomyositis (Myositis Tropicans) Using Primary Closure and Vacuum Drainage

Introduction: Tropical pyomyositis refers to bacterial infection that affects skeletal muscles causing single or multiple abscesses filled with pus. Aim: The study seeks to find out the effectiveness in the use of primary closure and vacuum drainage in the treatment of pyomyositis. Materials and Methods: The study was conducted between March 1, 2007 and February 28, 2014 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana on patients with pyomyositis. Results: Seventy-seven patients comprising 58 (75.32%) males and 19 (24.68%) females were included in the study with their ages ranging from 15 to 68 years. There was improvement in patient’s healing outcome. Conclusion: Primary wound closure and vacuum drainage provides patients with much satisfaction and better outcome as well and it is also effective.

Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions

AIM: To report a systematic review of published randomized controlled trials(RCTs) investigating the role of absorbable suture(AS) against non-AS(NAS) used for the closure of surgical incisions.METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR.RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection(OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity(P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down(OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P 【 0.0004).CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence,rather lead to a reduced risk of wound dehiscence compared to NAS.

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.

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.

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.

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.

Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System:A Pilot Study

Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.