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Objective: This study aims to explore the influence of combining autologous platelet-rich gel (APG) with continuous vacuum-sealed drainage (CVSD) and the exogenous recombinant human acidic fibroblast growth factor (rh-aFGF) on the healing processes of diabetic foot ulcers (DFU). The primary objective is to elucidate the complex molecular mechanisms associated with DFU, providing innovative perspectives for its treatment. Methods: Ninety patients diagnosed with DFU were randomly allocated into three distinct groups. Group A underwent CVSD following wound cleansing to facilitate healing. In Group B, in addition to conventional treatment, negative pressure wound therapy was applied, and rh-aFGF was introduced into normal saline for lavage, building upon the procedures of Group A. Group C received APG along with the interventions applied in Group B. The clinical efficacy of each group was systematically observed and analyzed. Additionally, changes in plasma oxidative stress, inflammatory markers, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF) were assessed both before treatment and 14 days post-treatment. Results: Following treatment, all groups exhibited commendable clinical efficacy. Group C demonstrated a superior wound healing rate, reduced frequency of dressing changes, and shorter wound healing duration (P< 0.05). Compared to baseline measurements, the levels of superoxide dismutase and PEDF increased, while malondialdehyde, VEGF, interleukin-6, interleukin-8, and monocyte chemotactic factor MCP-1 decreased in the wound tissue across all groups. Notably, Group C showed the most significant improvement in clinical efficacy and fortification of molecular mechanisms against oxidative stress (all P< 0.05). Conclusions: The integrative therapeutic approach combining APG with CVSD and rh-aFGF demonstrates notable efficacy in advancing wound healing. This effectiveness is evident through the reduced frequency of dressing changes and alleviation of wound-related pain. Additionally, the treatment regimen improves the cure rate for challenging, refractory wounds. These favorable outcomes can be attributed to the reduction of oxidative stress levels, attenuation of the local inflammatory response, and the enhancement of the balance between PEDF and VEGF. [ABSTRACT FROM AUTHOR]

The increasing incidence of surgical site infections (SSIs) following caesarean sections highlights the necessity for updated protocols that address risk factors throughout the preoperative, intraoperative, and postoperative stages. Negative Pressure Wound Therapy (NPWT) and hydrocolloid dressings have demonstrated potential for improving wound management and reducing complications, particularly by enhancing dressing integrity. Nevertheless, the application of NPWT requires careful consideration and adherence to local trust guidelines to ensure both its safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: Pressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps. Methods: A retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics. Results: In this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate. Conclusion: Closed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care. Trial registration. The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20–2023–25, Date: Mar. 24 2023). [ABSTRACT FROM AUTHOR]

Simple Summary: Anastomotic leakage (AL) has a reported incidence of up to 53% and contributes to a high morbidity and mortality after oesophagectomy. Because of its high success rates, endoluminal vacuum-assisted closure therapy (EVAC) is nowadays the standard treatment for AL. However, its effectiveness depends upon different factors. As most patients receive trimodal therapy (neoadjuvant therapy, followed by surgery and adjuvant therapy) due to their preoperative cancer staging, the question arises as to whether neoadjuvant therapy impacts the success rate of EVAC. Therefore, our aim was to identify any adverse effects of a neoadjuvant therapy on EVAC compared to no prior treatment, in order to improve patient care and treatment algorithms. We found no significant influence of neoadjuvant therapy on EVAC. Furthermore, EVAC proved to be an effective and secure treatment option, leading to no changes in the management of AL for now. Background: Anastomotic leakage (AL) is a dreaded complication after oesophagectomy. Endoluminal vacuum-assisted closure therapy (EVAC) has been increasingly used as a first-line treatment for AL. We aimed to identify any potential adverse effects of a neoadjuvant therapy (chemotherapy (CT) or radiochemotherapy (RCT)) on EVAC. Methods: We performed a retrospective cohort study at our tertiary centre between 2013 and 2024. All patients who underwent EVAC for AL after oesophagectomy were included in this study. Parameters such as success rate, length of therapy, number of sponges needed, changes in treatment, and survival were analysed. Results: A total of 29 patients were included, 19 of whom received CT/RCT and 10 of whom received no neoadjuvant treatment (NT). There was no significant difference in patient survival (30-day survival rate CT/RCT n = 1 (5.3%) vs. NT n = 1 (10%), p = 0.632), success rate (CT/RCT n = 15 (78.9%) vs. NT n = 9 (90%), p = 0.454), and length of therapy (CT/RCT vs. NT 24.11 vs. 23.8, p = 0.681), the number of sponges required (CT/RCT vs. NT 6.26 vs. 6.6, p = 0.835), and the need for changing treatment (CT/RCT n = 5 (26.3%) vs. NT n = 1 (10%), p = 0.303). Conclusions: NT did not affect the success rate or length of therapy. Thus, we found no significant influence of CT/RCT on EVAC for AL after oesophagectomy. [ABSTRACT FROM AUTHOR]

Earthquake-induced crush syndrome and subsequent acute kidney injury are important issues that affect morbidity and mortality. Fasciotomies prolong the length of stay in intensive care unit in patients with compartment syndrome due to the complications it causes. Infections and delayed wound healing are two common complications among these. Therefore, early closure of fasciotomy wounds is recommended. Although different treatments can be applied for treatment of wounds, data on this subject in pediatric patients are insufficient. We report the case of a 15-year-old girl who developed acute renal failure due to crush syndrome after being trapped in the wreckage for 9 hours and undergoing fasciotomy procedures for four locations, in the left extremity, two in the thigh and two in the cruris. Hemodialysis, antihypertensive, and antibiotic treatment were administered during the intensive care follow-up due to acute kidney injury, hypertension, and sepsis. With negative pressure therapy, silver alginate wound dressing, and hyperbaric oxygen therapy, all wounds epithelialized within two months. However, rehabilitation for drop foot syndrome caused by nerve cuts in the left extremity continues. [ABSTRACT FROM AUTHOR]

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]

Objective: Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites. Method: The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected. Results: Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported. Conclusion: In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use. [ABSTRACT FROM AUTHOR]

Introduction: Through a network meta-analysis, we compared different treatment measures for patients with diabetic foot ulcers (DFU), assessing their impact on the healing of DFU and ranking them accordingly. Methods: We searched the PubMed, the China National Knowledge Infrastructure (CNKI), Embase, the WanFang and the WeiPu database. The retrieval time was from database establishment to January 2024, and retrieval entailed subject and free words. Randomized controlled trials (RCTs) with different treatment measures for DFU were included. Data extraction and evaluation were based on the PRISMA guidelines. Meta-analyses using pairwise and network methods were employed to compare and rank the effectiveness of different treatments for DFU. Results: Ultimately, we included 57 RCTs involving a total of 4,826 patients with DFU. When it comes to ulcer healing rates, compared to standard of care(SOC), platelet-rich plasma(PRP), hyperbaric oxygen therapy(HBOT), topical oxygen therapy(TOT), acellular dermal matrix(ADM), and stem cells(SCs) in both direct meta-analysis(DMA) and network meta-analysis(NMA) can effectively increase the complete healing rate. For Scs+PRP, a statistically significant improvement was only observed in the NMA. Moreover, when compared to the negative pressure wound therapy(NPWT) group, the PRP+NPWT group was more effective in promoting the complete healing of ulcers. In terms of promoting the reduction of ulcer area, no statistical differences were observed among various treatment measures. When it comes to ulcer healing time, both PRP and NPWT can effectively shorten the healing time compared to SOC. Furthermore, when compared to the NPWT group, the combined treatment of PRP and ultrasonic debridement(UD) with NPWT is more effective in reducing healing time. In terms of amputation rates and adverse reactions, the PRP group effectively reduced the amputation rate and adverse reactions for patients with DFU. Additionally, compared to the NPWT group, the combined treatment of PRP and UD with NPWT reduced the incidence of adverse reactions. However, no significant differences were observed among other treatment measures in terms of amputation rates and adverse reactions. The ranking results showed that the efficacy of PRP+NPWT and UD+NPWT in promoting ulcer healing, reducing ulcer area, shortening healing time, decreasing amputation rates and adverse reactions is superior to that of the alone PRP group, NPWT group, and UD group. Conversely, the SOC group demonstrates the least effective performance in all aspects. Conclusion: Due to the particularity of the wound of DFU, the standard of care is not effective, but the new treatment scheme has a remarkable effect in many aspects. And the treatment of DFU is not a single choice, combined with a variety of methods often achieve better efficacy, and will not bring more adverse reactions. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Despite favourable outcomes in recurrence after off‐midline closure techniques in pilonidal surgery, between 18% and 40% of patients suffer from prolonged postoperative wound healing. The aim of this work was to investigate if closed‐incision negative‐pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery for complicated pilonidal sinus disease compared with conventional drainage and dressing.Patients were randomized to either NPWT for 4–7 days or loop‐vessel drain for 24 h and a dry dressing postoperatively. Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint). Healing was defined as one or no closing defects of ≤5 mm and with no undermining.Although we had wanted to recruit 200 patients, the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58) after interim analysis. Patients were comparable by age, sex, body mass index, previous smoking status and indication for BCL surgery. At 2 weeks 12% of patients were healed in both the NPWT and control groups [risk difference = 0.00(95% CI −0.12 to 0.11), p = 1.00]. After 12 weeks, 68% of patients were healed in the NPWT group and 72% in the control group [risk difference = −0.03 (95% CI 0.19 to 0.13), p = 0.82]. There was no significant difference in pain experienced postsurgery. In a symptom‐based questionnaire, the control group reported self‐esteem to be less affected (p = 0.015).Closed‐incision negative‐pressure wound therapy did not significantly improve healing after BCL surgery for complicated pilonidal sinus disease. [ABSTRACT FROM AUTHOR]

The article focuses on a study on the use of compression therapy in the assessment and management of the venous and arterial aetiologies underlying leg ulceration as part of a holistic care plan, which was presented in an expert panel discussion held in October 2023.

Background: medical teams continue to face challenges with infections following hip replacement surgery, whether they occur shortly after the procedure or months or years later. Certain medical conditions like diabetes, rheumatoid arthritis, and obesity are risk factors that make patients more susceptible to infections. Traditional intervention methods such as DAIR, one-step, or two-step procedures are being enhanced and refined to ensure quicker and more effective treatment. Some cases present particularly difficult challenges, featuring persistent fistulas and unpredictable responses to treatment. Methods: in our article, we share two unique cases, detailing their histories, progressions, and treatment decisions. We explore the use of antibiotic-impregnated calcium biocomposite as a local adjuvant therapy and the application of negative pressure therapy to expedite healing. The system of NWPT has seen widespread uptake and is now implemented routinely for open wounds, such as open fractures, fasciotomies, ulcers, and infected wounds. Results: our findings demonstrate that surgical debridement and calcium sulfate bead insertion successfully treat bone and joint infections without causing any side effects or complications. As a particularity, in the first case, we encountered the exteriorization of Stimulan pearls after surgery, without other complications related to the biocomposite. Conclusions: we have found that NPWT is a beneficial tool in managing complex wounds in both acute and chronic stages, after the infection is cured, reducing the need for frequent dressing changes, shortening hospital stays, and enhancing patient comfort. [ABSTRACT FROM AUTHOR]

Introduction: Open abdomen (OA) therapy is used in the management of patients who require surgery for severe abdominal conditions. This meta‐analysis aims to evaluate the VAWCM technique regarding short and long‐term outcomes. Methods: PubMed, Embase, and Cochrane Central were systematically searched for studies that analyzed VAWCM therapy in OA. Primary outcomes were the complete fascial closure rate and mean duration of OA treatment. Statistical analyses were performed using R statistical software. Results: Seven studies comprising 535 patients were included. We found a complete fascial closure rate of 77.3 per 100 patients (80.1%; 95% CI 59.6–88.7; I2 = 76%), with an overall mortality of 30.3 per 100 (33.5%; 95% CI 9.3–19.4; I2 = 78%). The pooled mean duration of OA treatment was 14.6 days (95% CI 10.7–18.6; I2 = 93%), while the mean length of hospital stay was 43.3 days (95% CI 21.2–65.3; I2 = 96%). As additional outcomes, we found an enteroatmospheric fistula rate of 5.6 per 100 patients (5.4%; 95% CI 2.3–13.3; I2 = 45%) and incisional hernia rate of 34.7 per 100 (34.6%; 95% CI 28.9–41.1; I2 = 0%). The subgroup analysis of mesh materials (polypropylene or polyglactin) showed a higher complete fascial closure rate for the polyglactin (89.1% vs. 66.6%; p = 0.02). Conclusion: Our findings showed that VAWCM is a viable option for OA treatment, successfully reaching complete fascial closure, with a low duration of the technique, even though it presented a high heterogeneity between the studies. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a rare but potentially lethal infection of the skin and soft tissue, commonly seen in the perianal and gluteal regions. Concomitant diabetes is a predisposing factor. Primary necrotizing fasciitis of the breast is rare in healthy women. In this article, we present a very rare case of breast necrotizing fasciitis in the context of the literature. We report the case of a 35-year-old female patient who had given birth two months prior to admission and developed necrotizing fasciitis of the breast during lactation. The patient presented to the emergency department with sepsis. Examination revealed widespread erythema, dark discoloration, edema, and necrotic areas indicative of wet gangrene and crepitation in the left breast. Necrotizing fasciitis is a rapid and aggressive disease that can be fatal, and delayed diagnosis may unfortunately result in death. Therefore, careful evaluation of all suspected cases, especially for patients with risk factors, is crucial for early diagnosis and timely treatment. This case highlights the importance of recognizing necrotizing fasciitis of the breast in lactating women to ensure prompt and appropriate management, potentially saving lives. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal (chronic) wounds are treated differently at varying healing stages and often require long periods of time to heal completely. Therefore, it is often very difficult to achieve this primary endpoint in clinical trials with wound products which are used temporarily. Thus, it seems reasonable to use valid wound healing parameters determined at an early stage, such as the percentage (wound) area reduction (PAR), as surrogates for predicting complete wound healing. Method: To identify studies on the association between potential surrogate endpoints and complete wound healing, a systematic literature search in MEDLINE, Embase and the Cochrane Library databases was performed. The findings of the studies were summarised qualitatively. Results: A total of 23 publications with a focus on hard-to-heal wounds (n=10 diabetic foot ulcers (DFUs), n=10 venous leg ulcers (VLUs), n=3 other ulcers) and various wound care regimens were identified. All studies showed a high bias potential. The available clinical evidence confirmed that the PAR at week 4 showed a good discriminatory capacity to predict which wounds would eventually heal and which would not. The chance to achieve complete wound healing was significantly higher for wounds achieving a PAR of >40% (VLU) or ≥50% (DFU) at week 4. Conclusion: The PAR thresholds of 40% (VLU) and 50% (DFU) can be used to identify the proportion of the wounds that will heal, and those that will not heal, to compare the efficacy of different wound dressings as early as week 4 in the setting of clinical trials. The available evidence may be limited by a potential risk of bias. [ABSTRACT FROM AUTHOR]

With advancements in naval warfare, the number and severity of seawater injuries have skyrocketed, necessitating effective seawater immersion (SWI) wound management. The unique marine pathogens, salinity, low temperature and alkalinity of seawater are the main environmental factors that can influence SWI wound healing. The current treatment strategy for SWI wounds follows a standard protocol based on terrestrial wound conditions, neglecting seawater conditions. The key requirements for ideal SWI treatment include good adhesion to the wound surface to minimize further exposure to seawater, enhanced wound healing properties to minimize wound healing time and antibacterial properties to prevent infections from marine pathogens. Current SWI wound‐specific treatments range from elaborate techniques like vacuum‐sealed drainage and vacuum‐assisted closure for severe blast injuries to simple application of hydrogels or collagen dressings for minor injuries. This review discusses the current status and development of various treatment modalities for SWI wounds. The development of these treatment strategies and an understanding of their mechanisms of action make us better prepared to manage and treat SWI injuries. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) and antibiotic‐loaded bone cement (ALBC) are commonly used treatments for diabetic foot ulcers (DFUs). However, the combined efficacy of these two modalities remains unclear. This clinical study aimed to assess the effectiveness and underlying mechanisms of NPWT&ALBC in the management of DFUs. A total of 28 patients were recruited, 16 of whom served as controls and received only NPWT, whilst 12 received NPWT&ALBC. Both groups underwent wound repair surgery following the treatments. Blood samples were obtained to detect infections and inflammation. Wound tissue samples were also collected before and after the intervention to observe changes in inflammation, vascular structure and collagen through tissue staining. Compared with the NPWT group, the NPWT&ALBC group exhibited a superior wound bed, which was characterised by reduced inflammation infiltration and enhanced collagen expression. Immunostaining revealed a decrease in IL‐6 levels and an increase in α‐SMA, CD68, CD206 and collagen I expression. Western blot analysis demonstrated that NPWT&ALBC led to a decrease in inflammation levels and an increase in vascularization and collagen content. NPWT&ALBC therapy tends to form a wound bed with increased vascularization and M2 macrophage polarisation, which may contribute to DFUs wound healing. [ABSTRACT FROM AUTHOR]

Objective: Unusual or unexpected effect of treatment Background: Infection control and reconstruction of bone and soft tissue are essential for treating infected nonunion. Continuous local antibiotic perfusion (CLAP) is a drug delivery system that continuously delivers antibiotics at the required concentration, area, and duration. This case report describes the instance of infected nonunion in which infection eradication and bone union were achieved using CLAP and synthetic bone grafting while retaining the implant. Case Report: The case was a 31-year-old woman with an infected nonunion. After she underwent osteosynthesis using nail for open fractures of tibia and fibula, bone union remained unachieved, and she exhibited skin defects and draining of pus. Following the removal of the infected granulation tissue from the bone defects, 2 bone marrow needles, serving as intramedullary antibiotic perfusion (iMAP) pins, were inserted into the medullary cavity tibia. A double-lumen tube was placed in the subcutaneous pocket as the intra-soft tissue antibiotic perfusion (iSAP) tube. No bone mobility was observed around the bone defect and nail, and replacement of the implant was not necessary. Beta-tricalcium phosphate was transplanted to the bone defect, and negative pressure wound therapy was applied. Gentamicin was injected continuously through iMAP and iSAP. Finally, the infection was eradicated, and cortical bone bridging was observed without additional surgery or adverse effects. Conclusions: CLAP emerges as a viable treatment option for infected nonunion, as it enables the delivery of antibiotics at a concentration sufficient for infection control while providing the surgeon with flexibility to design the area, dosage, and duration of antibiotic delivery. [ABSTRACT FROM AUTHOR]

Objective: This meta-analysis aimed to explore the impact of prophylactic negative pressure wound therapy (NPWT) on the occurrence of deep surgical site infections (SSIs) following orthopedic surgery. Methods: A systematic search was conducted across Medline, Embase, Cochrane Library, and Web of Science databases for articles concerning NPWT in patients who underwent orthopedic surgery up to May 20, 2024. Using Stata 15.0, the combined odds ratios (ORs) were calculated with either a random-effects model or a fixed-effects model, depending on the heterogeneity values. Results: From a total of 440 publications, studies that utilized NPWT as the experimental group and conventional dressings as the control group were selected to analyze their impact on SSIs. Ultimately, 32 studies met the inclusion criteria. These included 12 randomized controlled trials and 20 cohort studies, involving 7454 patients, with 3533 of whom received NPWT and 3921 of whom were treated with conventional dressings. The results of the meta-analysis demonstrated that the NPWT group had a lower incidence of deep SSIs in orthopedic surgeries than did the control group [OR 0.64, 95% CI (0.52, 0.80), P = 0.0001]. Subgroup analysis indicated a notable difference for trauma surgeries [OR 0.65, 95% CI (0.50, 0.83), P = 0.001], whereas joint surgeries [OR 0.65, 95% CI (0.38, 1.12), P = 0.122] and spine surgeries [OR 0.61, 95% CI (0.27, 1.35), P = 0.221] did not show significant differences. Additionally, when examined separately according to heterogeneity, trauma surgeries exhibited a significant difference [OR 0.50, 95% CI (0.31, 0.80), P = 0.004]. Conclusion: The results of our study indicate that the prophylactic use of NPWT reduces the incidence of deep SSIs following orthopedic trauma surgery when compared to the use of conventional dressings. We postulate that the prophylactic application of NPWT in patients at high risk of developing complications from bone trauma may result in improved clinical outcomes and an enhanced patient prognosis. [ABSTRACT FROM AUTHOR]

The prevalence and incidence of wounds is predicted to rise due to an ageing population, that is also likely to have an increasing number of comorbidities (Dowsett et al, 2017). This trend will invariably result in increased costs to the NHS. The estimated annual cost of wound management in 2017/2018 was £8.3 billion. The cost of managing 70% of wounds which healed was £2.7 billion while it cost £5.6 billion managing only 30% of unhealed wounds (Guest et al, 2020). In view of these figures, it is important that health professionals (HPs) recognise wounds that are not progressing to healing at an early stage and implement all available treatment modalities to ensure that the wound does not become non-healing or stalled. Therefore, this article defines non-healing wounds, how to identify wounds at risk of becoming non-healing and the timely implementation of advanced treatment modalities, such as single use negative pressure wound therapy (sNPWT). [ABSTRACT FROM AUTHOR]

Background: Diabetic hand syndrome is a complication of diabetes mellitus that is rarely described in Mexico. It covers a wide spectrum of nervous, tendinous and infectious disorders. The tropical variant of the disease is described as a necrotizing infection in the upper extremity, generally secondary to superficial trauma. Treatment includes metabolic control, antibiotics and different surgical techniques. Currently, complementary therapies include surgical debridement, flap reconstruction, negative pressure therapy, larval debridement, and stem cell grafting. The objective was to describe negative pressure therapy (NPT) as an adjunctive treatment for a case of tropical diabetic hand syndrome (TDHS) complicated by abscess and compartment syndrome, and we also made a literature review. Clinical case: 50-year-old male patient with diabetic hand syndrome complicated by abscess and compartment syndrome. Fasciotomy and surgical drainage were performed, complementing the treatment with negative pressure therapy. After 10 days of complementary therapy and 20 more days of follow-up, the patient presented adequate remission. Conclusion: The use of NPT in the treatment of TDHS helped to limit the infection damage, and allowed the patient to be monitored on an outpatient basis, reducing his hospital stay. [ABSTRACT FROM AUTHOR]

Background: Reversal of ileostomy is associated with morbidity including wound infection and prolonged wound healing. Negative pressure wound therapy (NPWT) has been shown to reduce time to wound healing by secondary intention. The aim of this study was to determine whether NPWT improved wound healing rates, compared with simple wound dressings, in patients undergoing reversal of ileostomy where the skin wound is closed with a purse‐string suture. Methods: This was a dual‐centre, open‐label, randomized controlled trial with two parallel intervention arms. Patients undergoing elective loop ileostomy reversal were randomized 1:1 to receive NPWT or simple wound dressings. The primary endpoint of the study was assessment of complete wound healing at day 42 post reversal of ileostomy and the secondary endpoints were patient‐reported wound cosmesis using a visual analogue scale and rates of surgical site infection (SSI). Results: The study was conducted from June 2018 to December 2021. The trial was approved by the local ethics committee. We enrolled 40 patients, 20 in each arm. One patient in each arm was lost to follow up. Nine patients (9/19, 47.36%) in the simple dressing group had wound healing vs. 13 patients (13/19, 68.42%) in the NPWT group (P = 0.188). There was no significant difference in patient‐ reported wound cosmesis or SSI. Conclusion: There was no difference in wound healing rates when comparing NPWT to simple wound dressings at early and late time points post reversal of ileostomy, where the skin wound was closed with a purse‐string suture. [ABSTRACT FROM AUTHOR]

Neuropathic arthropathy (Charcot arthropathy) is a progressive joint disease often associated with conditions such as diabetes, leading to severe joint deformity and pain. However, its occurrence in patients with rheumatoid arthritis (RA) is rare and not well documented. This case report describes a 48-year-old woman with a long history of RA who developed a severe deformity of her right ankle, identified as neuropathic arthropathy extending to the subtalar joint (Brodsky classification type 3A). After excluding other potential causes, the condition was determined to be secondary to RA-associated peripheral neuropathy. Surgery, including allograft and autograft fixation, was performed to correct the deformity. Post-operative complications, such as wound infection, were treated with negative pressure wound therapy and skin grafting. At the 18-month follow-up, the patient was able to walk without pain, demonstrating successful joint fusion. [ABSTRACT FROM AUTHOR]

Background: Free muscle flaps can develop significant postoperative edema and wound exudation, thereby increasing interstitial pressure and potentially compromising microcirculation. While concerns exist regarding negative pressure wound therapy (NPWT) to compress free flaps and hinder monitoring, recent studies have indicated a reduction in edema and an increase in blood flow. Objective: To compare microcirculation in free latissimus dorsi muscle (LDM) flaps dressed with and without NPWT. Methods: This retrospective cohort study analyzed prospectively collected data of patients who received free LDM flap reconstruction. Patients were separated into two groups according to management with or without NPWT. Microcirculation was evaluated continuously for up to 72 h utilizing laser doppler flowmetry and tissue spectrometry. Results: In total, n = 61 patients (26 females, 35 males) with an average age of 56.90 (17.4) years were included. NPWT was applied in 12 patients, while a regular cotton dressing was used in 49 patients. Overall, no significant differences in the number of minor and major complications were observed between groups. Both groups showed an increase in microvascular flow over the investigated time period. The flow showed higher absolute values in the NPWT group, reaching statistical significance at 12 h post-anastomosis, p = 0.038. There was a tendency for lower rHb values in the NPWT group, without reaching statistical significance. Conclusions: The presented study confirms the increase in microvascular flow after NPWT application. Whilst ensuring continuous free flap monitoring utilizing laser doppler flowmetry and spectrometry, the data further support the safety of NPWT application without risking vascular compromise due to external compression. [ABSTRACT FROM AUTHOR]

Negative-pressure-wound-therapy (NPWT) has become a widely used tool for the coverage and active treatment of complex wounds, including burns. This study aimed to evaluate the effectiveness of NPWT in acute burns of upper and lower extremities and to compare results to the standard-of-care (SOC) at our institution. Patients that were admitted to our institution between May 2019 and November 2021 with burns on extremities between 0.5 % and 10 % of the total body surface area (%TBSA) were included and randomized to either NPWT or SOC (polyhexanide gel, fatty gauze, and cotton wool). Treatment was performed until complete wound healing. Patients that required skin grafts, received additional NPWT after grafting independent on the initial group allocation. Sixty-five patients suffering from burn injury between May 2019 and November 2021 were randomized into treatment with NPWT (n = 33) or SOC (n = 32); of these, 33 patients (NPWT) and 28 patients (SOC) had complete data sets and were included in the analysis. Both groups were similar regarding age (39.8 ± 13.7 vs. 44.8 ± 16.2 years,p = 0.192), total burn size (3.1 ± 2.3 vs. 3.4 ± 2.8 %TBSA,p = 0.721) and treated wound size (1.9 ± 1.2 vs. 1.5 ± 0.8 %TBSA,p = 0.138). We found no differences regarding healing time (11.0 ± 4.9 vs. 8.6 ± 3.8,p = 0.074, and significant differences in a number of dressing changes throughout the study (2.4 ± 1.5 vs 4.2 ± 1.9,p < 0.001). The Kaplan-Meier time-to-event analysis exhibited no statistically significant difference in the time to healing or skin grafting (p = 0.085) in NPWT group compared with SOC group. The median time to healing or skin grafting was 10(8−11) days for NPWT and 9(7−11) days for SOC. The hazard ratio for healing or skin graft was HR= 0.64(0.38–1.08). The results of the time-to-event analysis as well as the Kaplan-Meier curve on the PPS confirmed this result. We found no differences in secondary surgical operations 15.2 vs 21.4 % pain or functional outcomes. In this study, we found no significant difference between the two groups in terms of time to detect wound healing. We also found no difference regarding further operations for wound closure, pain and/or scarring. However, dressing changes were significantly less frequent for patients that were treated with NPWT, which may be a psychological and logistical advantage. • No significant difference between negative pressure wound therapy or standard of care in terms of time to detect wound healing • Using negative pressure wound therapy, number of dressing changes can be reduced • No significant differences regarding scarring or quality of life. [ABSTRACT FROM AUTHOR]

Anastomotic leakage (AL) is a dreaded complication following esophageal resection. No clear consensus exist for the optimal handling of this severe complication. The aim of this study was to describe the treatment outcome following AL. We conducted a retrospective cross-sectional study including all patients with AL operated with Ivor Lewis esophagectomy from 2010 to 2021 at Oslo University Hospital, Norway. 74/526 (14%) patients had AL. Patient outcomes were analyzed and categorized according to main AL treatment strategy; stent (54%), endoscopic vacuum therapy and stent (EVT + stent) (19%), nasogastric tube and antibiotics (conservative) (16%), EVT (8%) and by other endoscopic means (other) (3%). One patient had surgical debridement of the chest cavity. In 66 patients (89%), the perforation healed after median 27 (range: 4–174) days. Airway fistulation was observed in 11 patients (15%). Leak severity (ECCG) was associated with development of airway fistula (P  = 0.03). The median hospital and intensive care unit stays were 30 (range: 12–285) and 9 (range: 0–60) days. The 90-days mortality among patients with AL was 5% and at follow up, 13% of all deaths were related to AL. AL closure rates were comparable across the groups, but longer in the EVT + stent group (55 days vs. 29.5 days, P  = 0.04). Thirty-two percent developed a symptomatic anastomotic stricture within 12 months. Conclusion: The majority of AL can be treated endoscopically with preservation of the conduit and the anastomosis. We observed a high number of AL-associated airway fistulas. [ABSTRACT FROM AUTHOR]

This is the first description of Negative Pressure Wound Therapy (NPWT) use in rescuing alloplastic ear reconstructions. Previously considered a sign of certain impending failure, severe infections with frank purulence can be salvaged. As a more recently developed technique, porous polyethylene (PPE) ear reconstruction provides benefits when compared to rib techniques. Increasing surgeon awareness of complication management may lead to further adoption of the technique and improve reconstructive results. Described herein are two cases of draining infections following PPE ear reconstruction that were salvaged with satisfactory results. Laryngoscope, 134:4122–4125, 2024 [ABSTRACT FROM AUTHOR]

The routine use of antimicrobial therapy to treat diabetic foot infections has been widely published. However, effective treatments can be interrupted with complications such as antimicrobial resistance, systemic toxicity and allergic reactions. This paper looked at 26 individual cases using calcium sulfate (Stimulan®, Biocomposites Ltd) as a carrier for delivering antimicrobials, in the form of beads, at a local level and at the site of infection. In 69% of patients, oral and parenteral antimicrobials were ceased at the point of treatment. Patients were managed under local protocols by the podiatry team to the point of wound closure. Additionally, average healing rates were seen to be significantly reduced. [ABSTRACT FROM AUTHOR]

Background: Surgical site complications are common post-operatively. Addressing these will improve patient experience and outcomes and reduce associated financial costs. Aims: To critically appraise the evidence for the routine use of single-use negative pressure wound therapy in preventing surgical site complications for abdominal wounds. Methods: Current research on the use of single-use negative pressure wound therapy was reviewed and selected for critical appraisal using Cochrane CENTRAL database, University of Huddersfield Library and Embase. Results: Two randomised controlled trials, two Cochrane reviews and one retrospective comparative study were included There was evidence of a reduction in wound complications including surgical site infection; however, this evidence is of low certainty. Conclusion: The use of single-use negative pressure wound therapy should be carefully considered for both the potential benefits and the limitations. [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]

Surgical wound complications are adverse events with important repercussions for the health of patients and health system. Surgical site infections and wound dehiscences are among the most important surgical wound complications, with a high incidence in paediatric patients undergoing surgery for non‐idiopathic scoliosis. Incisional negative pressure wound therapy for surgical incisions is used as a preventive measure against surgical wound complications in adults; however, there has been scant evidence for using it in children. The purpose of this study is to evaluate the cost‐effectiveness of incisional negative pressure wound therapy in preventing surgical wound complications in paediatric patients undergoing surgery to treat non‐idiopathic scoliosis. Randomized clinical trial. Children younger than 18 years of age undergoing surgery for non‐idiopathic scoliosis were randomly assigned into two groups to receive one of two different types of dressings for the first 7 days after surgery. One group were treated with a postoperative hydrofibre and hydrocolloid dressing with silver for wounds (control group), and the other group received a single‐use incisional negative pressure wound therapy system (intervention group). The wounds were assessed after removal of the dressings at 7 days after surgery and again at 30, 90, and 180 days after surgery. Surgical wound complications, sociodemographic variables, variables related to the procedure and postoperative period, economic costs of treatment of surgical wound complications, and time to healing of the surgical wound were recorded. Per protocol and per intention to treat analysis was made. The per protocol incidence of surgical wound complications was 7.7% in the intervention group versus 38.5% in the control group (p = 0.009; Fisher exact test. RR = 0.20 IC95%: 0.05–0.83). Surgical wound dehiscence, surgical site infections, seroma, and fibrin were the most common surgical wound complications. The type of surgery, duration of surgery, and patients' age were associated with a higher risk for surgical wound complications. Postoperative hydrofibre and hydrocolloid dressing with silver for wounds were found to be associated with a longer time to healing. Initial costs for dressings in the group receiving incisional negative pressure wound therapy were higher, but the total postoperative costs were higher for those receiving postoperative hydrofibre and hydrocolloid dressing with silver for wounds. It was found that for each US$1.00 of extra costs for using incisional negative pressure wound therapy, there was a benefit of US$12.93 in relation to the cost of complications prevented. Incisional negative pressure wound therapy is cost‐effective in the prevention of surgical wound complications in children undergoing surgery for non‐idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

Introduction: In severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma. Patients and Methods: The three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions. Results: We successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation. Conclusions: Highly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives.

Background: Open fractures are challenging due to susceptibility to Staphylococcus aureus infections. This study examines the impact of Vancomycin-Loaded Calcium Sulfate (VLCS) and negative pressure wound therapy (NPWT) on macrophage behavior in enhancing healing and infection resistance. Both VLCS and NPWT were evaluated individually and in combination to determine their effects on macrophage polarization and infection resistance in open fractures. Methods: Through single-cell RNA sequencing, genomic expressions in macrophages from open fracture patients treated with VLCS and NPWT were compared to a control group. The analysis focused on MBD2 gene changes related to macrophage polarization. Results: Remarkable modifications in MBD2 expression in the treatment group indicate a shift towards M2 macrophage polarization. Additionally, the combined treatment group exhibited greater improvements in infection resistance and healing compared to the individual treatments. This shift suggests a healing-promoting atmosphere with improved infection resilience. Conclusions: VLCS and NPWT demonstrate the ability to alter macrophage behavior toward M2 polarization, which is crucial for infection prevention in open fractures. The synergistic effect of their combined use shows even greater promise in enhancing outcomes in orthopedic trauma care. [ABSTRACT FROM AUTHOR]

Background: Refractory exit-site infections (ESIs) and tunnel infections (TIs) are challenging complications for patients undergoing peritoneal dialysis (PD). This study compared the outcomes of surgical intervention, notably the cuff-shaving (CS) procedure coupled with negative-pressure wound therapy (NPWT), and conservative management strategies for patients with refractory ESI and TI. Methods: We retrospectively reviewed patients who underwent PD at our center, focusing on the incidence and management of ESI and TI. We evaluated and compared treatment outcomes, including ESI scores, frequency of ESI and/or TI, identification of causative microorganisms, and duration of catheter survival or time until removal. Results: We identified 97 episodes of catheter-related ESI and/or TI across 71 patients with an incidence rate of 0.15 episodes per patient-year. Of the 23 patients with refractory ESI and/or TI, surgical intervention was performed in 8, while 15 chose conservative management. In the one-month follow-up, patients who underwent CS combined with NPWT showed no complications such as leakage, and their local symptoms resolved completely. The mean PD catheter survival time was significantly longer in the surgical group (29.38 ± 7.25 months) than in the conservative group (7.86 ± 2.13 months). Surgical intervention demonstrated a significantly higher therapeutic efficacy and extended catheter survival. Conclusions: The combination of CS and NPWT as a surgical approach is crucial for eradicating infectious foci and significantly improving the longevity of PD catheter function. This integrated surgical strategy offers a promising solution for the management of refractory ESI and TI in patients undergoing PD. [ABSTRACT FROM AUTHOR]

The number of solid organ transplant recipients (SOTRs) is growing as a consequence of an increase in transplantations and longer survival; these patients, thus, frequently suffer various comorbidities and are subjected to the detrimental effects of immunosuppressive agents, which expose them to a higher risk of developing malignancies. These drugs also complicate the surgical treatment of neoplasms, as they can hinder wound healing, especially when associated with other unfavorable factors (e.g., previous radiotherapy, diabetes, etc.). We herein present our experience with a 74-year-old SOTR who underwent a radical extended parotidectomy and reconstruction with a submental island flap for a persistent cutaneous squamous carcinoma after radiotherapy; his complicated clinical course was characterized by incredibly slow wound healing. The current literature was reviewed to provide a succinct overview of the main difficulties of head and neck surgery in SOTRs. In particular, the immunosuppressive regimen can be tapered considering the individual risk and other elements should be carefully assessed, possibly prior to surgery, to prevent cumulative harm. New developments, including intraoperative monitoring of flap vascularization through indocyanine green fluorescence video-angiography and the prophylactic application of negative pressure wound therapy, when feasible, may be particularly beneficial for high-risk patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The use of negative pressure therapy in the management of gunshot wound have a favorable outcome, NPT is easy to build, accelerates wound budding, reduces patient's stay in hospital and its low cost. It showed reassuring results in the management of wound with soft tissue lost, comparatively to other dressing. Wounds due to gunshot injuries are common in east of Republic Democratic of Congo and its management should be well known by surgeons and other health practitioners. Reconstruction is possible with simple surgeries using skin grafts and negative pressure therapy (NPT). In this study, we present our results of wounds treatment after gunshot injury with a simple non‐surgical procedure using NPT. We present four patients with soft tissue losses caused by gunshot injury. These patients underwent an average of four to eight sessions of vacuum dressing, the length of hospital stay was decrease and soft tissue losses were reconstructed using at the end skin grafts. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Negative pressure wound therapy (NPWT) aided in the management of complex soft tissue injury in a 14‐year‐old girl by managing moisture, reducing oedema, and stimulating wound granulation less than 2 months after the accident and prepared the skin for skin grafting, thus successfully saving the limb. This case study describes the use of a tubular bandage encompassing the whole limb to deliver successful NPWT in the treatment and reconstruction of extensive soft tissue damage extending from the right lower extremity to the hip in a 14‐year‐old female. [ABSTRACT FROM AUTHOR]

Purpose: Soft tissue infections can be severe and life-threatening. Their treatment consists currently in radical surgical wound debridement and combined systemic antimicrobial therapy. Different side effects are possible. Local antibiotic therapy represents a new approach to reduce side effects and improve healing. The aim of this study is to assess the effectiveness of the local sprayed use of antibiotics with fibrin sealing compared with negative pressure wound therapy as an established treatment of soft-tissue infections. Methods: In this retrospective study, patients with soft tissue infections who underwent surgical treatment were analysed. One group consists of patients, who received local fibrin-antibiotic spray (FAS) (n = 62). Patients treated by vacuum-assisted wound therapy (VAWT) as the established treatment were the control group (n = 57). Main outcomes were differences in the success of healing, the duration until healing and the number of needed operations. Results: Clinical healing could be achieved for 55 patients (98.21%) in the FAS group vs. 47 patients (92.16%) in the VAWT group (p = 0.19). Time to require this was 10.65 ± 10.38 days in the FAS group and 22.85 ± 14.02 days in the VAWT group (p < 0.001). In the FAS group, patients underwent an average of 1.44 ± 0.72 vs.3.46 ± 1.66 operations in the VAWT group (p < 0.001). Conclusion: Compared to vacuum-assisted wound therapy in soft tissue infections, local fibrin-antibiotic spray shows faster clinical healing and less needed operations. Leading to shorter hospital stays and more satisfied patients. The combination of sprayed fibrin and antibiotics can be seen as a promising and effective method. [ABSTRACT FROM AUTHOR]

Background A proportion of patients undergoing midline laparotomy will develop surgical site infections after surgery. These complications place considerable financial burden on healthcare economies and have negative implications for patient health and quality of life. The prophylactic application of negative pressure wound therapy devices has been mooted as a pragmatic strategy to reduce surgical site infections. Nevertheless, further availability of multicentre randomized clinical trial data evaluating the prophylactic use of negative pressure wound therapy following midline laparotomy is warranted to definitely provide consensus in relation to these closure methods, while also deciphering potential differences among subgroups. The aim of this study is to determine whether prophylactic negative pressure wound therapy reduces postoperative wound complications in patients undergoing midline laparotomy. Methods PROPEL-2 is a multicentre prospective randomized clinical trial designed to compare standard surgical dressings (control arm) with negative pressure wound therapy dressings (Prevena™ and PICO™ being the most commonly utilized). Patient recruitment will include adult patients aged 18 years or over, who are indicated to undergo emergency or elective laparotomy. To achieve 90% power at the 5% significance level, 1006 patients will be required in each arm, which when allowing for losses to follow-up, 10% will be added to each arm, leaving the total projected sample size to be 2013 patients, who will be recruited across a 36-month enrolment period. Conclusion The PROPEL-2 trial will be the largest independent multicentre randomized clinical trial designed to assess the role of prophylactic negative pressure wound therapy in patients indicated to undergo midline laparotomy. The comparison of standard treatment to two commercially available negative pressure wound therapy devices will help provide consensus on the routine management of laparotomy wounds. Enrolment to PROPEL-2 began in June 2023. Registration number: NCT05977816 (http://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Background: Surgical complications following breast reconstruction remain a significant concern. This study aimed to investigate if incisional negative pressure wound therapy (iNPWT) using Prevena™ provides superior wound treatment for patients undergoing immediate breast reconstruction (IBR) compared to conventional postoperative dressing. Additionally, we investigated whether intraoperative indocyanine green angiography (ICG-A) could predict and prevent postoperative complications. Methods: A randomized controlled study (RCT) comprising 39 patients was conducted. The primary outcome was time until surgical drain removal. ICG-A was applied to evaluate tissue perfusion and compared to rate of postoperative complications. Patients were followed for one year, including postoperative complications, quality of life (QoL), scar evaluation, incidence of lymphedema and timely administration of adjuvant therapy. Results: No significant differences were observed in time to surgical drain removal, hospitalization or incidence of postoperative complications between the two groups. Analysis revealed no significant association between ICG-A results and postoperative complications. After one year, both groups exhibited similar QoL and satisfaction with scars. One patient developed lymphedema during follow-up, and adjuvant treatment was timely administered in 82%. Conclusions: This RCT investigated iNPWT by Prevena™ compared to conventional postoperative dressing in IBR using implants or tissue expanders. ICG-A was applied to assess tissue perfusion and compared to postoperative complications. We did not find any significant differences in recovery time, hospitalization duration, postoperative complication rates, QoL, or scar satisfaction between the two groups within a one-year follow-up. Additionally, there were no significant association between ICG-A and postoperative complications. Larger randomized studies incorporating intraoperative ICG-A are needed to obtain higher quality data. Level of Evidence: Level I, Risk/Prognostic [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Method: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analysed. Results: During the study period, 1059 patients were admitted for STIs (88% required surgery). DM was an independent risk factor for LOS. Diabetic patients presented with higher body-mass index (28 vs. 26), larger abscess size (24 vs. 14 cm2) and had a longer length of stay (4.4 days vs. 2.9 days). They also underwent a higher proportion of wide debridement and application of negative pressure wound therapy (42% vs. 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs. 4). Diabetic patients were two times more likely to present with carbuncles (p = 0.02). Conclusion: The incidence of STIs among DM patients represent a significant disease burden, surgeons should consider intensive patient counselling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based upon lifestyle modification and glucose control. [ABSTRACT FROM AUTHOR]

Introduction. Werner’s syndrome is a rare autosomal recessive disorder characterised by premature ageing phenotypes, including skin ulcers resistant to conservative treatment. Purpose. To review the cases of surgical treatment of skin ulcers in patients with Werner’s syndrome published in the scientific literature. Methods. Scientific articles were searched using Google Scholar, PubMed and DeepDyve databases, applying the keyword “ulcer” and the word combination “Werner’s syndrome”. Based on the inclusion and exclusion criteria, 16 scientific publications were included in the review. Results. Depending on the location and nature of the ulcers in patients with Werner’s syndrome, different surgical options are available, with different surgical outcomes, such as partial or complete ulcer healing, non-healing or recurrence. Conclusions. In skin grafting, ulcers are more likely to heal incompletely or temporarily. Therefore additional treatment options can be used such as vacuum negative pressure therapy, Kirschner wires or removal of the upper layer of bone. Other grafts, such as artificial skin, are more reliable, especially in large joint areas. However, a critical assessment of each individual case is necessary before choosing surgical treatment, as these patients have different degrees of tissue blood flow, muscle atrophy and general condition. [ABSTRACT FROM AUTHOR]

Background: Sternal wound infection is a catastrophic complication after open heart surgery, so many studies have evaluated the effect of negative pressure wound therapy (NPWT) to prevent it. Objective: This study aimed to evaluate the impact of incisional negative pressure wound therapy on the wound healing process after midline sternotomy in open heart surgery. Patients and methods: 100 patients who underwent open heart surgery with midline sternotomy were included. They were divided equally into two groups: Group A included 50 patients who had negative pressure wound therapy and group B that contained 50 patients who had conventional wound dressing. Results: Patients who underwent negative pressure wound therapy had significantly lower incidences of TLC rising (P=0.043), and CRP rising (P=0.017), significantly lower incidences of overall post-operative wound infection (P=0.025), significantly lower post-operative progression to deep wound infection (P=0.024), significantly lower need for post-operative deep wound intervention (P=0.012), significantly shorter ICU stay (P=0.001), as well as shorter hospital stay (P=0.018) when compared to patients who had conventional wound dressing. Also, no mortality was detected among our studied patients. Conclusion: Negative pressure wound therapy was superior to conventional wound dressing as it was associated with significantly lower incidences of TLC and CRP rising, significantly lower incidences of overall post-operative wound infection and post-operative deep wound infection, significantly lower need for post-operative deep wound intervention, as well as significantly shorter ICU stay (due to readmission) and hospital stay, when compared to conventional wound dressing. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative wound infection after spinal surgery might be a challenge to manage. A wide range of procedures have been described for managing infected spinal wounds. An increasingly common procedure in the management of surgical site infections (SSI) is negative pressure wound therapy (NPWT), also known as vacuum-assisted closure. As there is a paucity of clear clinical advice the present investigation aims to update current evidence on the use of NPWT to manage postoperative SSI occurring after instrumented spine surgery. Methods: This systematic review was conducted according to the preferred reporting Items for systematic reviews and meta-analyses: the 2020 PRISMA statement. In January 2024, the following databases were accessed: PubMed, Web of Science, and Google Scholar. No time constraint was set for the search. All the clinical studies investigating the unique use of NPWT in treating postoperative spinal wound infections were accessed. Results: A total of 381 patients were included in the present study. Of them 52.5% (200 of 381 patients) were women. The mean age was 52.2 ± 15.2 years. The average length of the NPWT was 21.2 days (range 7–90 days). Conclusion: NPWT could be a valuable adjuvant therapy for the management of SSI after spine surgery. Additional high-quality investigations are required to assess the efficacy and safety of NPWT in SSI after spine surgery, especially if combined with contraindications or risk factors, such as the presence of intraoperative CSF leak. Level of evidence: Level IV, Systematic review [ABSTRACT FROM AUTHOR]

Anastomotic insufficiencies are severe complications of abdominal surgery, often leading to prolonged hospitalization, serious tissue inflammation, and even sepsis, along with the need for recurrent surgery. Current non-surgical treatments such as self-expanding metal stents (SEMSs) and endoscopic vacuum therapy (EVT) have limitations, including stent migration or perforation. This review evaluates the effectiveness of the VacStent GITM (Möller Medical GmbH, Fulda, Germany), a novel medical device combining SEMS and negative-pressure wound therapy in treating gastrointestinal leaks. Data were gathered from four prospective studies and compared with existing treatments. Studies on the VacStent GITM application demonstrate technical success and competitive closure rates in upper gastrointestinal leaks, with minimal complications reported. Comparative analyses with SEMS and EVT reveal promising and most importantly equally good outcomes while maintaining the possibility for sustained enteral nutrition and reducing the risk of stent migration. The VacStent GITM presents a promising alternative to current non-surgical treatments. Ongoing research aims to validate its efficacy in lower gastrointestinal leaks and comprehensively establish its role in leak management. Further investigation is necessary to confirm these findings and optimize treatment protocols. Future usages of the VacStent GITM in colonic anastomotic insufficiencies promise an effective approach and might be able to lower the rates of necessary implementations of a stoma. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) is extensively used in clinical settings to enhance the healing of wounds. Despite its widespread use, the molecular mechanisms driving the efficacy of NPWT have not been fully elucidated. In this study, skin wound-healing models were established, with administration of NPWT. Vimentin, collagen I, and MMP9 of skin tissues were detected by immunofluorescence (IF). Gene expression analysis of skin wound tissues was performed by RNA-sequencing (RNA-seq). Protein expression was assayed by a Western blotting or IF assay, and mRNA levels were quantified by quantitative PCR. Chromatin accessibility profiles of fibroblasts following NPWT or IL-17 exposure were analyzed by ATAC-seq. In rat wound-healing models, NPWT promoted wound repair by promoting reepithelialization, extracellular matrix (ECM) synthesis, and proliferation, which mainly occurred in the early stage of wound healing. These differentially expressed genes (DEGs) in NPWT wounds versus control wounds were enriched in the IL-17 signaling pathway. IL-17 was identified as an upregulated factor following NPWT in skin wounds. Moreover, the IL-17 inhibitor secukinumab (SEC) could abolish the promoting effect of NPWT on wound healing. Importantly, chromatin accessibility profiles were altered following NPWT and IL-17 stimulation in skin fibroblasts. Our findings suggest that NPWT upregulates IL-17 to promote wound healing by altering chromatin accessibility, which is a novel mechanism for NPWT's efficacy in wound healing. NEW & NOTEWORTHY: To our knowledge, this is the first report of the efficacy of negative pressure wound therapy (NPWT) in promoting wound healing via IL-17. Moreover, NPWT and IL-17 can alter chromatin accessibility. Our study identifies a novel mechanism for NPWT's efficacy in wound healing. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of negative‐pressure wound therapy (NPWT) in skin graft fixation has been demonstrated in several clinical studies. However, in vitro and in vivo studies on skin graft fixation with NPWT have been scarce. In this in vivo study, we aimed to determine whether NPWT fixation enhances skin graft survival and how it contributes to improving skin graft survival biologically. Materials and methods: We harvested skin from the bilateral abdominal wall of 88 mice after anesthetizing them. Full‐thickness skin grafts (FTSGs) were performed on contralateral harvest sites, and grafts were fixed using NPWT (continuous and intermittent modes), conventional compression methods, and wrapping with polyurethane foam as a control group. On days 5 and 10 of grafting, the survival rates of the FTSGs were evaluated. Immunohistopathological analysis and measurement of the expression levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF‐2), and epidermal growth factor (EGF) were performed. Results: The survival rates of FTSG in the continuous NPWT group were significantly higher than those in the other groups. The number of capillaries in the dermis was significantly higher in the continuous NPWT group than in the other groups. In the wound bed, VEGF levels were significantly higher in both NPWT groups than in the other groups. Conclusion: Continuous NPWT increases the survival rate of FTSGs and shortens the duration of skin graft survival. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the healing outcome of a platelet-rich plasma (PRP) gel prepared using TKKT01 (a wound care device to prepare the PRP gel) in patients with hard-to-heal diabetic foot ulcers (DFUs) and who showed an inadequate response to ≥4 weeks of standard of care (SoC). Method: This open-label, single-arm, multicentre study was conducted in 15 centres in Japan. Eligible patients received PRP gel treatment twice a week for eight weeks, followed by a final evaluation after the completion of week 8 (day 57). The primary endpoint was the percentage of patients who achieved ≥50% reduction in wound radius at the final evaluation (achievement criterion, ≥60% of patients). Secondary endpoints included: wound area and volume reduction rates; time to possible wound closure by secondary intention; time to possible wound closure using a relatively simple procedure (e.g., skin graft and suture); and safety at the final evaluation. Results: A total of 54 patients were included in the full analysis set, with 47 patients included in the per protocol set; the primary endpoint was met in 38/47 (80.9%) (95% confidence interval: 66.7–90.9%) patients who achieved ≥50% wound radius reduction at the final evaluation. High rates of wound area (72.8%) and volume (92.7%) reduction were observed at the final evaluation. The median time to possible wound closure by secondary intention and by use of a relatively simple procedure was 57 and 43 days, respectively. Complete wound closure at the final evaluation was achieved in 27 (57.4%) patients. No safety concerns were raised. Conclusion: In this study, the efficacy and safety of PRP gel treatment with TKKT01 in patients with hard-to-heal DFUs in Japan were confirmed by our findings. Declaration of interest: This study was funded by Rohto Pharmaceutical Co., Ltd., Japan. NO has been paid a consulting fee by Rohto Pharmaceutical Co., Ltd. KH is the Chief Medical Officer of Rohto Pharmaceutical. Co., Ltd. The other authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy is currently one of the most popular treatment approaches that provide a series of benefits to facilitate healing, including increased local blood perfusion with reduced localized oedema and control of wound exudate. The porous foam dressing is a critical element in the application of this therapy and its choice is based on its ability to manage exudate. Industry standards often employ aqueous solutions devoid of proteins to assess dressing performance. However, such standardized tests fail to capture the intricate dynamics of real wounds, oversimplifying the evaluation process. This study aims to evaluate the technical characteristics of two different commercial polyurethane foam dressings during negative pressure wound therapy. We introduce an innovative experimental model designed to evaluate the effects of this therapy on foam dressings in the presence of viscous exudates. Our findings reveal a proportional increase in dressing fibre occupancy as pressure intensifies, leading to a reduction in dressing pore size. The tests underscore the pressure system's diminished efficacy in fluid extraction with increasing fluid viscosity. Our discussion points to the need of establishing standardized guidelines for foam dressing selection based on pore size and the necessity of incorporating real biological exudates into industrial standards. [ABSTRACT FROM AUTHOR]