Value of negative pressure sealing drainage on wound healing of Gustilo IIIB and IIIC open fractures

BACKGROUND Gustilo III fractures have a high incidence and are difficult to treat.Patients often experience difficulty in wound healing.Negative pressure drainage technology can help shorten wound healing time and has positive value in improving patient prognosis.AIM To explore the clinical value of the negative pressure sealing drainage technique in wound healing of Gustilo IIIB and IIIC open fractures.METHODS Eighty patients with Gustilo IIIB and IIIC open fractures with skin and soft tissue injuries who were treated in the Second People’s Hospital of Dalian from March 2019 to December 2021 were selected as the research subjects.They were divided into a study group(n=40,healed with negative pressure closed drainage)and a control group(n=40,healed with conventional dressing changes)according to the variation in the healing they received.The efficacy of the clinical interventions,the variations in the regression indicators(time to wound healing,time to fracture healing,time to hospitalization),and the conversion and healing of bacterial wounds were compared 1-3 mo after the intervention.RESULTS The total effective rate of patients among the study group was 95.00%(38/40),which was notably higher than 75.00%(30/40)among the control group(P<0.05).The wound healing time,fracture healing time,and hospital stay of the patients in the study group was shorter than the control group(P<0.05).After the intervention,the negative bacterial culture at the wound site rate and wound healing rate of the patients among the study group increased compared to the control group(P<0.05).CONCLUSION Negative pressure sealing and drainage technology has a good therapeutic effect on patients with Gustilo IIIB and IIIC open fracture wounds with skin and soft tissue injury.It can notably enhance the wound healing rate and the negative rate of bacteria on the wound surface and help to speed up the recovery process of patients.

Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure

BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.

Characteristics of the pressure profile in the accelerator on the RF negative ion source at ASIPP

Neutral beam injection(NBI)systems based on negative hydrogen ion sources-rather than the positive ion sources that have typically been used to date-will be used in the future magnetically confined nuclear fusion experiments to heat the plasma.The collisions between the fast negative ions and neutral background gas result in a significant number of high-energy positive ions being produced in the acceleration area,and for the high-power long-pulse operation of NBI systems,this acceleration of positive ions back to the ion source creates heat load and material sputtering on the source backplate.This difficulty cannot be ignored,with the neutral gas density in the acceleration region having a significant impact on the flux density of the backstreaming positive ions.In the work reported here,the pressure gradient in the acceleration region was estimated using an ionization gauge and a straightforward 1D computation,and it was found that once gas traveled through the acceleration region,the pressure dropped by nearly one order of magnitude,with the largest pressure drop occurring at the plasma grid.The computation also revealed that the pressure drop in the grid gaps was substantially smaller than that in the grid apertures.

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts:A case report

BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.

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.

Asymmetric Fuzzy Control of a Positive and Negative Pneumatic Pressure Servo System

The pneumatic pressure control systems have been used in some fields. However, the researches on pneumatic pressure control mainly focus on constant pressure regulation. Poor dynamic characteristics and strong nonlinearity of such systems limit its application in the field of pressure tracking control. In order to meet the demand of generating dynamic pressure signal in the application of the hardware-in-the-loop simulation of aerospace engineering, a positive and negative pneumatic pressure servo system is provided to implement dynamic adjustment of sealed chamber pressure. A mathematical model is established with simulation and experiment being implemented afterwards to discuss the characteristics of the system, which shows serious asymmetry in the process of charging and discharging. Based on the analysis of the system dynamics, a fuzzy proportional integral derivative （PID） controller with asymmetric fuzzy compensator is proposed. Different from conventional adjusting mecha- nisms employing the error and change in error of the controlled variable as input parameters, the current cham- ber pressure and charging or discharging state are chosen as inputs of the compensator, which improves adaptability. To verify the effectiveness and performance of the pro- posed controller, the comparison experiments tracking sinusoidal and square wave commands are conducted. Experimental results show that the proposed controller can obtain better dynamic performance and relatively consis- tent control performance across the scope of work （2-140 kPa）. The research proposes a fuzzy control method to overcome asymmetry and enhance adaptability for the positive and negative pneumatic pressure servo system.

Biosorption effects of copper ions on Candida utilis under negative pressure cavitation

Under the optimal condition of copper ions adsorption on yeast,we found some different effects among static adsorption, shaking adsorption and negative pressure cavitation adsorption, and the methods of yeast with different pretreatments also affect adsorption of copper ions. At the same time, the change of intercellular pH before and after adsorption of copper with BCECF was studied. The copper distribution was located by using PhenGreen （dipotassium salt and diacetate）, and the surface of yeast was observed by an atomic force microscope. The results showed that negative pressure cavitation can improve bioadsorption capacity of copper ions on yeast. However, the yeasts＇ pretreatment has a higher effect on bioadsorption. It indicates that heavy metal bioadsorption on yeast has much relation with its cellular molecule basis. With the adsorping, the intercellular pH of yeast increased gradually and changed from acidity to alkalescence. These results may suggest that negative pressure cavitation can compel heavy metals to transfer from the cell surface into inside cell and make the surface of yeast coarse.

Water and salt movement in different soil textures under various negative irrigating pressures

supported by the National High-Tech R＆D Program of China （2013AA102901）

Effect of continuous negative pressure water supply on the growth, development and physiological mechanism of Capsicum annuum L.

Effects of continuous negative pressure water supply on water consumption, growth and development, as well as physiological mechanism and quality of Capsicum annuum L. were investigated in this paper. Meanwhile, the optimal negative pressure water supply conditions for growth of C. annuum L. were screened out to achieve the goals of water conservation, high yield and high quality, thus providing theoretical foundation for its field production. The pot experiment within the greenhouse was utilized; the continuous negative pressure water supply was adopted; the four treatments, artificial watering（CK）, –5 k Pa（T1）, –10 k Pa（T2）, and –15 k Pa（T3） were set; and the daily water consumption, yield, as well as the biomass, nitrate reductase, root activity, vitamin C, capsaicin, and nutrient uptakes of nitrogen（N）, phosphorus（P） and potassium（K） during various stages of its growth were determined. Compared with CK, when the water supply pressure was controlled at –5 to –15 k Pa in the experiment, the total water consumption of C. annuum L. reduced by 53.42 to 67.75%, the total water consumption intensity reduced by 54.29 to 67.14%, and the water use efficiency increased by 12.66 to 124.67%. The N accumulation in a single strain of C. annuum L. from the color turning stage to the red ripe stage increased by 15.99 to 100.55%, respectively, compared with that of CK; the P accumulation increased by 20.47 to 154.00% relative to that of CK, and the K accumulation increased by 64.92 to 144.9% compared with that of CK. Compared with CK, C. annuum L. yield was remarkably improved by 13.79% at T1, and contents of vitamin C, capsaicin as well as carotenoids at all growth stages were enhanced by 13.42–147.01%, 11.54–71.01%, and 41.1–568.06%, respectively. Nitrate reductase activity, root activity and chlorophyll（a＋b） were markedly increased by 335.78–500%, 79.6–140.68% and 114.95–676.19%, respectively, from immature stage to full ripe stage. Adopting the continuous negative pressure water supply for C. annuum L. has a significant water-saving effect, and the water supply pressure being stable at –5 k Pa contributes to its growth and development, improves yield, enhances root activity, promotes nutrient uptake, and improves its quality, thus achieving the effects of water conservation, high yield, high quality and high efficiency.

Time-series analysis of the characteristic pressure fluctuations in a conical fluidized bed with negative pressure

The negative pressure conical fluidized bed is widely used in the pharmaceutical industry.In this study,experiments based on the negative pressure conical fluidized bed are carried out by changing the material mass and particle size.The pressure fluctuation signals are analyzed by the time and the frequency domain methods.A method for absolutely characterizing the degree of the energy concentration at the main frequency is proposed,where the calculation is to divide the original power spectrum by the average signal power.A phenomenon where the gas velocity curve temporarily stops growing is observed when the material mass is light,and the particle size is small.The standard deviation and kurtosis both rapidly change at the minimum fluidization velocity and thus can be used to determine the flow regime,and the variation rule of the kurtosis is independent of both the material mass and particle size.In the initial fluidization stage,the dominant pressure signal comes from the material movement;with the increase in the gas velocity,the power of a 2.5 Hz signal continues to increase.A method of dividing the main frequency by the average cycle frequency can conveniently determine the fluidized state,and a novel concept called stable fluidized zone proposed in this paper can be obtained.Controlling the gas velocity within the stable fluidized zone ensures that the fluidized bed consistently remains in a stable fluidized state.

Negative Pressure Consolidation of Silt Inside Bucket Foundation

A series of model experiments of bucket foundations concerning suction installation and negative pressure consolidation in saturated silt were carried out in a cube steel bin at Tianjin University. The experimental results show that the silt inside the bucket has been strengthened by negative pressure, and the strengthening effect decreases with the increase of the distance from the bucket. A three-dimensional numerical model of the experiments was built by means of finite element software ABAQUS with fluid-solid coupling method. The results show that the bearing capacity of the silt inside the bucket foundation increases significantly at the former stage of negative pressure consolidation, while the increasing trend slows down over time. The rotation centers of the bucket foundation and the inner soil region tend to be closer to each other based on the consolidation. The bearing capacity of the bucket foundation is improved effectively with the increase of soil strength. The effects of negative pressure consolidation on the bearing capacity of bucket foundation were also illustrated by an actual offshore wind power project case.

The Relationship of Cavitation to the Negative Acoustic Pressure Amplitude in Ultrasonic Therapy

The relationship between the cavitation and acoustic peak negative pressure in the high-intensity focused ultrasound （HIFU） field is analyzed in water and tissue phantom. The peak negative pressure at the focus is determined by a hybrid approach combining the measurement with the simulation. The spheroidal beam equation is utilized to describe the nonlinear acoustic propagation. The waveform at the focus is measured by a fiber optic probe hydrophone in water. The relationship between the source pressure amplitude and the excitation voltage is determined by fitting the measured ratio of the second harmonic to the fundamental component at the focus, based on the model simulation. Then the focal negative pressure is calculated for arbitrary voltage excita- tion in water and tissue phantom. A portable B-mode ultrasound scanner is applied to monitor HIFU-indueed cavitation in real time, and a passive cavitation detection （PCD） system is used to acquire the bubble scattering signals in the HIFU focal volume for the cavitation quantification. The results show that： （1） unstable cavitation starts to appear in degassed water when the peak negative pressure of HIFU signals reaches 13.5 MPa; and （2） the cavitation activity can be detected in tissue phantom by B-mode images and in the PCD system with HIFU peak negative pressures of 9.0 MPa and 7.8 MPa, respectively, which suggests that real-time B-mode images could be used to monitor the cavitation activity in two dimensions, while PCD systems are more sensitive to detect scattering and emission signals from cavitation bubbles.

Application of Negative Pressure Manual Dressing Change Combined with Mupirocin Ointment in the Treatment of a Case of a Patient with Cirrhosis Complicated with Deep Thigh Abscess

Objective: To explore the treatment and nursing characteristics for pressure injury on the inside of the thigh caused by forced posture in patients with cirrhosis and diabetes mellitus. Methods: A patient with cirrhosis and diabetes mellitus complicated with abscess of right inner thigh pressure injury was selected as the study object, who was admitted to Xuzhou Medical University Hospital on June 29, 2019. The analysis of the clinical diagnosis, treatment and nursing process were applied to explore the prognosis of the patient with cirrhosis and diabetes mellitus complicated with deep abscess of the thigh. Results: The traditional treatment including incision and drainage was not allowed, as the general treatment was not effective for the patients with cirrhosis and diabetes mellitus complicated with deep abscess in the inner thigh. After 8 days of negative pressure manual dressing change combined with mupirocin ointment treatment, the local skin condition returned to normal. Conclusion: After literature search, it was found that the above-mentioned cirrhosis combined with diabetes and deep abscess cases in the inner thigh were rare clinically. When the traditional treatment of incision and drainage is limited, negative pressure manual dressing change combined with antibiotics is an effective method, which is worthy of clinical application and promotion.

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.

Negative Pressure Pulmonary Oedema: Management in Resource-Challenged Hospital: Two-Case Reports

Negative Pressure pulmonary oedema (NPPO) is a medical emergency. It occurs when there is a strong inspiratory effort in obstructed upper airway. Laryngospasm is the main cause of postextubation negative pressure pulmonary oedema. Though it is life-threatening, early diagnosis and prompt treatment lead to rapid resolution with no residual respiratory complications. The mainstay management is to provide respiratory support, mostly in the intensive care unit. The recommended mode of respiratory support is to provide an invasive or non-invasive positive airway pressure. This requires the use of a ventilator. Most surgery centres in sub-Saharan Africa do not have intensive care unit or ventilators in their recovery wards. We report two cases of postextubation NPPO which occurred in a typical African hospital with no ventilator. All these two cases were successfully managed with a non-rebreather mask. The periods of resolution, both clinical and radiological, were 24 - 48 hrs. This is not significantly different from the resolution periods quoted in literature from cases managed in well-resourced centres with means of positive pressure ventilation. We therefore conclude that early detection and prompt initiation of management are important keys which can lead to good outcomes, even in low-resource centres.