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Before the 20th century, peripheral artery disease (PAD) manifested as extreme pain, chronic wounds, and, eventually, gangrene requiring amputation. Despite this, it was rarely diagnosed. However, at the turn of the century, Western medicine shifted focus from infectious to chronic illnesses, and with this change, physicians' engagement with PAD transformed. Aiming to mitigate long-term injury, physicians now worked to identify and treat vessel disease to restore meaningful blood circulation. This article explores the development and deployment of a new device resulting from this refocus, the PAssive VAscular EXerciser (PAVAEX) Boot, and its role as a creative response to a previously intractable clinical problem. The PAVAEX Boot, designed in 1933 by vascular surgeons Louis G. Herrmann and Mont R. Reid, was one of the few interventions for PAD at the time. Based on the observation that continuous negative pressure results in vasoconstriction, while short bursts transiently increase blood flow, the PAVAEX Boot utilized intermittent negative pressure to enhance peripheral vascular perfusion. Well-marketed and praised throughout the 1930s, it vanished from public writing and academic literature just 20 years later. However, negative pressure wound therapy resurged in the late 20th century, and though its inventors failed to recognize the precedent of the PAVAEX Boot, many of these devices and therapies are rooted in identical theories. We examine why the PAVAEX Boot faded from use and argue that the device remains a crucial advancement in negative pressure therapy. [ABSTRACT FROM AUTHOR]

Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group ( n = 50 ), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group ( n = 50 ), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results. [ABSTRACT FROM AUTHOR]

IntroductionIn critically ill surgical patients treated with open abdomen and negative pressure therapy (OA/NPT), the association between nutritional support and clinical outcome is still controversial. The main objective of this study was to assess the effect of enteral nutritional support during the acute phase (i.e., the first 7 days) on clinical outcome (abdominal wall closure rate or fistula formation) in critically ill surgical patients treated by OA/NPT.MethodsOver a 5-year period, every critically ill patient who underwent nutritional support while treated by OA/NPT was retrospectively included. The main study outcome was a composite criterion, defined as delayed abdominal closure ≥8 days and/or secondary abdominal complications (secondary anastomotic leak, intra-abdominal abscess and fascial dehiscence). Inverse probability of treatment weight (IPTW) was derived from a propensity score model. Multivariable logistic regression was used to test the association between clinical outcome and different modalities of nutritional support (enteral nutrition vs. nil per os during the first week after OA/NPT, early vs. late enteral nutrition, normal vs. low caloric/protein intake).ResultsOver the study period, 171 patients were included and 50% underwent delayed abdominal closure and/or secondary abdominal complications. The rate of delayed abdominal closure or secondary abdominal complications was significantly lower in patients who received enteral nutrition versus those who remained nil per os (40% vs. 61%, p = 0.007), with an IPTW-adjusted OR of poor clinical outcome of 0.49 [95%CI: 0.25–0.98]. There was no other statistical association between modalities of nutritional support and the study outcome.ConclusionIn critically ill patients with OA/NPT, the use of enteral feeding within 7 days after surgery was associated with better clinical outcome. Further studies are mandatory to better define the adequate timing for enteral feeding, the energy needs and the protein requirements during the acute phase after OA/NPT.

La mucormycose est une infection fongique rare et grave, survenant majoritairement sur des terrains immunodéprimés, diabétiques, des polytraumatismes ou des brûlures. Les traitements de références actuels reposent sur des parages chirurgicaux carcinologiques itératifs, un traitement systémique par amphotéricine B liposomale et en deuxième ligne par du Posaconazole ou Isavuconazole. Le cas d'une patiente de 37 ans sans antécédents, ayant présenté une mucormycose disséminée, avec perte de substance cutanée estimée à 25 % et délabrement majeur de la paroi thoracique est rapporté. En plus du traitement de référence, des instillations locales d'amphotéricine B en utilisant le système VAC Veraflow® ont été réalisées. Nous pensons que les instillations locales d'amphotéricine B par VAC pourrait permettre d'améliorer le pronostic fonctionnel des patients présentant une atteinte cutanée. Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement. [ABSTRACT FROM AUTHOR]

Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group (n=50), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group (n=50), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.

This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF. Methods: We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non‐TNPT groups. The 2 years overall survival (OS) was compared through the log‐rank test. Results: There were 18 patients in the TNPT group and 29 in the non‐TNPT group. There was no significant between‐group difference in the healing rate (chi‐square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non‐TNPT group. The 2‐year OS rate was significantly higher in the TNPT group (p = 0.0473, log‐rank test). Conclusion: TNPT promoted wound healing after surgery for PCF and improved the 2‐year OS rate. This tool is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

The review presents a theoretical rationale for the effectiveness of including topically NPWT therapy and meglumine sodium succinate intravenously in the complex therapy of wounds of various etiologies. The biochemical pathways accompanying the formation of normoxia and hypoxia of varying severity, the significance of succinate in their formation, including depending on the form of its intake into the body (exogenous and endogenous pathways), are given. Thus, when endogenous production of succinic acid is decompensated, the tricarboxylic acid cycle is inhibited and anaerobic glycolysis is activated. At this moment and before the onset of irreversible biochemical damage, the restoration of energy exchange processes begins to depend on succinate, including its exogenous intake. Additional, but no less important, antihypoxic effects of exogenous succinate include stimulation of succinate oxidase oxidation of succinic acid with the restoration of its consumption in the mitochondrial respiratory chain and an increase in the activity of the antioxidant function of glutathione, as well as stimulation of protein metabolism. Reamberin (meglumine sodium succinate) significantly accelerates tissue recovery during hypoxia due to its antihypoxic, cytoprotective and other effects due to the activation of HIF-1ɑ biologically active factors.

Background. The concept of multistage surgical treatment of patients has been established in surgery rather recently and therefore the discussions on the expediency of using a particular surgical technique in a specific situation still continue. Vacuum-assisted laparostomy is being widely implemented into clinical practice for the treatment of abdominal compartment syndrome, severe peritonitis and abdominal trauma, but the indications and advantages of this method are not clearly defined yet.The aim of the study. To conduct a systematic review and meta-analysis on the comparison of the effectiveness of vacuum-assisted laparostomy with various variants of relaparotomy and laparostomy without negative pressure therapy in the treatment of patients with urgent abdominal pathology and abdominal trauma complicated by widespread peritonitis, sepsis or compartment syndrome.Material and methods. A systematic literature search was conducted in accordance with the recommendations of “Preferred Reporting Items for Systematic Reviews and Meta-Analyses”. We carried out the analysis of non-randomized (since January 2007 until August 6, 2022) and randomized (without time limits for the start of the study and until August 6, 2022) studies from the electronic databases eLibrary, PubMed, Cochrane Library, Science Direct, Google Scholar Search, Mendeley.Results. Vacuum-assisted laparostomy causes statistically significant shortening of the time of treatment of patients in the ICU and in hospital and a decrease in postoperative mortality compared to other variants of laparostomy without vacuum assistance.Conclusion. To obtain data of a higher level of evidence and higher grade of recommendations, it is necessary to further conduct systematic reviews and meta-analyses based on randomized clinical studies.

While reticulated open cell foam (ROCF) is a well‐established dressing for negative pressure wound therapy (NPWT), there is the known potential for granulation tissue ingrowth if left in place for longer than 72 h. This may cause wound bed disruption, bleeding, and pain upon dressing removal. In addition, any retained foam fragments may elicit an adverse tissue reaction. A novel, easy to use dressing designed to utilise the advantages of ROCF while addressing its challenges has recently been created. This 7 day study investigated the utility of a novel NPWT dressing under longer‐duration wear circumstances while assessing the prevalence of tissue ingrowth and ease of dressing removal in full‐thickness excisional wounds utilising a porcine model. Histopathology and morphometry evaluations indicated thicker granulation tissue with, depending on the parameters assessed, either comparable or better tissue quality for wounds treated with the novel dressing. Greater re‐epithelialization levels were also evident compared with ROCF. Three‐dimensional imaging analysis indicated faster wound fill with a corresponding decrease in wound area with the novel dressing. Furthermore, tissue ingrowth was limited to only ROCF‐treated wounds, which was not unexpected in this longer‐duration wear study. The force required to remove the novel dressing was considerably lower compared with ROCF, correlating to the tissue ingrowth results. Results of this study illustrate that the novel dressing provided more favourable wound healing results compared with traditional ROCF. In addition, reduction in the risk of tissue ingrowth and low dressing peel force may allow it to be used as a longer‐wear dressing. [ABSTRACT FROM AUTHOR]

Background: Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection. Methods: We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms. Results: A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64/53, P =.008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%/40%, P =.017). Conclusion: A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement. Level of Evidence: Level V, mechanism-based reasoning. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well‐designed RCTs with large sample sizes. [ABSTRACT FROM AUTHOR]

Background. Secondary postoperative diffuse peritonitis (SPDP) associates with a high incidence of abdominal sepsis and 35–92% mortality rate. An optimal surgical doctrine in this complication in lacking to date.Objectives. An efficacy assessment of vacuum-assisted laparostomy (VAL) with staged lavage relative to relaparotomy on demand (RD) in SPDP patients.Methods. Patient enrolment and analyses were conducted within period 01.11.2017-31.12.2020, totalling for 141 SPDP patients, 77 (54.6%) males and 64 (45.4%) females aged 64.5 (5972.7) years. Cohort I patients (n = 52) had post-abdominal-lavage VAL using Suprasorb® SNP (SNP-1 and SNP-2) equipment and consumables (Lohmann & Rauscher GmbH, Austria). Staged lavage was performed 48-72 h apart. Cohort II (n = 78) had a standard RD technique. Cohort III (n = 11) treatment included RD-to-VAL transition. The endpoint was the inpatient treatment outcome, a favourable completion or death. The additional estimated criteria were complications rate and severity (in ACCORDION-modified Clavien-Dindo classification), sepsis rate, C-reactive protein level, abdominal index dynamics, patient’s intensive-care and total-hospital lengths of stay.Results. Cohort I included 157 staged-lavage VALs, cohort II — 107 RDs, cohort III — 49 operations. The mortality rate was 3/52 (5.8%), 24/78 (30.8%) and 7/11 (63.6%) in cohorts I, II and III (respectively, p < 0.001). No difference was observed in the length of hospital stay, with a shorter intensive care stay after final abdominal closure in cohort I. Clavien — Dindo grade 3a complications were observed for 25.0% of cohort I, 60.3 and 45.5% — of cohorts II and III (respectively, p < 0.01); grade 3b complications were 0 (0%), 24.4 and 100% in cohorts I, II and III (respectively, p < 0.001; all 11 patients were reoperated). Multiple organ failure (grade 4b) was reported in 5.8, 30.8 and 63.6% of cohorts I, II and III (respectively, p < 0.001). By end of treatment, sepsis had resolved in 9/11 (81.8%) patients in cohort I, 5/24 (20.8%) and 1/6 (16.7%) — in cohorts II and III (respectively, p = 0.002).Conclusion. Programmed staged-lavage VAL is an optimal surgical treatment tactics in SPDP. Relative to RD, VAL provides a more effective management of local and systemic abdominal sepsis, lower mortality, fewer and less sever complications, shorter intensive care stays after abdominal closure.

La Terapia de Presión Negativa (TPN) es una técnica alternativa para el cierre de lesiones tales como heridas crónicas, úlceras por presión o dehiscencias quirúrgicas. Su uso se ha extendido desde los años 90 con los doctores Louis Argenta y Michael Morykwas. En la actualidad, se mantiene como una alternativa a los métodos de cicatrización tradicionales. El objetivo que persigue la revisión sistemática trata de resumir los últimos resultados obtenidos con la aplicación de la TPN mediante el análisis de las últimas publicaciones realizadas en las diferentes bases de datos. Además, se evalúan las mejoras que ésta produce en el ámbito económico y en la calidad de vida de los pacientes. Los resultados obtenidos han demostrado la efectividad de la TPN en el cierre de las lesiones analizadas en comparación con las técnicas tradicionales de curación, disminuyendo la estancia hospitalaria y los costes añadidos. Sin embargo, se encuentra como limitación que no existe un protocolo estandarizado sobre la aplicación de la terapia ni de la duración correcta de la misma. La muestra de estudio prevalente ha sido el adulto mayor, en el que la funcionalidad de la piel se ve afectada por la edad y por la patología subyacente. En lo que respecta a la calidad de vida de los pacientes se ha verificado su efectividad, disminuyendo el dolor de las lesiones y el tiempo de curación. Se puede concluir, por tanto, que la TPN es una técnica efectiva en el cierre de la lesión pero se hace necesario un mayor estudio de la técnica para asegurar un uso correcto y seguro, aplicado de la misma forma por todos los profesionales sanitarios.

Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Complex wounds require advanced techniques for their management and care. Wound care costs are high, so healthcare professionals need to be aware of available therapies. Negative pressure therapy is a technology for which more and more data on its effectiveness in complex wounds are being collected. Objective: The objectives of this review were to analyze if the application of negative pressure therapy in complex wounds is effective; to compare the effectiveness of negative pressure therapy with other conventional treatments, as well as its combination with other therapies; and to evaluate the quality of life of patients undergoing negative pressure therapy and collect their main characteristics. Methodology: A bibliographic review focused on articles published between November 2015 and June 2022 was carried out. The following databases were consulted: PubMed (Medline), Google Scholar, Web of Science (WOS), Scielo and Scopus. Results: The most used pressures in the studies coincide at −125 mmHg and in the range of −125 mmHg to −150 mmHg. In the pediatric population, pressure levels vary by age group. A pressure of −75 to −125 mmHg is recommended for children over 12 years of age, and −50 to −75 mmHg is recommended for children under 2 years of age. Conclusions: Negative pressure therapy stands out for its rapid rate of granulation, the prevention and effective treatment of infections, the variety and malleability of dressings, its various applications and the possibility of using it with other therapies to accelerate wound closure. [ABSTRACT FROM AUTHOR]

Negative pressure therapy (NPT) has been shown to facilitate wound healing and promote hair growth in a porcine model. However, there is a paucity of research on the impact of negative pressure on hair growth in murine models. Despite the ability of nude mice to develop hair follicles, the hair they produce is often flawed towing to genetically induced keratin disorders, rendering them a pertinent animal model for assessing hair regeneration. Therefore, this study aims to investigate the effects of negative pressure on hair follicle growth in a nude mouse model. To achieve this, a customized external tissue expansion device was developed to apply negative pressure to the dorsum of nude mice. The mice were subjected to several treatment courses consisting of 15 and 30 min of continuous negative pressure at 10 mmHg, which were repeated 5 and 10 times every other day until sacrifice. Dorsal skin samples were subsequently extracted from the suction and nonsuction areas. The sections were stained with various antibodies to assess the expression of SOX-9, LHX-2, Keratin-15, β-catenin, CD31, and vascular endothelial growth factor-A, and a TUNEL assay was used to analyze cell apoptosis. The results showed that the number of hair follicles and angiogenesis were significantly higher in the suction area than in the nonsuction area in all groups. Moreover, mice that received NPT for 15 min for 10 times had a higher hair follicle density than the other three groups. Immunofluorescence staining for LHX-2 and Keratin 15 further validated the results of these findings. In conclusion, this study demonstrated that negative pressure effectively promotes hair follicle growth and angiogenesis in nude mice through SOX-9- and LHX-2-mediated follicular regeneration and β-catenin-mediated hair follicle morphogenesis. Impact Statement The results of this study indicate that negative pressure therapy (NPT) is effective in promoting hair growth in nude mice, as evidenced by increased hair follicle density and angiogenesis in the treated areas. Using a custom external tissue expansion device (ETED) device, 15-min NPT treatment conducted over 10 sessions demonstrated the highest follicle density. This suggest that developing a regimen for NPT may offer to create innovative treatment approaches for hair loss, ultimately benefiting individuals suffering from hair loss disorders.

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Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m2 ); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.

Blast injury (BI) is a combat multifactorial injury resulting from the impulse action of the complex traumatic factors by the mine munition explosion, characterized an interconnected and increasingly severe impact, massive deep tissue damage and the development of a general contusion-shock syndrome. For severe BI with large skin and soft tissue defects, it is advisable to use negative pressure wound therapy (NPWT). Objective. To analyze the effectiveness of using the NPWT system in patients with blast injuries. Methods. Publications were searched in electronic systems Google Scholar, PubMed, ScienceDirect, archives of specialized journals. The results of treatment using NPWT of 134 patients were analyzed: 130 (97 %) men and 4 (3 %) women, average age 36.6 years (22‒64). According to the types of injuries, the patients were distributed as follows: blast injury -- 128 (95.5%), bullet injuries -- 6 (4.5 %). The results. The goal of BI treatment by negative pressure is to improve wound healing through multiple mechanisms of action at the macroscopic and microscopic levels. The use of NPWT reduces the risk of infectious complications, prevents excessive progression necrosis of affected tissues, accelerates the growth of granulation tissues and reduces pain syndrome. The result of the t reatment i s the wound p reparation f or p rimary h ealing or, in the case of significant soft tissue damage, the creation of favorable conditions for performing plastic surgeries. In general, NPWT accelerates treatment times, reduces risks of complication level and improves functional results. This current own research coincides with the results of majority authors and allows us to continue work in this direction. Conclusions. Treatment of blast injury wounds with the use of vacuum bandages and devices for creating negative pressure is an effective approach that contributes to the reduction of infectious complications, the growth of granulation tissue, facilitates further skin plasticity of the defect, accelerates the recovery time of the wounded and his rehabilitation. [ABSTRACT FROM AUTHOR]

Copyright of Nouveau Praticien Vétérinaire - Équine is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nouveau Praticien Vétérinaire - Équine is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Endoscopic vacuum therapy (EVT) has emerged as a novel treatment option for upper gastrointestinal wall defects. The basic principle of action of EVT entails evacuation of secretions, removal of wound debris, and containment of the defect. Furthermore, there is increasing evidence that EVT reduces interstitial edema, increases oxygen saturation, and promotes tissue granulation and microcirculation. Various devices, such as macroporous polyurethane sponge systems or open-pore film drains, have been developed for specific indications. Depending on the individual situation, EVT devices can be placed in- or outside the intestinal lumen, as a stand-alone procedure, or in combination with surgical, radiological, and other endoscopic interventions. Purpose: The aim of this narrative review is to describe the current spectrum of EVT in the upper gastrointestinal tract and to assess and summarize the related scientific literature. Conclusions: There is growing evidence that the efficacy of EVT for upper GI leakages exceeds that of other interventional treatment modalities such as self-expanding metal stents, clips, or simple drainages. Owing to the promising results and the excellent risk profile, EVT has become the therapy of choice for perforations and anastomotic leakages of the upper gastrointestinal tract in many centers of expertise. In addition, recent clinical research suggests that preemptive use of EVT after high-risk upper gastrointestinal resections may play an important role in reducing postoperative morbidity. [ABSTRACT FROM AUTHOR]

Mr Editor Infection at the operating site (ISO) is the most common postoperative surgical complication in general surgery. This is more frequent in cases of emergency interventions, compromises the patient's prognosis, causes high health costs, and signicantly increases the risk of reintervention. Negative pressure therapy (NPT) is an innovative strategy that was proposed about two decades ago, and has been gradually replicated around the world. This means that there are still many gaps in the evidence when it is used in many diseases and under different contexts. Nevertheless, it allows obtaining conclusive results in the time of healing, reduction of complications (mainly dehiscence and ISO), decrease in hospital stay, among other factors. In Latin America, there is very little evidence on the use of this strategy, and it is null regarding its use in emergency cases without being able to determine its impact on our environment. Recently, Lakhani et al 3 conducted a meta-analysis of 7 studies with a total of 1199 patients, where they evaluated the ISO rate in patients undergoing emergency laparotomy in whom NPT was used (n=566) vs. control group (standard care, n=633). The NPT group had a lower infection rate (13.6% vs. 25.1%), with a 57-percentage point reduction in the probability of presenting ISO (OR 0.43; 95% CI: 0.30 - 0.62).

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BACKGROUND: Negative pressure wound therapy (NPWT) has been established over years for treatment of chronic and complex wounds. OBJECTIVE: Aim of this study was to investigate the effect NPWT on the microperfusion. METHODS: Prospective single centre analysis of patients treated with NPWT due to acute (ACUTE) wounds after fasciotomy or patients with chronic wounds (CHRONIC) due to a chronic limb threatening ischemia was performed. NPWT was conducted through a three days sequence with a negative pressure of –120 mmHg. Before after and during the entire period of therapy the microperfusion was assessed (O2C™, LEA Medizintechnik). RESULTS: Comparison of the perfusion values of 28 patients (CHRONIC/ACUTE 5/23, women/men 8/20) before and after the NPWT sequence showed a non-significant improvement in the CHRONIC group (supine position: p = 0.144, elevated position p = 0.068) and a significant decrease in the ACUTE group (supine position p = 0.012, elevated position p = 0.034). This effect could also been demonstrated during the NPWT over time (CHRONIC: supine position: p = 0.320, elevated position: p = 0.053, ACUTE: supine position: p = 0.021, elevated position: p = 0.012). CONCLUSION: Microperfusion measurements showed alterations and differences in wound bed perfusion of acute and chronic wounds; acute wounds tended to a decrease of blood flow, whereas this effect was not seen in chronic wounds in peripheral artery disease. [ABSTRACT FROM AUTHOR]

Background: Edema is commonly seen after surgical fixation of ankle fractures. Rest, ice, compression, and elevation (RICE) is an established combination to prevent swelling but hardly able to stimulate lymphatic resorption. Recently, an epicutaneously applied negative pressure suction apparatus (LymphaTouch®) has been introduced to stimulate lymphatic flow. While postoperative recovery, soft tissue, and osseous healing as well as functional outcome are probably linked to the amount of postoperative swelling, estimates on this relative to prevention (RICE) or prevention + stimulated resorption (RICE+) of fluid are scarce. Methods and analysis: This is a single-center, evaluator-blinded randomized pilot trial to investigate postoperative swelling in adults requiring surgical fixation of a closed unilateral ankle fracture. A total of 50 patients will be recruited and randomly assigned to RICE or RICE+ prior to surgery. All patients will undergo evaluator-blinded measurements of the ankle volume the day before surgery and subsequently from the evening of the 2nd postoperative day every 24 h until discharge. RICE will be initiated right after surgery and continued until discharge from the hospital in all patients. Additional application of negative pressure therapy (RICE+) will be initiated on the morning of the 2nd postoperative day and repeated every 24 h until the time of discharge from the hospital. Outcome measures are (i) the relative amount and the time course of the postoperative swelling, (ii) the demand for analgesic therapy (type and amount) together with the perception of pain, (iii) the rate of complications, and (iv) mobility of the ankle joint and the recovery of walking abilities during a 12-weeks follow-up period. Serum and urine samples taken prior to sugery and during postoperative recovery will allow to evaluate the ratio of naturally occurring stable calcium isotopes (δ44/42Ca) as a marker of skeletal calcium accrual. Ethics and dissemination: The protocol was approved by the institutional Ethics Committee (Rostock University Medical Center, Rostock, Germany) in accordance with the Declaration of Helsinki (approval number: A 2020-0092). The results of this study will be actively disseminated through scientific publications and conference presentations. Trial registration: DRKS, DRKS00023739. Registered on 14 December 2020 [ABSTRACT FROM AUTHOR]

Background: The role of negative pressure wound therapy (NPWT) in the management of open chest wounds is unclear. Our aim was to determine the safety and efficacy of NPWT compared with conventional therapy for open chest wounds. Methods: Ten patients with infected open chest wounds were included in a prospective trial of NPWT after surgical debridement. Their outcomes were compared with those of 11 control patients treated during the same period with surgical debridement and open chest packing only. The control group data were obtained by retrospective review of medical records. Results: The median duration of NPWT was eight days (range 2-29 days), with closure in eight patients (80%). Two patients having NPWT had unveiling of occult pleural fistulas leading to early discontinuation. The patients having NPWT had a shorter median time to closure (7 versus 18 days; p = 0.071) and shorter initial (median 6 versus 20 days; p = 0.026) and total (median 6 versus 25 days; p = 0.024) hospital length of stay. Control patients had higher rates of new-onset atrial fibrillation (46% versus 0; p = 0.035) and septic shock (64% versus 10%; p = 0.024). The chest was either closed or healing at the time of the last visit in 100% of the NPWT patients versus 73% of control patients (p = 0.28). The 1-year survival estimates were 90% for the NPWT patients and 80% for the control patients (p = 0.69). Conclusion: Negative pressure wound therapy is feasible and safe for open infected chest wounds in selected patients compared with open packing alone and may reduce hospital stay duration and major complication rates. [ABSTRACT FROM AUTHOR]

Within the vascular patient population, there is an increased risk of developing wound complications especially in infrainguinal incisions. There has been increasing interest in using closed incisional negative pressure dressings to decrease the risk of wound complications. To assess the efficacy of these incisional wound dressings, we studied surgical site infections (SSI) and seroma rates of infrainguinal incisions in our vascular patient population. This was a multi-institutional, retrospective study from July 2015 to June 2019. In 2017, our institution began using the Prevena incisional wound system. Wound complication rates were compared with the non-Prevena group before 2017. There were a total of 100 infrainguinal incisions (left and right combined) that received the Prevena wound system and 138 infrainguinal incisions that had not. The primary end point was to assess for wound complication rates, including SSIs and seroma formation. SSIs were graded based on the American College of Surgeons National Surgical Quality Improvement Plan SSI criteria. Seroma formation was diagnosed based on clinical diagnosis, imaging studies (ultrasound examination, computed tomography scan) or needle aspiration of fluid collection. This analysis showed a statistically significant decrease in the rate of SSIs in the Prevena group when compared with the non-Prevena group (P =.012). There was no statistical difference between the two groups in the rate of seroma formation (P =.155). Of the 100 incisions that received the Prevena wound system, 1.2% (1/82) had a femoral SSI and 22.0% (4/18) had a popliteal SSI. For seroma formation, 24.4% (20/82) had a femoral seroma and 11.1% (2/18) had a popliteal seroma. Of the 138 incisions that did not have the Prevena wound system, 9.6% (10/104) had a femoral SSI and 8.8% (3/34) had a popliteal SSI. For seroma formation, 24.0% (25/104) had a femoral seroma and 8.8% (3/34) had a popliteal seroma. Comorbid conditions were assessed in the two study groups and there was no statistical significance regarding rates of SSIs between the groups. The use of an incisional negative pressure dressing decreases the rate of SSIs in infrainguinal incisions. Regarding the use of these wound systems for seromas, our study did not show a statistically significant decrease in seroma rates. [ABSTRACT FROM AUTHOR]

Transhiatal esophagectomy (THE) with cervical esophagogastric anastomosis is done for esophageal carcinoma and various benign lesions of the esophagus. Cervical anastomotic (CA) leak following THE is a serious complication that adds significantly to morbidity. As these leaks usually manifest in neck, local wound care is one of the essential components to manage such leaks. This study aims to evaluate the effect of negative pressure therapy (NPT) on healing of cervical wound following CA leaks. The record of all patients, who underwent THE for benign or malignant lesion of the esophagus from 2012 to 2019, was retrospectively analyzed. Of all the patients who had CA leak, patients with type II CA leak were only included for further analysis. The outcome of the patients who received NPT for wound care was compared with those who received simple wound dressings in terms of time to oral feed, hospital stay, mortality, and dysphagia at 6 months. Seventy-two patients were thus identified and 18 (25%) had an anastomotic leak. Patients with type II leaks (n = 16) were successfully managed by conservative approach. NPT for wound care in these patients was associated with significant reduction in hospital stay and early resumption of oral intake (p < 0.05) as compared with simple wound dressings. Conservative approach is effective for management of CA leaks. NPT for wound care significantly reduces associated morbidity. [ABSTRACT FROM AUTHOR]

Post‐sternotomy surgical site infections may be serious complications responsible for increased morbidity, mortality and length of hospital stay. A variety of wound‐healing strategies can be used over closed surgical incisions, including negative pressure wound therapy (NPWT). The aim of the study is to assess sternal wound complications after heart surgery using NPWT in patients at risk for surgical site complication. Considered risk factors affecting wound healing were type 2 diabetes, Body Mass Index (BMI) >30, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF) and myocardial revascularization by double mammary artery harvesting. With these premises, 90 patients were selected: 30 patients received traditional gauze dressings, 30 advanced dressings (hydrocolloid and carboxymethyl cellulose) and 30 patients NPWT. Thirty‐four patients (37.7%) had two risk factors, 41 patients (45.5%) were affected by three risk factors and 15 patients (16.6%) by four risk factors. The NPWT group had lower rates of diabetes and CRF and only one patient presented four risk factors. With regard to surgical times and types of surgical procedure, no significant differences were observed within the three groups. The patients who received NPWT over closed incision experimented a significantly lower rate of deep sternal complication over traditional gauze and hydrocolloid and carboxymethyl cellulose dressings. [ABSTRACT FROM AUTHOR]

Introduction: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. Material and methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. Results and conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist). [ABSTRACT FROM AUTHOR]

Objective: A randomized controlled trial (RCT) was undertaken to evaluate whether the prophylactic application of a specific single-use negative pressure (sNPWT) dressing on closed surgical incisions after incisional hernia (IH) repair decreases the risk of surgical site occurrences (SSOs) and the length of stay. Background: The sNPWT dressings have been associated to several advantages like cost savings and prevention of SSOs like seroma, hematoma, dehiscence, or wound infection (SSI) in closed surgical incisions. But this beneficious effect has not been previously studied in cases of close wounds after abdominal wall hernia repairs. Methods: An RCT was undertaken between May 2017 and January 2020 (ClinicalTrials.gov registration number NCT03576222). Participating patients, with IH type W2 or W3 according to European Hernia Society classification, were randomly assigned to receive intraoperatively either the sNPWT (PICO)(72 patients) or a conventional dressing at the end of the hernia repair (74 patients). The primary endpoint was the development of SSOs during the first 30 days after hernia repair. The secondary endpoint included length of hospital stay. Statistical analysis was performed using IBM SPSS Statistics Version 23.0. Results: At 30 days postoperatively, there was significatively higher incidence of SSOs in the control group compared to the treatment group (29.8% vs 16.6%, P < 0.042). There was no SSI in the treatment group and 6 cases in the control group (0% vs 8%, P < 0.002). No significant differences regarding seroma, hematoma, wound dehiscence, and length of stay were observed between the groups. Conclusion: The use of prophylactic sNPWT PICO dressing for closed surgical incisions following IH repair reduces significatively the overall incidence of SSOs and the SSI at 30 days postoperatively. [ABSTRACT FROM AUTHOR]

Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according to the PRISMA guidelines) on the use of NPWT in the treatment of PG, and we report our personal experience with two patients treated with this device. The result of the review showed that articles on the topic are, in their entirety, of low levels of evidence, such as case series, case reports, and reviews. Improvement in wound healing with the use of NPWT was observed in 85.1% of the patients studied. Besides, a significant association between improvement in wound healing with NPWT and immunosuppressive therapy was observed. Regarding the cases reported here, both showed good outcomes with the use of NPWT and skin graft during the treatment of PG injuries. Due to the rarity of PG, there is a scarcity of studies with robust evidence for standardization and comparison between treatments, which consequently makes it difficult to select therapeutic options. However, based on this systematic review and reported cases, we consider NPWT a safe option for adjuvant treatment of wounds caused by PG if combined with systemic immunosuppression, which plays a key role in greater chances of successful treatment. This approach should be recommended, whenever possible, associated with skin grafting to accelerate wound closure. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: a systematic review and personal experience. [ABSTRACT FROM AUTHOR]

Background: The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Complete fascial closure is an essential treatment objective and can be achieved by the use of different dynamic closure techniques. Both surgical technique and—decision making are essential for optimal patient outcome in terms of fascial closure. The aim of this study was to analyse patients' outcome after the use of mesh-mediated fascial traction (MMFT) associated with negative pressure wound therapy (NPWT) and identify important factors that negatively influenced final fascial closure.Methods: A single center ambispective analysis was performed including all patients treated for an open abdomen in a tertiary referral center from 3/2011 till 2/2020. All patients with a minimum survival >24 h after initiation of treatment were analyzed. The data concerning patient management was collected and entered into the Open Abdomen Route of the European Hernia Society (EHS). Patient basic characteristics considering OA indication, primary fascial closure, as well as important features in surgical technique including time after index procedure to start mesh mediated fascial traction, surgical closure techniques and patients' long-term outcomes were analyzed.Results: Data were obtained from 152 patients who underwent open abdomen therapy (OAT) in a single center study. Indications for OAT as per-protocol analysis were sepsis (33.3%), abdominal compartment syndrome (31.6%), followed by peritonitis (24.2%), abdominal trauma (8.3%) and burst abdomen (2.4%). Overall fascial closure rate was 80% as in the per-protocol analysis. When patients that started OA management with MMFT and NPWT from the initial surgery a significantly better fascial closure rate was achieved compared to patients that started 3 or more days later (p < 0.001). An incisional hernia developed in 35.8% of patients alive with a median follow-up of 49 months (range 6–96 months).Conclusion: Our main findings emphasize the importance of a standardized treatment plan, initiated early on during management of the OA. The use of vacuum assisted closure in combination with MMFT showed high rates of fascial closure. Absence of initial intraperitoneal NPWT as well as delayed start of MMFT were risk factors for non-fascial closure. Initiation of OA with VACM should not be unnecessary delayed.

Background: Anastomotic leak (AL) is a devastating complication. Several new treatment options are available, endoluminal negative pressure therapy is one. The aims of this systematic review are; to report success rates and stoma closure rates following endoluminal negative pressure therapy in colorectal AL patients. Methods: A systematic review of MEDLINE, PubMed, Cochrane and Embase databases from inception to June 2018. Search limits were; English language, humans, sample >5 and >18 years. Search terms were Endospong* OR Endo‐spong* OR Endo spong* OR Endoluminal negative pressure OR Endoluninal vac* OR Vacuum assisted OR negative pressure. Combined with colon OR rectum OR colorect* AND anastomotic leak OR leak*. Results: Twenty articles met inclusion criteria. There were 334 patients. Reported success rates ranged from 60% to 100%. However, success definition varied considerably. The most widely used definition was endoscopic assessment of residual cavity size, but this also varied from 0.5 cm to 3 cm. Stoma closure rates were only reported in 11 studies and ranged from 31% to 100%. Complication rates were reported in 13 studies (65%). The most common was on‐going sepsis. Conclusions: Included studies suggest that 60–100% of ALs heal with endoluminal negative pressure therapy. However, results from this review need to be interpreted with caution because of the variable definition of success. A more objective assessment of success may be stoma closure but this is only reported in 60% of studies. Further studies are needed to assess the benefit of negative pressure therapy in anastomotic leaks. [ABSTRACT FROM AUTHOR]

Objective To analyze the effects of different lower extremity arterial disease and tissue microcirculation on negative pressure therapy for diabetic foot ulcer, and to explore the peripheral vascular and tissue microcirculation conditions suitable for the treatment of diabetic foot ulcer with negative pressure wound therapy. Methods A total of 75 patients with diabetic foot ulcer (Wagner grade 2 to 3) who were hospitalized in the Diabetic Foot Treatment Center of Endocrinology and Metabolism Department of Guangxi Zhuang Autonomous Region People's Hospital from November 2015 to November 2019 were selected. According to the results of lower extremity vascular ultrasound, ankle-brachial index (ABI) and percutaneous oxygen partial pressure (TcPO2), the patients were divided into three groups (Group A, Group B and Group C) based on the condition of lower extremity arterial lesions and tissue microcirculation. Each group underwent negative pressure therapy for 2 weeks. Image J graphic analysis software was used to measure the ulcer area and granulation area. Wilcoxon rank sum test and Kruskal-Wallis test were used for comparison between groups. Spearman correlation analysis and multiple linear regression analysis were used to study the correlation and influencing factors of ulcer area reduction value and granulation area increase value at the end of 2 weeks negative pressure therapy. Results The decrease of ulcer area, and the increase of granulation area in three groups (27, 29 and 19 cases respectively) with different lower extremity arterial lesions and tissue microcirculation at the end of 2 weeks treatment were significantly different compared with those before treatment (P<0.05). In the comparison between the three groups, there were statistically significant differences between Group C and Group A, Group B in the value and rate of ulcer area reduction over the end of 2 weeks negative pressure therapy (P<0.05).However, there was no statistical difference between Group A and Group B (P>0.05). Besides, in the comparison between the three groups, there were statistically significant differences between Group C and Group A, Group B in the value and rate of increased granulation area over the end of 2 weeks negative pressure therapy (P<0.05), but there was no statistical difference between Group A and Group B (P>0.05). In addition, the change value of ulcer area at the end of treatment for 2 weeks was correlated with the diabetic duration (r=-0.311), ABI (r=0.394), TcPO2 (r=0.301) and lower limb vascular ultrasound (r=-0.292, P<0.05). The change value of granulation area at the end of treatment for 2 weeks was correlated with TcPO2 (r=0.239, P<0.05) and lower limb vascular ultrasound (r=-0.207, P<0.05).The independent influencing factors of ulcer area reduction at the end of 2 weeks negative pressure therapy were ABI and diabetic course (P< 0.05); the independent influencing factor of granulation area increment at the end of 2 weeks negative pressure therapy was TcPO2 (P<0.05). Conclusions The degree of diabetic lower extremity arterial disease and tissue microcirculation play a role in the efficacy of negative pressure assisted closure technique in the treatment of diabetic foot ulcer. The more severe the lower extremity vascular disease and tissue microcirculation disorder are, the worse the effects of negative pressure wound therapy on ulcer area reduction and granulation growth are. [ABSTRACT FROM AUTHOR]

Endoscopic negative pressure therapy (ENPT) is an increasingly popular method for the treatment of various defects of the upper and lower gastrointestinal (GI) tract and has been associated with high success rates. The largest reported series focus on intraluminal therapy of local defects, whereas larger defects connected to the abdominal or pleural cavity are still regarded as indications for surgical revision in many units. The aim of our study is to assess the efficacy and the periinterventional characteristics of ENPT applications in patients with defects with large cavities in the upper GI tract. We retrospectively analysed all cases of ENPT applications in the upper gastrointestinal tract performed in our clinic between 1 January 2010 and 31 December 2019 and identified the patients with defects leading to large cavities with a length of at least 7 cm. The procedural characteristics, intraprocedural and late complications and overall clinical success were analysed. We identified 14 cases meeting our inclusion criteria. In all cases, an intracavitary or combined intracavitary and intraluminal ENPT was applied. The average duration of therapy was 47.5 days and included an average of 10.4 changes per patient in an interval of 4.5 days. Clinical success rate was 92.9%, average hospital stay was 74.5 days. In three cases, a late stenosis occurred, which could be treated endoscopically. Based on the data of our case series, we conclude that ENPT is a feasible and promising therapeutic option for upper GI defects with contact to large cavities. [ABSTRACT FROM AUTHOR]

Endoscopic vacuum therapy (EVT) is an established technique for the treatment of rectal wall defects and especially anastomotic leaks. A wide range of EVT devices, both handmade and commercially available, allow for their successful placement even in small defects and difficult localizations. Reported success rates range between 85 and 97 %, while periintervenional morbidity is low and major adverse events are very rare. EVT has proven its effectiveness in the lower gastrointestinal tract and is now considered first line treatment for pelvic anastomotic leaks. This narrative review summarizes the current literature on EVT in the lower gastrointestinal tract, focusing on its indications, technical aspects and results, and offers tips and tricks for its clinical applications., Competing Interests: Declaration of competing interest K. Kouladouros has no relevant conflicts of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: While the use of negative pressure wound therapy (NPWT) with reticulated open cell foam (ROCF) is well established, the characteristics of ROCF do not allow for extended-wear use. There is the potential for dressing tissue ingrowth if left in place for greater than the recommended 2-3 days. An easy to use, novel peel and place dressing has been designed for extended wear with the wound management advantages of ROCF while alleviating the challenges of tissue ingrowth. Approach: Paraspinal, full-thickness or deep muscle excisional wounds were created in 11 and 2 swine, respectively, dressings applied with continuous negative pressure at -125 mmHg, and dressings changed weekly. Full-thickness excisional wounds were treated for 13 days and deep muscle wounds for 35 days. Wound dimensions were assessed. Granulation tissue thickness and re-epithelialization were measured via digital morphometry. Tissue quality, fibrinous material prevalence, and dressing removal peel force were analyzed. Results: The peel and place dressing substantially reduces dressing tissue ingrowth, is easy to remove with markedly low dressing peel force and promotes more granulation tissue at day 13 than ROCF with an interface layer. The extended-wear peel and place dressing, when applied to deep muscle wounds with weekly dressing changes, was applied for a total of 35 days. Successful wound closure was evident without any negative impact on wound healing. Innovation: This study assessed the wound management capabilities of an extended-wear peel and place NPWT dressing used until wound closure. Conclusion: The peel and place dressing is a suitable extended-wear NPWT dressing.

Objective: Esophageal perforation is a very serious condition carrying a mortality rate of 10–25%. Historically, primary treatment was an open approach, but over the last two decades minimally invasive treatments have been employed. Intraluminal negative pressure wound therapy has shown promise for esophageal perforation. We present a case of intraluminal negative pressure therapy through a novel approach. Method: Case report. Results: A 55 year old male presented in respiratory distress and intubated for airway protection. Outside hospital computerized tomography (CT) scan showed evidence of esophageal perforation. He underwent an esophageal stent placement by gastroenterology for a distal perforation. After extubation on hospital day (HD) 4, he did not tolerate his nasogastric (NG) tube and it was removed. His perforation failed to close despite stent placement, mediastinal drains and chest tubes. On HD#16 his swallow study showed persistent perforation, but the patient adamantly refused having an NG tube placed for decompression. On HD#17 a left sided cervical esophagostomy was performed in the operating room through a lateral neck incision. A wound vac sponge sutured to an NG tube was placed through the esophagostomy and advanced to the site of the perforation under fluoroscopic guidance. This was connected to continuous low suction. The sponge was changed weekly through the esophagostomy without difficulty. On HD#31 the leak had resolved and the sponge was removed. The esophagostomy was closed at bedside. Conclusion: Esophagostomy offers safe access for intraluminal negative pressure therapy for esophageal perforations.

Aim:Defects of the extremities due to high-energy trauma are common and it is necessary to repair these defects. Reconstruction is possible with simple surgeries using skin grafts and negative pressure therapy (NPT). In this study, we present our results of the reconstruction of extremity defects caused by high-energy trauma with a simple surgical procedure using NPT.Methods:Patients with soft tissue defects of the upper and lower extremities caused by high energy trauma, who were treated with NPT between November 2009 and June 2015, were included in the study.Results:NPT was performed in 63 patients. The average defect size was 60 cm2. The patients underwent an average of nine sessions. The average length of hospital stay was 26 days. The defects were reconstructed using skin grafts and local flaps in 58 and two patients, respectively. None of the patients required free flaps.Conclusion:Extremity defects occurring due to high energy trauma can be closed by simple surgical techniques using NPT, patients can be protected from the complications of free tissue transfer, and also treatment is possible at much lower costs.

Abstract Background A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated. Methods Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e., additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan-Meier curve analysis. Results Sixty-four pressure ulcer-related pelvic osteomyelitis in 61 patients (age, 47 (IQR, 36–63)) were included. Osteomyelitis was mostly polymicrobial (73%), with a predominance of S. aureus (47%), Enterobacteriaceae spp. (44%) and anaerobes (44%). Flap coverage was performed after 7 (IQR, 5–10) weeks of NPT, with 43 (68%) positive bone samples among which 39 (91%) were superinfections, associated with a high ASA score (OR, 5.8; p = 0.022). An increased prevalence of coagulase negative staphylococci (p = 0.017) and Candida spp. (p = 0.003) was observed at time of flap coverage. An ESBL Enterobacteriaceae spp. was found in 5 (12%) patients, associated with fluoroquinolone consumption (OR, 32.4; p = 0.005). Treatment duration was as 20 (IQR, 14–27) weeks, including 11 (IQR, 8–15) after reconstruction. After a follow-up of 54 (IQR, 27–102) weeks, 15 (23%) failures were observed, associated with previous pressure ulcer (OR, 5.7; p = 0.025) and Actinomyces spp. infection (OR, 9.5; p = 0.027). Conclusions Pressure ulcer-related pelvic osteomyelitis is a difficult-to-treat clinical condition, generating an important consumption of broad-spectrum antibiotics. The lack of correlation between outcome and the debridement-to-reconstruction interval argue for a short sequence to limit the total duration of treatment.

Objective: To evaluate the efficacy and safety of topical negative pressure therapy/vacuum-associated closure (TPN/VAC) in the treatment of cephalic facial skin abscess with infection. Methods: Forty-seven patients with cephalic facial skin abscesses were divided into two groups. The observation group was treated with negative pressure sealing drainage technique and primary wound suture. The control group was treated with abscess incision and drainage first; the second stage was wound suture after three to five days. The time and times of wound dressing, the pain score during wound dressing, the time of antibiotic use, and the recurrence rate were observed. Results: The wound healing time of the observation group was seven days, which was better than that of the control group for 10-12 days. The time of dressing change in the observation group was 14.9 ± 2.0 minutes (11-19 minutes), and the time of dressing change in the control group was 14.6 ± 2.6 minutes (10-20 minutes). There was no difference between the two groups (p > 0.05). The total number of dressing changes per patient in the observation group was three to five times, and the total number of dressing changes per patient in the observation group was five to eight times. There was a statistically significant difference between the two groups (p < 0.05). The pain score of the observation group was 3.2 ± 0.6 points (2-4 points), and the pain score of the control group was 5.1 ± 0.8 points (4-7 points). The difference between the two groups was statistically significant (p < 0.05). There was no recurrence in the observation group and two cases in the control group. Conclusion: Local negative pressure closed drainage technology can shorten the patient's healing course and reduce the duration of treatment, reduce the pain of dressing changes, improve prognosis, and have satisfactory therapeutic effect. It is a simple, effective, and safe technology, which is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Deep sternal wound infections are a serious complication following sternotomy for cardiothoracic surgery. "Conventional" treatment provides debridement and secondary closure or closed catheter irrigation. The combination of the Negative Pressure Therapy with flap coverages is an accepted technique and one or both Pectoralis Major muscles could be chosen. A multistep protocol was adopted. One hundred and sixty seven patients were treated with the combination of Negative Pressure Therapy with the Pectoralis Major muscle flap: 86 monolateral flap and 81 bilateral flap reconstruction. The main complications (hematoma, seroma, dehiscence, and re‐infection), the need for re‐intervention, mortality rates, Intensive Care Unit, and hospitalisation time were assessed. The mono‐pectoralis group had fewer complications and need for revision, with a shorter hospital stay. A statistically significant difference emerged for the hematoma rate (P =.0079). Monolateral flap should to be preferred because with the same coverage effectiveness, it guarantees the saving of controlateral muscle with its functionality and the possibility of its use in case of failure. Furthermore, as the technique is less invasive, it can be reserved for more fragile patients. [ABSTRACT FROM AUTHOR]