Autologous wound margin point columnar full-thickness skin grafting combined with negative pressure wound therapy improves wound healing in refractory diabetic foot ulcers

Diabetic lower extremity ulcers (DLEUs) are a severe complication of diabetes mellitus (DM) and are difficult to heal. This study aimed to explore the efficacy of autologous point columnar full-thickness skin graft taken from the ulcer wound margin combined with negative pressure wound therapy (NPWT) in refractory DLEUs. This is a prospective cohort study. A total of 40 inpatients with refractory DLEUs were recruited in the Diabetes Foot Center of Guangxi Zhuang Autonomous Region People's Hospital from October 2019 to November 2021. According to the doctors' professional suggestions and the patients' personal wishes, these enrolled patients were divided into two groups based on different topical wound management: the graft group (n = 18) and the conventional wound therapeutic (CWT) group (n = 22). The efficacy evaluations included the time to complete re-epithelialization of the wound and healing speed within 14 days of graft treatment or after 14 days of graft treatment in the two groups. Before the treatment, the graft group had a significantly larger ulcer area than the CWT group [27.22 (15.28, 46.59) versus 10.92 (7.00, 24.93) cm², P < .01]. However, the time to complete wound re-epithelialization in the graft group was shorter than in the CWT group [58.22 ± 30.60 versus 86.09 ± 49.54 d, P < .05]. Meanwhile, the healing speed in graft group was markedly faster than in CWT group, whether within 14 days [0.60 (0.40, 0.92) versus 0.16 (0.07, 0.34) cm²/d, P < .01] or after 14 days of graft treatment [0.57 (0.45, 0.91) versus 0.13 (0.08, 0.27) cm²/d, P < .01]. However, the total treatment cost in the graft group was lower than in the CWT group [419.59 ± 137.20 versus 663.97 ± 497.02 $, P < .05]. The novel treatment modality of autologous full-thickness skin graft taken from the ulcer wound margin combined with NPWT has hereby proposed for the first time, and is a safe, effective, and reliable method with a good performance-to-cost ratio to promote wound healing and shorten the healing time for DLEUs.     

The effect of pentoxifylline in treatment of skin degloving injuries: an experimental study

BACKGROUND: Management of skin degloving injuries is still a problematic issue and the avulsed part of the skin may become necrotic. In this pilot study, we attempted to develop an experimental model for degloving injuries and investigated the efficacy of pentoxifylline, a well-known potent agent in enhancement of erythrocyte flexibility and tissue vascularization, in treatment of this injury model. METHODS: Degloving injuries were created in 15 rats' tails by circular puncturing of the skin at the middle of the tail and then applying moderate force to avulse the skin from the underlying tissue. Then, the skin was repaired back to its original position. No treatment was given in the first group (n=6). In the second group (n=3), 0.4cm(3) physiological serum was administered intraperitoneally for 10 days. In the third group (n=6), intraperitoneal 25mg/kg pentoxifylline was administered for 10 days. Tails were observed daily for 21 days and then examined histopathologically. RESULTS: At the end of the study, the avulsed segment of the skin became cyanotic and ulcerated in the first and the second group, and in the third group, the skin was intact. In histopathological examination, loss of superficial ephitelium and dense infiltration of inflammatory cells were seen in groups 1 and 2, and the skin layers were normal in the group 3. CONCLUSION: Pentoxifylline improved tissue preservation and was proved to be highly beneficial in treatment of skin degloving injuries.     

负压封闭引流与常规敷料加压包扎治疗大面积皮肤撕脱伤的疗效对比研究

目的探讨负压封闭引流技术治疗大面积皮肤撕脱伤的临床疗效。方法对本院2007年3月—2010年8月采用原位全厚皮片回植方法治疗的62例大面积皮肤撕脱伤病例进行回顾性研究,其中多聚乙烯醇明胶海绵覆盖回植皮片、持续负压封闭吸引（负压引流组）35例,传统敷料加压包扎覆盖回植皮片（敷料加压组）27例。观察两组术后皮片成活情况、创面感染率和创面愈合效果,记录平均住院时间。结果负压引流组中有31例回植全厚皮片全部成活,皮片成活率88.6%,余4例皮片存活面积〉95%,;2例遗留创面感染,感染率5.7%;平均住院时间（12.3±5.4）d。敷料加压组全部成活18例,皮片成活率66.7%,余9例皮片成活面积〉75%;6例遗留创面感染,感染率22.2%;平均住院时间（19.7±8.3）d。对两组皮片成活率、创面感染率和平均住院时间进行比较,差异均有统计学意义（P〈0.05）。两组经换药或二次手术植皮后,撕脱创面均愈合。结论与常规敷料加压包扎技术比较,封闭负压引流技术可提高大面积皮肤撕脱伤创面植皮的成活率,降低感染率,缩短住院天数,是治疗大面积皮肤撕脱伤较为理想的方法。     

A retrospective cohort study evaluating efficacy in high‐risk patients with chronic lower extremity ulcers treated with negative pressure wound therapy

The purpose of this study was to evaluate the efficacy of negative pressure wound therapy (NPWT) compared with standard of care on wound healing in high‐risk patients with multiple significant comorbidities and chronic lower extremity ulcers (LEUs) across the 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, comorbidities, healing outcomes and ulcer characteristics. A total of 342 patients, 171 NPWT patients with LEUs were matched with 171 non‐NPWT patients with respect to age and gender, were included in this cohort from 2002 to 2010. The hazard ratios (HRs) were estimated by COX proportional hazard models after adjusting for potential confounders. The NPWT patients were 2·63 times (95% CI = 1·87–3·70) more likely to achieve wound closure compared with 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 with non‐NPWT patients. In addition, wound healing appeared to be positively affected by the timing of NPWT application. Compared with 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. This study showed that despite the greater significant comorbidities, patients receiving NPWT 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.     

The use of cross-leg free muscle flaps in the reconstruction of lower extremity injuries

The cover of soft tissue and bone defects of the distal one-third of the leg resulting from crush injuries is a challenging problem. In such injuries healthy recipient vessels for free tissue transfer are frequently unavailable. Three cases of gunshot wounds and a mine explosion were managed successfully with cross-leg free muscle flaps, two latissimus dorsi and one rectus abdominis. The disadvantages of this technique are patient discomfort due to immobilization between the main and the flap division procedures together with the long hospital stay.     

Role of negative pressure wound therapy in total hip and knee arthroplasty

Negative-pressure wound therapy(NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trialsincluding single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections.     

Effective use of negative pressure wound therapy provides quick wound-bed preparation and complete graft take in the management of chronic venous ulcers

Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.     

Evaluation of an ultra‐lightweight,single‐patient‐use negative pressure wound therapy system over dermal regeneration template and skin grafts

As the use of negative pressure wound therapy (NPWT) over skin grafts has increased, traditional methods of NPWT system reimbursement and application are increasingly being challenged. A simplified method of accessing and operating NPWT in the outpatient setting is needed, particularly in cases where immediate outpatient use of NPWT is optimal. We evaluated use of a new ultra‐lightweight, off‐the‐shelf, disposable, single‐patient‐use NPWT system (SP‐NPWT; V.A.C.Via? Therapy, KCI USA, Inc., San Antonio, TX) over dermal regeneration template (DRT) and/or skin grafts. SP‐NPWT was initiated over a DRT and/or skin graft in 33 patients with 41 graft procedures. Endpoints were recorded and compared to a historical control group of 25 patients with 28 grafts bolstered with traditional rental NPWT (V.A.C.® Therapy, KCI USA, Inc.). Average length of inpatient hospital stay was 0·0 days for the SP‐NPWT group and 6·0 days for the control group (P < 0·0001). The average duration of SP‐NPWT post‐DRT or skin graft was 5·6 days for the SP‐NPWT group and 7·0 days for the control (P < 0·0001). Preliminary data suggest that, compared to traditional NPWT, off‐the‐shelf SP‐NPWT may provide a quicker, seamless transition to home, resulting in decreased hospital stay and potential cost savings.     

A retrospective analysis of securing autologous split-thickness skin grafts with negative pressure wound therapy in paediatric burn patients

Background and Aim

Deep dermal and full-thickness burn wounds are excised and grafted with split-thickness skin grafts. Especially in less compliant patients such as young children, conventional fixing methods can often be ineffective due to high mobility rates in this age group.The aim of this retrospective single-centre study was to give an overview of our experience in the fixation of autologous split-thickness skin grafts (ASTSGs) on burn wounds by negative pressure wound therapy (NPWT) in paediatric patients.

Methods

A retrospective analysis describing 53 paediatric patients with burns or burn-related injuries who were treated as 60 individual cases were conducted. All patients received ASTSGs secured by NPWT.

Results

Of the individual cases, 60 cases with a mean age of 8 ± 6 years (the youngest was 3 months, the eldest was 24 years old) were treated in a single procedure with ASTSG and NPWT. Total burn surface area (TBSA) was, median (med) 4.5% (3.0–12.0%). The TBSA of deep dermal thickness to full-thickness (IIb–III°) burns was med 4.0% (2.0–6.0%). The TBSA treated with ASTSG and NPWT was med 3.5% (2.0–6.0%). Take rate was, med 96% (90–99%) with a total range of 70–100%. The only significant correlation that could be found was between the grafted TBSA and the take rate. The smaller the grafted TBSA the better the take rate resulted, as expected. In three cases, major complications were noted.

Conclusion

To sum up our experience, the NPWT system has developed itself to be a constant, well-implemented and useful tool in securing ASTSGs to the wound bed. The main advantage of the technique is a much higher mobility of the patient compared to conventional fixation methods. The high compliance rate of an often challenging group of patients such as children recompenses possible higher costs compared to conventional fixation methods.     

Management and short-term patency of lower extremity venous injuries with various repairs

BACKGROUND: Although several methods of repair of extremity venous injuries have been shown to be efficacious, patency rates have varied significantly from center to center. METHODS: A retrospective review was made of treatment outcomes of adult and pediatric patients with major venous injuries of the lower extremity. RESULTS: From 1997 to 2002, 82 patients sustained 86 major lower extremity venous injuries. Venous injuries were treated with primary repair in 27, complex repair in 37 (autogenous vein, 10, and ringed polytetrafluoroethylene [PTFE], 27) and ligation in 20. Prior to repair, temporary intraluminal venous shunts were used in 18 patients. Follow-up duplex imaging or venography or both were performed on 42 extremities at a mean of 10.9 +/- 7.1 days after repair with an overall patency rate of 73.8% (primary repair 76.5%; autogenous vein graft 66.7%; and PTFE 73.7%). CONCLUSIONS: Overall early patency rate of venous repairs performed by an experienced trauma team is similar irrespective of the type of repair. The use of temporary intraluminal shunts is acceptable in selected circumstances, while ringed PTFE grafts are reasonable alternatives when the contralateral saphenous vein is too small.     

Pain and trauma in negative pressure wound therapy: a review

Negative pressure wound therapy (NPWT) is considered an effective wound treatment, but there are a number of issues that need to be addressed for improvements to be made. This review aimed to explore the literature relating to the pain and skin trauma that may be experienced during NPWT. A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE and PsyARTICLES. A total of 30 articles were reviewed. Studies reported varying levels of pain in patients undergoing NPWT, with certain treatment factors affecting the level of pain, such as the NPWT system and the dressing/filler used. Similarly, although there is much less research exploring NPWT‐related trauma, findings suggest that dressing and filler type may impact on whether trauma occurs. However, further research needs to consider the different stages of NPWT and how pain and trauma can be minimised during the whole procedure. As both pain and skin trauma impact on the patient's well‐being and on wound healing, it is essential that research further explores the factors that may affect the experience of pain and trauma, so as to inform developments in wound care.     

Negative pressure wound therapy: an adjuvant to surgical reconstruction of large or difficult skin and soft tissue defects

Wide and deep wound defects are a challenge to surgeons, particularly when aggressive or more radical operations are unavailable. This article introduces refined techniques, indications and the clinical experience of the application of negative pressure wound therapy (NPWT) as an easy ancillary wound dressing method for the reconstruction of large or difficult skin and soft tissue defects. The authors used NPWT on 88 patients as an adjuvant therapy before reconstructive surgery since 2006. NPWT was applied for two different treatment strategies: as an adjuvant therapy to facilitate the formation of a healthy wound bed and to reduce the size and depth of a defect. NPWT was used as an alternative dressing method for skin grafting for infants or mobile skin surfaces such as the neck, penis, dorsum of the hand, knee joint, abdomen, etc. There were no typical wound complications. NPWT application, if used appropriately, produces successful surgical reconstructions for large, deep skin and soft tissue defects without extensive or radical flap surgery or loss of skin graft.     

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection.     

Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta-analysis of randomised controlled trials

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.     

带血管蒂髂骨瓣移植修复下肢骨及其周围软组织缺损

目的探讨带血管蒂髂骨瓣移植在修复下肢骨及其周围软组织缺损中的作用。方法针对小腿、足解剖结构和伤后骨与软组织易缺损的特点,利用游离髂骨移植必须携带周围肌肉,设计带血管蒂的髂骨肌肉瓣,移植修复下肢骨及软组织缺损;髂骨肌肉瓣血管与受区血管吻合后于骨瓣周围肌肉表面皮片覆盖。结果手术后1周,移植皮片全部植在髂骨周围的肌肉表面,皮片成活间接证明移植骨瓣成活;皮片全部成活4例,大部分成活3例;术后1个月均可见髂骨瓣与受区断端间有少量的骨痂形成,修复足跖骨4个月后拔除克氏针,胫骨6～8个月拆除外固定架,扶拐行走2～4个月：术后随访经6～15个月(平均10个月),双下肢等长,无溃疡,行走负重良好,外形及功能满意。结论单纯髂骨游离移植修复骨及软组织缺损一次完成手术操作,解剖塑形及外观比传统术式更满意,是修复小腿及足外伤软组织和骨缺损的较好术式。     

聚乙烯醇泡沫负压伤口疗法在脊柱结核术后反复窦道不愈合中的应用

目的评价深腔填塞聚乙烯醇（polyvinylalcohol,I）VA）泡沫行负压伤口疗法（negativepressure wound therapy,NPWI、）侄脊柱结核术后治疗窦道不愈合中的效果。方法对2008年1月一2011年1月临床收治的17例脊柱结核术后反复窦道不愈合的病例,延窦道行病灶清除联合深腔填塞PVA泡沫行NPWT,观察在院治疗效果和愈后复发情况。结果患者伤121安置PVA泡沫10—25d,平均安置15。7d,伤口完全愈合17—29d,平均21．5d。随访6～30个月,无结核病灶复发。结论NPWT是脊柱结核术后反复宾道不愈合治疗中一项重要的手段,它在促进伤121愈合、结核脓肿排空、消灭脓肿死腔等方面起到了不可忽视的作用。     

Treatment of anticoagulated patients with negative pressure wound therapy

There is a paucity of evidence surrounding the use of negative pressure wound therapy (NPWT) in patients receiving anticoagulant medication. Guidelines generally recommend caution regarding the use of NPWT in anticoagulated patients in general, but areas of particular risk are frequently not highlighted. The US Food and Drug Authority (FDA) reported six mortalities between 2009 and 2011 in patients receiving NPWT. These mortalities were associated with the use of NPWT over vascular graft sites. The coagulation status of these patients was not reported. It is the authors' recommendation that guidelines regarding the use of NPWT in anticoagulated patients highlight specific clinical situations of risk, although there is insufficient evidence to support the avoidance of NPWT in anticoagulated patients in general.     

Negative-pressure wound therapy in skin grafts: A systematic review and meta-analysis of randomized controlled trials

IntroductionAlthough skin grafts are widely used in reconstruction of large skin defect and complex wounds, many factors lead to suboptimal graft take. Negative-pressure wound therapy (NPWT) reportedly increases the graft take rates when added to skin grafting, but a summary analysis of the data of randomized controlled trials has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to compare the effectiveness and safety of NPWT and non-NPWT for patients with skin grafts.MethodsWe searched PubMed, Embase, Cochrane Library, and CNKI for relevant trials based on predetermined eligibility criteria from database establishment to February 2020. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heterogeneity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis.ResultsTen randomized controlled trials with 488 patients who underwent NPWT or non-NPWT were included. Compared with non-NPWT, NPWT yielded an improved the percentage of graft take, a reduction in days from grafting to discharge, with lower relative risk of re-operation, and no increased relative risk of adverse event. Further, the subgroup analysis showed an improved the percentage of graft take in negative pressure of 80 mmHg, and no improved the percentage of graft take in negative pressure of 125 mmHg.ConclusionNPWT is more effective than non-NPWT for the integration of skin grafts, and the negative pressure of 80 mmHg can be recommended. Data on adverse events and negative pressure are, however, limited. A better understanding of complications after NPWT and the ideal negative pressure for the integration of skin grafts is imperative.     

自体组织移植联合负压创面治疗技术在创伤性创面治疗中的应用

目的：探讨自体组织移植联合负压创面治疗技术在治疗创伤性创面中的临床分析。方法：选择2010年4月-2012年4月笔者所在医院收治的创伤性创面患者64例,所有患者早期均采取负压创面治疗技术治疗,根据创面情况选择皮瓣移植手术或者皮片移植手术。结果：64例患者创面分泌物进行细菌培养,培养阳性患者37例,阳性率为57.81%;64例患者采取皮瓣移植手术患者30例、采取皮片移植手术患者34例,皮瓣移植手术优良率为96.67%,皮片移植优良率为88.24%,两者比较差异不具有统计学意义（P＞0.05）。结论：自体组织移植联合负压创面治疗技术能够促进创伤性创面的愈合,提高自体组织移植的成活率,值得临床推广运用。