Subatmospheric pressure dressing as a bridge to free tissue transfer in the treatment of open tibia fractures
ABSTRACT Free flap reconstruction performed shortly after injury is associated with reduced complications but is not always feasible. Subatmospheric pressure dressings have several beneficial effects on wounds. This study reviewed a large series of open tibia fractures to determine whether subatmospheric pressure dressings affected complication rates.
One hundred five patients underwent free muscle flap reconstruction for open tibia fractures between 1991 and 2005. Patients were divided into three groups: acute (flap performed 1 to 7 days after injury), subacute (8 to 42 days after injury), and chronic (>42 days after injury). Five outcome measures were used: infectious complications, flap-related complications, surgical procedures, hospital stay, and time to bony union. The subacute group was divided into patients who underwent subatmospheric pressure dressing therapy and those who did not.
The complication rate in the subacute group (n = 55) was 47 percent, compared with 39 percent in the chronic group (n = 18) and 31 percent in the acute group (n = 32). Time to union was significantly shorter in the acute group than in the other groups. Subacute patients who underwent subatmospheric dressing therapy had lower overall complication (35 percent), infectious complication (6 percent), and flap-related complication rates (12 percent) than those who did not (53, 18, and 21 percent, respectively). Time to union was significantly shorter with the dressings.
Subatmospheric pressure dressing therapy as a "bridge" to free flap reconstruction in patients with open tibia fractures was associated with reduced complication rates in the subacute group, suggesting that the dressings may effectively extend the acute period when early free tissue transfer is not possible.
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ABSTRACT: Abstract Background: A high rate of surgical site infection (SSI) accompanies the repair of large ventral hernias in the presence of bacterial contamination. Recent clinical and laboratory studies suggest that negative-pressure therapy (NPT) applied to closed surgical incisions may reduce the risk of SSI in high-risk populations. We hypothesized that NPT would reduce the risk of SSI in patients undergoing the repair of contaminated ventral hernias. Methods: We reviewed retrospectively our prospectively collected database for patients undergoing repair of potentially contaminated and infected ventral hernias with or without NPT. All of the patients had primary wound closure. In the NPT group, a vacuum dressing was applied over the closed midline wound. The primary outcome measure was SSI at 30 d post-operatively. Results: We evaluated 119 patients (70 with a standard wound dressing (SWD) and 49 with NPT). The groups were similar in age, gender, body mass index (BMI), the prevalence of chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and smoking; and the number of prior abdominal operations. The SWD group had a higher American Society of Anesthesiologists (ASA) score than did the NPT group (3.0 vs. 2.8; p=0.01). The two groups were similar in the sizes of their hernia defects and duration of surgery, and did not differ in their 30-d rates of SSI (25.8% SWD vs. 20.4% NPT; p=0.50) or in the distribution of major and minor SSIs (SWD: 6 major, 12 minor vs. NPT: 2 major, 8 minor; p=0.56). Factors associated with an increased risk of SSI included ASA score (p=0.02), BMI (p=0.05), defect area (p<0.01), DM (p=0.01), and duration of surgery, (p<0.01). Conclusions: This retrospective, non-randomized study found that NPT in the setting of a closed surgical incision after potentially contaminated or infected ventral hernia repair (VHR) did not reduce the incidence of SSI. Although prophylactic NPT has reduced wound morbidity in some surgical populations, it does not appear to offer the same reduction in wound morbidity in high-risk, contaminated, and potentially contaminated open VHR.Surgical Infections 04/2013; 14(3). DOI:10.1089/sur.2012.059 · 1.72 Impact Factor
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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.The Open Orthopaedics Journal 06/2014; 8(1):168-77. DOI:10.2174/1874325001408010168
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ABSTRACT: Hidradenitis suppurativa is a chronic, debilitating disease that is difficult to treat. Once medical management fails, wide local excision offers the best chance for cure. However, the resultant wound often proves too large or contaminated for immediate closure. The authors performed a retrospective chart review of hidradenitis cases managed surgically between 2005 and 2010. Data collected included patient characteristics, management method, and outcomes. Approximately half of the patients received internal vacuum-assisted closure therapy using the vacuum-assisted closure system and delayed closure and half of the patients received immediate primary closure at the time of their excision. Delayed closure consisted of closing the majority of the wound in a linear fashion following internal vacuum-assisted closure while accepting healing by means of secondary intention for small wound areas. Patients managed with internal vacuum-assisted closure had wounds on average four times larger in area than patients managed without internal vacuum-assisted closure. In both groups, all wounds were eventually closed primarily. Healing times averaged 2.2 months with internal vacuum-assisted closure and 2.7 months without. At an average follow-up time of 2.3 months, all patients with internal vacuum-assisted closure had no recurrence of their local disease. Severe hidradenitis presents a treatment challenge, as surgical excisions are often complicated by difficult closures and unsatisfactory recurrence rates. This study demonstrates that wide local excision with reasonable outcomes can be achieved using accelerated delayed primary closure. This method uses internal vacuum-assisted closure as a bridge between excision and delayed primary closure, facilitating closure without recurrence in large, heavily contaminated wounds. Therapeutic, III.Plastic and Reconstructive Surgery 03/2014; 133(3):370e-7e. DOI:10.1097/PRS.0000000000000080 · 3.33 Impact Factor