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Concept: Negative pressure wound therapy

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We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications.

Concepts: Vacuum, Chronic wound, Negative pressure wound therapy

28

The purpose of this study is to evaluate the efficacy of negative pressure wound therapy (NPWT) as compared to standard of care on wound healing in high-risk patients with multiple significant co-morbidities and chronic lower extremity ulcers (LEUs) across a continuum of care settings. A retrospective cohort study of ‘real world’ high-risk patients was conducted using Boston University Medical Center electronic medical records, along with chart abstraction to capture detailed medical history, co-morbidities, healing outcomes and ulcer characteristics. A total of 342 patients, 171 NPWT patients with LEUs were matched with 171 non NPWT patients by age and gender, are included in this cohort from 2002 to 2010. The hazard ratios (HRs) were estimated in COX proportional hazard models after adjusted for potential confounders. NPWT patients were 2·63 times (95% CI = 1·87-3·70) more likely to achieve wound closure compared to non NPWT patients. Moreover, incidence of wound closure in NPWT patients were increased in diabetic ulcers (HR = 3·26, 95% CI = 2·21-4·83), arterial ulcers (HR = 2·27, CI = 1·56-3·78) and venous ulcers (HR = 6·31, 95% CI = 1·49-26·6) compared to non NPWT patients. Additionally, wound healing appears to be positively affected by timing of NPWT application. Compared to later NPWT users (1 year or later after ulcer onset), early NPWT users (within 3 months after ulcer onset) and intermediate NPWT users (4-12 months after ulcer onset) were 3·38 and 2·18 times more likely to achieve wound healing, respectively. Our study showed that despite the greater significant co-morbidities, patients with NPWT treatment healed faster. Early use of NPWT demonstrated better healing. The longer the interval before intervention is with NPWT, the higher the correlation is with poor outcome.

Concepts: Scar, Diabetic foot, Proportional hazards models, Chronic wound, Wound healing, Negative pressure wound therapy, Healing, Cohort study

26

The development and subsequent deterioration of diabetic foot ulceration (DFU) is a common occurrence across all healthcare divides, concerning all patient groups, age, gender and social environments. It increases demand on clinical resources and creates unnecessary hardship for patients. Chronic DFU is challenging to prevent and notoriously difficult to manage owing to the complex nature of the patient and the disease itself. The improvement of oxygenation to many chronic wound groups is gaining momentum across wound care; particularly in those wounds such as DFU that present with circulatory, oxygen-deficient scenarios.

Concepts: Medicine, Chronic wound, Medical terms, Negative pressure wound therapy, Wound healing, Patient, Wound, Infection

26

Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.

Concepts: Tendinosis, Infection, Arithmetic mean, Achilles tendon, Negative pressure wound therapy, Chronic wound, Tendon, Achilles tendon rupture

26

Wound dehiscence and SSI’s can have a profound impact on patients, as they often require hospital re-admission, additional surgical interventions, lengthy IV antibiotic administration and delayed rehabilitation. Negative pressure wound therapy(NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid and stimulation of cellular proliferation of granulation tissue.

Concepts: Hospital, Infection, Wound healing, Wound dehiscence, Blood, Chronic wound, Immune system, Negative pressure wound therapy

25

Microbial burden of chronic wounds is believed to play an important role in impaired healing and development of infection-related complications. However, clinical cultures have little predictive value of wound outcomes, and culture-independent studies have been limited by cross-sectional design and small cohort size. We systematically evaluated the temporal dynamics of the microbiota colonizing diabetic foot ulcers (DFU), a common and costly complication of diabetes, and its association with healing and clinical complications. Dirichlet multinomial mixture modeling, Markov chain analysis, and mixed-effect models were used to investigate shifts in the microbiota over time and its associations with healing. Here we show to our knowledge previously unreported temporal dynamics of the chronic wound microbiome. Microbiota community instability was associated with faster healing and improved outcomes. DFU microbiota were found to exist in one of four community types that experienced frequent and non-random transitions. Transition patterns and frequencies associated with healing time. Exposure to systemic antibiotics destabilized the wound microbiota, rather than altering overall diversity or relative abundance of specific taxa. This study provides to our knowledge previously unreported evidence that the dynamic wound microbiome is indicative of clinical outcomes and may be a valuable guide for personalized management and treatment of chronic wounds.

Concepts: Medicine, Bacteria, Infection, Chronic wound, Negative pressure wound therapy, Wound, Diabetic foot, Wound healing

25

With the growing demand for the specialized care of wounds, there is an ever expanding abundance of wound care modalities available. It is difficult to identify which products or devices enhance wound healing and thus a critical and continual look at new advances is necessary. The goal of any wound regimen should be to optimize wound healing by combining basic wound care modalities including debridement, off-loading, and infection control with the addition of advanced therapies when necessary. This review takes a closer look at current uses of negative pressure wound therapy, bioengineered alternative tissues, and amniotic membrane products. While robust literature may be lacking, current wound care advances are showing great promise in wound healing. This article is protected by copyright. All rights reserved.

Concepts: Infection, Negative pressure wound therapy, All rights reserved, Copyright, Traumatology, Wound, Wound healing, Chronic wound

24

Negative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness.

Concepts: Vacuum, Cost-effectiveness analysis, Medicine, Chronic wound, Negative pressure wound therapy

16

Activated carbon (AC) has been used in wound therapy as an active substance inside dressings. Applying AC directly on a wound is a new concept. The aim of this study was to analyse the outcomes of chronic wounds which were managed with directly applied activated carbon knitted cloth (ACC, Zorflex) in Swiss patients.

Concepts: Negative pressure wound therapy, Carbon, AC, Infection, Chronic wound, Activated carbon, Wound healing, Wound

11

PURPOSE: To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). METHODS: We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear). RESULTS: In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation. CONCLUSION: Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.

Concepts: Medicine, Abdomen, Respiratory physiology, Therapy, Human abdomen, Negative pressure wound therapy, Red blood cell, Blood