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

A simple and low-cost technique of creating a Negative Pressure Wound Therapy (NPWT) machine on the example of a severe phlegmon of lower limb in lower socio-economic area.

The Negative Pressure Wound Therapy (NPWT) is an approved method of healing lower extremity ulcers of various origin, accelerating the wound closure process, thus decreasing the hospital-stay time and lowering the cost of the treatment. Although it is scarcely needed in developing countries such as Kenya, there is a lack of official supplier of the NPWT equipment. We present an improvised method of constructing a reliable and effective NPWT dressing form widely available tools in a case of treating a post-traumatic phlegmon in a HIV-positive patient

Negative pressure wound therapy of an anal cancer to facilitate further treatment – case report.

A common treatment of bad healing wounds is vacuum assisted therapy (negative pressure wound therapy). The main clinical goal are: reduced time of wound healing, decreasing frequency of septic complications, and better functional and cosmetic effect. One of the main contraidications include a malignant process in the patient, however, it is reported that in some cases it has achieved possitive results. 68 years-old man was admitted to the hospital due to resection of giant anal cancer. Because of severe problems with passing stool, size of the lesions, sphincter infiltration and full dysfunction, according to the patient’s acceptation abdominoperineal rectal resection with end colostomy was performed. An open, non-healed wound was a contraindication for radiotherapy – the most advisable type of treatment in advanced anal cancer. Despite of potential malignancy in the wound, because the non-healed wound delaying the radiotherapy the negative pressure wound therapy was introduced to improve healing, close the wound and enable radiotherapy. Potential benefits and risks of npwt treatment should always be considered. In some selected cases of oncologic patients after the surgery npwt can be considered, especially when our treatment is used in palliative management or even when the proliferation of neoplastic tissues does not affect the duration of life (paliative treatment, morbidity, old age etc.)   &nbsp

New perspectives in the treatment of hard-to-heal wounds

Hard-to-heal wounds continue to be a challenge in the everyday surgical practice. Their treatment is time-consuming, expensive and in many cases requires interdisciplinary assessment. Therapy option include properly selected surgical procedures and dressings combined with systemic antibiotherapy. Application of  vacuum assisted closure (VAC) facilitates the evacuation of pathological discharge, reduces tissue oedema and eliminates bacterial biofilm. Complementary administration of antibiotics to control chronic infection relies today in most cases on vancomycin, ciprofloxacin or piperacillin with tazobactam, with good clinical effect. An alternative to antibiotics against MRSA, administered at hospitals might be dalbavancin, a new generation lipoglycopeptide, which belongs to the same class as vancomycin. Introduction of dalbavancin and VAC might be an alternative to traditional methods of therapy

The role of negative pressure wound therapy in the treatment of pilonidal disease

Pilonidal disease is a particularly difficult disorderto treat. Guidelines and recommendations for the treatment ofpilonidal disease neglect the use of negative pressure woundtherapy (NPWT), but studies strongly support the role of NPWTin preventing surgical site infection in high-risk patients.During a webinar on the pilonidal disease, we asked 51participants to complete a questionnaire about the treatmentof pilonidal disease. They answered questions about treatmentpractices for patients with a pilonidal disease, and the use ofNPWT.The study showed that a relatively large number of surgeonsuse NPWT to treat patients with the pilonidal disease. Themajority of them are satisfied with maintaining the tightnessand effectiveness of a vacuum dressing and would use thesingle-use NPWT systems if they were more easily available andaffordable. It seems that the NPWT in the pilonidal disease isincreasingly used and this method is gaining popularity amongpractitioners

Improvement of Therapy Outcomes after Negative Pressure Wound Therapy in a Patient with Acne inversa.

Treatment of acne inversa (also known as hidradenitis suppurativa) is complicated and chronic. This debilitating, inflammatory disease of the follicular sacks affects mostly young adults and has a strong negative impact on their quality of life. We present a case of a 28 year old woman with a history of acneinversa of Hurley grade 2 for 6 years. Patient underwent surgical excision of the skin of the left inguinum followed by negative pressure therapy dressings for 2 and a half weeks (5 dressing changes). This allowed a full closure of the wound after 12 weeks and formation of a well accepted scar. Patient’s paindecreased from 4.5 to 1.5 according to visual assessment scale. We also noted a 28 point decrease in disease severity score according to Sartorius scale and a 19 point decrease in Dermatology Life Quality Index. Two years prior admission patient had undergone surgical treatment of her right inguinum with split thickness skin grafting, which healed for 26 weeks and yielded less satisfactory results. Comparison photographs of both treatment results are presented

Trace elements and rat pouchitis

The procedure of restorative proctocolectomy is associated with a complete removal of the colon and slight reduction of ileum length, which together can lead to systemic shortages of trace elements. Inflammatory changes in the pouch mucosa may also have some impact. However, there is no data on trace elements in pouchitis. Therefore, in the present study we aimed to assess the effect of acute pouchitis on the status of selected trace elements in rats. Restorative proctocolectomy with the construction of intestinal J-pouch was performed in twenty-four Wistar rats. Three weeks after the surgery, pouchitis was induced. Eight untreated rats created the control group. Liver concentrations of selected micronutrients (Zn, Cu, Co, Mn, Se) were measured in both groups six weeks later, using inductively coupled plasma mass spectrometry. Liver concentrations of trace elements did not differ between the study and the control groups. However, copper, cobalt and selenium concentrations [μg/g] were statistically lower (p<0.02, p<0.05 and p<0.04, respectively) in rats with severe pouchitis (n=9) as compared with rats with mild pouchitis (n=7) [median (range): Cu - 7.05 (3.02-14.57) vs 10.47 (5.16-14.97); Co - 0.55 (0.37-0.96) vs 0.61 (0.52-0.86); Se - 1.17 (0.69-1.54) vs 1.18 (0.29-1.91)]. In conclusion, it seems that acute pouchitis can lead to a significant deficiency of trace elements

Single-use NPWT device with telemedical wound monitoring in the treatment of acne inversa in a pregnant patient – case report

Acne inversa (AI) is a chronic inflammatory skindisease significantly impacting the patient’s quality of life.Management guidelines for acne inversa during pregnancy donot exist. We decided to use a single-use negative pressurewound therapy (PICO, Smith &amp; Nephew) while managing apregnant patient with AI. Negative pressure wound therapy(NPWT) seemed to improve the patient’s condition, managingthe exudation, reducing edema, and improving local regeneration,as well as epithelialization. The method was also absolutelysafe for the fetus and feasible to conduct in the outpatientdepartment - what was of utmost importance for the patient.The telemedical monitoring of wound healing using mobiletechnologies seems to be gaining importance for patients andmedical practitioners. In the described case, we used the iWound(Polmedi, Poland) application in an outpatient setting