RESUMEN

Background: Free muscle flaps can develop significant postoperative edema and wound exudation, thereby increasing interstitial pressure and potentially compromising microcirculation. While concerns exist regarding negative pressure wound therapy (NPWT) to compress free flaps and hinder monitoring, recent studies have indicated a reduction in edema and an increase in blood flow. Objective: To compare microcirculation in free latissimus dorsi muscle (LDM) flaps dressed with and without NPWT. Methods: This retrospective cohort study analyzed prospectively collected data of patients who received free LDM flap reconstruction. Patients were separated into two groups according to management with or without NPWT. Microcirculation was evaluated continuously for up to 72 h utilizing laser doppler flowmetry and tissue spectrometry. Results: In total, n = 61 patients (26 females, 35 males) with an average age of 56.90 (17.4) years were included. NPWT was applied in 12 patients, while a regular cotton dressing was used in 49 patients. Overall, no significant differences in the number of minor and major complications were observed between groups. Both groups showed an increase in microvascular flow over the investigated time period. The flow showed higher absolute values in the NPWT group, reaching statistical significance at 12 h post-anastomosis, p = 0.038. There was a tendency for lower rHb values in the NPWT group, without reaching statistical significance. Conclusions: The presented study confirms the increase in microvascular flow after NPWT application. Whilst ensuring continuous free flap monitoring utilizing laser doppler flowmetry and spectrometry, the data further support the safety of NPWT application without risking vascular compromise due to external compression.

RESUMEN

Background: In emergency surgery, managing abdominal sepsis and critically ill patients with imminent abdominal compartment syndrome (ACS) using an open abdomen (OA) approach has become standard practice for damage control. To prevent significant complications associated with OA therapy, such as abdominal infections, entero-atmospheric fistula (EAF), and abdominal wall hernia formation, early definitive fascial closure (DFC) is crucial. This study aims to assess the feasibility of a novel device designed to facilitate early fascial closure in patients with an open abdomen. Methods: Between 2019 and 2020, nine patients undergoing open abdomen management were enrolled in this study. All patients were treated using vertical mesh-mediated fascial traction combined with a novel vertical traction device (VTD). Data from these cases were collected and retrospectively analyzed. Results: In this study, all patients were treated with OA due to impending ACS. Three patients died before achieving DFC, while the remaining six patients successfully underwent DFC. The mean number of surgical procedures after OA was 3 ± 1, and the mean time to DFC was 9 ± 3 days. The use of the VTD in combination with negative pressure wound therapy (NPWT) resulted in a 76% reduction in fascia-to-fascia distance until DFC was achieved. The application of the VTD did not affect ventilation parameters or the Simplified Acute Physiology Score II (SAPS II), but intra-abdominal pressure (IAP) was reduced from 31 ± 8 mmHg prior to OA to 8.5 ± 2 mmHg after applying the device. The primary complication associated with the device was skin irritation, with three patients developing skin blisters as the most severe manifestation. Conclusion: Overall, the novel VTD appears to be a safe and feasible option for managing OA cases. It may reduce complications associated with OA by promoting early definitive fascial closure.

RESUMEN

Negative Pressure Wound Therapy (NPWT) is a commonly employed clinical strategy for wound healing, yet its early-stage mechanisms remain poorly understood. To address this knowledge gap and overcome the limitations of human trials, we establish an NPWT C57BL/6JNarl mouse model to investigate the molecular mechanisms involved in NPWT. In this study, we investigate the intricate molecular mechanisms through which NPWT expedites wound healing. Our focus is on NPWT's modulation of inflammatory immune responses and the concurrent orchestration of multiple signal transduction pathways, resulting in shortened coagulation time and reduced inflammation. Notably, we observe a significant rise in dickkopf-related protein 1 (DKK-1) concentration during NPWT, promoting the differentiation of Hair Follicle Stem Cells (HFSCs) into epidermal cells, expediting wound closure. Under negative pressure, macrophages express and release DKK-1 cytokines, crucial for stimulating HFSC differentiation, as validated in animal experiments and in vitro studies. Our findings illuminate the inflammatory dynamics under NPWT, revealing potential signal transduction pathways. The proposed framework, involving early hemostasis, balanced inflammation, and macrophage-mediated DKK-1 induction, provides a novel perspective on enhancing wound healing during NPWT. Furthermore, these insights lay the groundwork for future pharmacological advancements in managing extensive wounds, opening avenues for targeted therapeutic interventions in wound care.

Asunto(s)

RESUMEN

BACKGROUND: The study introduces the application of negative pressure wound therapy (NPWT) in pediatric stoma closure, emphasizing the importance of enhancing aesthetics and minimizing surgical site infections (SSI). CASE PRESENTATION: The case series involves four infants undergoing non-umbilical stoma closure with a combination of purse-string closure (PSC) and NPWT, focusing on aesthetic outcomes and infection prevention. NPWT was initiated immediately after surgery, and patients were monitored every 3-4 days. Notably, none of the four infants experienced SSI or other complications. The patients adequately tolerated NPWT, with no significant adverse events. Furthermore, Manchester Scar Scale (MSS) was 9 [7-10], and Patient and Observer Scar Assessment Scale (POSAS) (observer) was 12.5 [12-19], POSAS (patient) was 12.5 [11-16] (all median values [minimum-maximum]), indicating that excellent aesthetic outcomes were achieved. DISCUSSION: We emphasizes the significance of aesthetics in pediatric patients; in addition, our findings demonstrate that four infants who received NPWT combined with PSC achieved superior outcomes that did the most recent four infants who underwent PSC only at our institution. It also addresses the risk of SSI in stoma closure and discusses the pros and potential cons of using NPWT in pediatric cases, underlining the need for further research and the accumulation of additional reports. CONCLUSIONS: This is the inaugural report of prophylactic NPWT for pediatric stoma closure, emphasizing the effectiveness of combining PSC and NPWT for SSI prevention and improved aesthetics. The study calls for additional research and reports on NPWT in pediatric cases to further solidify its benefits in this patient population.

RESUMEN

Introduction: Deep sternal wound infection (DSWI) is a serious complication that may occur after median sternotomy, with potentially devastating consequences. By reporting our case and analyzing the existing literature, this article aimed to provide a thorough understanding of the role of negative-pressure wound therapy (NPWT) and the importance of flap choice in managing DSWI accompanied by severe heart injury and high hemodynamic risk. Case description: A 60-year-old woman with severe aortic stenosis, aortic valve regurgitation, and heart failure underwent redo sternotomy, which resulted in an intraoperative right ventricle injury. She required extracorporeal membrane oxygenation support because of low blood pressure and subsequently developed complications, including surgical site hematoma, wound dehiscence, and fat necrosis. She was referred for wound closure, where a significant 10 × 20-cm soft tissue defect in the anterior chest wall was observed. A pedicled vertical rectus abdominis myocutaneous flap addressed the soft tissue defect. The wound showed remarkable improvement at the 8-month follow-up visit. Conclusions: DSWI management is a complex and multifaceted challenge. NPWT, when combined with appropriate surgical strategies, including wound debridement and flap selection, may promote successful wound healing. This case report highlights the successful management of a complex DSWI using a multidisciplinary approach, including debridement, appropriate antibiotic therapy, and free-flap reconstruction, which resulted in favorable outcomes.

RESUMEN

INTRODUCTION: Fournier's Gangrene is a severe and rapidly progressing necrotic infection of the skin and fascia that can affect the external genitals, perineum, anus, and abdomen. It can extend to the abdominal cavity and result in necrosis of the soft tissue with a high mortality rate. This case gives a unique perspective on managing such a complicated infection in a smaller community hospital. PRESENTATION OF CASE: This report describes a particularly challenging case of Fournier's Gangrene in a 34 year old male with multiple pre-existing comorbidities, including alcohol use disorder, chronic kidney disease, and hepatitis B. Development of gangrene was preceded by sepsis. The patient's treatment was based on intravenous antibiotic therapy and early surgical intervention with extensive resection of necrotic tissue, supported by Hyperbaric Oxygen Therapy (HBOT) and Negative Pressure Wound Therapy (NPWT). DISCUSSION: The majority of the patient's treatment was done at a local community hospital with remote coordination with the Hyperbaric Medicine Center where the patient was temporarily transferred to for HBOT. Multiple treatment modalities were employed in this case of Fournier's gangrene, including intravenous antibiotic therapy, necrosectomy, chronic wound care with septic dressings and tissue debridement, HBOT and NPWT. Interdisciplinary cooperation between different medical specialists was crucial in treatment. CONCLUSION: The presented case shows that despite the large scale of difficulty and the complexity of treatment, it is possible to effectively manage Fournier's Gangrene in a local community hospital through interdisciplinary cooperation with specialized quaternary care centers. HBOT and NPWT proved to be useful treatment modalities.

RESUMEN

Treatment of spinal brucellosis with bilateral psoas abscess is a challenging clinical endeavor. We retrospectively evaluated a case of lumbar infection and bilateral psoas abscess, and was effectively managed through a unilateral extreme lateral approach with the aid of NPWT for bilateral drainage. We hypothesize that NPWT can influence the Piezo1 receptor of neutrophils and further influence the interaction between neutrophils and endothelial cells to promote the clearance of infected lesions, and this phenomenon is also observed in pathological slides. This proves that NPWT can rapidly enhance the recruitment of neutrophils in the infected area and improve the local immune response, and after a year of reassessment and tracking, Bilateral drainage using NPWT via a unilateral Extreme Lateral Approach could acquire satisfactory surgical outcomes, can be used as a treatment modality for lumbar infection with bilateral psoas abscesses.

Asunto(s)

RESUMEN

Background: Split thickness skin graft (STSG) is a routine reconstructive manoeuvre, particularly after excision of cutaneous lower limb malignancies. While surgical technique is well established, evidence supporting the postoperative management of these grafts is less robust. Compression therapy after the index procedure may be an important adjunct for graft take and minimizing complications, particularly in patients susceptible to oedema from a concurrent lymph node procedure. Methods: An initial PubMed literature search was performed using the terms "split thickness skin graft", "compression" and "oedema" yielding no results, hence a broader search was performed combining the terms "compression", "pressure" and "split thickness skin graft" providing 383 results. One hundred articles remained for abstract review after an initial screen. Results: The literature on compression therapy to promote split thickness graft take is modest, with only 12 articles described (12/100, 12.0%). Even then, none of these were in the setting of grafting after oncological resection. Many of the articles promote negative pressure wound therapy (NPWT) as an established adjunct to promote graft take (80/100, 80.0%). Conclusions: There is limited demonstrated efficacy of postoperative compression therapy for lower limb STSG let alone in patients with an ancillary lymph node procedure. Further large-scale trials ideally in a prospective fashion are warranted to validate this as a simple, widely available and cost-effective adjunct to STSG in this particularly susceptible population of reconstructive patients.

RESUMEN

Background: The treatment of bone defects remains a clinical challenge. The effect of negative pressure wound therapy (NPWT) on osteogenesis in bone defects has been recognized; however, bone marrow fluid dynamics under negative pressure (NP) remain unknown. In this study, we aimed to examine the marrow fluid mechanics within trabeculae by computational fluid dynamics (CFD), and to verify osteogenic gene expression, osteogenic differentiation to investigate the osteogenic depth under NP. Methods: The human femoral head is scanned using micro-CT to segment the volume of interest (VOI) trabeculae. The VOI trabeculae CFD model simulating the bone marrow cavity is developed by combining the Hypermesh and ANSYS software. The effect of trabecular anisotropy is investigated, and bone regeneration effects are simulated under NP scales of -80, -120, -160, and -200 mmHg. The working distance (WD) is proposed to describe the suction depth of the NP. Finally, gene sequence analysis, cytological experiments including bone mesenchymal stem cells (BMSCs) proliferation and osteogenic differentiation are conducted after the BMSCs are cultured under the same NP scale. Results: The pressure, shear stress on trabeculae, and marrow fluid velocity decrease exponentially with an increase in WD. The hydromechanics of fluid at any WD inside the marrow cavity can be theoretically quantified. The NP scale significantly affects the fluid properties, especially those fluid close to the NP source; however, the effect of the NP scale become marginal as WD deepens. Anisotropy of trabecular structure coupled with the anisotropic hydrodynamic behavior of bone marrow; An NP of -120 mmHg demonstrates the majority of bone formation-related genes, as well as the most effective proliferation and osteogenic differentiation of BMSCs compared to the other NP scales. Conclusion: An NP of -120 mmHg may have the optimal activated ability to promote osteogenesis, but the effective WD may be limited to a certain depth. These findings help improve the understanding of fluid mechanisms behind NPWT in treating bone defects.

RESUMEN

Purpose: To investigate the effectiveness and safety of negative-pressure wound therapy (NPWT) in treating primary spinal infections. Methods: Patients who underwent surgical treatment for primary spinal infection between January 2018 and June 2021 were retrospectively evaluated. They were divided into two groups based on the type of surgery: one that underwent negative-pressure wound therapy (NPWT) and another that underwent conventional surgery (CVSG-Posterior debridement, bone grafting, fusion, and internal fixation in one stage). The two groups were compared in terms of the total operation time, total blood loss, total postoperative drainage, postoperative pain score, time for the postoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to return to normal, postoperative complications, treatment time, and recurrence rate. Results: A total of 43 cases of spinal infection were evaluated, with 19 in the NPWT group and 24 in the CVSG group. The NPWT group had a superior postoperative drainage volume, antibiotic use time, erythrocyte sedimentation rate and CRP recovery times, VAS score at 3 months after the operation, and cure rate at 3 months after operation compared with the CVSG group. There were no significant variations in the total hospital stay and intraoperative blood loss between the two groups. Conclusions: This study supports the use of negative pressure in the treatment of a primary spinal infection and indicates that it has a notably better short-term clinical effect than conventional surgery. Additionally, its mid-term cure rate and recurrence rate are more desirable than those of conventional treatments.

RESUMEN

Brucella spondylitis (BS) is a specific spinal infection. Surgical treatment is required for Brucella spondylitis that has caused neurological symptoms in the lower extremities and developed an intraspinal abscess. The main purpose of surgery is to remove the lesion and restore the stability of the spine. However, both the anterior approach and the posterior approach cannot completely remove the lesions, resulting in a low cure rate and a certain recurrence rate. Although anterior or posterior debridement is more thorough, it is unbearable for some patients with poor general condition. In this study, for the first time, a negative pressure wound therapy (NPWT) device was introduced into the intervertebral space through the extreme lateral approach to treat a patient with Brucella spondylitis. We summarize the treatment process, and discuss the feasibility and effectiveness of this surgical approach through 1-year follow-up.

RESUMEN

Fournier's gangrene (FG) is a Necrotizing Soft Tissue Infection (NSTI) of the perineal region characterized by high morbidity and mortality even if appropriately treated. The main treatment strategies are surgical debridement, broad-spectrum antibiotics, hyperbaric oxygen therapy, NPWT (Negative Pressure Wound Therapy), and plastic surgery reconstruction. We present the case of a 50-year-old woman with an NSTI of the abdomen, pelvis, and perineal region associated with a rectal fistula referred to our department. After surgical debridement and a diverting blow-out colostomy, an NPWT system composed of two sponges connected by a bridge through a rectal fistula was performed. Our target was to obtain healing in a lateral-to-medial direction instead of depth-to-surface to prevent the enlargement of the rectal fistula, promoting granulation tissue growth towards the rectum. This eso-endo-NPWT technique allowed for the primary suture of the perineal wounds bilaterally, simultaneously treating the rectal fistula and the perineum lesions. A systematic review of the literature underlines the spreading of NPWT and its effects.

RESUMEN

INTRODUCTION: Axillary and inguinal lymph node dissection (LND) are performed in metastatic skin tumors with several local complications, such as lymphorrhea, lymphoceles, and lymphedema. The purpose of this study is to determine whether negative pressure wound therapy (NPWT) applied as a preventive measure could improve outcomes. MATERIALS AND METHODS: A monocentric study included patients who underwent axillary or inguinal LND from May 2010 to March 2020, with a retrospective evaluation of prospectively collected data. Patients were divided into two groups: the conventional wound care (CWC) and the NPWT groups. Patients were systematically reviewed at D7, D30, and at 1 year postoperative, and data regarding lymphorrhea, lymphoceles, and lymphedema were collected. RESULTS: A total of 109 axillary and inguinal LND were performed. NPWT was applied on 68 LND and CWC on 41 LND. The variables, diabetes, smoking, gender, associated treatments, and primary pathology (melanoma, squamous cell carcinoma, or Merkel tumors) were similar in both groups. Analyses have shown a significant difference in the rate of scar disunion during the first month between the two groups (p=0.045 between D1 and D7; p=0.011 between D8 and D30), as well as the presence of lymphorrhea (p=0.000 between D1 and D7; p=0.002 between D8 and D30). The rate of lymphoedema was significantly reduced in the NPWT group versus CWC (p=0.000 between D8 and D30; p=0.034 between D31 and 1 year). CONCLUSION: NPWT reduces local complications (scar disunion, lymphorrhea, and lymphedema) during the first year following LND in the management of node metastatic skin tumors.

Asunto(s)

RESUMEN

PURPOSE: To evaluate the efficacy and safety of negative pressure wound therapy (NPWT) for post-operative deep surgical site infection (SSI) after posterior instrumented spinal surgery. METHODS: We retrospectively compared the clinical outcomes of NPWT with standard debridement for deep SSI after posterior instrumented spinal surgery from 2012 to 2020 in our department. The primary outcomes were peri-operative characteristics including positive organism results, duration of fever, and visual analogue scale (VAS) pain scores three days after re-operation. The secondary outcomes were post-operative characteristics including implant infection recurrence, implant retention rate, duration of hospitalization, and VAS at discharge. Pearson's chi-squared analysis (categorical) and Student's t test (continuous) were used to determine the differences. RESULTS: Thirty-four patients were included, of which 19 underwent NPWT, and 15 underwent standard debridement. Patients in the NPWT group all significantly improved primary outcomes including duration of fever after re-operation (0.95 ± 1.13 vs 4.07 ± 5.35, P = 0.001), positive organism results (14 of 19 vs 2 of 15, P < 0.01), and VAS at 3 days after re-operation (2.58 ± 0.69 vs 3.40 ± 1.06, P < 0.05). Patients in NPWT group exhibited significant decrease in implant infection recurrence (0 of 19 vs 5 of 15, P < 0.01), implant retention rate (19 of 19 vs 10 of 15, P < 0.01), duration of hospitalization (27.74 ± 10.95 vs 37.67 ± 13.67, P < 0.01). CONCLUSIONS: NPWT is a feasible and safe treatment option for deep SSI after posterior instrumented spinal surgery.

Asunto(s)

RESUMEN

BACKGROUND: Major bile duct injuries (BDIs) are hazardous complications during 0.4%-0.6% of laparoscopic cholecystectomies. Major BDIs usually require surgical repair, ideally either immediately or at least six weeks after the damage. The complexity of our case lies in the coexistence of early BDI followed by 2-week biliary peritonitis with massive midline evisceration which, in combination, has over 40% mortality risk. METHODS & CASE REPORT: We describe the case of a 65-year-old male, transferred to our tertiary HPB service on day 14 after common bile duct complete transection during cholecystectomy and postoperative laparotomy. The patient presented with biliary peritonitis along with full wound dehiscence and extensive evisceration. During emergency peritoneal wash-out surgery we deemed immediate BDI repair feasible by primary Roux-en-Y hepaticojejunostomy (HJ), with multi-stage abdominal closure. In the following days we performed progressive abdominal wall closure in multiple sessions under general anesthesia, aided by vacuum-assisted wound closure and intraperitoneal mesh-mediated fascial traction-approximation (VAWCM) with permeable mesh. An expected late incisional hernia was eventually repaired through component separation and biological mesh. DISCUSSION & CONCLUSION: The simultaneous use of Roux-en-Y HJ and VAWCM has proven safe and effective in the treatment of BDI and 2-week biliary peritonitis with massive midline evisceration.

RESUMEN

INTRODUCTION AND IMPORTANCE: Necrotizing soft tissue infections (NSTI) are caused by toxin-producing bacteria and fungi that results in rapid progression of disease with significant local tissue destruction. CASE PRESENTATION: We present a case report of a 57-year-old male patient in line with the SCARE 2020 criteria. He was admitted to the emergency department with a small abrasion on the right antero-lateral chest wall, and a diffuse necrotic patch of skin and soft tissues with purulent discharge. CLINICAL DISCUSSION: Clinical examination, routine blood investigations, CT scan chest, and chest x-ray were performed. Patient underwent debridement six times, followed by negative pressure wound therapy (NPWT). After negative culture report, Integra Meshed Dermal Regeneration Template (IMDRT), measuring 4 × 5 in. was applied and NPWT continued. The outer layer of IDRT was removed on Day 19. Split thickness skin grafting (STSG) was performed once neodermis formation was confirmed. NPWT was continued post skin grafting for a week. IDRT was successfully taken up over the raw area with exposed lung. Patient was discharged 10 days after STSG. The patient's condition improved remarkably and he was able to breathe normally. There was no puckering or tethering effect on the grafted area and not much fibrosis. He showed speedy recovery with healed donor site and 100% uptake of grafted tissue. CONCLUSION: IDRT along with NPWT is an effective and useful technique for spontaneous regeneration of the dermis and basement membrane to promote wound healing in traumatic patients with NSTIs. LEVEL OF EVIDENCE: Level V. STUDY TYPE: Therapeutic.

RESUMEN

INTRODUCTION: Negative pressure wound therapy (NPWT), also called vacuum-assisted closure, is an adjunctive therapy used to manage open wounds that apply subatmospheric pressure to the wound surface. The therapeutic effects of NPWT are exerted by stabilizing the wound environment, increasing blood flow, and macro-deformation of wounds that initiate granulation tissue formation. CASE PRESENTATION: We present a case of a 28-year-old Caucasian male who developed a giant non-resolving hepatic abscess secondary to a gunshot wound (GSW) to the upper right abdomen. The abscess was successfully treated with open debridement followed by NWPT with instillation therapy. Significant reduction in abscess diameter and cessation of trauma-induced bile leak was observed following 15 days of wound vac treatment. DISCUSSION: Wound vac treatment was essential in this patient due to the inherent erosive properties of bile that damage surrounding tissue and perpetuate opportunistic growth of pathogenic microbes. Prior to standard NPWT treatment, debridement of devitalized tissues and infection should be managed; however, instillation therapy has permitted NPWT to be used in the presence of infection or as an adjuvant to surgical infection management. CONCLUSION: NPWT is indicated for a wide range of acute and chronic wounds; however, the utilization of NPWT to treat abscesses remains unclear.

RESUMEN

Objectives: Despite a common utilization of "Negative Pressure Wound Therapy" (NPWT) Devices in a wide range of specialties, some of the basic mechanisms of action of the techniques are still on debate. Conflicting results from prior studies demonstrate our lack of understanding how wound-bed perfusion or cutaneous microcirculation is affected by NPWT. Methods: We conducted a prospective randomized study which included 45 healthy subjects to further investigate the acute effects of NPWT on cutaneous microcirculation underneath the applied dressing. Three modes of application, namely, continuous, intermittent, cyclic, were tested. Amongst others, measurements of elicited surface pressure and a comprehensive microcirculatory analysis were carried out by utilizing an O2C-device. For the detection of (systemic) remote effects, perfusion changes of the contra-lateral thigh were evaluated. Results: All three tested modes of application led to a significant (p < 0.05) improvement in local tissue perfusion with an increased blood flow of max +151% and tissue oxygen saturation of +28.2% compared to baseline values. Surface pressure under the dressing significantly increased up to 29.29 mmHg due to the activation of the NPWT device. Continuous, intermittent, and cyclic application of negative pressure were accurately sensed by participants, resulting in reported pain values that mirrored the different levels of applied suction. Although the cyclic application mode showed the most pronounced effects regarding microcirculatory changes, no statistical significance between groups was observed. Conclusion: We could demonstrate a significant improvement of cutaneous microcirculation under an applied NPWT dressing with favorable effects due to cyclic mode of application. An increased surface pressure leads to a better venous drainage of the tissue, which was shown to increase arterial inflow with a consecutive improvement of oxygen supply. Further research is warranted to evaluate our findings regarding wound bed perfusion in the clinical field with respect to formation of granulation tissue and wound healing.

RESUMEN

PURPOSE: The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden. METHODS: In this study, 45 wounds (44 affecting lower extremities (97.7%)), resulting from different types of injuries: soft tissue (ST), soft tissue complications from closed fracture (F), and open fracture (OF) in 43 patients (age 55.0 ± 18.2 years, 46.7% female), were treated with the simultaneous application of MD and split-thickness skin grafting. The study was designed as a retrospective cohort study from March 2013 to March 2020. Patients were stratified into three groups: ST, F, and OF. Outcome variables were defined as the recurrence of treated wound defects, which required revision surgery, and the reduction of bioburden in terms of reduction of number of different bacterial strains. For statistical analysis, Student's t-test, analysis of variance (ANOVA), Mann-Whitney U test, and Pearson's chi-squared test were used. RESULTS: There was no significant difference in the rate of recurrence in the different groups (F: 0%; OF: 11.1%; ST: 9.5%). The duration of VAC therapy significantly differed between the groups (F: 10.8 days; OF: 22.7 days; ST: 12.6 days (p < 0.05)). A clinically significant reduction of bioburden was achieved with NPWT (bacterial shift (mean (SD), F: - 2.25 (1.89); OF: - 1.9 (1.37); ST: - 2.6 (2.2)). CONCLUSION: MD-augmented split-thickness skin grafting is an appropriate treatment option for full-thickness wounds with take rates of about 90%. The complexity of an injury significantly impacts the duration of the soft tissue treatment but does not have an influence on the take rate. NPWT leads to a relevant reduction of bioburden and is therefore an important part in the preconditioning of full-thickness wounds.

Asunto(s)

RESUMEN

The purpose of this study was to assess the risk factors for morbidity and mortality of diabetic foot ulcers (DFUs). For the treatment of diabetic foot ulcers, negative pressure wound therapy (NPWT) combined with platelet-rich plasma-fibrin glue (PRP) was also investigated. There were 653 patients in the diabetic foot ulcer group and 510 patients in the diabetic patients without foot ulceration (NFU) group, for a total of 1163 patients in the study samples after individuals without follow-up were excluded. The patients were randomized into two groups: the negative pressure wound therapy group and the negative pressure wound therapy combined with the PRP group. The findings of the univariate analysis revealed the blood indicators for predicting diabetic foot ulcer morbidity risk factors, such as C-reactive protein, albumin, creatinine, alkaline phosphatase, procalcitonin, platelets, 25-hydroxyvitamin D, ß-2-microglobulin, monocyte ratio, low-density protein cholesterol (LDL), triglyceride, alanine aminotransferase (ALT), aminotransferase (AST), creatine kinase (CK) and total cholesterol. Using logistic regression analysis revealed only albumin and age to be independent predictors of diabetic foot ulcer mortality. Our study also revealed that, compared to negative pressure wound therapy alone, negative pressure wound therapy combined with PRP accelerated wound healing and reduced the mortality rate. According to the findings of this pilot study, new risk factors for diabetic foot ulcer morbidity and mortality have been found, and negative pressure wound therapy combined with PRP therapy may provide the first information that it is an effective adjunct treatment for diabetic foot ulcers.