Negative Pressure Wound Therapy Versus Conventional Wound Care In Cancer Surgical Wounds: A Meta-Analysis Of Observational Studies And Randomised Controlled Trials

Abstract The application of negative pressure wound therapy (NPWT) in cancer surgical wounds is still controversial, despite its promising usage, because of the risks of increased tumorigenesis and metastasis. This study aimed to review the risks and benefits of NPWT in surgical wounds with the underlying malignant disease compared with conventional wound care (CWC). The first outcome was wound complications, divided into surgical site infection (SSI), seroma, hematoma, and wound dehiscence. The secondary outcome was hospital readmission. We performed a separate meta-analysis of observational studies and randomised controlled trials (RCTs) with CI 95%. Thirteen observational studies with 1923 patients and seven RCTs with 1091 patients were included. NPWT group showed significant decrease in the risk of SSI (RR = 0.45) and seroma (RR = 0.61) in observational studies with P value <0.05, as well as RCTs but were not significant (RR = 0.88 and RR = 0.68). Wound dehiscence (RR = 0.74 and RR = 1.15) and hospital readmission (RR = 0.90 and RR = 0.62) showed lower risks in NPWT group but were not significant. Hematoma (RR = 1.08 and RR = 0.87) showed no significant difference. NPWT is not contraindicated in cancer surgical wounds and can be considered a beneficial palliative treatment to promote wound healing

PERAN HUMAN FIBRIN GLUE TERHADAP TRANSFORMING GROWTH FACTOR BETA-1 (TGF-B1), PROLIFERASI FIBROBLAS DAN SINTESIS KOLAGEN PADA LUKA AKUT TIKUS PUTIH

Latar Belakang: Hingga saat ini, pemilihan metode penutupan luka sangat bervariasi, baik secara operatif maupun dengan farmakologi, bergantung dari luka itu sendiri. Penutupan luka dengan penjahitan merupakan salah satu pilihan dan teknik yang paling efisien diantara yang lain, namun dengan resiko dapat terjadi dehisen dan penyembuhan luka yang lama. Sebagai alternatif lain, telah dikembangkan bahan untuk memperbaiki dan menjamin penutupan luka yang baik. Human Fibrin Glue sering digunakan pada pembedahan karena memiliki efek hemostatis dan juga kemampuan merekatkan pada saat bersamaan. Bahan ini dipercaya membantu migrasi seluler, menghasilkan keratinosit dan proliferasi fibroblas pada luka. Tujuan: Untuk mengetahui pemberian Human Fibrin Glue dapat mempengaruhi kadar TGF-1, jumlah fibroblast, dan kerapatan serat kolagen pada luka akut Materi dan Metode: Penelitian eksperimental ini menggunakan 36 ekor tikus putih yang diberikan perlukaan akut pada punggung tikus, yang kemudian dibagi menjadi 2 kelompok : perlakuan (n=18) dan kontrol (n=18). Pada kelompok kontrol tidak diberikan Human Fibrin Glue dan hanya ditutup dengan transparent dressing, sedangkan pada kelompok perlakuan, diberikan aplikasi Human Fibrin Glue serta ditutup dengan transparent dressing. Pengamatan secara histopatologi dilakukan untuk menilai kadar TGF-1, jumlah fibroblas dan kerapatan serat kolagen pada hari ke-2, hari ke-4 dan hari ke-14 penelitian. Hasil : Terdapat peningkatan bermakna kadar TGF-1 pada kelompok perlakuan pengamatan hari ke-2 terhadap kelompok kontrol (p = 0.001 (nilai p<0.05)), sedangkan pada hari ke-4 (p = 0.088 (nilai p>0.05)) dan hari ke-14 tidak terdapat perbedaan bermakna (p = 0.108 (nilai p>0.05)). Tidak terdapat peningkatan bermakna pada jumlah fibroblas kelompok perlakuan hari ke-2 terhadap kelompok kontrol (p = 0.059 (nilai p>0.05)), begitu pula pada hari ke-4 (p = 0.438 (nilai p>0.05)), sedangkan pada pengamatan hari ke-14, terdapat perbedaan bermakna (p = 0.005 (nilai p<0.05)). Tidak terdapat peningkatan bermakna pada kerapatan serat kolagen pada kelompok perlakuan terhadap kelompok kontrol pada pengamatan hari ke-2 (p = 1.00 (nilai p>0.05)), begitu pula pada hari ke-4 (p = 0.138 (nilai p>0.05)), dan pada pengamatan hari ke-14, juga tidak terdapat perbedaan bermakna (p = 0.138 (p>0.05))

Pressure Injury Management in Critically Ill Patients with COVID-19 in a Makeshift Hospital in Indonesia: A Report of Two Cases

ABSTRACT: Patients who are critically ill with COVID-19 need ventilation support in the ICU. However, ICU patients are at higher risk of developing a pressure injury (PI). Unfortunately, PI prevention is not optimally implemented in Indonesia, especially in the makeshift hospitals created during the COVID-19 pandemic. Here, the authors report two cases of critically ill patients with COVID-19 who developed large sacral PIs during hospitalization in a makeshift hospital in Indonesia. The first patient developed a stage 3, 7 × 7-cm sacral PI on the 14th day of hospitalization. The second patient developed a stage 4, 12 × 8-cm sacral PI on the 16th day of hospitalization. Both patients had elevated d-dimer levels and used a noninvasive ventilator for 1 week. The wounds were treated with surgical debridement, silver hydrogel dressing, and hydrocolloid dressing and complemented with static air mattress overlay. The authors recommend that in situations where there is a shortage of healthcare workers, the government should provide pressure-redistribution devices and silicone foam dressings for all critically ill patients to prevent PI development and lighten the workload of healthcare workers

Characteristics of Patients with Pressure Injuries in a COVID-19 Referral Hospital

Abstract Objective: This retrospective study aimed to describe the characteristics of patients treated at a COVID-19 referral hospital from March 2020 to June 2021 who experienced pressure injuries (PIs) either before or after admission. Methods: The researchers collected and analyzed data on patients' demographic characteristics, symptoms, comorbidities, location and severity of PI, laboratory values, oxygen therapy, length of stay, and vasopressor use. Results: During the study period, 1,070 patients were hospitalized for COVID-19 with varying degrees of severity, and 12 patients were diagnosed with PI. Eight (66.7%) of the patients with PI were men. The median age was 60 (range, 51-71) years, and half of the patients had obesity. Eleven of the patients with PI (91.4%) had at least one comorbid condition. The sacrum and gluteus were the two most commonly affected sites. Those with stage 3 PI had a substantially greater median d-dimer value (7,900 ng/mL) than patients with stage 2 PI (1,100 ng/mL). The average length of stay was 22 (range, 9.8-40.3) days. Conclusions: Health professionals should be aware of an increase in d-dimer in patients with COVID-19 and PI. Even though PIs in these patients might not result in mortality, an increase in morbidity can be avoided with the right care