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Obesity
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Negative pressure wound therapy does not decrease the incidence of wound complications in women with obesity and appears to increase the risk of skin reactions for the group receiving negative pressure therapy, as studied so far [277–280]; however, some studies have shown some benefit [281]. Likewise, silver nylon dressings did not confer a benefit over gauze [282].
Necrotizing Soft Tissue Infections
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
After initial resuscitative care and source control, supportive critical care is necessary as patients undergo multiple debridements and recover from their septic insult. While most aspects of the management of these patients is according to general critical care support, they may have very substantial surface area wounds, with extensive evaporative losses of fluid from their wounds and increased fluid requirements, and concomitant electrolyte fluctuations requiring close attention. Once the wounds are satisfactorily clean enough to allow its use, negative pressure wound therapy may be helpful to limit wound size, accelerate healing, contract wounds, and aid in tracking the amount of insensible losses.
Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Treatment for early-onset infection consists of antibiotic therapy such as penicillin 4 million units intravenously every 4 hours or cefazolin 2 g intravenously every 6 hours, and prompt debridement of necrotic tissue (71). Later infections usually respond to simple incision and drainage. Antibiotics are required only if there is extensive cellulitis, bacteremia, or failure to defervesce within 12 to 24 hours of opening the wound (71). Debridement under anesthesia is sometimes required (70). Fascial dehiscence of the wound occurs in 0.5% of post-cesarean patients and may be more common when wound infection is present (64,70). Fascial repair under anesthesia may be necessary. Modern management of open wounds, including secondary closure within 1 to 4 days of disruption, negative pressure wound therapy (vacuum-assisted closure), or healing by secondary intention with dressings that keep the wound moist and absorb drainage, has been shown to be superior to frequently changed, traditional “wet-to-dry” dressings and cleansers that disrupt wound healing (65).
Stem cell therapies for wound healing
Published in Expert Opinion on Biological Therapy, 2019
Nina Kosaric, Harriet Kiwanuka, Geoffrey C Gurtner
Standard wound care protocols rely largely on debridement, or the removal of necrotic and infected tissue to expose healthy, vascularized tissue [11], followed by application of wound dressings and topical agents to protect the healing wound from infection and promote the healing process [6]. Offloading the chronic wound using external compression is important, particularly in DFUs where excessive pressure is the primary cause of ulcer formation [12]. Advanced therapies have been developed for wounds that persist after an initial period of using standard wound care measures and span several modalities. Negative pressure wound therapy has exhibited superior clinical efficacy over standard therapy for the treatment of open amputation wounds, diabetic foot ulcers (DFUs), and venous leg ulcers (VLUs) [13] by accelerating granulation tissue formation, wound area contraction, and primary healing [14]. Importantly, negative pressure wound therapy improves engraftment and retention of skin grafts upon application to wound beds [15]. Other advanced treatment modalities include hyperbaric oxygen therapy and ultrasound and are expertly reviewed in Frykberg et al [6].
Ten-year follow-up of a case of necrotizing fasciitis successfully treated with negative-pressure wound therapy, dermal regeneration template application, and split- thickness skin autograft
Published in Acta Chirurgica Belgica, 2018
Broad spectrum antibiotics must be administered without delay. In our patient, amoxicillin with clavulanic acid and clindamycin were initially administered. After identification of the infectious agent as a group A beta hemolytic streptococcus, the patient was given piperacillin with tazobactam and ciprofloxacin. The next phase of the treatment of our patient was debridement and the application of negative pressure wound therapy with vacuum-assisted closure. Sub-atmospheric pressure, originally used for the chronic wounds, is now used in treatment of acute conditions like burns, surgical site infections, diabetic foot, necrotizing fasciitis, and a myriad of other conditions [9]. The application of negative pressure accelerates wound healing by optimizing blood flow, which increases local oxygenation and promotes fibroblast stimulation and granulation tissue formation. NPWT with VAC also decreases local edema by removal of excessive fluid from the wound bed, therefore facilitating the removal of the bacteria from the affected site [7]. The elimination of toxins and the virulent organisms is key to the recovery of NF patients, and even the most meticulous surgical debridement can significantly benefit from the VAC application, which will continue to debride the wound and drain the pathogenic organisms and their toxins [8]. Patients usually tolerate the VAC better than the classic bandages, and this treatment has been shown to reduce the hospitalization period [10].
Effect of subcutaneous tissue depth on outcomes of kidney transplantation
Published in Baylor University Medical Center Proceedings, 2021
Richard Ruiz, Thomas Cox, Gregory J. McKenna, Nicholas Onaca, Giuliano Testa, Hoylan Fernandez, Johanna Bayer, Anji Wall, Eric Martinez, Amar Gupta, J. Michelle DiNubila, Nicole Jennings, Kari Wicklund
Patients were followed for complications for 90 days posttransplant. The criteria for placement of negative pressure vacuum wound-assisted closure (wVAC) therapy included (1) the presence of a wound infection, (2) excessive and/or prolonged serous wound drainage, and (3) delayed wound healing characterized by skin nonunion or significant subcutaneous tissue exposure before or after skin staple removal. Patients with wVACs were followed in our transplant clinic and/or at our established hospital wound care center. The number of negative pressure wound therapy days was recorded from the time of placement to the time of discontinuation. KCI V.A.C.® therapy was utilized in all patients requiring negative pressure wound therapy.