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Lee SYC, Bayan L, Sato A, Vankayalapati DK, Antoniou V, Shami MZ, Sulaiman HO, Yap N, Nakanishi H, Than CA, Wong KY. Benefits of negative pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomised controlled trials. J Plast Reconstr Aesthet Surg 2025; 102:204-217. [PMID: 39932531 DOI: 10.1016/j.bjps.2025.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 11/04/2024] [Accepted: 01/24/2025] [Indexed: 03/09/2025]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is a widely used adjunct for wound healing and an alternative to conventional dressings for skin grafts. This meta-analysis aimed to quantify the effectiveness of NPWT versus conventional dressings in this population through randomised control trials (RCTs). METHODS A literature search in several databases was conducted from inception to October 2023. Eligible studies were RCTs reporting the efficacy and post-operative outcomes of NPWT and non-NPWT (control) in patients ≥18 years with skin grafts. Pooled proportions were analysed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42023471105). RESULTS Overall, 16 RCTs met the criteria for inclusion in the meta-analysis. This included 411 patients and 401 controls. Compared to conventional dressings, NPWT demonstrated 8.3% higher overall graft take (95% CI: 2.97, 13.63, I2 = 85%), 10.0% higher graft take at -80 mmHg (95% CI: 5.69, 14.34, I2 = 0%), higher graft success rates (OR = 1.86, 95% CI: 1.05, 3.30, I2 = 0%), lower graft loss rates (OR = 0.44, 95% CI: 0.23, 0.85, I2 = 0%), lower complication rates (OR = 0.36, 95% CI: 0.13, 0.99, I2 = 76%) and lower reoperation rates (OR = 0.31, 95% CI: 0.13, 0.72, I2 = 0%). CONCLUSION NPWT is a safe and effective approach for dressing skin grafts in adult patients compared to conventional wound dressings. NPWT improved graft take and graft success while reducing graft failure, reoperations and overall complications.
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Affiliation(s)
- Sum-Yu Christina Lee
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus.
| | - Laith Bayan
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Alma Sato
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Dilip K Vankayalapati
- Oxford Thames Valley Foundation School, Buckinghamshire NHS Trust, Oxford Thames Valley, UK
| | - Valeria Antoniou
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - M Zaid Shami
- HCA Florida Aventura Hospital, Aventura Hospital and Medical Center, Miami, FL, USA
| | - Hafsa Omer Sulaiman
- Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, Cleveland, OH, USA
| | - Nathanael Yap
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus; St George's University of London, London SW17 0RE, UK
| | | | - Christian A Than
- Department of Basic & Clinical Sciences, University of Nicosia Medical School, 2408 Nicosia, Cyprus; St George's University of London, London SW17 0RE, UK; School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Kai Yuen Wong
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Neyt J, Victor J, Cornu O. Can we DAIR in FRI ? Debridement techniques in osteomyelitis. Acta Orthop Belg 2024; 90:691-697. [PMID: 39869874 DOI: 10.52628/90.4.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2025]
Abstract
The concept of Debridement, Antibiotics and Implant Retention (DAIR) is well known in periprosthetic joint infections. Extrapolating this concept to fracture related infections is mired in controversies. Characteristics of the metal implant, duration of infection, state of fracture healing, microbiological profile etc. appear to play a role in the decision making process whether or not to keep, adjust , exchange or remove (infected) metalwork. More than likely it is the quality of source control by meticulous debridement having a major impact whether a DAIR approach to FRI could result in a successful outcome.
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Afzal H, Dawson E, Fonseca R, Canas M, Diaz L, Filippis AD, Bochicchio KM, Bochicchio GV. Does Negative Pressure Wound Therapy Impact the Outcome for Patients With Necrotizing Soft Tissue Infection Infected With Anaerobic Bacteria? Surg Infect (Larchmt) 2024; 25:179-184. [PMID: 38381953 DOI: 10.1089/sur.2023.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Background: A notable improvement in the treatment of necrotizing soft tissue infections (NSTIs) is the development of negative pressure wound therapy (NPWT). Clinicians are still debating whether NPWT is as successful as conventional wet-to-dry dressings at removing bacteria. Recent research has revealed potential oxygen deprivation effects of NPWT in underlying wound tissues, although clinical trials regarding the effects of reduced oxygen on anaerobic bacterial soft tissue infections remain noticeably lacking. Hypothesis: We hypothesized that NPWT-treated patients with NSTIs who were solely infected by anaerobic bacteria would have worse outcomes than those who were infected with other bacterial species. Patients and Methods: Our study included a retrospective examination of the 2008-2022 period of our Acute and Critical Care Surgery database. Patients who had been identified as having necrotizing fasciitis, Fournier gangrene, or gas gangrene and who had their conditions verified by positive wound cultures acquired during the initial debridement and subsequently received NPWT made up the study cohort. Comorbidities, surgical techniques, and clinical results were all covered by the data. Based on their wound infections, patients were divided into two groups: those with exclusively anaerobic NSTIs and those with different bacterial groups (such as polymicrobial and aerobic). Multiple regression, χ2 analysis, and analysis of variance (ANOVA) were among the analytical methods used. Results: One hundred twelve patients with NSTI who had received NPWT comprised the study cohort. Sixteen of these patients (14.3%) had NSTIs that were exclusively anaerobic, whereas the remaining 96 (85.7%) had NSTIs that were mixed aerobic, facultative, or polymicrobial. Between the two groups, there was no difference in the initial wound size. Patients with anaerobic NSTI who underwent NPWT showed a statistically significant increase in the number of debridements (3 [interquartile range {IQR},1-9] vs. 2 [IQR, 1-4]; p = 0.012) and an increased 100-day re-admission rate (37.5% vs. 12.5%; p = 0.012) when compared with patients with non-anaerobic NSTI. The 100-day re-admission rate increased three-fold in NPWT-treated anaerobic NSTIs, according to a logistic regression analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.06-12.44; p = 0.04). Conclusions: In contrast to patients with other bacterial strains, our data show that patients with NSTI treated with NPWT who only have anaerobic bacterial infections have a larger number of debridements and are much more likely to require re-admission within 100 days. We call for additional prospective studies to be conducted to identify additional risk factors and consider alternate treatment options for individuals with exclusively anaerobic NSTIs in light of these findings.
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Affiliation(s)
- Hussain Afzal
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erin Dawson
- Trauma and Surgical Critical Care, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ricardo Fonseca
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Melissa Canas
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonardo Diaz
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kelly M Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant V Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Marais LC, Hungerer S, Eckardt H, Zalavras C, Obremskey WT, Ramsden A, McNally MA, Morgenstern M, Metsemakers WJ. Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 2024; 144:259-268. [PMID: 37921993 PMCID: PMC10774153 DOI: 10.1007/s00402-023-05073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/11/2023] [Indexed: 11/05/2023]
Abstract
A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. This narrative review summarizes the current evidence with respect to soft tissue management in patients diagnosed with FRI. Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice.Level of evidence Level V.
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Affiliation(s)
- Leonard C Marais
- Department of Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sven Hungerer
- Department of Joint Surgery and Arthroplasty, Trauma Center Murnau, Murnau Germany and Paracelsus Medical University (PMU) Salzburg, Salzburg, Austria
| | - Henrik Eckardt
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Charalampos Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex Ramsden
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Martin A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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Rawson KB, Neuberger T, Smith TB, Bell IJ, Looper RE, Sebahar PR, Haussener TJ, Kanna Reddy HR, Isaacson BM, Shero J, Pasquina PF, Williams DL. Ex vivo comparison of V.A.C.® Granufoam Silver™ and V.A.C.® Granufoam™ loaded with a first-in-class bis-dialkylnorspermidine-terphenyl antibiofilm agent. Biofilm 2023; 6:100142. [PMID: 37484784 PMCID: PMC10359492 DOI: 10.1016/j.bioflm.2023.100142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023] Open
Abstract
Implementation of negative pressure wound therapy (NPWT) as a standard of care has proven efficacious in reducing both the healing time and likelihood of nosocomial infection among pressure ulcers and traumatic, combat-related injuries. However, current formulations may not target or dramatically reduce bacterial biofilm burden following therapy. The purpose of this study was to determine the antibiofilm efficacy of an open-cell polyurethane (PU) foam (V.A.C.® Granufoam™) loaded with a first-in-class compound (CZ-01179) as the active release agent integrated via lyophilized hydrogel scaffolding. An ex vivo porcine excision wound model was designed to perform antibiofilm efficacy testing in the presence of NPWT. PU foam samples loaded with a 10.0% w/w formulation of CZ-01179 and 0.5% hyaluronic acid were prepared and tested against current standards of care: V.A.C.® Granufoam Silver™ and V.A.C.® Granufoam™. We observed statistically significant reduction of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii biofilms with the CZ-01179 antibiofilm foam in comparison to current standard of care foams. These findings motivate further development of an antibiofilm PU foam loaded with CZ-01179.
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Affiliation(s)
- Kaden B. Rawson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Bone and Biofilm Research Lab, University of Utah, Salt Lake City, UT, USA
- Carle Illinois College of Medicine, University of Illinois, Urbana, IL, USA
| | - Travis Neuberger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Bone and Biofilm Research Lab, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, UT, USA
- Carle Illinois College of Medicine, University of Illinois, Urbana, IL, USA
| | - Tyler B. Smith
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Bone and Biofilm Research Lab, University of Utah, Salt Lake City, UT, USA
| | - Isaac J. Bell
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Bone and Biofilm Research Lab, University of Utah, Salt Lake City, UT, USA
| | - Ryan E. Looper
- Department of Chemistry, University of Utah, Salt Lake City, UT, USA
- Curza Global, LLC, Salt Lake City, UT, USA
| | - Paul R. Sebahar
- Department of Chemistry, University of Utah, Salt Lake City, UT, USA
- Curza Global, LLC, Salt Lake City, UT, USA
| | - Travis J. Haussener
- Department of Chemistry, University of Utah, Salt Lake City, UT, USA
- Curza Global, LLC, Salt Lake City, UT, USA
| | | | - Brad M. Isaacson
- Bone and Biofilm Research Lab, University of Utah, Salt Lake City, UT, USA
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, USA
- The Geneva Foundation, Tacoma, WA, USA
| | - John Shero
- Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio Fort Sam Houston, San Antonio, TX, USA
| | - Paul F. Pasquina
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Dustin L. Williams
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- Bone and Biofilm Research Lab, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, UT, USA
- Curza Global, LLC, Salt Lake City, UT, USA
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
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Lai H, Chen G, Zhang W, Wu G, Xia Z. Research trends on platelet-rich plasma in the treatment of wounds during 2002-2021: A 20-year bibliometric analysis. Int Wound J 2023; 20:1882-1892. [PMID: 36480439 PMCID: PMC10333001 DOI: 10.1111/iwj.14047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/28/2022] [Indexed: 09/10/2023] Open
Abstract
Platelet-rich plasma (PRP) has attracted attention because of its potential to accelerate the wound healing process. However, resources for evaluating research trends in the treatment of wounds with PRP were limited. In this study, we aimed to make a bibliometric analysis of the literature related to PRP in the treatment of wounds and explore the research status, hotspots and frontiers in this field in recent 20 years. Studies about PRP treatment for wounds from 2002 to 2021 were retrieved from the Science Citation Index Expanded (SCI-E) of Web of Science (WOS) database. Visualisation softwares such as VOSviewer and SCImago Graphica, and CiteSpace were used to analyse the research trends and features. A total of 1748 studies were identified in the SCI-Expanded from 2002 to 2021. The number of publications on PRP in the treatment of wounds has shown an increasing trend, from 6 (in 2002) to 228 (in 2021). The papers published in the United States have led in times cited (14637) and H-index (63). Though Italy was slightly lower than China in the number of publications, the H-index and average cited (47, 28.45) were higher than that of China (38, 27.01). The strongest keyword was "fibrin" (strength = 13.07), and the longest burst duration keyword was "thrombin" (began in 2002 and ended in 2014). The largest 10 co-citation clusters are as follows: endothelial cell proliferation (#0), regenerative medicine-associated treatment (#1), diabetic wound healing (#2), autologous derived (#3), platelet-rich fibrin (#4), tissue engineering (#5), regenerative potential (#6), clinical randomised trial (#7), histologic observation (#8), and wound bacteria (#9). The United States has made the most outstanding contribution in this field. Chinese researchers need to enhance the quality of publications further. Wound Repair Regen. is the most noteworthy journal. The mechanism of growth factors of PRP, combination therapy, preparation of PRP, and related clinical trials may be topics that need attention.
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Affiliation(s)
- Honghao Lai
- Department of Burn, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina
- Department of Burn Surgery, Changhai HospitalNaval Medical UniversityShanghaiChina
- Research Institute, Guangzhou Eighth People's HospitalGuangzhou Medical UniversityGuangzhouChina
| | - Guangping Chen
- Department of Burn, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina
| | - Wei Zhang
- Department of Burn Surgery, Changhai HospitalNaval Medical UniversityShanghaiChina
| | - Guosheng Wu
- Department of Burn Surgery, Changhai HospitalNaval Medical UniversityShanghaiChina
| | - Zhaofan Xia
- Department of Burn, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina
- Department of Burn Surgery, Changhai HospitalNaval Medical UniversityShanghaiChina
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Rupp M, Walter N, Szymski D, Taeger C, Langer M, Alt V. The antibiotic bead pouch - a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery. J Bone Jt Infect 2023; 8:165-173. [PMID: 37818255 PMCID: PMC10561378 DOI: 10.5194/jbji-8-165-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/23/2023] [Indexed: 10/12/2023] Open
Abstract
Soft tissue defects resulting from trauma and musculoskeletal infections can complicate surgical treatment. Appropriate temporary coverage of these defects is essential to achieve the best outcomes for necessary plastic soft tissue defect reconstruction. The antibiotic bead pouch technique is a reasonable surgical approach for managing temporary soft tissue defects following adequate surgical debridement. This technique involves the use of small diameter antibiotic-loaded bone cement beads to fill the dead space created by debridement. By applying antibiotics to the bone cement and covering the beads with an artificial skin graft, high local dosages of antibiotics can be achieved, resulting in the creation of a sterile wound that offers the best starting position for soft tissue and bone defect reconstruction. This narrative review describes the rationale for using this technique, including its advantages and disadvantages, as well as pearls and pitfalls associated with its use in daily practice. In addition, the article provides a comprehensive overview of the literature that has been published since the technique was introduced in surgical practice.
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Affiliation(s)
- Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christian Taeger
- Plastische Chirurgie & Ästhetik an der Isar, Widenmayerstraße 16, 80538 Munich, Germany
| | - Martin Franz Langer
- Department of Trauma, Hand and Reconstructive Surgery, Waldeyerstrasse 1, 48149 Muenster, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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8
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Is There a Wound Recontamination by Eluates with High Bacterial Load in Negative-Pressure Wound Therapy with Instillation and Dwell Time? Plast Reconstr Surg 2023; 151:136e-147e. [PMID: 36251856 PMCID: PMC9788932 DOI: 10.1097/prs.0000000000009770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study investigated bacterial colonization of the foam eluate after negative-pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) to obtain an indication of possible recontamination of the wound during NPWTi-d. To detect bacterial colonization and the extent of planktonic and nonplanktonic bioburden as comprehensively as possible, routine culture and molecular biology methods were used. METHODS Before (time point 1) and after (median 3.0 days; time point 2) NPWT ( n = 15) and NPWTi-d with antiseptic installation ( n = 15), wound bed [22 acute, eight chronic wounds; median age, 51 years (range, 24 to 91); 26 men], foam, and eluate were examined by routine culture methods and fluorescence in situ hybridization (FISH), polymerase chain reaction, and FISH sequencing (FISHseq). RESULTS At time point 2, 94.9% (37 of 39) of the pathogens identifiable in the eluate were also detected in the wound bed. Foam and eluate were always bacterially contaminated. NPWTi-d resulted in a significant reduction in the number of pathogen species compared with NPWT (NPWTi-d, time point 1 versus time point 2: P = 0.026; NPWT, time point 1 versus time point 2: not significant). Routine culture of wound bed samples at time point 2 identified only 28 of 52 (53.8%) of the pathogens, whereas examination of wound bed, foam, and eluate and additional FISHseq use detected 50 of 52 (96.2%) of the bacterial species. FISHseq identified biofilm in one and microcolonies in 10 wounds (time point 2). CONCLUSIONS The bacterial load of the foam is flushed back into the wound during NPWTi-d. FISHseq should be used in addition to the routine culture method when pathogen identification and detection of nonplanktonic bacterial growth is particularly important for the patient's therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Gálvez-Sirvent E, Ibarzábal-Gil A, Rodríguez-Merchán EC. Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management. EFORT Open Rev 2022; 7:554-568. [PMID: 35924649 PMCID: PMC9458943 DOI: 10.1530/eor-22-0004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.
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Affiliation(s)
- Elena Gálvez-Sirvent
- Department of Orthopaedic Surgery, “Infanta Elena” University Hospital, Valdemoro, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Aitor Ibarzábal-Gil
- Department of Orthopaedic Surgery, “La Paz” University Hospital, Madrid, Spain
| | - E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, “La Paz” University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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Kumaar A, Shanthappa AH, Ethiraj P. A Comparative Study on Efficacy of Negative Pressure Wound Therapy Versus Standard Wound Therapy for Patients With Compound Fractures in a Tertiary Care Hospital. Cureus 2022; 14:e23727. [PMID: 35509767 PMCID: PMC9060726 DOI: 10.7759/cureus.23727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Orthopedic surgeons face a difficult task in treating serious open fractures, which usually result in complications, morbidity, and even amputation. Compound fracture wounds were traditionally treated with a standard saline dressing. To avoid infection and problems during therapy, several studies found that open fractures require early skeletal stability as well as soft tissue repair. In favoring the above fact vacuum-assisted closure (VAC) is now undergoing a paradigm shift. With this background, this study aimed to compare the effects of VAC dressing versus standard wound dressing on compound fracture wounds. Methodology: This study has been conducted as a single-blind randomized control trial among 128 patients who got admitted to the Department of Orthopedics, R L Jalappa Hospital attached to Sri Devaraj Urs Medical College, Karnataka, India from August 2019 to November 2021. The study participants were randomly allotted into two groups negative pressure wound therapy (NPWT) and standard wound therapy (SWT) consisting of 64 participants in each group. VAC dressing was used on group NPWT, while normal saline wound dressing was used on group SWT. Both groups were followed up for a month after their discharge from the hospital. Frequency in dressing changes wound healing time, infection presence, and hospitalization days were all recorded and compared over one month. The data collection was done using questionnaires and the statistical analysis was done with SPSS version 21 (Chicago, IL: IBM Corp.). Results: There was a statically significant difference favoring group NPWT compared to group SWT with a hospital stay, number of dressings required, wound size reduction, wound healing time, and deep infection rate (p<0.05). Conclusions: The use of NPWT speeds up the healing of compound fracture wounds significantly. It is affordable and can be used as a substitute in resource-constrained areas to reduce infection and manage open fracture wounds quickly.
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11
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Yu CM, Yu CM, Yao WT, Chen YF, Lee AL, Liu YC, Tu CP, Huang WC, Tung KY, Tsai MF. Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection. Int Wound J 2022; 19:1829-1837. [PMID: 35289489 PMCID: PMC9615267 DOI: 10.1111/iwj.13788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Few studies have assessed the efficacy and safety of reconstruction of sternal infection using a pectoralis muscle flap combined with a rectus abdominis muscle (RAM) sheath fasciocutaneous flap. We report here our experience with this procedure to reconstruct the sternal defect in patients (n = 46) with a deep sternal wound infection (DSWI) after cardiac surgery. After wound reconstruction, the proportion of prolonged mechanical ventilation use and intensive care unit (ICU) stay were 17.4% (n = 8) and 21.7% (n = 10), respectively. The 30‐day all‐cause mortality was 15.2%; recurrence rate was 17.4%; postoperative complications were 15.2%; and median hospital stay was 31 (0‐157) days. Multivariate logistic regression analysis revealed that hypertension (β = 21.32, 95%CI 4.955‐37.68, P = .014), drainage‐tube use (β = 0.944, 95%CI 0.273‐1.614, P = .008), and prolonged intensive care unit stay (β = 53.65, 95%CI 31.353‐75.938, P < .001) were significantly correlated with hospital stay. In conclusion, a procedure including surgical debridement, sternal reconstruction with bilateral PM and RAM sheath flap, long‐term antibiotics, and adequate drainage is a beneficial technique in the reconstruction of deep sternal wound infection after cardiac surgery. Duration of drainage tube use may be as an index for a hospital stay or wound healing.
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Affiliation(s)
- Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - An-Li Lee
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Ying-Chun Liu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Chih-Peng Tu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, Collage of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan
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12
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Tsvetkov VO, Ivkov AV, Mikaelyan LS, Kolovanova OV. A promising contribution to negative pressure wound therapy in treatment of prosthetic joint infection. Discussion based on case report. Ann Med Surg (Lond) 2022; 75:103339. [PMID: 35242316 PMCID: PMC8881371 DOI: 10.1016/j.amsu.2022.103339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Although a significant number of periprosthetic joint infection cases and well-proven algorithm of its cure are available, there still is a potential to make a more justified decision and thus improve treatment result. CASE PRESENTATION This paper presents a case report of late simultaneous Prosthetic Joint Infection of both knees.Clinical discussion dedicates to the possible contribution of Negative Pressure Wound Therapy in treatment of Prosthetic Joint Infection. CONCLUSION We conceive the role of NPWT in the treatment of PJI to be underestimated to date and should be assessed in controlled trial.
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Affiliation(s)
- Vitaly O. Tsvetkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- V.V. Vinogradov Moscow Municipal Hospital, Moscow Healthcare Department, Moscow, Russia
| | - Alexey V. Ivkov
- V.V. Vinogradov Moscow Municipal Hospital, Moscow Healthcare Department, Moscow, Russia
- N.I.Pirogov Russian National Research Medical University, Moscow, Russia
| | - Liana S. Mikaelyan
- V.V. Vinogradov Moscow Municipal Hospital, Moscow Healthcare Department, Moscow, Russia
| | - Olga V. Kolovanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- V.V. Vinogradov Moscow Municipal Hospital, Moscow Healthcare Department, Moscow, Russia
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13
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Rawson KB, Neuberger T, Smith T, Reddy HRK, Haussener TJ, Sebahar PR, Looper RE, Isaacson BM, Shero J, Pasquina PF, Williams DL. Antibiofilm potential of a negative pressure wound therapy foam loaded with a first-in-class tri-alkyl norspermidine-biaryl antibiotic. J Biomed Mater Res B Appl Biomater 2022; 110:1780-1788. [PMID: 35213779 DOI: 10.1002/jbm.b.35035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/18/2022] [Accepted: 02/09/2022] [Indexed: 11/07/2022]
Abstract
Negative-pressure wound therapy (NPWT) is commonly utilized to treat traumatic injuries sustained on the modern battlefield. However, NPWT has failed to decrease the incidence of deep tissue infections experienced by Wounded Warriors, despite attempts to integrate common antimicrobials, like Ag+ nanoparticles, into the wound dressing. The purpose of this study was to incorporate a unique antibiofilm compound (CZ-01179) into the polyurethane matrix of NPWT foam via lyophilized hydrogel scaffolding. Foam samples with 2.5%, 5.0%, and 10.0% w/w CZ-01179 were produced and antibiofilm efficacy was compared to the current standards of care: V.A.C.® GRANUFOAM SILVER™ and V.A.C.® GRANUFOAM™. Gravimetric analysis and elution kinetics testing confirmed that this loading technique was both repeatable and controllable. Furthermore, zone of inhibition and antibiofilm efficacy testing showed that foam loaded with CZ-01179 had significantly increased activity against planktonic and biofilm phenotypes of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii compared to the clinical standards. These findings motivate additional ex vivo and in vivo work with NPWT foam loaded with CZ-01179 with the overall objective of reducing NPWT-associated infections that complicate battlefield-related and other wounds.
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Affiliation(s)
- Kaden B Rawson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Travis Neuberger
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Tyler Smith
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Paul R Sebahar
- Curza Global, Salt Lake City, Utah, USA.,Department of Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Ryan E Looper
- Curza Global, Salt Lake City, Utah, USA.,Department of Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Brad M Isaacson
- The Geneva Foundation, Tacoma, Washington, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - John Shero
- Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Extremity Trauma and Amputation Center of Excellence, San Antonio, Texas, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Dustin L Williams
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Curza Global, Salt Lake City, Utah, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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14
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Wu L, Wen B, Xu Z, Lin K. Research progress on negative pressure wound therapy with instillation in the treatment of orthopaedic wounds. Int Wound J 2022; 19:1449-1455. [PMID: 35029043 PMCID: PMC9493210 DOI: 10.1111/iwj.13741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Negative pressure wound therapy with instillation (NPWTi) has the dual function of negative pressure sealing drainage and irrigation, which overcomes the disadvantages of NPWT, such as tube obstruction, inability to apply topical medicine, and poor anti‐infection ability. NPWTi has been researched extensively and widely used in various types of wounds, and certain effects have been achieved. A series of parameters for NPWTi have not been unified at present, including the flushing fluid option, flushing mode, and treatment period. This paper reviews the research progress of these parameters for NPWTi and their application in the treatment of orthopaedic wounds.
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Affiliation(s)
- Lijiao Wu
- Department of Orthopedic Surgery, Fujian Provincial Hospital Jinshan Branch, Fuzhou, China.,Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Baoyu Wen
- Department of Orthopedic Surgery, Fujian Provincial Hospital Jinshan Branch, Fuzhou, China.,Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Zhaorong Xu
- Burn and Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kefeng Lin
- Department of Orthopedic Surgery, Fujian Provincial Hospital Jinshan Branch, Fuzhou, China.,Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
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15
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Morgan SJ, Durfey SL, Ravishankar S, Jorth P, Ni W, Skerrett DT, Aitken ML, McKone EF, Salipante SJ, Radey MC, Singh PK. A population-level strain genotyping method to study pathogen strain dynamics in human infections. JCI Insight 2021; 6:e152472. [PMID: 34935640 PMCID: PMC8783678 DOI: 10.1172/jci.insight.152472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A hallmark of chronic bacterial infections is the long-term persistence of 1 or more pathogen species at the compromised site. Repeated detection of the same bacterial species can suggest that a single strain or lineage is continually present. However, infection with multiple strains of a given species, strain acquisition and loss, and changes in strain relative abundance can occur. Detecting strain-level changes and their effects on disease is challenging because most methods require labor-intensive isolate-by-isolate analyses, and thus, only a few cells from large infecting populations can be examined. Here, we present a population-level method for enumerating and measuring the relative abundance of strains called population multi-locus sequence typing (PopMLST). The method exploits PCR amplification of strain-identifying polymorphic loci, next-generation sequencing to measure allelic variants, and informatic methods to determine whether variants arise from sequencing errors or low-abundance strains. These features enable PopMLST to simultaneously interrogate hundreds of bacterial cells that are cultured en masse from patient samples or are present in DNA directly extracted from clinical specimens without ex vivo culture. This method could be used to detect epidemic or super-infecting strains, facilitate understanding of strain dynamics during chronic infections, and enable studies that link strain changes to clinical outcomes.
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Affiliation(s)
- Sarah J. Morgan
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Samantha L. Durfey
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sumedha Ravishankar
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter Jorth
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wendy Ni
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Duncan T. Skerrett
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Moira L. Aitken
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Stephen J. Salipante
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Matthew C. Radey
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Pradeep K. Singh
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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16
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Anagnostakos K, Thiery A, Sahan I. Retained Negative Pressure Wound Therapy Foams as a Cause of Infection Persistence. Adv Wound Care (New Rochelle) 2021; 10:699-710. [PMID: 32870776 DOI: 10.1089/wound.2019.1088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Negative pressure wound therapy (NPWT) has become a valuable adjunct in the treatment of acute and chronic wounds in several surgical disciplines. Retained foams are among its side effects, and they pose a rare but devastating complication at the site of this therapy, which might be associated with wound-healing complications, infection persistence, repeated surgical revisions, and prolonged antibiotic courses. Recent Advances: In the past 15 years, an increasing number of studies have identified this potential problem. Although the exact incidence remains unknown, initial studies have indicated rates of up to 10% in large collectives being treated by NPWT. Critical Issues: The lack of radiopaque markers does not allow for the visual control of retained foams using plain radiographs. Further imaging methods (e.g., CT and MRI) also do not help in adequate differential diagnosis. The lack of routine documentation of the number, type, and localization of the inserted foam(s) and unplanned surgery with a different surgical team pose risk factors for foam retainment. Future Directions: Introducing new documentation records for wounds treated with NPWT is recommended. At foam removal, all dressing materials should be examined for integrity. The development of foams with radiopaque markers by the industry, such as those routinely used in surgical gauze swabs, might also be a useful step to minimize the risk of foam retainment within wounds.
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Affiliation(s)
- Konstantinos Anagnostakos
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Andreas Thiery
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Ismail Sahan
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
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17
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Trucillo P, Di Maio E. Classification and Production of Polymeric Foams among the Systems for Wound Treatment. Polymers (Basel) 2021; 13:1608. [PMID: 34065750 PMCID: PMC8155881 DOI: 10.3390/polym13101608] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/28/2021] [Accepted: 05/14/2021] [Indexed: 12/19/2022] Open
Abstract
This work represents an overview on types of wounds according to their definition, classification and dressing treatments. Natural and synthetic polymeric wound dressings types have been analyzed, providing a historical overview, from ancient to modern times. Currently, there is a wide choice of materials for the treatment of wounds, such as hydrocolloids, polyurethane and alginate patches, wafers, hydrogels and semi-permeable film dressings. These systems are often loaded with drugs such as antibiotics for the simultaneous delivery of drugs to prevent or cure infections caused by the exposition of blood vessel to open air. Among the presented techniques, a focus on foams has been provided, describing the most diffused branded products and their chemical, physical, biological and mechanical properties. Conventional and high-pressure methods for the production of foams for wound dressing are also analyzed in this work, with a proposed comparison in terms of process steps, efficiency and removal of solvent residue. Case studies, in vivo tests and models have been reported to identify the real applications of the produced foams.
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Affiliation(s)
- Paolo Trucillo
- Department of Chemical, Material and Industrial Production Engineering (DICMAPI), University of Naples Federico II, Piazzale Vincenzo Tecchio 80, 80125 Napoli, Italy;
- IODO S.r.l., 84123 Salerno, Italy
| | - Ernesto Di Maio
- Department of Chemical, Material and Industrial Production Engineering (DICMAPI), University of Naples Federico II, Piazzale Vincenzo Tecchio 80, 80125 Napoli, Italy;
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18
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Ferguson J, Alexander M, Bruce S, O'Connell M, Beecroft S, McNally M. A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services. J Bone Jt Infect 2021; 6:151-163. [PMID: 34084705 PMCID: PMC8137857 DOI: 10.5194/jbji-6-151-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 03/21/2021] [Indexed: 12/16/2022] Open
Abstract
Aims: An investigation of the impact of a multidisciplinary bone infection unit (BIU) undertaking osteomyelitis surgery with a single-stage protocol on clinical
outcomes and healthcare utilisation compared to national outcomes in
England. Patients and Methods: A tertiary referral multidisciplinary BIU was compared to the rest of
England (ROE) and a subset of the 10 next busiest centres based on osteomyelitis treatment episode volume (Top Ten), using the Hospital
Episodes Statistics database (HES). A total of 25 006 patients undergoing
osteomyelitis surgery between April 2013 and March 2017 were included. Data
on secondary healthcare resource utilisation and clinical indicators were
extracted for 24 months before and after surgery. Results:
Patients treated at the BIU had higher orthopaedic healthcare utilisation in
the 2 years prior to their index procedure, with more admissions (p< 0.001) and a mean length of stay (LOS) over 4 times longer than other groups (10.99 d, compared to 2.79 d for Top Ten and 2.46 d
for the ROE, p< 0.001). During the index inpatient period, the BIU had fewer mean theatre visits (1.25) compared to the TT (1.98, p< 0.001) and the ROE (1.64, p= 0.001). The index inpatient period was shorter in the BIU (11.84 d), 33.6 %
less than the Top Ten (17.83 d, p< 0.001) and 29.9 % shorter
than the ROE (16.88 d, p< 0.001). During follow-up, BIU patients underwent fewer osteomyelitis-related reoperations than Top Ten centres (p= 0.0139) and the ROE (p= 0.0137). Mortality was lower (4.71 %) compared to the Top Ten (20.06 %, p< 0.001) and the ROE (22.63 %, p< 0.001). The cumulative BIU total amputation rate was lower (6.47 %) compared to the Top Ten (15.96 %, p< 0.001) and the ROE (12.71 %, p< 0.001). Overall healthcare
utilisation was lower in the BIU for all inpatient admissions, LOS, and
Accident and Emergency (A&E) attendances. Conclusion: The benefits of managing osteomyelitis in a multi-disciplinary team (MDT) specialist setting included reduced hospital stays, lower reoperation rates
for infection recurrence, improved survival, lower amputation rates, and
lower overall healthcare utilisation. These results support the
establishment of centrally funded multidisciplinary bone infection units that will improve patient outcomes and reduce healthcare utilisation.
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Affiliation(s)
- Jamie Ferguson
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7HE, UK
| | | | - Stuart Bruce
- Health Economic and Outcomes Research Consultant, University of Otago, Dunedin, New Zealand
| | | | | | - Martin McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7HE, UK
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19
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Current concepts in the prevention, diagnosis and treatment of fracture-related infection (FRI). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:957-966. [PMID: 33778904 DOI: 10.1007/s00590-021-02956-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
Fracture-related infection (FRI) is one of the most challenging complications following operative management of fractures. It can have profound implications for the patient, can be associated with considerable morbidity and often lead to impaired outcomes. There are significant healthcare-related costs. In recent years, there has been significant progress towards developing preventative strategies. Furthermore, diagnostic algorithms and management protocols have recently been reported. Lack of a strong evidence base has previously hindered efforts to implement these and develop established standards of care. There are multiple aspects of care that need to be considered and a multi-disciplinary approach is recommended. In this narrative review, we present the most up-to-date recommendations in the prevention, diagnosis and management of FRI.
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20
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Guedes GMM, Santos-Filho ASP, Regis WFM, Ocadaque CJ, Amando BR, Sidrim JJC, Brilhante RSN, Cordeiro RA, Bandeira SP, Rocha MFG, Castelo-Branco DSCM. Ex situ model of biofilm-associated wounds: providing a host-like environment for the study of Staphylococcus aureus and Pseudomonas aeruginosa biofilms. J Appl Microbiol 2021; 131:1487-1497. [PMID: 33556197 DOI: 10.1111/jam.15026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
AIM This study aimed to assess an ex situ model of biofilm-associated wounds on porcine skin for the study of Staphylococcus aureus and Pseudomonas aeruginosa biofilms in a host-like environment, after 48 to 120 h of incubation. MATERIAL AND RESULTS Ex situ and in vitro biofilms were comparatively analysed. Overall, CFU-counts and matrix quantification yielded significantly (P < 0·05) higher results for ex situ than in vitro biofilms. Confocal microscopy revealed greater (P < 0·05) biomass and thickness at 48-72 h and greater (P < 0·05) robustness at 72 h of growth. S. aureus ex situ biofilms produced less (P < 0·05) siderophore and proteases than in vitro biofilms, while P. aeruginosa ex situ biofilms produced more (P < 0·05) siderophores and less proteases than in vitro biofilms. CONCLUSIONS Biofilms grown ex situ present a greater amount of bacterial cells and polymeric matrix than their in vitro counterparts, reaching maturity at 72 h of growth. Moreover the production of virulence factors differs between ex situ and in vitro biofilms. SIGNIFICANCE AND IMPACT OF THE STUDY These findings emphasize the importance of using ex situ biofilm models, once they mimic in vivo conditions. The use of these models brings perspectives for the pursuit of therapeutic alternatives, as tests may be performed in a host-like environment.
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Affiliation(s)
- G M M Guedes
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - A S P Santos-Filho
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - W F M Regis
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - C J Ocadaque
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - B R Amando
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - J J C Sidrim
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - R S N Brilhante
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - R A Cordeiro
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - S P Bandeira
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - M F G Rocha
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Postgraduate Program in Veterinary Sciences, College of Veterinary, State University of Ceará, Fortaleza, Ceará, Brazil
| | - D S C M Castelo-Branco
- Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Department of Pathology and Legal Medicine, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil
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21
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Metsemakers WJ, Morgenstern M, Senneville E, Borens O, Govaert GAM, Onsea J, Depypere M, Richards RG, Trampuz A, Verhofstad MHJ, Kates SL, Raschke M, McNally MA, Obremskey WT. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 2020; 140:1013-1027. [PMID: 31659475 PMCID: PMC7351827 DOI: 10.1007/s00402-019-03287-4] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 12/15/2022]
Abstract
Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. As a well-established diagnosis is the first step in the treatment process of FRI, such a definition should not only improve the quality of published reports but also daily clinical practice. The FRI consensus group recently developed guidelines to standardize treatment pathways and outcome measures. At the center of these recommendations was the implementation of a multidisciplinary team (MDT) approach. If such a team is not available, it is recommended to refer complex cases to specialized centers where a MDT is available and physicians are experienced with the treatment of FRI. This should lead to appropriate use of antimicrobials and standardization of surgical strategies. Furthermore, an MDT could play an important role in host optimization. Overall two main surgical concepts are considered, based on the fact that fracture fixation devices primarily target fracture consolidation and can be removed after healing, in contrast to periprosthetic joint infection were the implant is permanent. The first concept consists of implant retention and the second consists of implant removal (healed fracture) or implant exchange (unhealed fracture). In both cases, deep tissue sampling for microbiological examination is mandatory. Key aspects of the surgical management of FRI are a thorough debridement, irrigation with normal saline, fracture stability, dead space management and adequate soft tissue coverage. The use of local antimicrobials needs to be strongly considered. In case of FRI, empiric broad-spectrum antibiotic therapy should be started after tissue sampling. Thereafter, this needs to be adapted according to culture results as soon as possible. Finally, a minimum follow-up of 12 months after cessation of therapy is recommended. Standardized patient outcome measures purely focusing on FRI are currently not available but the patient-reported outcomes measurement information system (PROMIS) seems to be the preferred tool to assess the patients' short and long-term outcome. This review summarizes the current general principles which should be considered during the whole treatment process of patients with FRI based on recommendations from the FRI Consensus Group.Level of evidence: Level V.
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Affiliation(s)
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Olivier Borens
- Orthopedic Department of Septic Surgery, Orthopaedic-Trauma Unit, Department for the Musculoskeletal System, CHUV, Lausanne, Switzerland
| | - Geertje A M Govaert
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolien Onsea
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, USA
| | - Michael Raschke
- Department of Trauma Surgery, University Hospital of Münster, Münster, Germany
| | - Martin A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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Kapukaya R, Ciloglu O. Treatment of chronic wounds with polyurethane sponges impregnated with boric acid particles: A randomised controlled trial. Int Wound J 2020; 17:1159-1165. [PMID: 32662209 DOI: 10.1111/iwj.13463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022] Open
Abstract
The objective of this study was to investigate the effectiveness of the sponge with boric acid particles combined with the negative pressure wound treatment (NPWT) system for chronic wounds with tissue defects. Our study was designed as a prospective randomised study. One hundred patients who were planned to have NPWT due to chronic wounds were included in this study from Orthopaedics and Traumatology and Plastic Surgery clinics. Patients were divided into two groups. In the first group, a new method, boric acid impregnated sponge, combined with the NPWT system, was used, and in the second group, sponge with silver nitrate was used. Besides the wide-broad spectrum antibacterial properties of silver nitrate, the antimicrobial, angiogenetic, and epithelial effects of boric acid were aimed to investigate by macroscopically and histopathologically. Thirty-six patients in the silver nitrate group and 44 patients in the boric acid group completed the study. A decrease in wound size and granulation was observed in both groups. Macroscopically, a decrease in wound size reduction, epithelialization and granulation were more prominent in the first group in which boric acid impregnated sponge was used than the second group in which silver sponge was used. Moreover, microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1. In this clinical study, the broad-spectrum antimicrobial properties of boric acid and its positive effect on the cells responsible for wound healing were found to be more pronounced compared to silver nitrate sponges. A combination of boric acid sponges with the NPWT system may be an alternative method for chronic wounds.
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Affiliation(s)
- Rana Kapukaya
- Department of Plastic and Reconstructive Surgery, University of Health Sciences Adana City Research and Training Hospital, Adana, Turkey
| | - Osman Ciloglu
- Department of Orthopaedic and Traumatology, University of Health Sciences Adana City Research and Training Hospital, Adana, Turkey
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Raizman R. Fluorescence imaging guided dressing change frequency during negative pressure wound therapy: a case series. J Wound Care 2020; 28:S28-S37. [PMID: 31509488 DOI: 10.12968/jowc.2019.28.sup9.s28] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Knowledge of wound bioburden can guide selection of therapies, for example, the use of negative pressure wound therapy (NPWT) devices with instillation in a heavily contaminated wound. Wound and periwound bacteria can be visualised in real-time using a novel, non-contact, handheld fluorescence imaging device that emits a safe violet light. This device was used to monitor bacterial burden in patients undergoing NPWT. METHODS Diverse wounds undergoing NPWT were imaged for bacterial (red or cyan) fluorescence as part of routine wound assessments. RESULTS We assessed 11 wounds undergoing NPWT. Bacterial fluorescence was detected under sealed, optically-transparent (routine) adhesive before dressing changes, on foam dressings, within the wound bed, and on periwound tissues. Bacterial visualisation in real-time helped to guide: (1) bioburden-based, personalised treatment regimens, (2) clinician selection of NPWT, with or without instillation of wound cleansers, and (3) the extent and location of wound cleaning during dressing changes. The ability to visualise bacteria before removal of dressings led to expedited dressing changes when heavy bioburden was detected and postponement of dressing changes for 24 hours when red fluorescence was not observed, avoiding unnecessary disturbance of the wound bed. CONCLUSION Fluorescence imaging of bacteria prompted and helped guide the timing of dressing changes, the extent of wound cleaning, and selection of the appropriate and most cost-effective NPWT (standard versus instillation). These results highlight the capability of bacterial fluorescence imaging to provide invaluable real-time information on a wound's bioburden, contributing to clinician treatment decisions in cases where bacterial contamination could impede wound healing.
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Affiliation(s)
- Rose Raizman
- Adjunct Lecturer, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Department of Professional Practice, Scarborough Health Network
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Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. INTERNATIONAL ORTHOPAEDICS 2019; 44:3-14. [PMID: 31641803 PMCID: PMC6938795 DOI: 10.1007/s00264-019-04426-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.
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Cooper R, Kirketerp-Møller K. Non-antibiotic antimicrobial interventions and antimicrobial stewardship in wound care. J Wound Care 2019; 27:355-377. [PMID: 29883284 DOI: 10.12968/jowc.2018.27.6.355] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Control of wound infection today relies largely on antibiotics, but the continual emergence of antibiotic-resistant microorganisms threatens a return to the pre-antibiotic era when physicians used antiseptics to prevent and manage infection. Some of those antiseptics are still used today, and others have become available. A diverse variety of non-antibiotic antimicrobial interventions are found on modern formularies. Unlike the mode of action of antibiotics, which affect specific cellular target sites of pathogens, many non-antibiotic antimicrobials affect multiple cellular target sites in a non-specific way. Although this reduces the likelihood of selecting for resistant strains of microorganisms, some have emerged and cross-resistance between antibiotics and antiseptics has been detected. With the prospect of a post-antibiotic era looming, ways to maintain and extend our antimicrobial armamentarium must be found. In this narrative review, current and emerging non-antibiotic antimicrobial strategies will be considered and the need for antimicrobial stewardship in wound care will be explained.
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Affiliation(s)
- Rose Cooper
- Professor of Microbiology, Department of Biomedical Science, Cardiff School of Health Sciences, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
| | - Klaus Kirketerp-Møller
- Orthopaedic Surgeon, Copenhagen Wound Healing Center, Department of Dermatology and Wounds, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV
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Abstract
Periprosthetic joint infection (PJI) is a serious complication occurring in 1% to 2% of primary arthroplasties, which is associated with high morbidity and need for complex interdisciplinary treatment strategies. The challenge in the management of PJI is the persistence of micro-organisms on the implant surface in the form of biofilm. Understanding this ability, the phases of biofilm formation, antimicrobial susceptibility and the limitations of host local immune response allows an individual choice of the most suitable treatment. By using diagnostic methods for biofilm detection such as sonication, the sensitivity for diagnosing PJI is increasing, especially in chronic infections caused by low-virulence pathogens. The use of biofilm-active antibiotics enables eradication of micro-organisms in the presence of a foreign body. The total duration of antibiotic treatment following revision surgery should not exceed 12 weeks. Cite this article: EFORT Open Rev 2019;4:482-494. DOI: 10.1302/2058-5241.4.180092
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Affiliation(s)
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, Corporate Member of Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
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Popivanov G, Kjossev K, Mutafchiyski V. The open abdomen - still a challenge for the surgeons. Which is the best technique for temporary abdominal closure? A focus on negative pressure wound therapy. G Chir 2019; 38:267-272. [PMID: 29442056 DOI: 10.11138/gchir/2017.38.6.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Motiei M, Sadan T, Zilony N, Topaz G, Popovtzer R, Topaz M. Gold nanoparticles for tracking bacteria clearance by regulated irrigation and negative pressure-assisted wound therapy. Nanomedicine (Lond) 2018; 13:1835-1945. [PMID: 30152260 DOI: 10.2217/nnm-2018-0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIM Regulated negative pressure-assisted wound therapy is a fundamental, nonpharmaceutical technology for acute and chronically infected wounds, yet bacterial clearance and biofilm buildup remain a challenge for healing. Regulated irrigation combined with negative pressure (RI-NPT) is emerging as an alternative therapeutic strategy for reducing bacterial load. Here, we analyzed RI-NPT hydrokinetics and efficacy of bacterial load reduction in wounds. MATERIALS & METHODS Escherichia coli were loaded with gold nanoparticles, quantified by flame atomic absorption spectroscopy. Computed tomography (CT) imaging tracked bacterial distribution over time in a low-flow rat wound model. Bacterial load was quantified using a novel CT ruler. RESULT Flame atomic absorption spectroscopy showed loading of 1.7 × 103 ± 0.2 gold nanoparticles/cell. CT tracking revealed that while regulated negative pressure-assisted wound therapy reduced bacterial load to a limited extent (5%), RI-NPT significantly increased bacterial outflow and clearance (by 45%). CONCLUSION This nanotechnology-based approach demonstrates that RI-NPT is essential for reducing bacterial load and, thus, for promoting wound healing.
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Affiliation(s)
- Menachem Motiei
- Faculty of Engineering & the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
| | - Tamar Sadan
- Faculty of Engineering & the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
| | - Neta Zilony
- Faculty of Engineering & the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
| | - Guy Topaz
- Department of Internal Medicine, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rachela Popovtzer
- Faculty of Engineering & the Institute of Nanotechnology & Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
| | - Moris Topaz
- Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel
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Yusuf E, Chan M, Renz N, Trampuz A. Current perspectives on diagnosis and management of sternal wound infections. Infect Drug Resist 2018; 11:961-968. [PMID: 30038509 PMCID: PMC6053175 DOI: 10.2147/idr.s130172] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Deep sternal wound infection (DSWI), also known as mediastinitis, is a serious and potentially fatal condition. The diagnosis and treatment of DSWI are challenging. In this current narrative review, the epidemiology, risk factors, diagnosis, and surgical and antimicrobial management of DSWI are discussed. Ideally, the management of DSWI requires early and sufficient surgical debridement and appropriate antibiotic therapy. When foreign material is present, biofilm-active antibiotic therapy is also needed. Because DSWI is often complex, the management requires the involvement of a multidisciplinary team consisting of cardiothoracic surgeons, plastic surgeons, intensivists, infectious disease specialists, and clinical microbiologists.
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Affiliation(s)
- Erlangga Yusuf
- Department of Medical Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Antwerp, Belgium,
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Nora Renz
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
| | - Andrej Trampuz
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
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The Effect of Negative Pressure Wound Therapy with and without Instillation on Mature Biofilms In Vitro. MATERIALS 2018; 11:ma11050811. [PMID: 29772696 PMCID: PMC5978188 DOI: 10.3390/ma11050811] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 01/02/2023]
Abstract
Background: To investigate the effect of negative pressure wound therapy (NPWT) with and without instillation (NPWTi) on in vitro mature biofilm. Methods: Mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus were grown under shear (130 rpm) on polycarbonate coupons in a CDC biofilm reactor for 3 days. Coupons containing biofilms were placed in a sterile petri dish and sealed using NPWT or NPWTi. Coupons were exposed to treatment for 24 h with NPWT alone or with instillation of: Povidone iodine solution (PVP-I) (10% w/v equivalent to 1% w/v available iodine, BETADINE®, Mundipharma, Singapore), surfactant based antimicrobial solution with polyhexamethylene biguanide (SBPHMB) (Prontosan®, B Braun Medical, Melsungen, Germany), Gentamicin 1 µg/mL (GM) (G1264 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) Rifampicin 24 µg/mL (RF) (R3501 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) and NaCl 0.9% (Baxter, Deerfield, IL, USA). Bacterial cell viability and biofilm architecture pre-and post-treatment were assessed using colony forming units (cfu), Live/Dead viability staining, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Results: Significant reductions were obtained in S. aureus biofilm thickness (65%) and mass (47%) when treated with NPWTi as compared to NPWT only. NPWTi with instillation of SBPHMB, PVP-I and RF achieved between 2 and 8 log10 reductions against S. aureus biofilm (p < 0.05–0.001). Conversely, PVP-I and SBMO achieved a 3.5 log10 reduction against P. aeruginosa (p < 0.05). Conclusions: NPWT alters biofilm architecture by reducing biofilm thickness and mass, but this does not affect bacterial cell viability. NPWT with instillation of certain antimicrobials solutions may provide a further synergistic effect in reducing the number of viable biofilm microorganisms. Our in vitro model may be used for screening the effectiveness of antimicrobials used under instillation prior to animal or human studies.
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Wang G, Li Z, Li T, Wang S, Zhang L, Zhang L, Tang P. Negative-Pressure Wound Therapy in a Pseudomonas aeruginosa Infection Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9496183. [PMID: 29862301 PMCID: PMC5976956 DOI: 10.1155/2018/9496183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Negative-pressure wound therapy (NPWT) is an effective strategy for the management of contaminated wounds, including those infected by Pseudomonas aeruginosa. We hypothesized that NPWT would reduce virulence factors as well as biofilm components and inhibit virulence-regulated gene expression in a model of P. aeruginosa wound infection. METHODS Wounds were created in anesthetized rabbits and P. aeruginosa was inoculated to the wound surface for 24 h. Wounds were treated with either NPWT or a sterile gauze dressing. Virulence factors including exotoxin A, rhamnolipid, and elastase were quantified by the enzyme-linked immunosorbent assay, orcinol, and elastin-Congo red methods, respectively. A biofilm component, eDNA, was quantified using a commercial kit. Virulence-regulated genes were determined by quantitative real-time polymerase chain reaction (RT-PCR). Biofilms were observed in vivo by staining with concanavalin A conjugated to Alexa Fluor® 647. RESULTS NPWT was more effective than the control treatment in reducing virulence factors and bacteria counts in vivo. A biofilm component, eDNA, was less abundant in the NPWT group. The results of the RT-PCR indicated that the expression levels of P. aeruginosa virulence-regulated genes and quorum-sensing population density-dependent systems were significantly inhibited by NPWT treatment. CONCLUSION NPWT reduced bacteria counts, virulence factors, and eDNA in a P. aeruginosa wound infection model in vivo. These beneficial effects are likely to be related to the reduced expression of virulence-regulated genes and the drainage induced by NPWT treatment. These findings may help clinicians to obtain a better understanding of the mechanism of NPWT for the treatment of infected wounds.
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Affiliation(s)
- Guoqi Wang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Zhirui Li
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Tongtong Li
- Department of Orthopedics, Tianjin Hospital, No. 406 Jiefangnan Road, Tianjin 300211, China
| | - Song Wang
- Medical College, Nankai University, Tianjin 300071, China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China
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Guoqi W, Zhirui L, Song W, Tongtong L, Lihai Z, Licheng Z, Peifu T. Negative pressure wound therapy reduces the motility of Pseudomonas aeruginosa and enhances wound healing in a rabbit ear biofilm infection model. Antonie van Leeuwenhoek 2018; 111:1557-1570. [PMID: 29468490 PMCID: PMC6097727 DOI: 10.1007/s10482-018-1045-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/07/2018] [Indexed: 12/25/2022]
Abstract
Pseudomonas aeruginosa motility, virulence factors and biofilms are known to be detrimental to wound healing. The efficacy of negative pressure wound therapy (NPWT) against P. aeruginosa has been little studied, either in vitro or in vivo. The present study evaluated the effect of negative pressure (NP) on P. aeruginosa motility in vitro, and the effect of NPWT on virulence factors and biofilms in vivo. P. aeruginosa motility was quantified under different levels of NP (atmospheric pressure, − 75, − 125, − 200 mmHg) using an in vitro model. Swimming, swarming and twitching motility were significantly inhibited by NP (− 125 and − 200 mmHg) compared with atmospheric pressure (p = 0.05). Virulence factors and biofilm components were quantified in NPWT and gauze treated groups using a rabbit ear biofilm model. Biofilm structure was studied with fluorescence microscopy and scanning electron microscopy. Additionally, viable bacterial counts and histological wound healing parameters were measured. Compared with the control, NPWT treatment resulted in a significant reduction in expression of all virulence factors assayed including exotoxin A, rhamnolipid and elastase (p = 0.01). A significant reduction of biofilm components (eDNA) (p = 0.01) was also observed in the NPWT group. The reduction of biofilm matrix was verified by fluorescence- and scanning electron-microscopy. NPWT lead to better histologic parameters (p = 0.01) and decreased bacterial counts (p = 0.05) compared with the control. NPWT treatment was demonstrated to be an effective strategy to reduce virulence factors and biofilm components, which may explain the increased wound healing observed.
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Affiliation(s)
- Wang Guoqi
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Li Zhirui
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Wang Song
- Medical College, Nankai University, Tianjin, 300071, People's Republic of China
| | - Li Tongtong
- Department of Orthopedics, Tianjin Hospital, No. 406 Jiefangnan Road, Tianjin, 300211, People's Republic of China
| | - Zhang Lihai
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Zhang Licheng
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Tang Peifu
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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Abstract
BACKGROUND Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches. MATERIAL AND METHODS The principles of diagnostics and combined surgical and antibiotic treatment are presented based on the current specialist literature. RESULTS With the help of a team approach the goals of treatment of an infected osteosynthesis, i.e. fracture healing, return to function and eradication of infection can be achieved. While the osteosynthesis material can usually be retained in acute infections, it is better to remove the infected hardware in chronic infections as eradication of the mature biofilm is no longer possible. DISCUSSION With adequate local wound débridement, the use of local and systemic antibiotics, as indicated by the specialist for infectious diseases and appropriate soft tissue coverage and wound closure, acute as well as chronic infections can be successfully treated. Nowadays, the surgeon has many different options for the management of bone defects. Depending on the anatomical location and the size of the defect a variety of techniques ranging from acute shortening to the Masquelet technique up to the Ilizarov distraction technique are available. These techniques should be combined with local bactericidal treatment.
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Affiliation(s)
- O Borens
- Abteilung für Traumatologie und Abteilung für Septische Chirurgie, Klinik für Orthopaedie und Traumtologie, Universitätsspital Lausanne - CHUV, Universität Lausanne, Rue du Bugnon 46, 1011, Lausanne, Schweiz.
| | - N Helmy
- Abteilung für Orthopaedie und Traumtologie des Bewegungsapparates, Bürgerspital Solothurn, Solothurn, Schweiz
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Yin Y, Zhang R, Li S, Guo J, Hou Z, Zhang Y. Negative-pressure therapy versus conventional therapy on split-thickness skin graft: A systematic review and meta-analysis. Int J Surg 2018; 50:43-48. [PMID: 29292216 DOI: 10.1016/j.ijsu.2017.12.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/04/2017] [Accepted: 12/20/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the clinical outcomes of negative-pressure wound therapy (NPWT) versus conventional therapy on split-thickness skin after grafting surgery. DESIGN Meta-analysis. BACKGROUND Split-thickness skin grafts are widely used in reconstruction of large skin defects. Conventional therapy causes pain during dressing changing. NPWT is an alternative method to cover the wound bed. METHODS The Pubmed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) or cohort studies for articles published between 1993 and April 2017 comparing NPWT to conventional wound therapy for split-thickness skin grafts. The rate of graft take was the primary outcome of this meta-analysis. Wound infection and reoperation rate of the wound were secondary outcomes. Data analysis was conducted using the Review Manager 5.3 software. RESULTS Five cohort studies and seven RCTs including 653 patients were eligible for inclusion. Patients treated with NPWT had a significantly higher rate of graft take compared to those treated with conventional therapy [MD = 7.02, (95% CI 3.74, 10.31)] (P = .00). NPWT was associated with a reduction in reoperation [RR = 0.28, (95% CI 0.14, 0.55)] (P = .00). The reduction in wound infection was not significant [RR = 0.63, (95% CI 0.31, 1.27)] (P = .20). CONCLUSION Compared with conventional therapy, NPWT significantly increases the rate of graft take and reduces the rate of reoperation when applied to cover the wound bed with split-thickness skin graft. No significant impact on wound infection was found in this study.
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Affiliation(s)
- Yingchao Yin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei Province, China.
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei Province, China.
| | - Shilun Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei Province, China.
| | - Jialiang Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei Province, China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei Province, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei Province, China.
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Glass GE, Murphy GR, Nanchahal J. Does negative-pressure wound therapy influence subjacent bacterial growth? A systematic review. J Plast Reconstr Aesthet Surg 2017; 70:1028-1037. [DOI: 10.1016/j.bjps.2017.05.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/10/2017] [Indexed: 01/20/2023]
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Panayi AC, Leavitt T, Orgill DP. Evidence based review of negative pressure wound therapy. World J Dermatol 2017; 6:1-16. [DOI: 10.5314/wjd.v6.i1.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/15/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy (NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms (macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms (including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.
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Van Hecke LL, Haspeslagh M, Hermans K, Martens AM. Comparison of antibacterial effects among three foams used with negative pressure wound therapy in an ex vivo equine perfused wound model. Am J Vet Res 2017; 77:1325-1331. [PMID: 27901391 DOI: 10.2460/ajvr.77.12.1325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare antibacterial effects among 3 types of foam used with negative-pressure wound therapy (NPWT) in an ex vivo equine perfused wound model. SAMPLES Abdominal musculocutaneous flaps from 6 equine cadavers. PROCEDURES Each musculocutaneous flap was continuously perfused with saline (0.9% NaCl) solution. Four 5-cm circular wounds were created in each flap and contaminated with 106 CFUs of both Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). After a 1-hour incubation period, 1 of 4 treatments (NPWT with silver-impregnated polyurethane foam [NPWT-AgPU], polyurethane foam [NPWT-PU], or polyvinyl alcohol foam [NPWT-PVA] or a nonadherent dressing containing polyhexamethylene biguanide without NPWT [control]) was randomly applied to each wound. An 8-mm punch biopsy specimen was obtained from each wound immediately before and at 6, 12, 18, and 24 hours after treatment application to determine the bacterial load for both P aeruginosa and MRSA. RESULTS The bacterial load of P aeruginosa for the NPWT-PVA treatment was significantly lower than that for the other 3 treatments at each sampling time after application, whereas the bacterial load for the NPWT-AgPU treatment was significantly lower than that for the NPWT-PU and control treatments at 12 hours after application. The bacterial load of MRSA for the NPWT-PVA treatment was significantly lower than that for the other 3 treatments at each sampling time after application. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that wounds treated with NPWT-PVA had the greatest decrease in bacterial load; however, the effect of that treatment on wound healing needs to be assessed in vivo.
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Jentzsch T, Osterhoff G, Zwolak P, Seifert B, Neuhaus V, Simmen HP, Jukema GN. Bacterial reduction and shift with NPWT after surgical debridements: a retrospective cohort study. Arch Orthop Trauma Surg 2017; 137:55-62. [PMID: 27988849 DOI: 10.1007/s00402-016-2600-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgical debridement, negative-pressure wound therapy (NPWT) and antibiotics are used for the treatment of open wounds. However, it remains unclear whether this treatment regimen is successful in the reduction and shift of the bacterial load. METHODS After debridement in the operating room, NPWT, and antibiotic treatment, primary and secondary consecutive microbiological samples of 115 patients with 120 open wounds with bacterial or yeast growth in ≥1 swab or tissue microbiological sample(s) were compared for bacterial growth, Gram staining and oxygen use at a level one trauma center in 2011. RESULTS Secondary samples had significantly less bacterial growth (32 vs. 89%, p < .001, OR 17), Gram-positive bacteria (56 vs. 78%, p = .013), facultative anaerobic bacteria (64 vs. 85%, p = .011) and Staphylococcus aureus (10 vs. 46%, p = .002). They also tended to include relatively more Coagulase-negative Staphylococci (CoNS) (44 vs. 18%) and Pseudomonas species (spp.) (31 vs. 7%). Most (98%) wounds were successfully closed within 11 days, while wound revision was needed in 4%. CONCLUSIONS The treatment regimen of combined use of repetitive debridement, irrigation and NPWT in an operating room with antibiotics significantly reduced the bacterial load and led to a shift away from Gram-positive bacteria, facultative anaerobic bacteria, and S. aureus, as well as questionably toward CoNS and Pseudomonas spp. in this patient cohort. High rates of wound closure were achieved in a relatively short time with low revision rates. Whether each modality played a role for these findings remains unknown.
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Affiliation(s)
- Thorsten Jentzsch
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
| | - Georg Osterhoff
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Pawel Zwolak
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Gerrolt N Jukema
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
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Nie B, Yue B. Biological effects and clinical application of negative pressure wound therapy: a review. J Wound Care 2016; 25:617-626. [DOI: 10.12968/jowc.2016.25.11.617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- B. Nie
- Associated Professor Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - B. Yue
- Associated Professor Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Well-promising outcomes with vacuum-assisted closure in an infected wound following laparotomy: A case report. Ann Med Surg (Lond) 2016; 10:73-6. [PMID: 27570621 PMCID: PMC4990566 DOI: 10.1016/j.amsu.2016.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/30/2016] [Accepted: 07/31/2016] [Indexed: 11/23/2022] Open
Abstract
Introducation Negative pressure wound therapy (NPWT) represents an alternative method to optimize conditions for wound healing. Delayed wound closure is a significant health problem, which is directly associated with pain and suffering from patient's aspect, as well with social and financial burden. Presentation of case We report a case of vacuum-assisted wound therapy with hypertonic solution distillation and continuous negative pressure application, in an infected wound after laparotomy for incisional hernia reconstruction with mesh placement. Negative pressure was initiated at the wound margins after failure of conventional treatment with great outcomes, achieving a total closure of the incision within two weeks. Discussion Each wound has particular characteristics which must be managed. Vacuum assisted closure (VAC) with continuous negative pressure and simultaneous wound instillation and cleanse can provide optimum results, reducing the cavity volume, by newly produced granulated tissue. Conclusion The simultaneous use of instillation and constant pressure seemed to be superior in comparison with NPWT alone. Compared to conventional methods, the use of VAC ends to better outcomes, in cases of infected wounds following laparotomy.
A VAC device with automated solution distribution (with saline solution plus hypertonic saline), continuous pressure of −125 mmHg with equal distribution was applied. Within 4 days bacterial culture was negative. On the 7th day the wound was half in diameter and depth. After 15 days in total, therapy was discontinued achieving closure.
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Prosthetic Vascular Graft Infections: Bacterial Cultures from Negative-Pressure-Wound-Therapy Foams Do Not Improve Diagnostics. J Clin Microbiol 2016; 54:2190-3. [PMID: 27252462 DOI: 10.1128/jcm.01102-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 05/25/2016] [Indexed: 12/21/2022] Open
Abstract
We analyzed the diagnostic value of microorganisms cultured from negative-pressure-wound-therapy (NPWT) foam samples compared to that of microorganisms cultured from deep tissue samples from patients with vascular graft infections. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 58%, 86%, 81%, and 66%, respectively. The diagnostic value of microbiological cultures from NPWT foams was poor.
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Arti H, Khorami M, Ebrahimi-Nejad V. Comparison of negative pressure wound therapy (NPWT) &conventional wound dressings in the open fracture wounds. Pak J Med Sci 2016; 32:65-9. [PMID: 27022347 PMCID: PMC4795891 DOI: 10.12669/pjms.321.8568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: Successful closure is a primary step of treatment in open fracture wounds. Delayed healing or complications can lead to increased treatment duration, costs and disability rates. The aim of this study was to compare Negative Pressure Wound Therapy (NPWT) and conventional wound dressings in patients with open fracture wounds. Methods: In a prospective randomized clinical trial study, 90 patients with open fractures that were referred for treatment were enrolled between February 2013 to March 2015. Patients were divided into two groups. Group I underwent NPWT and group II underwent conventional wound dressing. Then patients were followed up for one month. Within the one month, the number of dressing change varied based on the extent of the wound. Duration of wound healing, presence of infection and the number of hospitalization days in these patients were recorded and compared at the end of the study between the two groups. Questionnaires and check lists were used to collect data. Analysis was done with SPSS 20, paired sample T-test, and chi-square tests. P<0.05 was considered significant. Results: There was a significant difference between the rate of wound healing in the group one or NPWT group and group II (conventional wound dressings) P<0.05. There was no significant difference between two groups in incidence of infection (P=0.6). Conclusion: Using NPWT expedites the healing process of extremity wounds. It is more economical and can be considered as a substitute for the treatment of extremity wounds.
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Affiliation(s)
- Hamidreza Arti
- Prof. Hamidreza Arti, Department of Orthopedic Surgery & Trauma Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Khorami
- Mohsen Khorami, Assistant Professor, Department of Orthopedic Surgery & Trauma Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vahid Ebrahimi-Nejad
- Vahid Ebrahimi-Nejad, Resident, Department of Orthopedic Surgery & Trauma Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications. Diagn Microbiol Infect Dis 2015; 84:261-5. [PMID: 26707065 DOI: 10.1016/j.diagmicrobio.2015.11.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/25/2022]
Abstract
Deep sternal wound infection (DSWI) is a feared complication following cardiac surgery. This study describes clinical, microbiological, and treatment outcomes of DSWI and determines risk factors for complications. Of 55 patients with DSWI, 66% were male and mean age was 68.2 years. Initial sternotomy was for coronary artery bypass graft in 49% of patients. Sternal debridement at mean 25.4±18.3 days showed monomicrobial (94%), mainly Gram-positive infection. Secondary sternal wound infection (SSWI) occurred in 31% of patients, was mostly polymicrobial (71%), and was predominantly due to Gram-negative bacilli. Risk factors for SSWI were at least 1 revision surgery (odds ratio [OR] 4.8 [95% confidence interval {CI} 1.0-22.4], P=0.047), sternal closure by muscle flap (OR 4.6 [1.3-16.8], P=0.02), delayed sternal closure (mean 27 versus 14 days, P=0.03), and use of vacuum-assisted closure device (100% versus 58%, P=0.008). Hospital stay was significantly longer in patients with SSWI (69 days versus 48 days, P=0.04).
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Giesecke MT, Schwabe P, Wichlas F, Trampuz A, Kleber C. Impact of high prevalence of pseudomonas and polymicrobial gram-negative infections in major sub-/total traumatic amputations on empiric antimicrobial therapy: a retrospective study. World J Emerg Surg 2014; 9:55. [PMID: 25364376 PMCID: PMC4216372 DOI: 10.1186/1749-7922-9-55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/15/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction Emergency treatment of major sub-/total traumatic amputations continue to represent a clinical challenge due to high infection rates and serious handicaps. Effective treatment is based on two columns: surgery and antimicrobial therapy. Detailed identification of pathogen spectrum and epidemiology associated with these injuries is of tremendous importance as it guides the initial empiric antibiotic regimen and prevents adverse septic effents. Methods In this retrospective study 51 patients with major traumatic amputations (n = 16) and subtotal amputations (n = 35) treated from 2001 to 2010 in our trauma center were investigated. All patients received emergency surgery, debridement with microbiological testing within 6 h after admission and empircic antimicrobial therapy. Additionally to baseline patient characteristics, the incidence of positive standardized microbiologic testing combined with clinical signs of infection, pathogen spectrum, administered antimicrobial agents and clinical complications were analyzed. Results 70.6% of the patients (n = 36) acquired wound infection. In 39% wounds were contaminated on day 1, whereas the mean length of duration until first pathogen detection was 9.1 ± 13.4 days after injury. In 37% polymicrobial colonization and 28% Pseudomonas were responsible for wound infections during hospitalization. In 45% the empirc antimicrobial therapy focussed on Gram positive strains did not cover the detected bacteria, according antimicrobial resistogram. It was significantly more often found in infections associated with Pseudomonas (p 0.02) or polymicrobial wound infections. Conclusions This epidemiologic study reveals a pathogen shift from Gram-positive to Gram-negative strains with high incidence of Pseudomonas and polymicrobial infections in sub-/total major traumatic amputations. Therefore, empiric antimicrobial treatment historically focussing on Gram-positive strains must be adjusted. We recommend the use of Piperacillin/Tazobactam for these injuries. As soon as possible antimicrobial treatment should be changed from empiric to goal directed therapy according to the microbiological tests and resistogram results.
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Affiliation(s)
- Moritz T Giesecke
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philipp Schwabe
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Florian Wichlas
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Kleber
- Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
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A N, Khan WS, J P. The evidence-based principles of negative pressure wound therapy in trauma & orthopedics. Open Orthop J 2014; 8:168-77. [PMID: 25067971 PMCID: PMC4110388 DOI: 10.2174/1874325001408010168] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/21/2014] [Accepted: 04/06/2014] [Indexed: 12/20/2022] Open
Abstract
Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.
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Affiliation(s)
- Novak A
- Department of Trauma & Orthopedics, Basingstoke & North Hampshire Hospital, Wessex, UK
| | - Wasim S Khan
- University College London Institute of Orthopedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Palmer J
- Department of Trauma & Orthopedics, Basingstoke & North Hampshire Hospital, Wessex, UK
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Patmo AS, Krijnen P, Tuinebreijer WE, Breederveld RS. The Effect of Vacuum-Assisted Closure on the Bacterial Load and Type of Bacteria: A Systematic Review. Adv Wound Care (New Rochelle) 2014; 3:383-389. [PMID: 24804158 DOI: 10.1089/wound.2013.0510] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022] Open
Abstract
Significance: A high bacterial load interferes with the healing process of a wound. Vacuum-assisted closure (VAC) is a wound healing therapy that utilizes a dressing system that continuously or intermittently applies a negative pressure to the wound surface. Recent Advances: VAC stimulates wound healing, but data on changes in the bacterial load and changes in the bacterial spectrum are scarce. Critical Issues: While VAC supposedly removes bacteria from the treated wounds and therefore reduces the risk of infection, this relationship has not yet been clinically proven. If VAC increases the bacterial load instead of decreasing it, then this may be a reason not to use VAC on certain types of wounds. Only seven small and heterogeneous studies reporting on the relationship between VAC usage and the bacterial load and type of bacteria in the treated wounds in clinical practice were found in the literature. Although there is some low quality evidence that VAC therapy does not change the bacterial load, no definite conclusions on changes in the bacterial load and type of bacteria during VAC can be drawn. Future Directions: Prospectively monitoring changes in the bacterial load and bacterial spectrum in patients that will receive VAC treatment on indication might be an effective way to find out whether it should indeed be used on specific wounds.
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Affiliation(s)
- Aryan S.P. Patmo
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Roelf S. Breederveld
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery-Traumatology, Beverwijk Red Cross Hospital, Beverwijk, The Netherlands
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Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. Curr Probl Surg 2014; 51:301-31. [PMID: 24935079 DOI: 10.1067/j.cpsurg.2014.04.001] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/15/2014] [Indexed: 12/13/2022]
Abstract
The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients.
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