Bogota-VAC – A Newly Modified Temporary Abdominal Closure Technique

Background  We present Bogota-VAC, a newly modified temporary abdominal closure (TAC) technique for open abdomen condition after abdominal compartment syndrome (ACS). Methods  A thin isolation bag (Bogota bag) and a vacuum assisted closure (VAC) system were combined. A matching bag was tension-free fixed on the abdominal fascia by fascia suture. A ring shaped black polyurethane foam of the VAC system was placed into the gap between Bogota bag, abdominal fascia and the wound edge. A constant negative topic pressure of 50–75 mmHg was used in the VAC system. Results  Intra-abdominal pressure (IAP: 22 ± 2 mmHg) of four patients with ACS after severe traumatic brain injury and one patient with isolated ACS after blunt abdominal trauma decreased significantly (p = 0.01) after decompressive laparotomy and treatment with Bogota-VAC (IAP: 10 ± 2 mmHg) and remained low, measured via urinary bladder pressure. Intracranial pressure (ICP) in the four traumatic brain injury patients decreased from 42 ± 13 mmHg to 15 ± 3 mmHg after abdominal decompression. Cerebral perfusion pressure (57 ± 14 mmHg) increased to 74 ± 2 mmHg. Conclusion  The advantage of the presented Bogota-VAC is leak tightness, wound conditioning (soft tissue/fascia), skin protection and facilitation of nursing in combination with highest volume reserve capacity (VRC), thus preventing recurrent increased intra-abdominal and intracranial pressure in the initial phase after decompression of ACS compared to other TAC techniques.     

封闭负压引流技术对人慢性创面中胶原酶活性的影响

目的研究人慢性创面经封闭负压引流（vacuum—assisted closure，VAC）治疗前后，创面渗出液中胶原酶活性的变化，以部分阐明VAC促进慢性创面愈合的机理。方法取4例急性创面在术后1、2、3d的创面引流液（乳癌术后），同时收集6例慢性创面（4例静脉性溃疡，2例压力性溃疡）在VAC治疗前以及治疗后2、4、6d的创面渗出液，利用酶谱分析的方法，观察各时间点的渗出液对可溶性Ⅲ型胶原的降解情况，同时应用强力霉素抑制实验来分析渗出液中胶原酶的类型。结果急性创面引流液可以部分降解Ⅲ型胶原，随时间推移变化较小，慢性创面渗出液中的胶原酶活性较高，VAC治疗前基本将Ⅲ型胶原全部降解，随时间推移、降解减少，胶原酶活性下降，强力霉素抑制实验证明在100μmol／L浓度时无抑制，在600μmol／L浓度时出现部分抑制。结论在慢性创面渗出液中胶原酶活性增高，VAC的应用可以降低胶原酶的活性，阻止胶原蛋白大量降解，利于创面愈合，在慢性创面渗出液中胶原酶应主要是MMP-1型（成纤维细胞型）。     

Adjuvant methotrexate,vinblastine, adriamycin,and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma

Objectives: To evaluate the efficacy of adjuvant platinum based chemotherapy in upper urinary tract urothelial cancer following surgical resection in terms of survival benefit and inhibition of bladder cancer recurrence. Methods: Between April 1986 and August 2005, a total of 132 patients with a diagnosis of upper urinary tract urothelial cancer underwent radical nephroureterectomy with cuff of bladder at our department. A total of 46 patients (13 with pT2pN0M0 and 33 with pT3 pN0M0 transitional cell carcinoma without prior bladder cancer) were enrolled. Patients with locally advanced disease were divided into two groups: the adjuvant chemotherapy group (24 patients) who received adjuvant methotrexate, vinblastine, adriamycin, and cisplatin (M‐VAC) and the non‐adjuvant chemotherapy group who did not receive adjuvant M‐VAC (22 patients). Results: There were no statistically significant differences in patient characteristics or 10‐year survival between the two groups. The recurrence rate in the non‐adjuvant chemotherapy group was significantly higher than in the adjuvant chemotherapy group (log‐rank test, P < 0.0001). Only non‐adjuvant chemotherapy was a significant and independent risk factor (hazard ratio 6.97) for the development of intravesical recurrence (P < 0.01). Conclusion: Adjuvant M‐VAC is an important optional adjuvant therapy and can prevent recurrent bladder tumors following surgery for upper urinary tract transitional cell carcinoma. To determine whether adjuvant chemotherapy has further benefit, a randomized study would be needed.     

Management of the radial forearm free flap donor site with the vacuum-assisted closure (VAC) system

INTRODUCTION: The radial forearm free flap is a popular reconstructive flap in modern head and neck surgery. Poor wound healing at the forearm donor site is common and frequently results in tendon exposure. The Vacuum-Assisted Closure (VAC) system (Kinetic Concepts Inc., San Antonio, TX) is a topical negative pressure dressing that has been shown to improve skin graft viability when used as a bolster dressing. In this study, we investigated the use of the VAC system in the management of the radial forearm free flap donor site. METHODS: A retrospective chart review was performed on all subjects who underwent a radial forearm free flap reconstruction in which the VAC system was used as a bolster dressing at the donor site from January 1, 2003, through March 31, 2005. RESULTS: Thirty-four consecutive subjects were included in the study. Exposed tendon did not occur in 14 (0%) subjects in which the VAC bolster was used for a minimum of 6 days. Eleven of the 20 subjects (55%) who used the VAC bolster for 5 days demonstrated small amounts of tendon exposure (<2 cm) on follow-up clinic examination. The minimum follow up for all subjects was 4 months. CONCLUSION: This study demonstrates that the VAC system is a feasible alternative to conventional bolster dressing in the management of the radial forearm free flap skin-grafted donor site. Based on this study, when used for a minimum of 6 days, the VAC bolster dressing eliminated tendon exposure at the forearm donor site.     

Treatment of anastomotic leakage after rectal resection with transrectal vacuum-assisted drainage (VAC)

Objective Anastomotic leakage after rectal resection is associated with high morbidity and mortality. Patients without peritonitis can be treated conservatively by transrectal rinsing and drainage. However, healing is often very slow, and formation of abundant scar tissue resulting in a poor functional result is not uncommon. Vacuum-assisted closure (VAC) has been shown to accelerate wound healing by increasing local blood flow, reducing bacterial load and stimulating growth of granulation tissue. In this paper, we describe VAC as a method for treating anastomotic leakage after rectal resection.Methods Four patients with anastomotic leakage after rectal resections were treated with VAC.Results Healing time for these patients was median 51 days (43–195). The control group consisted of patients treated conservatively in the previous 5-year period. Ten patients were identified with median healing time 336 days (52–1434).Conclusion VAC treatment may possibly shorten healing time of anastomotic leakages after rectal resection. However, the presented results are preliminary, with only few patients included, and obviously, larger, randomized, clinical trials are needed to confirm these results and establish the indication for VAC treatment in clinical practice. We believe VAC therapy is a promising treatment of anastomotic leakage after rectal resection.     

Management of complicated gastroschisis with porcine small intestinal submucosa and negative pressure wound therapy

Introduction

In almost all cases of gastroschisis, fascial closure may be achieved primarily or after silo reduction. Rarely, fascial and skin closure are impossible. We report our experience with visceral coverage in complicated cases of gastroschisis with porcine small intestinal submucosa (SIS) augmented by negative pressure wound therapy (NPWT).

Methods

Over a 3-year period, 55 infants with gastroschisis were managed. In 3 of these cases, fascia and skin could not be approximated safely after complete reduction of abdominal viscera with a spring-loaded silo. Visceral coverage in each case was achieved with 0.42-mm-thickness Surgisis ES (Cook Surgical, Bloomington, Ind) that was sewn to the fascial edges. Negative pressure wound therapy was then initiated at 75 mm Hg over the exposed SIS using vacuum-assisted closure.

Results

In each case, granulation tissue developed quickly and was followed by complete epithelialization. Two patients subsequently developed umbilical hernias.

Conclusion

We have successfully used SIS augmented by NPWT in the management of 3 infants with complicated gastroschisis. In the rare situation in which fascial closure cannot be achieved, the combination of SIS and NPWT can provide a safe and effective means of abdominal wall closure.     

Use of vacuum-assisted closure system in the management of complex wounds in the neonate

The vacuum-assisted closure (VAC) system has become an accepted treatment modality for acute and chronic wounds in adults. The use of negative-pressure dressing has been documented in adults and, to some extent, in children. However, its use in premature infants has not been reported in the literature. The results of using the VAC system were examined in two premature infants with complex wounds. The VAC system was found to be effective in facilitating the closure of large and complex wounds in these patients. Complete epithelialization of the wounds was achieved in both patients without skin grafting. In conclusion, in two premature neonates with extraordinary soft tissue defects, the VAC system was a safe and effective choice to assist in closing these wounds.     

Vacuum‐assisted closure (VAC)‐Instill® with continuous irrigation for the treatment of Mycoplasma hominis mediastinitis

A 56‐year‐old patient who underwent ascending aorta replacement postoperatively developed mediastinitis with atypical Mycoplasma hominis. We present the first successful treatment of M. hominis mediastinitis after cardiac surgery with vacuum‐assisted closure (VAC)‐Instill^® therapy combined with dilute antiseptic irrigation for bacterial eradication.     

Caustic burn caused by intradermal self administration of muriatic acid for suicidal attempt: optimal wound healing and functional recovery with a non surgical treatment

Background

Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts.

Case report

We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start^®), hyaluronic acid-based matrix (Hyalomatrix^®) and Vacuum-Assisted Closure (VAC) Therapy^®.

Results

We obtained complete healing in 6 weeks.

Conclusions

Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient’s compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full.     

How to isolate a high output enteroatmospheric fistula in the open abdomen with negative pressure therapy: an institution's step by step guide to the VAC donut

There is multiple evidence to suggest that isolation techniques of high output enteroatmospheric fistulas (EAF) in open abdomens can be advantageous in controlling fistula effluent while allowing time for abdominal wall to granulate. The large loss of proteins, electrolytes and fluid, and the distressing nature of the open abdomen for both patients and doctors, make managing these EAFs a clinical challenge. We present our experience with a high output mucosal protruding EAF and the creation of a ‘VAC donut’ allowing a successful diversion of the enteric content whilst promoting granulation of the tissue bed.