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Advanced wound management of complex surgical wounds remains a significant challenge as more patients are being admitted to the hospital with infected wounds. Reducing recurrent infections and promoting granulation tissue formation are essential to overall wound healing. Negative pressure wound therapy (NPWT) has been widely practiced for 2 decades for the management of such wounds, but NPWT with instillation and dwell time (NPWTi-d) is a relatively recent adjunctive treatment of wounds that require serial debridements.
This study evaluates the advantages and disadvantages of NPWTi-d alone as well as NPWTi-d as an adjunct to standard NPWT in the treatment of complex wounds in patients with serious comorbidities.
In this case series, the NPWTi-d group was given instillation therapy only. In the combined group, instillation therapy was applied and then, as the bioburden in the wound decreased, NPWT therapy was substituted. Repeated volumetric measurements and photographs of the wounds were taken. An approthis study, NPWTi-d proved to be more effective in clearing the bioburden and reducing the number of surgeries for debridement. Complementing it with NPWT led to reduced episodes of troubleshooting and proved to be more cost-effective. Thus, NPWT may be considered as an adjunct therapy in select cases of complex wounds. However, more evidence is required.
In reconstructive surgery, the latissimus dorsi (LD) muscle is known as a workhorse flap and is commonly used as a pedicled or free flap. Postoperative complications of a reconstructive procedure with an LD flap include seroma and hematoma formation at an early stage after LD transfer. Late-onset hematoma at the donor site are considered to be extremely rare postoperative complications; late, expanding pseudotumor-like hematoma can occur months or years after surgery. Shearing forces and poor coagulation are thought to be the primary reasons for these postoperative complications.
This report presents 2 cases of pseudotumors 12 and 29 years after LD transfer. Magnetic resonance imaging was performed prior to complete surgical excision. After surgical removal, patients received negative-pressure wound therapy with instillation and dwell time (NPWTi-d) for several days. After vacuum-assisted wound bed preparation, wound closure was performed with secondary sutures.
The case report presented 2 incidences of rare late-onset pseudotumors many years after the initial LD reconstruction. To the authors' knowledge, this late-onset occurrence (ie, after 3 decades) has not been reported in the literature to date. If solidification of the late hematoma makes aspiration impossible, surgical intervention is required. Negative pressure wound therapy with instillation and dwell time potentially minimizes the wound size and reduces shear forces at the back donor-site.
The case report presented 2 incidences of rare late-onset pseudotumors many years after the initial LD reconstruction. To the authors' knowledge, this late-onset occurrence (ie, after 3 decades) has not been reported in the literature to date. If solidification of the late hematoma makes aspiration impossible, surgical intervention is required. Negative pressure wound therapy with instillation and dwell time potentially minimizes the wound size and reduces shear forces at the back donor-site.
Necrotizing fasciitis is a devastating infectious process associated with high mortality and morbidity rates. Medical and surgical interventions are necessary for survival. Negative pressure wound therapy (NPWT) has been shown to be beneficial in wound and graft care in these patients. Recently, NPWT has evolved to include instillation and dwell time (NPWTi-d) with encouraging results. However, no studies have examined the efficacy of NPWTi-d in graft care. The authors report the first 2 cases of necrotizing fasciitis with resulting complex wounds in which NPWTi-d was utilized during all phases of care (including after graft transfer) with excellent outcomes.
Two patients presented with histories of sustaining external trauma to their lower extremities with subsequent development of erythema, edema, and pain. Diagnosis of necrotizing fasciitis was made through history and physical examination findings, supported by LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores of greater than or equages in caring for skin grafts and could aid in graft survivability and take in certain clinical scenarios. Higher level evidence is needed to determine the true indications and contraindications of NPWTi-d.
The advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d) of a topical solution that dwells on the wound have been shown to include removal of fibrinous and bacterial exudate and increased granulation tissue formation. The treatment is best suited for chronic, complex wounds with areas of nonviable tissue on the wound surface.
A 73-year-old female with spondylolisthesis and stenosis of the spinal canal experienced dehiscence formation of the postoperative wound with continuous exudate after fusion and decompression surgery (TLIF L4-L5) of the lumbar spine. As a result, she had a complicated clinical course with multiple revision surgeries. Negative pressure wound therapy with continuous negative pressure was utilized for about 6 weeks, and regular dressing changes (saline gauze and honey dressings) were performed every day until NPWTi-d treatment was initiated; this protocol was not successful, so NPWTi-d with saline solution was initiated (average instillation time, 4 hours; dwell time, 15 minutes; continuous negative pressure, -125 mm Hg). During the course of therapy, 10 dressing changes were performed 3 to 5 days apart. After 31 days of therapy, healthy granulation tissue with minimal exudate was noted. Complete wound closure was achieved after 5 months of treatment.
Negative pressure wound therapy with instillation and dwell time can enhance the healing potential of a complex surgical wound after spinal fusion.
Negative pressure wound therapy with instillation and dwell time can enhance the healing potential of a complex surgical wound after spinal fusion.
Thoracic aortic graft infection is a rare complication after cardiac surgery with no consensus having been reached on the most appropriate type of management. Although most commonly caused by gram-positive cocci, aortic graft infection by Mycoplasma hominis can occur.
A 63-year-old male patient with an aneurysm of the ascending aorta was admitted to the authors' institution for surgical treatment. A replacement of the ascending aorta with a polyester vascular graft was performed using a valve-sparing aortic valve reimplantation technique. During postoperative course, the patient became septic with a spiking fever and elevated inflammatory markers. A computed tomography scan revealed signs of mediastinitis. M hominis was identified in blood cultures and intraoperative tissue samples. An antibiogram-based antibiotic solution (tigecycline in 5% glucose solution) was instilled twice daily into the thoracic cavity using negative pressure wound therapy with instillation and dwell time for 8 days. This type of management allowed the authors to avoid graft replacement, and good midterm outcomes were achieved.
To the authors' best knowledge, this is the first described successful treatment of an aortic graft infection caused by M hominis without a surgical removal of the prosthetic material using antibiotic irrigation.
To the authors' best knowledge, this is the first described successful treatment of an aortic graft infection caused by M hominis without a surgical removal of the prosthetic material using antibiotic irrigation.
Open abdominal wounds with intestinal fistula formation are challenging complications in abdominal surgery. Z-DEVD-FMK research buy Special fistula devices (SFD) used along with negative pressure wound therapy with instillation and dwell time (NPWTi-d), may improve management of these wounds, increasing NPWT dressing durability and helping decrease dressing leakage.
A 57-year-old, obese (body mass index 55 kg/m²) female with a long history of Crohn disease and multiple intestinal resections, presented with an incarcerated parastomal hernia, abscess formation, and septic shock. After the hernia was repositioned and the infection controlled, a bovine mesh-augmented hernia repair was performed. Skin rotation flaps for wound closure became necrotic and led to an infected, open abdominal wound measuring about 60 cm x 50 cm with formation of 2 additional small bowel fistulas alongside the ostomy and a massive bacterial and fungal superinfection. After surgical debridement, NPWTi-d with 10 minutes soaking time with isotonic saline soluwith SFDs represents a viable tool for the management of challenging fistulizing abdominal wounds.
Pyoderma gangrenosum (PG) is a rare, ulcerative dermatosis that is part of a systemic auto-inflammatory process. The overall incidence of PG is 5.8 per 100 000 individuals and it is associated with an increased mortality rate compared with the general population. Due to the pathergy phenomenon-present in 20% to 30% of cases-traumatic events, such as debridement or surgery, are often avoided in these patients. This report is on the use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) combined with a reticulated open cell foam dressing with through holes (ROCF-CC) to achieve debridement and granulation in a lower extremity PG wound.
A known patient with history of neuropathic arthritis, systemic lupus erythematosus, and cryoglobulinemic vasculitis presented with worsening of his lower extremity wound including new onset pain, odor, and purulent discharge. Negative pressure wound therapy with instillation and dwell time using a hypochlorous acid solution and a ROCF-CC was initiated. Significant decrease in necrotic tissue was noted by day 4, with improved granulation tissue growth by day 25. No pathergy occurred in this case.
The use of NPWTi-d with ROCF-CC demonstrated positive debridement effects on this PG wound.
The use of NPWTi-d with ROCF-CC demonstrated positive debridement effects on this PG wound.
This retrospective observational study analyzes the bacteriological profile of pathogens causing burn wound infections in a tertiary care center.
This study was conducted at Father Muller Medical College Hospital, Karnataka, India, from January 2014 through December 2016. The specimens (ie, pus or a wound swab) were collected from patients with suspected of infection and processed as per standard microbiological techniques. The antibiotic sensitivity testing was performed by the Kirby Bauer's disk diffusion test on Mueller-Hinton agar as per Clinical and Laboratory Standards Institute guidelines.
During the study period, a total of 124 eligible patient samples were collected; 22 samples were excluded as there was no significant growth/colonization. Among the 102 patients included in the study, 56 (54.9%) were females and the majority (33, 32.35%) of the patients were between 18 to 30 years. Acinetobacter species and Pseudomonas aeruginosa (26.56% each) were the most common pathogen among gram-negative bacteria and Staphylococcus aureus (36, 11.
