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

Instillation-TIME (iTIME) as a rationale amendment for TIME conception. Is there enough evidence for the efficiency of negative pressure wound therapy with instillation (iNPWT) to announce a breakthrough idea for wound treatment?

An increased number of patients developing difficult-to-heal wounds results in billions spending for chronic wound care management. Introduction of TIME conception has been a breakthrough idea for wound healing based on phase-adapted wound therapy that interacts and influence each other and included: T – tissue management, I - infection control, M - moisture balance, E - edge of the wound. Negative pressure wound therapy (NPWT) revolutionized the management of wound healing. Moreover, recently NPWT with instillation (iNPWT) has gained the popularity of optimizing wound healing. In the context of acceleration of wound healing, iNPWT meets the criteria of the TIME conception. All individual components of TIME strategy are found in iNPWT providing “all in one” conception. Such management is easy to apply, monitor and it is well- tolerated by patients. Based on the current studies, iNPWT is found to be an important alternative for other methods of wound healing. It is believed that iNPWT will evolve and gain popularity as an innovative treatment for TIME conception

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

Late Band Migration After SAGB. Case Report

Obesity, a major public health issue of the 21st century, is increasingly common in adults and children. No good results of pharmacological treatment of obesity results in rapid development of bariatric surgery, which treats obesity and comorbidities associated. There are many surgical options for treating obesity. Options for surgical management of morbid obesity include restrictive (adjustable gastric banding, vertical band gastroplasty), restrictive/resective (sleeve gastrectomy), restrictive/malabsorptive (Rouxen-Y gastric by-pass, biliopancreatic diversion with duodenal switch) and purely malabsorptive procedures (duodenal switch). Among them, swedish adjustable gastric banding (SAGB) or laparoscopic adjustable gastric banding (LAGB) have been more frequently performed. SAGB is considered to be safe and effective method of weight loss and elimination of diseases associated with obesity. Laparoscopic gastric banding offers the advantages of minimally invasive surgery, adjustability, and reversibility. Despite fewer number of complications than other bariatric operations, patients after SAGB may have unique complications that are characteristic of the SAGB and require special management and treatment. This paper presents a rare case of complete migration of the band into the gastric lumen

Health-related quality of life assessment among patients with inflammatory bowel diseases after surgery – review

Aim of the work was to review systematically the published literature addressing whether quality of life (QoL) and health-related QoL (HRQoL) are influenced by surgery among patients with inflammatory bowel disease (IBD). Electronic databases and published articles were searched to identify relevant studies published in the years 1990–2015. Then, a multistep selection was undertaken to identify articles that met specific selection criteria, such us specific key-words (IBD, HRQoL, ulcerative colitis (UC), Crohn’s disease (CD), and surgery), and the population was assessed (studies concerning patients < 18 years old were excluded). The review included 27 studies that were evaluated in the context of the influence of surgery on QoL and HRQoL. Concluding, with the increase in the incidence of IBD, monitoring of QoL is an important indicator of the health effects at each stage of the surgical treatment

A novel model of acellular dermal matrix plug for anal fistula treatment. Report of a case and surgical consideration based on first utility in Poland

Anal fistula (AF) is a pathological connection between anus and skin in its surroundings. The main reason for the formation of anal fistula is a bacterial infection of the glands within the anal crypts. One of the modern techniques for the treatment of fistulas that do not interfere with the sphincters consists in implantation of a plug made from collagen material. We are presenting the first Polish experience with a new model of biomaterial plug for the treatment of anal fistula. We also point out key elements of the procedure (both preoperative and intraoperative) associated with this method. In the authors’ opinion, the method is simple, safe and reproducible. Innovative shape of the plug minimizes the risk of its migration and rotation. It also perfectly blends with and adapts to the course and shape of the fistula canal, allowing it to become incorporated and overgrown with tissue in the fistula canal. The relatively short operation time, minor postoperative pain and faster convalescence are with no doubt additional advantages of the method. Long-term observation involving more patients is essential for evaluation of the efficacy of the treatment of fistulas with the new type of plug

Checklist in colorectal surgery – proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery

A checklist is a collection of information that helps reduce the risk of failure due to limitations in human memory and attention. In surgery, the first Surgical Safety Checklist (SSC), created under the supervision of WHO (World Health Organization), was established in 2007 and covers three stages related to the patient's stay in the operating theater and operation: 1. Prior to initiation (induction) of anesthesia; 2. before cutting the skin; 3. before the patient leaves the operating room Colorectal surgery is particularly at high risk for complications and relatively high mortality. Elimination or, more likely, reducing the risk of complications by standardizing perioperative procedures may be particularly important in this group. The introduction of "dedicated" colorectal checklist surgery seems to be justified. The checklist proposed by the authors in colorectal surgery is divided into four stages, in which conscientious completion of checklists is intended to reduce the potential risk of complications due to hospitalization and surgical treatment. The presented checklist is obviously not closed, as a new publications or recommendations appear, some points may be modified, new issues may be added to the checklist. At present, however, it is a tool considering the well-known and confirmed elements of intraoperative procedures, the compliance of which may significantly reduce the rate of adverse events or surgical complications

Zastosowanie nowego modelu zatyczki z bezkomórkowej macierzy skórnej w leczeniu przetok odbytu. Opis przypadku oraz spostrzeżenia własne na podstawie pierwszego zastosowania w Polsce

Przetoka odbytu (anal fistula, AF) jest patologicznym połączeniem odbytu i skóry okolicy odbytu. Główną przyczyną tworzenia się przetok odbytu jest infekcja bakteryjna gruczołów w obrębie krypt odbytowych. Jedną z nowoczesnych technik leczenia przetok nieingerujących w aparat zwieraczowy jest implantacja materiału kolagenowego w formie zatyczek. Poniżej przedstawiamy pierwsze polskie doświadczenia z nowym modelem zatyczki biomateriałowej stosowanym w leczeniu przetok odbytu oraz wskazujemy na kluczowe elementy postępowania przed- i śródoperacyjnego związanego z zastosowaniem tej metody. W opinii autorów metoda jest prosta, bezpieczna i powtarzalna. Nowatorska organizacja przestrzenna materiału minimalizuje ryzyko migracji i rotacji zatyczki oraz idealnie wkomponowuje się i dopasowuje do przebiegu i kształtu kanału przetoki, umożliwiając jej inkorporowanie i przerastanie przez tkanki kanału przetoki. Relatywnie krótki czas operacji, niewielkie pooperacyjne dolegliwości bólowe i szybsza rekonwalescencja są niewątpliwie dodatkowymi zaletami metody. W celu oszacowania skuteczności leczenia przetok z zastosowaniem nowego typu zatyczki kluczowa jest długoterminowa obserwacja obejmująca większą ilość pacjentów

Lista kontrolna w chirurgii kolorektalnej : propozycja ekspertów Polskiego Klubu Koloproktologii oraz Konsultanta Krajowego w chirurgii ogólnej

Lista kontrolna (z ang. checklist) to zbiór informacji pomagających zmniejszyć ryzyko wystąpienia niepowodzenia wynikające z ograniczeń ludzkiej pamięci i uwagi. W chirurgii pierwsza edycja checklisty (SSC z ang. Surgical Safety Checklist) powstałej pod nadzorem WHO (Światowa Organizacja Zdrowia z ang. World Health Organization) powstała w 2007 roku i obejmuje trzy etapy związane z pobytem pacjenta na sali operacyjnej i samej operacji: 1. przed rozpoczęciem (indukcją) znieczulenia; 2. przed nacięciem skóry; 3. przed opuszczeniem przez pacjenta sali operacyjnej Chirurgia kolorektalna jest szczególnie obciążona dużym ryzykiem powikłań i relatywnie wysokim odsetkiem śmiertelności. Eliminacja lub, co bardziej prawdopodobne, zmniejszenie ryzyka powikłań poprzez wystandaryzowanie procedur okołooperacyjnych może być szczególnie istotna w tej grupie. Wprowadzenie “dedykowanych” chirurgii kolorektalnej checklist wydaje się być jak najbardziej uzasadnione. Proponowana przez autorów checklista w chirurgii kolorektalnej podzielona jest na cztery etapy, podczas których sumienne wypełnianie list kontrolnych ma zmniejszyć potencjalne ryzyko związane z hospitalizacją i leczeniem operacyjnym pacjentów. Prezentowana checklista nie ma oczywiście charakteru zamkniętego, w miarę pojawiania się nowych publikacji czy rekomendacji pewne punkty mogą ulegać modyfikacjom, nowe zagadnienia mogą uzupełniać checklistę. Na chwilę obecną jest ona jednak narzędziem biorącym pod uwagę znane i potwierdzone elementy postępowania śródoperacyjnego, których przestrzeganie może znacząco zmniejszyć odsetek zdarzeń niepożądanych czy powikłań chirurgicznych.A checklist is a collection of information that helps reduce the risk of failure due to limitations in human memory and attention. In surgery, the first Surgical Safety Checklist (SSC), created under the supervision of WHO (World Health Organization), was established in 2007 and covers three stages related to the patient's stay in the operating theater and operation: 1. Prior to initiation (induction) of anesthesia; 2. before cutting the skin; 3. before the patient leaves the operating room Colorectal surgery is particularly at high risk for complications and relatively high mortality. Elimination or, more likely, reducing the risk of complications by standardizing perioperative procedures may be particularly important in this group. The introduction of "dedicated" colorectal checklist surgery seems to be justified. The checklist proposed by the authors in colorectal surgery is divided into four stages, in which conscientious completion of checklists is intended to reduce the potential risk of complications due to hospitalization and surgical treatment. The presented checklist is obviously not closed, as a new publications or recommendations appear, some points may be modified, new issues may be added to the checklist. At present, however, it is a tool considering the well-known and confirmed elements of intraoperative procedures, the compliance of which may significantly reduce the rate of adverse events or surgical complications

Instillation-TIME (iTIME) as a rationale amendment for TIME conception. Is there enough evidence for the efficiency of negative pressure wound therapy with instillation (iNPWT) to announce a breakthrough idea for wound treatment?

An increased number of patients developing difficult-to-heal wounds results in billions spending for chronic wound care management. Introduction of TIME conception has been a breakthrough idea for wound healing based on phase-adapted wound therapy that interacts and influence each other and included: T – tissue management, I - infection control, M - moisture balance, E - edge of the wound. Negative pressure wound therapy (NPWT) revolutionized the management of wound healing. Moreover, recently NPWT with instillation (iNPWT) has gained the popularity of optimizing wound healing. In the context of acceleration of wound healing, iNPWT meets the criteria of the TIME conception. All individual components of TIME strategy are found in iNPWT providing “all in one” conception. Such management is easy to apply, monitor and it is well- tolerated by patients. Based on the current studies, iNPWT is found to be an important alternative for other methods of wound healing. It is believed that iNPWT will evolve and gain popularity as an innovative treatment for TIME conception