Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.     

Gauze-based negative pressure wound therapy to infected deep sternotomy wound complicated by cardiac tamponade: a case report

Negative pressure wound therapy is the standard of care for infections after median sternotomy. Foam-based systems are commonly used even in scenarios when the myocardium is exposed. Gauze-based systems have recently gained popularity. We describe a case of deep sternal dehiscence that lead to a life-threatening complication secondary to wound filler choice.     

Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases

The open abdomen is an ongoing challenge for professionals engaged in its treatment. The change in the integrity of the abdominal wall, the loss of fluids, heat and proteins and contamination of the wound are the main problems. The objective of this article is to describe our experience using the abdominal dressing vacuum‐assisted closure therapy in treatment of the open abdomen. Since December 2006, all patients requiring treatment with the open abdomen technique have been treated with the abdominal dressing system and vacuum‐assisted closure therapy (VAC^® KCI, San Antonio, USA). The results obtained with this technique in non traumatic patients are analysed herein. The abdominal dressing system was used on 46 patients in the period between January 2006 and December 2009, with a mean 63 years old (29–80), with a gender distribution of 33 men (72%) and 13 women (28%). Closure of the abdominal wall was possible in 24 patients, 5 of which were primary in the recent postoperative phase, 5 had primary suture of the fascia and application of the supra‐aponeurotic prosthesis and 14 had closure of the abdominal wall with a composite polytetrafluoroethylene (PTFE) and polypropylene mesh. Second intention closure took place in the remaining 22 patients (48%), as their conditions did not allow primary closure. The mean treatment time with abdominal dressing was 26 days (6–92) with an average of eight changes per patient. The abdominal dressing topical negative pressure system is a useful option for consideration in the event of needing to leaves the abdomen open. It stabilises the abdominal wall and quantifies and collects exudate from the wound, protects the intra‐abdominal viscera and keeps the fascia intact and the cutaneous plane for subsequent closure of the wall.     

脂多糖对正常人皮肤成纤维细胞胶原合成的影响

目的:研究脂多糖(lipopolysaccharide,LPS)对正常人皮肤成纤维细胞胶原合成的影响,以阐明LPS在皮肤创伤愈合中的可能作用.方法:体外培养正常人皮肤成纤维细胞,采用3H-脯氨酸掺入法观察不同浓度(0、0.005、0.01、0.05、0.1、0.5和1.0 μg·ml-1)的LPS对成纤维细胞胶原合成的影响.结果:LPS刺激浓度在0.005 μg·ml-1时,皮肤成纤维细胞胶原蛋白合成增加;随着刺激浓度增加,刺激作用增强;但当LPS浓度为0.5 μg·ml-1时,促胶原合成作用开始降低;当浓度达到1.0 μg·ml-1时则呈现抑制效应.结论:在一定浓度范围内LPS促进成纤维细胞胶原合成,表明LPS在皮肤创伤愈合中可能具有重要作用.     

高温高湿环境下负压伤口疗法对创面愈合的影响

目的探讨高温高湿环境下局部负压伤口治疗对创伤愈合的影响。方法以兔背部皮肤全层皮肤缺损的急性创面为模型,将24只创伤兔按随机数字表法随机分为常温对照组、常温实验组、高温对照组、高温实验组,每组6只。实验组给予局部负压伤口治疗,对照组用纱布覆盖,不给予负压引流。在相应干预后的不同时间对各组动物的创面大体情况、创面愈合时间、创面愈合百分比、病理形态学进行观察和检测。结果高温对照组与常温对照组比较,创面愈合时间、创伤后7d创面愈合率、创面感染率及组织损伤程度显著增高（P〈0.05）,而实验组较相应的对照组则显著降低（P〈0.05）。结论高温高湿环境是阻碍创面愈合的重要因素之一,局部负压伤口疗法具有促进创面愈合的作用。     

护理干预在行消化道手术病人切口感染预防中的作用

[目的]探讨护理干预预防消化道手术病人切口感染的效果.[方法]对2008年6月-2010年6月在本院行消化道手术的356例病人进行术前、术后护理干预,包括加强营养支持、心理护理、做好肠道准备、注意切口护理和合理应用抗生素等.[结果]术后15例发生切口感染,切口感染率为4.2%.术后切口感染与病人全身健康状况、医务人员素质及应用抗生素等方面有着重要关系.[结论]在临床护理工作中,可以通过改善全身状况、充分做好肠道准备、合理应用抗生素、严密观察病情、注意切口护理等干预方式,降低术后切口感染率.     

藻酸盐敷料在腹部感染伤口中的应用体会

目的探讨藻酸盐敷料与干性敷料对腹部感染伤口愈合的效果。方法将腹部感染伤口10例分成2组,分别应用藻酸盐敷料和干性敷料换药,对比伤口愈合时间的不同。结果使用藻酸盐敷料较干性敷料换药伤口愈合时间明显缩短。结论藻酸盐敷料对促进腹部感染伤口的愈合效果明显。     

经桡动脉冠状动脉介入术后伤口的观察与护理

目的探讨经桡动脉介入术后伤口的观察和护理。方法对221例经桡动脉冠状动脉介入术后伤口的观察与护理进行总结。结果穿刺处伤口无并发症205例,穿刺点皮下淤血6例,右手肿胀5例,压迫周围水泡3例,右上臂肿胀1例,桡动脉闭塞1例,对症处理后均治愈出院。结论细致的观察和及时、正确的处理对于对经桡动脉穿刺患者的伤口护理非常重要。     

伤口与呼吸道分泌物中铜绿假单胞菌的耐药情况对比研究

目的 比较两种主要临床标本的铜绿假单胞菌(PA)的耐药情况,为合理应用抗菌剂提供依据.方法 收集住院患者呼吸道和伤口分泌物中的PA进行鉴定和药敏实验.结果 PA分离率以呼吸道分泌物(48.21%)最高,伤口分泌物(39.70%)次之,两者之和为87.91%.呼吸道和伤口分泌物的PA药物敏感性不一样.呼吸道分泌物PA耐药...     

Gasless laparoscopically assisted myomectomy using a wound retraction system

Introduction: The purpose of this study was to elucidate the feasibility of gasless laparoscopically assisted myomectomy (LAM) using a wound retraction system. This method treats symptomatic uterine myomas by combining laparoscopy with a mini‐laparotomy to enucleate myoma nodules and to close the uterine myometrium. Methods: This study includes 275 patients who underwent gasless LAM. For patients with fewer than three myoma nodules, the location of the largest nodule was classified as anterior, fundal, or posterior. The operative outcomes, intraoperative and postoperative courses, and complications were examined. Results: All operations were performed satisfactorily, and no conversions to laparotomy were required. None of the patients developed serious complications. The mean blood loss and operating time were 190.3 mL and 152.2 minutes, respectively. The mean myoma size was 8.9 cm, and the mean number of myomas per patient was 2.8. The average postoperative hospital stay was 5.7 days. There were no significant differences in resected myoma size, blood loss, and surgical duration with respect to the location of the largest nodule. Conclusion: Gasless LAM with a wound retractor is feasible and allows surgeons to perform myomectomy safely and cost‐effectively, without requiring advanced laparoscopic surgical skills and while maintaining minimum invasiveness.