Difficulties and errors in the treatment of infected wounds

Errors resulting in delayed healing of wounds (266 observations) can be divided into 2 groups: inexpedient drainage of the purulent wounds and irrational local application (on the wound) of drugs. The latter was found to consist in the use of drugs without the phase of the inflammatory process taken into consideration and in the continuous application of one and the same drug. The resulting drug allergy prevented the wound healing.     

Topical negative pressure in the treatment of infected wounds with exposed orthopaedic implants

The use of TNP on infected open wounds with exposed orthopaedic implants has not yet been described in the literature. Here, its application on these wounds accelerated healing and enabled definitive wound closure to be undertaken.     

The use of transposed rectus femoris muscle in the treatment of infected abdominal wounds

Summary A recent publication, where three experienced workers in the field of managing post-operative contaminated open wounds, especially of the abdominal wall, underscores the considerable number of different methods that are in vogue. Infected abdominal wounds are usually treated by debridement, the administration of appropriate antibiotics and wound closure on a delayed basis. In the presence of a surgical implant, the latter is often partially or completely removed depending on the circumstances that led to its insertion. While healing often results, there remain a hard core of recalcitrant cases where multiple operations are necessary to heal the wound. Over 30 years ago a method was introduced to treat a variety of non-healing and infected wounds, namely the use of transposed muscles. Experience shows that this approach is either unknown or rejected by physicians treating patients with recalcitrant wounds and, at times, major ablations are performed. Introduced originally by a general surgeon, the procedure is better known by those engaged in plastic surgery. At our wound center, patients who have been unsuccessfully treated by multiple operations are regularly seen, which indicates that physicians need to be reminded of this proven, but perhaps forgotten, method of management. For this reason an illustrative case report is presented of a patient whose abdominal wall hernia was treated and which resulted in an infected non-healing wound that was successfully managed using a transposed rectus femoris muscle.     

Indicators of immunity during treatment of infected wounds by low-frequency ultrasonics

In the experiment on 30 guinea pigs and in observation of 63 patients with the infected wounds, it was established that treating wounds by low-frequency ultrasound contributed to reduction in the degree of wound contamination with bacteria, penetration of bacterial antigens into the blood, and as well decrease in the number of T-lymphocytes, levels of the IgG, IgM and complement depending on the type of the infective agent and time of wound treatment.     

Treatment of open infected wounds

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1. If a wound becomes infected, all thought of primary union should be abandoned.     

Pectoralis major muscle transposition for treatment of infected median sternotomy wounds

Median sternotomy, currently the standard incision in open heart procedures, is rarely complicated by wound infection, but when present, it is associated with a high morbidity and mortality. Adequate treatment can be provided by means of transposition of the pectoralis major muscle. After thorough sternal wound debridement the muscle, based on the thoraco-acromial pedicle, is transposed into the defect. From September 1986 until December 1992 14 patients (mean age 67 years) with sternal infection were treated using this technique. Mean hospital stay after operation was 23 days; mean follow-up was 24 months. In 10 patients (72%) a successful treatment, i.e. a permanently cured infection, was achieved. Three patients (21%) developed a recurrence; one of them died during follow-up as a consequence of cardiac failure, the other two underwent reoperation and healing occurred at a later stage. In one patient (who died of a unknown cause 2 months after muscle transposition) the result was classified as unknown. In conclusion, transposition of the pectoralis major muscle is an adequate treatment for severe sternal infections. In comparison with conservative methods, mortality and morbidity can be reduced and hospital stay can be shortened.     

Negative pressure dressings as an alternative technique for the treatment of infected wounds

Coverage of wounds caused by infection and subsequent treatment often are variable because of the location of the wound and wound size. Although much research has been done to expand the indications of negative pressure wound treatment systems, little investigation has been done to quantify the reduction of wound size for vacuum-assisted closure treatment in the presence of infection. In this series, 14 patients who had wounds caused by infections were treated with the vacuum-assisted wound closure system. All wounds were greater than 20 cm2. The duration of treatment averaged 10 days (range, 2-27 days), and the initial wound size averaged 70 cm2 (range, 22.5-288 cm2). After the course of treatment, the final wound size averaged 39 cm2 (range, 10-147 cm2). The average wound size reduction was 43%. This method seems to enhance the rapidity of wound reduction, and because it is a closed system of treatment, it has the added benefit of minimizing exposure of staff and other patients to communicable diseases. Vacuum-assisted wound closure systems add another option in the care of musculoskeletal infections.     

10%聚维酮碘乳膏治疗皮肤感染性创面的疗效

目的观察10%聚维酮碘乳膏治疗皮肤感染性创面的疗效。 方法收集华中科技大学同济医学院附属梨园医院收治的50例出现皮肤感染性创面患者,随机分为观察组与对照组（每组各25例患者）,观察组患者给予10%聚维酮碘乳膏治疗,对照组患者则给予常规敷药治疗,比较两组患者治疗有效率和创面愈合时间。 结果观察组和对照组患者的治疗有效率分别为96%和80%,差异具有统计学意义（t = 15.62,P = 0.02）。观察组和对照组患者平均创面愈合时间分别为（5.3±0.4）d和（10.3±1.3）d,差异具有统计学意义（χ²= 8.654,P = 0.03）。 结论使用10%聚维酮碘乳膏能够有效治疗皮肤感染性创面,有利于患者预后,同时缩短创面的愈合时间。     

Topical silver treatment after escharectomy of infected full thickness burn wounds in rats

White male Sprague Dawley rats (200 g.) with 20% full thickness scald burns seeded with 10 Pseudomonas aeruginosa, strain 59-1244, were used as experimental animals. Studies including the following: (1). Control groups. (2). DC pretreatment groups. (3). Treatment groups. P. aeruginosa infected burn wounds were excised, and then treated with either autograft or silver-nylon dressings, with (SNDC) or without (SN) application direct current. Excision and treatment were initiated 1, 2, 3, 4 or 5 days after burning and inoculation. (4). Groups for antimicrobial barrier function study. Mortality of each group was recorded at 21 days PB.With burns alone, there was no mortality. Without treatment 19 of 20 burn inoculated controls died. In the pretreatment study, the mortality of the group pretreated with SN was 95% while that of the group pretreated with SNDC was only 30%. With excision and autografting, PB mortality rose from 5/20 at day 2 PB to 19/20 at day 3 PB. In the excision and SN groups, mortality rose from 5/20 at day 3 PB to 18/20 at day 4 PB. In the excision and SNDC groups, mortality rose from 5/20 at day 3 PB to 18/20 at day 4 PB. In the antimicrobial barrier function study, the 10% mortality in the SN dressing group was significantly less than that of 95% in the plain nylon dressed group.Histologic examination revealed progressively deepening colonization of non-viable wound tissue, progressing to invasion of underlying viable tissue by PB day 4. With wound excision, SN, SNDC, and autografting were equally protective for the first two days, but only SN and SNDC extended this effect to the third PB day.In conclusion, SN and SNDC have a strong local anti-microbial effect on the burn wound when applied within 72 hours of the time of bacterial inoculation, but little effect if applied after the bacteria have invaded unburned vessels and viable tissue adjacent to the burn.     

Nano-silver modified porcine small intestinal submucosa for the treatment of infected partial-thickness burn wounds

Background and aimSilver has been widely used as a topical antimicrobial agent in burn wound care. In a previous study, we demonstrated the introduction of nano-silver particles to porcine small intestinal submucosa (NS-PSIS) led to significant enhancement in antibacterial property in repairing contaminated abdominal defect. In this study, we explored the efficacy of NS-PSIS in the treatment of Pseudomonas aeruginosa-infected partial-thickness burn wounds.Methods48 male Sprague-Dawley rats were divided into four groups of equal number. Standardized and reproducible Pseudomonas aeruginosa-infected partial-thickness thermal burns wound model were created using these rats. NS-PSIS, PSIS (porcine small intestinal submucosa) or lipido-colloid dressingss (Urgotul?) were tested for 14 days to assess their ability to heal the rats’ burn wounds. Control group was without any treatment after the establishment of infected burn-wound. The wound contraction rate, animal body weight change, histological examination, and the quantification of IL-6 and C-reactive protein (CRP) were measured to evaluate the healing effects.ResultsNS-PSIS significantly promoted wound healing and recovered the normal growth of rats. There were significantly lower expression levels of pro-inflammatory cytokine (IL-6) and CRP in NS-PSIS group as compared with the PSIS or Urgotul group in the treatment of infected partial-thickness burn wounds. Histological exams revealed significant less inflammatory cells infiltrating, more re-epithelization and neovascularization in NS-PSIS group. There were also less inflammatory cells infiltrations in the major organs in NS-PSIS group.ConclusionsNano-silver modified porcine small intestinal submucosa (NS-PSIS) can be used as a biological derivative dressing for the treatment of infected partial-thickness burn wounds.     

Reconstruction of infected median sternotomy wounds

Infected median sternotomy represents a major complication of cardiac surgery, with significant morbidity and mortality. The treatment of choice is immediate drainage and closure over suction irrigation catheters. However, when this conservative approach fails or radical debridement makes primary closure impossible, muscle flap closure is indicated. This form of reconstruction facilitates the obliteration of large mediastinal wounds; prevents spreading of infection on the heart, suture lines, grafts, or prosthetic material; and significantly decreases morbidity and mortality. We performed muscle flap closure in 11 consecutive patients in whom conservative treatment of infected median sternotomy wounds failed. All patients required closure with at least two muscle flaps or omentum for the complete obliteration of the mediastinal wounds. There was one postoperative death in our series due to acute heart failure. There were two superficial skin losses requiring skin grafting and one persistent draining sinus after reconstruction. Based on our experience and that of others, we conclude that muscle flap reconstruction should be considered as an important technique for the reconstruction of infected median sternotomy wounds.     

Morphological examinations of infected burn wounds

Electron microscopical and electron radioautographic methods have been used for morphological examination. This allowed to raise sensitivity of the tests facilitating detection of living solitary bacterial cells (by intensive mark above them). Radioautography showed functional status of wound bacteria (the intensity of the metabolism and reproduction). It was determined that in living tissues, not damaged by the burn and unchanged morphologically bacteria do not penetrate. Especially massive accumulations of the microorganisms are found in necrotic tissues, under the scab, at the external border of demarcation protuberance, and they represent colonization of the wound. When modern methods of treatment and early necrectomy are used, morphological examination usually does not reveal pathogenic microorganisms. Only inflammatory reaction of the wound tissues could be seen: oedema, hyperemia, hemorrhages, cellular infiltrates. The development of granulation tissue indicated cessation of wound infection. Especially favourable feature, demonstrating healing of the wound, was appearance and reproduction of young cells of fat tissue (indusion of labelled thymidine). The results of the study have confirmed the advantage of new electronic methods for microscopy in infected burn wounds.