Complications of open aortofemoral bypass
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
Many types of dressing, including gauze, silver-impregnated, and cyanoacrylate glue, have been used, however no one has consistently been proven to be superior. Much attention has been paid to the use of a topical negative-pressure wound therapy system placed at the time of surgery in an effort to decrease wound complications. A self-contained dressing consisting of a sponge and occlusive dressing is placed over a closed incision and connected to a portable vacuum device that maintains a subatmospheric pressure, which is thought to help decrease fluid within the underlying wound bed, maintain apposition of skin edges and, and allow minimal external contamination. These are applied at the time of skin closure and maintained in place until postoperative day 5–7. These types of dressing have been shown to drop the rate of incision dehiscence and surgical site infection from previously published rates as high as 20% to 5–11%. There was no difference in the rate of other groin incision complications, however most trials did not specifically attempt to measure this variable.51–54
Vulvar cancer and post-vulvectomy complications
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Lately, negative pressure wound therapy has been studied in postoperative wound closure, creating a clean, dry wound microenvironment, decreasing postoperative seromas, and accelerating wound healing (31,32). Vacuum-assisted closure (VAC) dressing is the treatment of choice. In the past, there were also other proposed types of treatment, such as hyperbaric oxygen therapy (33). The disposable components of the V.A.C. Therapy System® (Figure 13.1) include the foam dressing kits (i.e., V.A.C. GranuFoam™, KCI, TX, USA; V.A.C. GranuFoam Silver®, KCI, TX, USA; or V.A.C. WhiteFoam™ dressing). The therapy accessories are packaged sterile and are latex-free materials. The ActiV.A.C.® (KCI, TX, USA), InfoV.A.C.® (KCI, TX, USA), V.A.C. ATS® (KCI, TX, USA), and V.A.C. Freedom® (KCI, TX, USA). Negative pressure wound therapy systems are dedicated to wound management on an inpatient or outpatient basis. The created negative pressure forms an environment that increases wound healing by secondary or tertiary intention, promoting granulation tissue formation, removing exudates, and reducing edema (34–37).
Surgical Principles: Bowel Anastomosis, Wound Management and Surveillance
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Negative pressure wound therapy can be a convenient means of nursing an open abdomen and there has been much experience of its use in a trauma setting. There was some initial concern that the negative pressure may itself be fistulogenic but careful application avoids frequent need for dressing change, which may itself be a cause for iatrogenic injury. Carlson et al.63 described the outcomes of 578 non-randomised patients treated with an open abdomen, mainly in the setting of sepsis, over an 18 month period in the UK. Intestinal fistulation, death, bleeding and intestinal failure were no more common in the 355 patients treated with negative pressure therapy than in the 223 treated by assorted other means, though delayed primary closure was significantly less common.
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].
SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome
Published in Acta Orthopaedica, 2020
Ilka Kamrad, Bengt Söderberg, Hedvig Örneholm, Kerstin Hagberg
The most frequently registered surgical technique for TTA was sagittal flaps (72%) followed by anterior/posterior flaps (14%), long posterior flaps (9%), and skew flaps (4%). Regional differences were seen when considering the use of sagittal flaps, ranging from 33% to 85%. Primary skin closure was performed with sutures in 67% of our cases, with staples in 21%, and open treatment was registered in 2%. In 10% of cases, negative pressure wound therapy was applied additionally. Postoperative residual limb care after TTA included in 95% of the cases a rigid dressing followed by compression treatment with a silicone liner, sometimes combined with an elastic stump shrinker. Liner therapy was in 79% of cases started within 3 weeks postoperatively.
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.
Related Knowledge Centers
- Burn
- Chronic Wound
- Diabetic Foot Ulcer
- Pressure Ulcer
- Suction
- Venous Ulcer
- Bone Fracture
- Exudate
- Dressing
- Wound Dehiscence