Use of negative pressure wound therapy after infection and flap dehiscence in radical vulvectomy: A case report

IntroductionVulvar cancer has a lower incidence in high income countries, but is rising, in part, due to the high life expectancy in these societies. Radical vulvectomy is still the standard treatment in initial stages. Wound dehiscence contitututes one of the most common postoperative complications.Presentation of caseA 76 year old patient with a squamous cell carcinoma of the vulva, FIGO staged, IIIb is presented. Radical vulvectomy and bilateral inguinal lymph node dissection with lotus petal flaps reconstruction are performed as the first treatment. Wound infection and dehiscence of lotus petal flaps was seen postoperatively. Initial management consisted in antibiotics administration and removing necrotic tissue from surgical wound. After this initial treatment, negative wound pressure therapy was applied for 37 days with good results.DiscussionWound dehiscence in radical vulvectomy remains the most frequent complication in the treatment of vulvar cancer. The treatment of this complications is still challenging for most gynecologic oncologist surgeons.ConclusionThe utilization of the negative wound pressure therapy could contribute to reduce hospitalization and the direct and indirect costs of these complications.     

Wound dressings: principles and practice

Wound dressings have increased in efficacy and number as the scientific understanding of wound healing has improved. However current practice is governed by expert opinion as high-quality studies comparing the effectiveness of different dressings are lacking. Surgeons are regularly involved in wound management, therefore require a good understanding of the properties and uses of different wound dressings. By having a firm grasp of the pathophysiology that underlies the wound-healing process a surgeon can make informed decisions about how best to manage a patient. An overview of optimal conditions for healing and the assessment of wounds is provided here. Dressings and their modes of action are discussed to provide guidance for their use in different wounds.     

鼻骨整形结合硅胶假体置入治疗陈旧性外伤性鼻塌陷畸形

目的：探索一种安全、简单、有效的陈旧性外伤性鼻畸形的治疗方法。方法：对2004年9月至2009年10月间收治的8例陈旧性外伤性鼻塌陷畸形患者进行了鼻畸形矫治,在鼻骨整形的同时进行硅胶假体置入术。结果：8例患者均取得了理想的手术效果。结论：对于陈旧性外伤性鼻畸形,可以采用鼻骨整形结合硅胶假体置入的方法进行治疗。     

中药烫洗法在骨伤时的应用

目的：探讨中药烫洗疗法在治疗骨伤时的临床应用疗效。方法：对701例临床骨伤患者在进行常规治疗的基础上，配合以中药烫洗疗法。结果：701例患者中显效413例，有效282例，总有效率达99．14％。结论：中药烫洗疗法在治疗骨伤时具有非常好的疗效，这种治疗方法在以后为骨伤患者进行临床治疗可更广泛的应用。     

富血小板血浆促进软组织损伤修复的实验研究

目的观察富血小板血浆（platelet-rich plasma,PRP）对犬软组织损伤的修复作用,探讨其促进软组织修复的机制。方法杂种犬4只,体重：18kg～24kg,雌雄不限。随机选择每只犬的一侧后腿的大腿内侧分别制作两个直径为4cm×3cm椭圆形创面和长度为3cm的直线伤口,深及皮下筋膜层,再随机选择一个椭圆形创面和直线伤口为实验创面,用PRP凝胶覆盖创面,对照组创面任其渗血在创面凝固,两组都用3M愈肤膜覆盖损伤处。分别于术后7天、14天、21天、28天通过大体观察和组织学观察对比两侧创伤愈合情况。结果术后7天,对照组创面少许肉芽组织生长,伤口周围有炎症反应;实验组创面清洁,有较多肉芽组织生长,伤口周围无明显炎症反应。术后7～28天,两组的椭圆形创面逐渐缩小,但实验组创面缩小明显并无明显瘢痕;实验直线伤口于术后14～21天完全愈合,无明显瘢痕,对照组可见到明显瘢痕。组织学观察：实验组创面愈合较快,至术后28天,形成比较成熟的皮肤组织,而对照组创面可见到较多瘢痕组织;实验组直线伤口术后14～21天即形成较成熟的皮肤组织,对照组直线形伤口于21～28天形成较成熟的皮肤组织,但瘢痕组织较多。结论 PRP能加快犬软组织损伤的愈合,并能减少瘢痕。     

Oxygen in acute and chronic wound healing

Oxygen is a prerequisite for successful wound healing due to the increased demand for reparative processes such as cell proliferation, bacterial defence, angiogenesis and collagen synthesis. Even though the role of oxygen in wound healing is not yet completely understood, many experimental and clinical observations have shown wound healing to be impaired under hypoxia. This article provides an overview on the role of oxygen in wound healing and chronic wound pathogenesis, a brief insight into systemic and topical oxygen treatment, and a discussion of the role of wound tissue oximetry. Thus, the aim is to improve the understanding of the role of oxygen in wound healing and to advance our management of wound patients.     

Hard to heal pressure ulcers (stage III-IV): Efficacy of injected activated macrophage suspension (AMS) as compared with standard of care (SOC) treatment controlled trial

The objective of this study was to compare local injections of AMS with SOC treatments for stage III and IV pressure ulcers in elderly patients. It was designed as historically prospective 2-arms non-parallel open controlled trial, and conducted in a department of geriatric medicine and rehabilitation of a university affiliated tertiary hospital. We studied 100 consecutive elderly patients with a total of 216 stage III or IV pressure ulcers, 66 patients were assigned to the AMS group and had their wounds injected, while 38 patients were assigned to the SOC group. Primary outcome was rate of complete wound closure. Time to complete wound closure and 1-year mortality served as secondary outcomes. Statistical analyses were performed at both patient and wound levels. Percentage of completely closed wounds (wound level and patient level) were significantly better (p < 0.001/p < 0.001, respectively) in all patients in favor of AMS, as well as in the subset of diabetic patients (p < 0.001/p < 0.001). Similarly, AMS proved significantly better for the subset of those with leg ulcers and with baseline wounds ≤15 cm², compared with SOC. There were no statistically significant differences with regard to time to complete closure or 1-year mortality rates in the two groups. It is concluded that there is a significant difference in favor of stage III and IV wound closure rates by AMS, as compared with SOC treatments.     

Role of acute negative pressure wound therapy over primarily closed surgical incisions in acetabular fracture ORIF: A prospective randomized trial

BackgroundNegative pressure wound therapy use over closed surgical incisions (iNPWT) has proven to be effective at reducing hematoma, wound drainage and infection in high-risk wounds. The purpose of this study was to determine if iNPWT decreased the risk of infection in patients undergoing open reduction internal fixation (ORIF) for acetabular fractures.Methods71 patients who underwent operative intervention for an acetabular fracture between March 2008 and September 2012 consented and prospectively randomized to iNPWT or a standard postoperative (dry gauze) dressing. The primary endpoint was deep infection, i.e. necessitating surgical debridement. Patients were followed until fracture union.Results33 patients were randomized to treatment with a standard gauze dressing and 33 patients were randomized to the iNPWT cohort. There were no statistically significant differences between the groups with respect to patient demographics, clinical, or surgery characteristics. Overall, seven patients (10.6%) were diagnosed with infections; two patients (6.1%) in the placebo group and 5 (15.2%) in the treatment group.ConclusionsIn this randomized prospective trial, iNPWT did not decrease the incidence of deep infections when compared to gauze dressings in patients with acetabular fractures. Although not statistically significant, patients in the iNPWT cohort were 2.77 times more likely to develop a deep infection.