The use of a gentamicin-collagen sponge (Garamycin sponge) with NPWT for the treatment of difficult wounds in patients with Chron's disease. A case series

Negative pressure wound therapy (NPWT) is extremely important in the treatment of difficult wounds in patients with proctological diseases, including patients with Crohn's colitis. Despite the many advantages of this therapy, it has some limitations, including the lack of bactericidal activity. Hence, NPWT is combined with antibacterial products. One of them is the gentamicin-collagen sponge, presented in the three cases described below. The combination of the gentamicin-collagen sponge with NPWT may be beneficial in difficult wounds with a high risk of infection, and also in patients with impaired wound healing

Impact of negative pressure wound therapy and nanocrystalline silver dressings on the quality of life of patients with chronic non-healing ulcers: a preliminary study

Therapeutic measures should be primarily directed to promote healing, but also to improve or at least to maintain HRQoL. This prospective randomized pilot study was conducted to assess the impact on HRQoL of negative pressure wound therapy (NPWT) combined with nanocrystalline silver dressings in outpatients with chronic nonhealing ulcers. A total of 17 patients were included in the study, 10 of which were treated with the combined method and 7 with NPWT only. Patients were followed for 6 weeks. The 36-item short-form (SF-36) questionnaire was administered to at baseline and at the end of treatment. Patients included in the study had multiple concomitant pathological conditions and a mean age of 70 years. Significant changes in different domains of the SF-36 questionnaire, including physical functioning, role limitations (physical), vitality, mental health, social functioning, bodily pain, and general health, before and after treatment were not found. The mean (standard deviation, SD) score of social functioning was 53.1 (31.8) before treatment and 66.3 (23.6) after treatment (P = 0.09). The application of NPWT with nanocrystalline silver dressings or NPWT alone for 6 weeks was effective in wound healing promotion. The impact on HRQoL was non-significant except for somewhat better benefits in the social domain in patients treated with NPWT and silver dressings. The present preliminary data could be the basis for the design of future, more robust clinical studies

Negative Pressure Wound Therapy applied to a cholecystoparietal fistula: How to treat a rare complication of a common condition - a case report

A cholecystoparietal fistula is an uncommon complication of gallstone disease as a result of neglected gallbladder disease).The subcutaneous abdominal wall abscess, derived from this condition, might be wide and hard to treat, especially in elderly and debilitated patients. The best management of cholecystoparietal fistula depends on its etiology and may require medical, surgical, or endoscopic treatment. Negative Pressure Wound Therapy (NPWT) is a valuable support therapy that can improve the prognosis of the disease and the patient’s outcome. We report the case of an 89-year-old female patient affected by a spontaneous cholecystoparietal fistula with a wide abdominal wall abscess treated by a one-stage surgical approach combined with NPWT over the resulting skin loss

Management of distal radius fractures using closed-incision negative pressure wound therapy. Retrospective study.

Abstract— Background: Negative pressure wound therapyhas proven to be an ecient tool in the provision of temporarywound coverage in cases where definitive primary woundcoverage is impossible. This initial achievement led to the useof NPWT as an incisional dressing in wounds that could beprimarily closed, but posing high risk due to the amount ofsoft-tissue injury, location of the fracture, or high BMI.Distal radius fracture is one of the most common injuries,especially in elderly patients. Typically, fractures occur in theosteoporotic bone as a result of low-energy trauma. Conservativetreatment is still dominant in the management of distalradius fractures. In general, displaced unstable fractures orfractures that fail conservative treatment are indicated forsurgical therapy. In our study, we present ten-year-experienceof distal radius fracture management at our department.Methods: Detailed analysis of retrospective data obtainedfrom the hospital information system was carried out. Thestudy included patients operated on at our department fromJanuary 1, 2010, to December 31, 2019. We evaluated age,gender, surgical approach, complications, and implant removal.Results: in total, 207 patients were evaluated, women tomen ratio was 2:1 (144:63 cases). The mean age was 56 years(women 62 years, men 45 years). Volar surgical approach withvolar locking plate osteosynthesis predominated (199 cases). Thecomplication rate was 10% with implant-associated complicationsbeing the most common (3.7%). The implant removal ratewas 17%. No surgical site infection (SSI) was detected. Closedincision negative pressure therapy (ciNPT) was applied in highriskwounds.Conclusion: Volar locking plate osteosynthesis is a methodof choice with a low complication rate. Implant removal is notroutinely indicated. Preventive application of ciNPT is beneficialin high-risk wounds, but diagnosis of fracture of the distalforearm according to the occurrence in our analysis is notessential for preventive use of NPWT, since the incidence ofwound infection, in high-risk patients, is extremely low

Deferred anastomosis in severe secondary peritonitis using a temporary intestinal shunt – case report

Introduction: As part of the damage control surgery concept applied to the treatment of sepsis due to severe secondary peritonitis following intestinal perforation and/or in high-risk patients we describe the novel "temporary intestinal shunt" (TIS) technique with delayed intestinal anastomosis, as an alternative to primary anastomosis or enterostomy. Material and Methods: We present three patients in whom urgent laparotomy was performed due to intestinal perforation, with intestinal resection and TIS. Case reports:Case 1: A 39-year-old male presented with acute myeloid leukemia M3 and generalized peritonitis, sigmoid colon perforation and secondary jejunal loop involvement. In view of these findings, we performed 10 cm jejunal resection with TIS placement, sigmoid colon resection, and negative pressure therapy (NPT). Reoperation after 48 hours showed no evidence of peritonitis, so a manual jejuno-jejunal anastomosis and terminal colostomy were performed. Case 2: A 65-year-old woman treated with corticosteroids presented with a pneumoperitoneum secondary to a road traffic accident. Urgent laparotomy revealed a 2 cm jejunal perforation. Resection of the jejunal segment and TIS with NPT was performed. Exploration of the peritoneal cavity 96 hours later showed clinical improvement and a jejuno-ileal anastomosis was performed. Case 3: A 73-year-old male was admitted due to intestinal subocclusion. Clinical deterioration occurred rapidly and we performed an urgent laparotomy diagnosing jejunal perforation secondary to torsion and ischemia of the affected loop, and generalized peritonitis. Intestinal resection and TIS with NPT placement were thus decided. Anastomosis and closure of the abdominal appendage were deferred until 96 hours after the first surgery. Conclusion: Although the evidence we present is limited, we believe TIS to be an additional tool in damage control surgery. This staged management strategy allows definitive reconstruction with the patient in a more favorable physiological condition

Use of ciNPWT in cardiac surgery: single center observational study

Surgical site infections and complications (SSI, SSC) are relatively rare but potentially devastating events; particularly in cardiac surgery because of the importance of the structures involved. In accordance with the main international guidelines, that recommend the use of negative pressure therapy in closed surgical wounds (ciNPWT) in high-risk patients, we selected a group of 112 patients at high risk of developing surgical site complications, presenting in the clinic from January 2018 to December 2019. We applied 165 single-use negative pressure dressings in our cohort and kept them for seven days ($\pm$ 1). All the wounds were closed by primary intention without edema or hematoma. Three cases of postoperative bleeding required us to pause the negative pressure therapy. After discharge, five patients at particularly high risk developed sternal wound dehiscence. In conclusion, the use of ciNPWT, applied following a dedicated algorithm, gave good results in the prevention of SSI or SSC. Some limitations in the results are determined by the specific requirements of cardiac surgery

Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group

Recent SARS-CoV-2 pandemic leading to a rapidly increasing number of hospitalizations enforced reevaluation of wound management strategies. The optimal treatment strategy for patients with chronic wounds and those recovering from emergency and urgent oncological surgery should aim to minimize the number of hospital admissions, as well as the number of surgical procedures and decrease the length of stay to disburden the hospital staff and to minimize viral infection risk. One of the potential solutions that could help to achieve these goals may be the extensive and early use of NPWT devices in the prevention of wound healing complications. Single-use NPWT devices are helpful in outpatient wound treatment and SSI prevention (ciNPWT) allowing to minimize in-person visits to the health care center while still providing the best possible wound-care. Stationary NPWT should be used in deep SSI and perioperative wound healing disorders as soon as possible. Patient’s education and telemedical support with visual wound healing monitoring and video conversations have the potential to minimize the number of unnecessary in-person visits in patients with wounds and therefore substantially increase the level of care

Severe deep neck infections successfully treated with negative pressure wound therapy with instillation - a case report

Background: Deep neck infection (DNI) is a life-threatening complication associated with significant mortality and morbidity rates. The most common causes of DNI are the tonsilitis, dentitis, salivary glands inflammation, malignancies, and foreign bodies. As a result of neck infection, patients are at high risk of potential secondary complications which include: descending mediastinitis, pleural empyema, septicemia, jugular vein thrombosis, pericarditis. We presented a case of successful management of DNI with the utility of negative pressure wound therapy with instillation (iNPWT). Method: A 37-year-old male with deep neck infection due to dentitis was qualified for iNPWT. Due to previous incisions and drainage of the neck abscesses, some undermined wounds drained towards each other’s were revealed with an excessive amount of purulent content. Standard NPWT dressing was placed and polyurethane foam was covered with contact layer dressing. Additionally, an inflow drain was placed within one of the wounds in regard to instill an antimicrobial solution. The wound was instilled four times daily. Results: The patient underwent a total of eight iNWPT sessions. Locally, a reduction in purulent content was achieved with a decrease of wounds’ dimensions and improvement of wound bed granulation. Moreover, improvement of the patient’s general condition and decrease of inflammatory markers was achieved. Conclusions: iNPWT may play an important role in the management of combined, complicated wounds due to DNI. The instilled antimicrobial solution facilitates dissolving and removing of the purulent content that impairs the wound healing

Novel, self-made and cost-ective technique for closed-incision negative pressure wound therapy

Background: It has been suggested that applying the negative pressure wound therapy (NPWT) to a closedsurgical incision may hasten the healing of the incision and decrease the incidence of wound healing complications. The goal of this study is to present the new idea of a simple, self-made, low-cost wound vacuum dressing for closed-incision NPWT that may become an alternative to currently manufactured medicalindustry products.Method: We designed a simple dressing for closed-incision NPWT from gauze pads, polyurethane adhesive film, stoma paste, and a drain tube. Negative pressure was created using a standard 50 ml syringe connected to the drain. First, the dressing was applied to the wound model and on the healthy volunteer. Finally, the dressing was applied to 10 patients after low anterior rectal resection. The vacuum dressing was left in place for 3 days, then changed and placed once more for the next 3 days.Results: We did not observe any adverse effects associatedwith the dressing. All postoperative wounds healed properly. 18 out of 20 dressings were still air-tight 72h post-placement.Conclusions: This simple, self-made dressing for NPWT is safe and effective and may decrease the wound infection rate. However future studies are needed to confirm that hypothesis

Negative pressure wound therapy as a „bridge” for the final reconstruction of tissue defect following a degloving injury of the forearm – a case report

Degloving injuries are traumatic avulsions usually resulting in large areas of soft tissue defects. The injury involves separation of skin and subcutaneous tissue from fascia and muscles. The complex nature of these injuries requires a patient-oriented multidisciplinary surgical approach and a wide variety of therapeutic options. Negative pressure wound therapy can be of benefit at every stage of the long-lasting treatment. In this paper, we present a case of a 29-year-old male after an occupational accident with a conveyor belt leading to a degloving injury of the right forearm treated in the Department of Plastic Surgery of the Medical University in Gdańsk. The use of NPWT, hyperbaric oxygen therapy, dermal regeneration templates, skin grafting, and early rehabilitation resulted in an excellent functional and aesthetic outcome