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.

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 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.

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.

Choice and management of negative pressure drainage in anterior cervical surgery

BACKGROUND Postoperative unobstructed drainage is an important measure for avoiding hematoma formation and preventing complications from anterior cervical surgery.AIM To discuss the characteristics and key points of clinical management of two types of commonly used negative pressure drainage systems in clinical settings.METHODS Two types of commonly used silica gel negative pressure drainage balls and a type of gastrointestinal decompression apparatus were fully emptied and then injected with different amounts of water and air.Following this,the negative pressure values of the three devices were measured.Meanwhile,we undertook a retrospective analysis of the clinical data of 1328 patients who had been treated with different negative pressure drainage apparatuses during their anterior cervical surgery in our department between January 2007 and January 2018.RESULTS As the amount of injected air or water increased,the negative pressure of the silica gel negative pressure drainage ball decreased rapidly,dropping to zero when 150 mL of water or air was injected.In contrast,the negative pressure of gastrointestinal decompression apparatus decreased slowly,maintaining an ideal value even when 300 mL of water or air was injected.And statistical analysis demonstrated that patients who had been treated with the gastrointestinal decompression apparatus were less likely to develop severe complications than those who had been treated with the silica gel negative pressure drainage ball(P<0.05).CONCLUSION This study showed that the gastrointestinal decompression apparatus has the advantages of large suction capacity,long duration of continuous negative pressure,and good drainage effect,all of which are the favorable factors for the use of this apparatus for negative pressure drainage in anterior cervical surgery.

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.

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.

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.

LIQUID-LIQUID PHASE EQUILIBRIUM OF POLYMER SOLUTIONS AND POLYMER BLENDS UNDER POSITIVE AND NEGATIVE PRESSURE

In this paper we would like to give a brief review about the extensibility of the liquid-liquid locus into the negativepressure region. Negative pressure states are hardly explored; most researchers believe that the pressure scale ends at p = 0.We would like to show that this is not true, the p = 0 point is not a special point for liquids, it can be 'easily' crossed. We aregoing to give a few example, where the extension of liquid-liquid locus for polymer blends and solutions below p = 0 givesus some interesting results, like the merging of UCST and LCST branches in weakly interacting polymer solutions or thereason why most UCST blends exhibit pressure induced immiscibility. Also, we will see what happens with the immiscibilityisland of aqueous polymer solutions when -- reaching the critical molar mass -- it 'disappears'.

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.

Mechanical performance and negative pressure instability for venous walls

Mechanical properties, such as the deformation and stress distributions for venous walls under the combined load of transmural pressure and axial stretch, are examined within the framework of nonlinear elasticity with one kind of hyper-elastic strain energy functions. The negative pressure instability problem of the venous wall is explained through energy comparison. First, the deformation equation of the venous wall under the combined loads is obtained with a thin-walled circular cylindrical tube. The deformation curves and the stress distributions for the venous wall are given under the normal transmural pressure, and the regulations are discussed. Then, the deformation curves of the venous wall under the negative transmural pressure or the internal pressure less than the external pressure are given. Finally, the negative pressure instability problem is discussed through energy comparison.

Negative pressure for diabetic foot:Evaluation based on calcitonin gene-related peptide in the limb skin of dogs

BACKGROUND: Very good therapeutic effect has been obtained for limb negative pressure in treating limb ischemic diseases. But its mechanism in treating diabetic foot needs further investigation. OBJECTIVE: To observe the changes of calcitonin gene related peptide (CGRP) in sensory nerve fiber of skin of dogs with diabetic foot before and after limb negative pressure treatment, and make a comparison with normal dogs, then analyze the mechanism of limb negative pressure in treating diabetic foot. DESIGN: A randomized controlled animal experiment. SETTING: Third Department of General Surgery, Xijing Hospital, Fourth Military Medical University of Chinese PLA. MATERIALS: Fifteen healthy hybrid dogs, of either gender, weighing 12-18 kg, were provided by Animal Room, Xijing Hospital of the Fourth Military Medical University of Chinese PLA. After being numbered, the involved dogs were randomly assigned into 3 groups: treatment group, model group and normal control group, 5 dogs each. Limb negative pressure therapeutic machine (self-made); Anti-CGRP serum (primary antibody, Watpa Company, England); rabbit anti-BigG (second antibody), ABC compound solution, DAB reagent, glucose oxidase reagent, Trixon-X100 solution (Sigma company, USA), ammonium nickelous sulfate reagent (Xi'an Chemical Reagent Factory), neutral gum-solution (import, Shanghai Reagent Co.,Ltd.); Leitz1400 sliding freezing microtome (Leitz Company, Germany); Leica1800 cryostat microtome (Leica Company, Germany); Quantimet570 image analyzer (Leica Company, Germany). METHODS: This experiment was carried out in the Animal Room, Xijing Hospital, Fourth Military Medical University of Chinese PLA from October 2005 to June 2006. ① After the dogs in the treatment and model groups were anesthetized, their pancreatic tissues were removed completely and animal models of type Ⅰ diabetes mellitus were developed. All the femoral artery branches including deep femoral artery were ligated and cut off. A helical wire was inserted into the distal femoral artery cavity for narrowing femoral artery 1/2, then contributing to ischemic status of this limb, thus, dog models of diabetic foot of posterior limbs were developed. When the dogs in the treatment group were successfully modeled, negative pressure treatment was conducted on their affected limbs after 14 days. When the dogs were lightly anesthetized, depilation was performed on the base of left posterior limb in ring form. Then, their depilated limbs were placed in self-made negative pressure cabin for 15 minutes of -12 kPa negative pressure treatment every day within 10 days successively. Negative pressure treatment on affected limbs was omitted in the model group. The dogs in the normal control group were not modeled or given negative pressure treatment. ②After 10 days of treatment, 3 groups of animals all subjected to immunohistochemical staining of toe skin of affected limb for detecting CGRP-immunoreactive positive nerve fibers. Analysis of variance and LSD-t test were used for comparison of measurement data. MAIN OUTCOME MEASURES: Changes of CGRP in sensory nerve fibers of skin of 3 groups of animals. RESULTS: CGRP-immunoreactive positive nerve fibers in the skin of animals of model group were (53.24±5.6) μm/mm2, which were significantly more than those of control group [(11.73±2.3) μm/mm2,t =16.94,P < 0.01]. CGRP-immunoreactive positive nerve fibers in the skin of animals of treatment group were (32.49±2.9) μm/mm2, which were less than those of model group (t =8.47,P < 0.01), but were still more than those of normal control group (t =8.47,P < 0.01). CONCLUSION: ① Following the onset of diabetic foot, CGRP-immunoreactive positive nerve fibers in the skin of distal limb are obviously increased, which may be a self-protective mechanism of body. ② Limb negative pressure treatment can treat diabetic foot, which attributes to that the release of CGRP in the sensory nerve fibers can promote vasodilatation.

Computer tomography-guided negative pressure drainage treatment of intrathoracic esophagojejunal anastomotic leakage:A case report

BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.However,treatment remains challenging and controversial.We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography(CT)-guided negative pressure drainage treatment.CASE SUMMARY A 69-year-old male patient complained of difficulty swallowing within the last six months.He was diagnosed with esophagogastric junction carcinoma,Siewert II,cT3N0M0 stage II.Total gastrectomy and Roux-en-Y esophagojejunostomy were performed.High fever,left chest pain and dyspnea appeared on postoperative day 5,and EJAL was confirmed by CT,gastroscopy and oral blue-dimethylene tests.Conservative treatment measures were applied immediately,including antibiotics,nasojejunal tubes,and repeated thoracic puncture and drainage under ultrasound guidance.However,without sufficient and effective drainage,the thoracic infection and systemic condition continued to deteriorate.With the cooperation of multiple departments,percutaneous CT-guided drainage(24 Fr 7 mm)in the thoracic cavity was successfully placed near the anastomotic leakage.Because of continuous negative pressure suction,the infection symptoms were effectively controlled and the general situation gradually recovered.Subsequent follow-up examination showed that the patient was in good condition.CONCLUSION Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.

Intracystic negative pressure may promote bone formation around jaw cysts

The growth and enlargement of jaw cysts are associated with raised intracystic pressure and bone resorption surrounding the cysts.The major bone-resorbing cells are the osteoclasts.They are acting under the influence of local bone-resorbing factors: prostaglandins,proteinases and cytokines.It was found that positive pressure enhanced the expression of IL-1αmRNA and protein in epithelial cells of odontogenic keratocyst,and increased the secretion of matrix metalloproteinase and PGE2 in a co-culture of odontogenic keratocyst fibroblasts and epithelial cells.However,the signal intensities for IL-1α mRNA and protein in the epithelium were significantly decreased after marsupialization which relived intracystic pressure.Experimental study indicated that intermittent negative pressure could promote osteogenesis in human bone marrow-derived stroma cells(BMSCs) in vitro.We propose a hypothesis that bone formation around the cyst of the jaws would be stimulated by intracystic negative pressure.

Evaluation of global cardiac systolic performance and diastolic filling in central hypovolumia by lower body negative pressure with Doppler echocardiography

Objective ：To overall evaluate the change of global cardiac systolic performance and diastolic filling in hypovoleamia by LBNP, Methods：10 healthy male subjects were placed in a standard LBNP chamber. Baseline haemodynamic and echocardiographic measurements were made after a period of least 10 min resting supine within the chamber. Pressure was then decreased to -10,-20 and -30 mmHg, with each pressure maintained for 15 rain. The indices of four transvalvular and SVC flow were measured using Doppler echocardiography. Results ：The results showed that S wave, Re wave ,and VTI of SVC progressively decreased with increasing LBNP. At -30 mmHg stage, S wave decreased by 35.4 % （change of 0.21±0.03 m/s, P 〈 0.001）. This reduction in pre-load Was associated with a progressive decrease in SV（by 21.5 ± 4.5 ml at -30 mmHg,P 〈 0.001 ）, decrease in CO（by 1.2 ± 0.2 L min^-1 at -30 mmHg LBNP,P 〈 0.001 ）. The diastolic filling of mitral and tricuspid flow also reduced significantly. At -30 mmHg stage, the E wave of MVF and TVF decreased 31% and 32% respectively （change of 0.23 ± 0.05 m/s,P 〈 0.001 and 0.18 ± 0.01 m/s,P 〈 0.001）. VTI of MVF and TVF decreased 27% and 27.7% respectively（change of 5.55 ± 1.41cm,P 〈 0.01 and 4.25 ± 0.44 cm,P 〈 0.01）. A wave of both sides did not change significantly. Conclusion：Doppler indices changes in different LBNP stage can roughly reflect the degree of hypovoleamia caused by blood volume redistribution. The indices of Doppler echocardiography are more sensitive than traditional physiological indexes in evaluating cardiovascular responses of LBNP. Echocardiography techniques overall can evaluate the global cardiac function including systolic performance and diastolic filling.

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.

Postischemic Lower Extremity Wounds Treated with and without Negative Pressure Dressing

Background: Vacuum-assisted dressing is a noninvasive closure system of the wound, which makes localized and controlled negative pressure. Its mechanical tension reduces edema, stimulates granulation tissue formation and angiogenesis, and prepares the wound bed for closure. In this study, a patient has been presented, who suffered from serious lower extremity wounds due to arterial emboli, one of her wounds has been treated with vacuum-assisted dressing and the other with conventional dressing to evaluate the efficacy of vacuum-assisted dressing in acute ischemic wounds. Methods: A 65-year-old female patient was admitted to the emergency clinic, due to complaint of severe pain in her right lower extremity which suggested an acute arterial occlusion. She immediately underwent an embolectomy operation;however, a few days later, severe ischemia on the leg and foot became appearant. All of the necrosis was sharply debrided under sterile conditions in the operating room, and then lower leg wound was covered with vacuum-assisted dressing, also calcaneal wound was dressed with silver sulphadiazine. Results: Eighteen days after the first dressing with negative pressure, distal leg wound became ready for closure, whereas, enough granulation tissue over the calcaneal area developed merely thirty-four days later. Calcaneal wound closed spontaneously within fifty-three days. Conclusions: When dealing with this experience, using the negative pressure dressing in patient with severe lower limb wounds following arterial emboli, accelerates wound healing by means of developing the granulation tissue, and rapidly prepares the wound for closure, so it may reduce the risk of amputation.

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.