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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: For...

Presence of bacteria in wounds can delay healing. Addition of a regularly instilled topical solution over the wound during negative‐pressure wound therapy (NPWT) may reduce bioburden levels compared with standard NPWT alone. We performed a prospective, randomised, multi‐centre, post‐market trial to compare effects of NPWT with instillation and dwell of polyhexamethylene biguanide solution vs NPWT without instillation therapy in wounds requiring operative debridement. Results showed a significantly greater mean decrease in total bacterial counts from time of initial surgical debridement to first dressing change in NPWT plus instillation (n = 69) subjects compared with standard NPWT (n = 63) subjects (−0.18 vs 0.6 log10 CFU/g, respectively). There was no significant difference between the groups in the primary endpoint of required inpatient operating room debridements after initial debridement. Time to readiness for wound closure/coverage, proportion of wounds closed, and incidence of wound complications were similar. NPWT subjects had 3.1 times the risk of re‐hospitalisation compared with NPWT plus instillation subjects. This study provides a basis for exploring research options to understand the impact of NPWT with instillation on wound healing.

Background Topical negative pressure wound therapy (TNPWT) is one of the most frequently used techniques in wound treatment. But some of the underlying mechanisms still remain unclear. One possible explanation is an improved microcirculation by TNPWT. Objective This study investigated the influence of TNPWT on microcirculation on intact skin in real-time. Methods In healthy individuals, we performed a combined tissue - laser/photo - spectrometry technique to monitor changes of 4 different microcirculation parameters in real-time: The local blood flow, the capillary-venous oxygen saturation, the blood flow velocity and the relative amount of hemoglobin. We compared these parameters using two different protocols: a continuously (VAC ON 60/OFF 60) and discontinuously (VAC ON 30/OFF 60/ON 5) application. Results Our results demonstrate a significant increase of all four measured parameters during the active TNPWT and the pressure free period. The comparison of two different protocols shows an advantage of the examined parameters using a discontinuous TNPWT application. Conclusions Our study demonstrated the changes of the microvascular tissue perfusion in intact human skin under the conditions of negative pressure and may thereby offer a broader understanding of mechanisms underlying the TNPWT.

RATIONALE AND KEY POINTS: This article aims to provide an overview of the technique for applying vacuum-assisted closure therapy (V.A.C. therapy), using the example of one of the most basic dressing types: V.A.C. GranuFoam, a black polyurethane foam. Practitioners should refer to the manufacturer's instructions for application of other dressing types. ▶ V.A.C. therapy is used to apply negative pressure to the wound bed to promote wound healing. ▶ V.A.C therapy promotes perfusion, reduces oedema, draws the wound edges together and stimulates the formation of granulation tissue. ▶ The correct technique for applying V.A.C. therapy is essential to ensure patient safety and optimum wound healing outcomes. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice. 2. How the use of V.A.C. therapy might affect the patient's experience.

Einleitung: Die Vakuumsaugtherapie (VT) hat sich im klinischen Alltag weitgehend gegen andere konservative Wundtherapiemodalitaten durchgesetzt, obwohl es keine Daten mit hohem Evidenzgrad fur die therapeutische Uberlegenheit und Kosteneffektivitat im G-DRG-System gibt. Ziel dieser Studie war eine Analyse der Kosteneffektivitat der VT unter Berucksichtigung des G-DRG-Systems und der moglichen Abbildung uber die operationsspezifischen Prozeduren (OPS), um Daten uber die tatsachlichen Kosten und Erlose der VT im Rahmen der stationaren Therapie zu gewinnen. Patienten/Material und Methoden: In die retrospektive Analyse wurden 176 Patienten eingeschlossen, die von 2007 bis 2011 eine VT erhielten. In die Analyse der Kosteneffektivitat konnten 149 Patienten eingeschlossen werden. Um den Einfluss auf die Kosteneffektivitat zu ermitteln, wurde fur jeden Kasus die Gesamtbasiserlosrate bestimmt. Dann wurde in einem Testsystem eine virtuelle identische Vergleichsgruppe generiert, indem fur jeden Patienten die VT-Prozedur storniert und durch die Prozedur „Chirurgische Wundtoilette unter operativen Bedingungen“ ersetzt wurde. Anschliesend wurden die Kosten fur Verbandsmaterialien und Pumpenmiete (V/M) fur die VT verrechnet. Dieser fiktive Kasus wurde neu gruppiert und die Gesamtbasiserlosrate neu berechnet. Aus der Differenz wurde der effektive Erlos fur die VT individuell pro Kasus berechnet. Ergebnisse: Bei der Analyse der Kosteneffektivitat wirkte sich bei 108 Fallen die VT nicht auf die Gesamt-DRG-Erlosrate aus (72,5 %). Unter Beibehaltung der jeweiligen Baserate betrug hier der Gesamt-DRG-Erlos unabhangig von der VT 2 323 570,04 €. Die Kosten fur V/M betrugen 102 669,20 €. Bei 41 Fallen erbrachte die VT einen Einfluss auf die Kosteneffektivitat (27,5 %); der DRG-Erlos mit VT betrug 607 422,03 € im Gegensatz zu 442 015,10 € ohne VT. Die Kosten fur V/M betrugen fur diese 41 Falle 47 376,68 €. Bezogen auf die Gesamtgruppe von 149 Patienten ergab sich ein Kostenvorteil durch die VT von 6759,09 € in 5 Jahren. Schlussfolgerung: Unter Berucksichtigung erhohter Kosten durch V/M ist die VT auf Grundlage der hier dargestellten Daten kostendeckend bei medizinischer Indikation einzusetzen. Trotz der Abbildung im G-DRG-System verbleibt in einem allgemeinchirurgischen Patientengut nur ein sehr geringfugiger, zusatzlicher Erlos. Der Behandlungsvorteil der VT (Wirkungsweise, Patientenkomfort, Behandlercompliance) ist von dieser isolierten Betrachtung unberucksichtigt. Weiterfuhrende Untersuchungen sind notwendig, um die Rolle der VT unter okonomischen Aspekten langfristig zu analysieren.

Topical negative pressure therapy is an alternative treatment for complex wounds that consists of the direct application of sub-atmospheric pressure, obtaining a number of effects that are beneficial for tissues, promoting the healing of both acute and chronic wounds and complementing surgical procedures. We report the case of a 75 year old man diagnosed with surgical wound dehiscence after a femorotibial bypass graft, who was hospitalized again with the aim to perform the implantation of a topical negative pressure therapy in the infected wound. We designed a care plan for this patient following the steps of the scientific method and basing ourselves on the NANDA, NIC, and NOC taxonomies.

IntroductionThe topical negative pressure therapy (TNP) is a non-invasive method to treat chronic and acute wounds locally, using a continuous or intermittent negative pressure.The objective of this study is to present the first experience of this type of treatment used in clinical cases in our department. By presenting these cases, we highlight indication and efficiency of this new technique applied in relatively complicated situations, at the same time it also allows a significant improvement in treating injuries and chronic wounds.Materials and methodsIn this study, we present the recent experience of the Department of Reconstructive and Plastic Surgery of the University Hospital Center of Avicenne in Rabat. This therapy was used for the first time this year (in 2014), in three young patients who presented with chronic wounds associated with local and general factors that are unfavorable for the healing process.ResultsIn all three of our cases we obtained highly satisfactory clinical results.TNP allows wounds to bud in a shorter time, as well as a fast healing by second intention due to controlled wound healing or split-skin graft without using flaps. This enables to decrease the margin of error, the time and the number of dressing replacements, and to reduce the length of hospital stay.ConclusionThis is an expensive and specific equipment. However, the cost-benefit ratio analysis shows that it is an essential method that should be part of our therapeutic strategies.Keywords: loss of substance, negative pressure, budding, healing.

The aim of this article is to improve the treatment of patients with complete skin loss of the penile shaft after Fournier's gangrene or hidradenitis suppurativa using modern biomatrices and topical negative pressure therapy. From January 2010 to December 2011, three patients with Fournier's gangrene or hidradenitis suppurativa were treated. After initial radical debridements, topical negative pressure therapy was applied for wound stabilisation. After that dermal templates (acellular dermal matrix) were used to achieve early healing and topical negative pressure-dressing in a special setting or a special foam compression bandage was used together with a urinary catheter. After integration of the dermal template, a split-thickness skin graft is used for coverage and again secured with a circular total negative pressure-dressing. In all cases, the split-thickness skin grafts healed very well applying this therapy concept. The patients were very satisfied with the functional as well as with the aesthetic outcome. We suggest a new method of staged reconstruction to successfully preserve the functionality of the penis after complete loss of the skin and soft tissue of the penile shaft using modern biomatrices and topical negative pressure therapy.

Research into topical negative pressure therapy (TNPT) started in 1989 with Dr Louis Argenta and Prof Michael Morykwas of Wake Forest University School of Medicine in North Carolina, USA.In 1997, Morykwas and Argenta concluded that TNPT both enhanced granulation tissue formation and helped bacterial clearance, through the actions of negative pressure Armstrong and Lavery confirmed this in 2005, concluding that TNPT therapy was promoting the development of granulation tissueNumerous other studies have proved that TNPT is beneficial for a myriad of other wounds including: sternotomy wounds, extensive de-gloving injuries, various soft tissue injuries prior to surgical closure), skin grafting, pressure sores, leg ulcers, sacral pressure ulcers, acute traumatic soft tissue defects, and soft tissue defects following rigid stabilisation of lower extremity fractures.This review aims to summarise the clinical and scientific concepts of TNPT and its future applications.

The likelihood of periprosthetic infection in high-risk patients (obesity and diabetes mellitus) after revisional arthroplasty is extremely high. The authors conducted a pilot prospective comparative study of clinical and economical efficacy of interactive absorbing dressings based on carboxymethyl cellulose impregnated with silver ions and single-use vacuum assisted dressings in prevention of surface surgical site infections in high-risk patients.

To evaluate the efficacy of negative pressure therapy for superficial and deep mesh infections after ventral and incisional hernia repair by a prospective monocentric observational study. During a 6-year period, 724 consecutive open ventral and incisional hernia repairs were performed. Pre- and intraoperative data as well as postoperative complications were prospectively recorded. In case of wound infection, negative pressure therapy (NPT) was our primary treatment. Sixty-three patients (8.7 %) were treated using negative pressure therapy after primary ventral and incisional hernia repair. Infectious complications needing NPT occurred in 54 patients in the retromuscular group (54/523; 10.3 %), none when laparoscopically treated and in 9 patients (9/143; 6.3 %) treated by an open intraperitoneal mesh technique. Considering outcome, all meshes were completely salvaged in the retromuscular mesh group after a median of 5 dressing changes (range, 2–9), while in the intraperitoneal mesh, group 3 meshes needed complete (n = 2) or partial (n = 1) excision. Mean duration to complete wound closure was 44 days (range, 26–63 days). NPT is a useful adjunct for salvage of deep infected meshes, particularly when large pore monofilament mesh is used.

The application of controlled levels of negative pressure on to a wound has been shown to accelerate evacuation of dead cells, debris and fluid which eventually encourages wound healing in a verity of surgical wounds. Vacuum Assisted Closure (V.A.C.) therapy—KCI Medical Limited, the terminology by which this is widely known, became popular, especially among the plastic surgery professionals in America and soon gained recognition worldwide. It is now widely used in the UK to manage and assist healing in a wide variety of wounds. Although KCI’s V.A.C. machines were the only ones on the market for a number of years, several wound management companies have now brought out their own machines and these are now known collectively as topical negative pressure therapy (TNPT). Traditional TNPT is often considered a relatively costly procedure. It is often used in patients with large wounds to facilitate dressing management and promote rapid cleaning and granulation. This may also allow them to be discharged to the community when they would otherwise remain inpatients, thereby saving bed days. Capital purchase of the machines is expensive and hospitals often rent or lease them on a short or long term basis. This can lead to difficulties in arranging the finances for discharge to the community. Subsequent dressing changes (recommended every 48 - 72 hrs) also incur high costs and involvement of the trained medical or nursing staff. As we all know; “Need is the mother of invention”. The disposable TNPT machine (V.A.C. ViaTM KCI Medical Ltd) has been introduced to help to solve these problems. It is a single use machine, inclusive of a dressing and canister and available off the shelf. It is very cost effective, easy to use and is used for small to moderate sized wounds. Senior author is using this machine which excellent results and illustrated the use of this machine with pictures in this paper.

Surgeons frequently encounter open wounds. These include wounds which have failed to close by primary means, wounds which are left open at the outset and wounds which fail to heal by secondary intention in a timely manner. Wound healing is a complex process involving tissue repair and remodelling at the same time as removal of necrotic tissue and foreign material. Topical negative pressure (TNP) is a wound management technique which applies subatmospheric pressure to a healing wound in an attempt to facilitate healing. The potential mechanisms of action of TNP are poorly understood and may involve mechanical and biochemical effects. TNP has been suggested to be of value in a variety of settings, ranging from management of acute wounds to ischaemic and diabetic ulcers. There has been inadequate scientific evaluation of TNP, which has rarely been subjected to rigorous clinical trials or adequate effective economic evaluation. Although in general TNP does appear to be largely safe and acceptable to patients, the risk of fistulation associated with its use in the open abdomen remains to be determined and is currently being evaluated by a national audit.

Wound exudate can have a significant impact on patient's quality of life and delay wound healing. It is also challenging for clinicians and can be costly in terms of clinical time and dressing cost. Understanding the difference between acute and chronic wound fluid is essential in order for clinicians to select the most appropriate treatment for their patients. Good patient assessment is the starting point for successful management and should include assessment of the patient, their wound and the type and amount of exudate. The management pathway should aim to address contributory factors, improve the patient's quality of life, optimise the wound bed and ensure the correct level of moisture at the wound bed. Dressings and topical negative pressure therapy are the main option for managing exudates and selection should be based on their clinical and cost effectiveness. A structured approach to exudate assessment and management as outlined in this article will help to reduce complications such delayed wound healing, prolonged treatment and patient suffering.

Topical negative pressure (TNP) therapy is increasingly used in open abdomen management. It is not known to what extent this pressure propagates through the dressing to the bowel surface, potentially increasing the risk of bowel fistula formation. The present study in a porcine model was designed to evaluate pressure propagation.A commercially available TNP therapy system (ABThera/VAC) was applied in six pigs after laparotomy. Pressure sensors were placed in predetermined positions in the dressing and in the abdominal cavity and the pressure was registered at TNP settings of -50, -75, -100, -125, and -150 mmHg. Next, after infusing 200 ml of saline into the abdomen through a catheter, the amount of fluid drained through the system during 10 min of TNP therapy was registered. Finally, pressure was measured above and below eight layers of paraffin gauzes during TNP therapy.Observed pressure within the outer two foams and the foam of the visceral protective layer correlated with preset TNP. The median pressure at the bowel surface was between -2 and -10 mmHg, regardless of preset TNP. Median fluid drainage was 95% of the infused fluid at -75 mmHg and 124% at -150 mmHg. Paraffin gauzes had a limited isolating effect, reducing the pressure by 13% in median.Negative pressure reaching the bowel surface during TNP therapy with the ABThera system is limited for all TNP levels. Reduced therapy pressure does not lead to reduced pressure at the bowel surface. The system drains the abdominal cavity completely of fluid. Paraffin gauzes are of limited value as a means of pressure isolation.

Despite practical advantages (such as exudate management and reduced dressing changes) the adoption of topical negative pressure therapy (TNP) in home care may be restricted through logistical issues and a perception that the intervention is more expensive than the more traditionally utilised wound management products. This pilot study followed the experiences of 20 subjects with a variety of acute and chronic wounds who received TNP either in hospital (n=10), at home (n=5) or in both care settings (n=5). All except one subject showed both reductions in wound surface area and improved appearance of the wound bed during the course of treatment ranging from 2 to 74 days. The single subject, where a deterioration in their wound was noted, had presented with an unclear wound diagnosis thus highlighting the absolute need for accurate diagnosis of wound aetiology prior to commencement of any treatment regime. The cost of treatment was lower where subjects were treated at home (mean cost per day pound45.9 SD: 17.0) and highest where care was delivered exclusively in hospital (mean cost per day pound259.1 SD: 2.8). Direct comparison of these data with other published studies on the use of TNP therapies is obviously restricted through regional differences in the cost of nursing care, patterns of use of the TNP consumables and the wound outcomes followed in individual cases, however, there would appear to be a qualitative and economic benefit from home care.

Quality of care is the slogan of all health care institutions. In order to meet the standards advanced techniques are adopted. In wound dressing also there are various advanced wound care procedures, among them Negative Pressure Wound Therapy is widely practised. Negative pressure wound therapy also called vacuum therapy, Vacuum assisted closure, vacuum sealing or topical negative pressure therapy is a sophisticated development of a standard surgical procedure, the use of vacuum assisted drainage to remove blood or serous fluid from a wound or operation site.

Topical negative pressure therapy (TNP) is an established part of modern wound healing. With an increasing choice in TNP providers, understanding the differing modes of action, the biochemical and biophysical effects on the wound at a microscopic and macroscopic level, plus the role of the interface dressings, will aid the clinician in planning a clear goal of therapy. This article reviews the scientific evidence for TNP to date and explores each mechanism of action and the implications for wound healing and patient outcomes.

Redon drains are still used to suction wounds for vacuum sealing. Vacuum-assisted closure (V.A.C.((R)); Kinetic Concepts Inc, San Antonio, TX) is a computer-controlled therapy system for delivering topical negative pressure therapy. The efficiency of V.A.C. in the treatment of pressure ulcers was prospectively studied in a randomised controlled trial in which patients with pressure ulcers were randomly assigned to negative pressure wound therapy (NPWT) using either V.A.C. or Redon bottles. The target parameters were absolute and relative proportion of wound area consists of granulation tissue, fibrin and necrosis. Other outcome measures were the number of dressing changes and time invested using each system. The study was terminated after a post hoc analysis after inclusion of ten patients because of the significantly better results when using V.A.C., and the substantially larger care effort needed in the Redon group compared with the V.A.C. group. An increase in surface granulation tissue of 54% was observed in the V.A.C. group, and a reduction in the Redon group (P = 0.001). The Redon group showed an increase in fibrin tissue at the wound base of 21.8%, whereas in the V.A.C group, a 27% reduction was observed (P = 0.035). Necrosis was reduced in the V.A.C. group, but this difference did not reach significance. Redon bottles are not a good alternative for V.A.C. therapy for delivering NPWT.

Behçet’s disease is a chronic, relapsing, inflammatory disorder. This case report describes how use of an improvised topical negative pressure (TNP) device in a patient with a non-healing para-ileostomal ulcer with Behçet’s disease

Objective: To discover the impact of topical negative pressure (TNP) on quality of life. Method: An exploratory prospective cohort study was conducted on 26 patients undergoing TNP. The Cardiff Wound Impact Schedule (CWIS), a wound-specific tool, was used to investigate quality-of-life scores before therapy and four weeks after therapy or at wound closure. Wound dimensions were measured at both assessments, and the values for the CWIS domains (physical symptoms, social functioning, well-being and overall quality of life) were investigated using parametric and non-parametric tests. Results: The mean duration of TNP therapy was 3.3 ± 1.7 weeks. Topical negative pressure therapy helped to achieve complete wound closure in 14 patients (54%), and there was a mean reduction in wound surface area from 52.2cm2 (range 4–150) to 26.8cm2 (0–120). While there was no significant change in quality of life in patients whose wounds healed (1 ± 11.9), the physical-functioning domain improved in obese patients (20 ± 21, p

Negative-pressure wound therapy (NPWT) plays an important role in the treatment of complex wounds. Its effect on limb salvage in the management of the diabetic foot is well described in the literature. However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers. Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.Keywords: vacuum therapy; subatmospheric pressure dressing; topical negative-pressure therapy; diabetic ulcers; wound bed preparation; amputation(Published: 1 July 2015)Citation: Diabetic Foot & Ankle 2015, 6: 27618 - http://dx.doi.org/10.3402/dfa.v6.27618

This article aims to reintroduce readers to biologically based and tissue-engineered wound management products. Indications for their use in clinical practice are suggested. It also examines two well-established wound management interventions, topical negative pressure therapy and larval therapy, which could have a positive effect on the outcome of biologically based and tissue-engineered wound management products.

Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy (TNP), is a topical treatment that uses negative pressure applied directly to the wound bed to promote healing in acute and chronic wounds.

Objective: The objective assessment of chronic wound therapies for exudate management (WRAP study) tested a variety of methods that could be used to improve understanding of dressing performance in the presence of wound exudate, including measurement of the levels of exudate production. The aim of this study was to identify a valid and reliable method of measuring wound exudate production per unit area of wound surface. Method: Two methods were tested. Method A measured the weight of exudate collected in dressings by ‘before and after’ weighing of all dressing materials that came into contact with wound exudate. Method B measured wound exudate collected as part of topical negative pressure (TNP) therapy. Results: Method A: Complete data were collected on three patients (at which point the study was halted), but it was only possible to obtain accurate measurements for two of these. Exudate production was 0.10g/cm2/24 hours and 0.21g/cm2/24 hours. It was time-consuming and required special equipment. Method B: Fifteen measurements from five patients were analysed and showed a mean exudate production of 1.3g/cm2/24 hours. Conclusion: There are problems with both methods of exudate measurement, but measuring wound fluid collected in TNP canisters seems simpler than weighing dressings and deserves further investigation. Declaration of interest: This study was part of the Wrap project and was funded by the Engineering and Physical Science Research Council.

INTRODUCTION During the last 10 years sub-atmospheric pressure dressings (Topical Negative Pressure Therapy = TNP) has become a well accepted standard therapeutic modality in the management of acute and chronic wounds. However, in the hand and the fingers TNP treatment is not as an established method as elsewhere in the body. This is mostly due to difficulties in the technique of sealing wounds near the interdigital folds, especially when the interdigital folds are affected themselves. MATERIALS AND METHODS Over a period of 36 months we treated 9 extensive open wounds of the hand with the TNP dressing procedure. To optimize the effective sealing procedure several methods of closure were applied: sterile vinyl gloves, split V.A.C. gel-straps and the "Sandwich"-principle. RESULTS In all cases we were able to achieve a tight vacuum sealing with the use of our vinyl or latex free surgical glove as an aid to cover the interdigital spaces. There was a rapid and complete remission of the symptoms in terms of edema, redness, tenderness and range of motion. The indication spectrum encompassed infection control, temporary coverage of exposed bone or tendons, intermittent irrigation with local antiseptics as well as wound preconditioning before skin grafting or flap coverage. For the definite closure or coverage a second operation was necessary in all cases. CONCLUSIONS The TNP-dressing can be securely achieved even in wounds encompassing the interdigital folds or adjacent to the in digital spaces with a modified surgical gloving technique to aid the standard sealing foil. It is a suitable principle for the management of severe hand infections with a reduction of clinical symptoms, reduction of the frequency of dressing changes compared to open approaches and a significant amelioration in the quality of life both for patients and health care personnel.

症例は63歳,男性.背部の激しい疼痛を主訴に当院へ搬送された.著明な局所炎症所見,血液生化学検査結果, CT所見,切開時に認めた筋膜を含む皮下組織の広範な壊死像などから壊死性筋膜炎と診断した.未治療の糖尿病,高齢,体幹部を発症とすることなど重症化する要因を備えていたが,早期の広範囲デブリードマンによって救命できた.術後は背部に深いポケットを伴う皮膚欠損が生じたため,局所陰圧療法を行った.大きなポケットは完全に閉鎖され,わずかな植皮のみで皮膚欠損を再建できた. 本症は早期診断,早期デブリードマンによって救命した後も,ポケットを伴う広範な皮膚欠損の創管理,再建に難渋することが多い.術後は開放創として管理することが原則となっているが,急性炎症期を乗り切った後は,局所陰圧療法によって閉鎖創として管理することも有用と思われた.

Background: Topical negative-pressure therapy is a widely used wound management system that generates a negative pressure at the wound surface through a foam pad, which aids in wound stimulation through mechanical forces on the wound bed. System guidelines state that the foam dressing should be placed in direct apposition with the wound surface; however, an interface dressing is often inserted at this point to promote comfort at dressing changes. Methods: Topical negative-pressure dressings were applied tb 40 healthy volunteers. Pressures at the skin surface under the dressing were recorded and compared with those measured by a topical negative-pressure machine using the Therapeutic Regulated Accurate Care pad system. These were repeated, inserting different types of interface dressings: petroleum jelly (Vaseline)-impregnated gauze, nonadherent silicone dressing, and mylar polyester film dressing. Results: Pressures recorded at the skin interface with no interface dressing were dose to those set on the topical negative-pressure machine (mean pressure change, -5.11 ± 0.55 mmHg). Interposition of dressings at the skin/ foam interface affected pressure transmission through the foam, and some caused significant decreases in pressures recorded at the skin surface (e.g., Vaseline-impregnated gauze: mean pressure change, -11.76 mmHg; maximum pressure change, -41 mmHg). Conclusion: The loss in negative pressure means that pressures designated by the machine cannot be relied on as a measure of wound pressure when certain dressings are used at the interface. This could be important in determining the outcome of some wounds under topical negative-pressure therapy treatment.

Topical negative pressure has been demonstrated to improve graft take in a number of noncomparative studies. This study aimed to assess whether split-thickness skin graft take is improved qualitatively or quantitatively with topical negative pressure therapy compared with standard bolster dressings. A blinded, prospective, randomized trial was conducted of 22 adult inpatients of Liverpool Hospital between July of 2001 and July of 2002 who had wounds requiring skin grafting. After grafting, each wound half was randomized to receive either a standard bolster dressing or a topical negative pressure dressing. Skin graft assessment was performed at 2 weeks by a single observer blinded to the randomization. Two patients were lost to follow-up and were excluded from the study. There were 20 patients (12 men and eightwomen) in the study group. The median patient age was 64 years (range, 27 to 88 years), and the mean wound size was 128 cm2 (range, 35 to 450 cm2). The wound exposed subcutaneous fat in eight patients, muscle in six patients, paratenon in four patients, and deep fascia in two patients. At 2 weeks, wounds that received a topical negative pressure dressing had a greater degree of epithelialization in six cases (30 percent), the same degree of epithelialization in nine cases (45 percent), and less epithelialization in five cases (25 percent) compared with their respective control wounds. Graft quality following topical negative pressure therapy was subjectively determined to be better in 10 cases (50 percent), equivalent in seven cases (35 percent), and worse in three cases (15 percent). Although the quantitative graft take was not significant, the qualitative graft take was found to be significantly better with the use of topical negative pressure therapy (p < 0.05). Topical negative pressure significantly improved the qualitative appearance of split-thickness skin grafts as compared with standard bolster dressings.

Background Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. Methods Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. Results The fat survival rate of the experimental group (75.4%±3.9%) was higher than that of the control group (53.1%±4.3%) (P Conclusions Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

Tophaceous gout complicated by septic arthritis presents a management dilemma which can often require multiple surgical debridements. There is little published in the literature regarding treatment of these concomitant conditions. We postulate that biofilm may play a role increasing the difficulty of sterilising a tophaceous joint. The use of topical negative pressure therapy that targets biofilm has been well established for a range of wounds. A new device that incorporates both intermittent negative pressure therapy and wound irrigation was introduced in 2012. This case report describes the use of this topical negative device with the instillation option in the management of severe septic arthritis with concomitant gout and suggests directions for further research.

1. Gregor S, Maegele M, Saurland S, Krahn JF, Peinemann F, Lange S.Negative pressure wound therapy: a vacuum of evidence? Arch Surg.2008;143(2):189e196.2. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematicreview of topical negative pressure therapy for acute and chronicwounds. Br J Surg. 2008;95(6):685e692.3. Brown KM, Harper FV, Aston WJ, O’Keefe PA, Cameron CR.Vacuum-assisted closure in the treatment of a 9-year-old child withsevere and multiple dog bite injuries of the thorax. Ann Thorac Surg.2001;72(4):1409e1410.4. Durai R, Mownah A, Ng PC. Bridge vacuum-assisted closure: a noveltechnique of using a single vacuum machine for multiple adjacentwounds. Int J Clin Pract. 2010;64(1):93e94.

A review of the development and use of sub-atmospheric pressures in the management of patients with different types of wound

The surgical management of congenital naevi is a difficult problem for the reconstructive surgeon. We present a technique where accurate perforations made in the outer silicone layer of Integra® using a punch-biopsy forceps, in combination with topical negative pressure therapy, reduces revascularisation time of the dermal substitute with a favourable outcome.

This case report discusses the use of topical negative pressure therapy on a suture line infected with methicillin-resistant Staphylococcus aureus in a patient with diabetes who had undergone a femoropopliteal bypass using an artifi cial graft

Implanted prosthetic materials such as polypropylene (Prolene) and polyester mesh are routinely used in surgical abdominal hernia repair. These materials provide strength, permit tension-free repair and are associated with lower rates of hernia recurrence than when open suture techniques are used. However, complications include

A series of basic animal studies using a new subatmospheric pressure technique (The V.A.C.) to expedite wound healing are presented. The technique entails placing an open-cell foam into the wound, sealing the site with an adhesive drape, and applying subatmospheric pressure (125 mmHg below ambient) that is transmitted to the wound in a controlled manner. Utilizing a pig model, four studies were undertaken to determine the effect of subatmospheric pressure on laser Doppler-measured blood flow in the wound and adjacent tissue (N = 5), rate of granulation tissue formation (N = 10), clearance of bacteria from infected wounds (N = 5), and measurement of nutrient flow by random-pattern flap survival (N = 5). Blood flow levels increased fourfold when 125 mmHg subatmospheric pressure was applied. Significantly increased rates of granulation tissue formation (por = 0.05) occurred with both continuous (63.3 +/- 26.1%) and intermittent (103% +/- 35.3%) application. Tissue bacterial counts significantly decreased (por = 0.05) after 4 days of application. Random-pattern flap survival significantly increased (por = 0.05) by 21% compared to controls. We determined that the application of controlled subatmospheric pressure creates an environment that promotes would healing.

To the Editor:Vascular involvements including skin ulcers, gangrenes and fissures are frequently seen in patients with systemic sclerosis (SSc). Because they tend to be unresponsive to medical mana...

The authors present the case of a 23-year-old paratrooper who was admitted to intensive therapy unit with florid meningococcal septicemia. Being young, fit, and well, he survived this acute episode with supportive therapy, antibiotics, and inotropes. He made a good recovery and was left with multiple wounds all over his body predominantly on the extensor aspects of his upper and lower limbs and torso.

Combining silver-based dressings with negative pressure therapy after radical excision of chronically infected breast disease is a novel application of two technologies. One patient with complex, chronic, infected breast disease underwent radical excision of the affected area and was treated early with a combination of silver-based dressings and topical negative pressure therapy. The wound was then assessed sequentially using clinical measurements of wound area and depth, pain severity scores and level of exudation. It is possible to combine accepted techniques with modern dressing technologies that result in a positive outcome. In this case, the combination of a silver-based dressing with negative pressure therapy following radical excision proved safe and was well tolerated by the patient. Full epithelisation of the wound was achieved and there was no recurrence of the infection for the duration of the treatment.

Tissue engineering research has demonstrated the potential of a variety of different matrix materials to enable cell adhesion, diffusion of nutrients, vascular ingrowth, nutrition and growth promotion. Therefore it appears attractive to apply these features also to topical negative pressure therapy. The article discusses several aspects of foam materials and their possible interactions with the wound surface.

We describe 2 cases of children with malignant disease who developed severe mucositis with perineal necrotizing fasciitis during severe neutropenia after chemotherapy. Treatment with topical negative pressure therapy with silver foam dressing, together with large spectrum antibiotics, resolved the problem with complete closure of the wound after 30 and 36 days of treatment, respectively.