Sistema de presión negativa en loxoscelismo cutáneo-visceral. Reporte de un caso

Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).

Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.

Terapia de presión negativa para pacientes con enfisema subcutáneo y neumomediastino masivo / Negative pressure therapy for patients with subcutaneous emphysemaand massive pneumomediastinum

Se han descrito diversas técnicas para el tratamiento del enfisema subcutáneo y del neumomediastino. Algunos pacientes con pequeñas perforaciones traqueales pueden ser manejados de forma expectante, salvo que requieran ventilación mecánica. Se presentan las imágenes de un paciente con enfisema subcutáneo y neumomediastino no candidato a cirugía y quien fue tratado exitosamente con terapia de presión negativa.

Different techniques have been described for the treatment of subcutaneous emphysema and pneumomediatinum. Some patients with small tracheal perforations can be managed expectantly, unless they require mechanical ventilation. Images of a patient with subcutaneous emphysema and pneumomediastinum not a candidate for surgery and who was successfully treated with negative pressure therapy are presented.

Research about evaluation index system of home treatment quality for chronic wound patients with negative pressure therapy / 中国实用护理杂志

Objective To study the evaluation index system for home treatment quality of negative pressure therapy. Methods Two-round Delphi expert consultation method was used to consult 20 experts, so as to initially establishthe quality evaluation index system. Results An evaluation index system for home treatment quality of negative pressure therapy was formed, including 4 items of primary indexes, 13 items of secondary indexes and 30 items of tertiary indexes. Conclusions The evaluation index system for home treatment quality of negative pressure therapy in patients with chronic wounds has a clear hierarchy, the reliability of the research results is high, which provides a standardized reference for the objective evaluation of the work and the continuous improvement of nursing quality.

Development of miniature negative pressure aspirator / 医疗卫生装备

Objective To develop a miniature negative pressure aspirator with easy operation,stable negative pressure,low weight,small volume and high portability.Methods A double-faced printed circuit board with a size of 6 cm×4 cm×1 cm was manufactured with the functions of regulating the current and DC/AC conversion.DC vacuum pump and Panasonic li-ion battery pack were used to generate the desired pressure between-0.017 and-0.060 MPa,and mechanically-driven deformation vacuum gauge was involved in manufacturing the aspirator.Two sizes (150 and 200 ml) of drainage bottles were made of medical silica gel.Results The aspirator facilitated negative-pressure therapy when the patient was walking or discharged,which decreased the hospital cost and stay.Conclusion The aspirator gains advantages in stable negative pressure,low power consumption,easy operation and high safety,and thus is worthy promoting clinically.

A Rabbit Model of Fat Graft Recipient Site Preconditioning Using External Negative Pressure

BACKGROUND: Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. METHODS: Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. RESULTS: The fat survival rate of the experimental group (75.4%+/-3.9%) was higher than that of the control group (53.1%+/-4.3%) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups. CONCLUSIONS: Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

Development of intelligent wound instillation-negative pressure therapeutic instrument / 医疗卫生装备

Objective To develop an intelligent wound therapeutic instrument based on active instillation and negative pressure suction.Methods SCM coordinated peristaltic pumps, solenoid valves and pressure receptor to infuse perfusate into the wound and retained it for a period of time. The perfusate then was eliminated by negative pressure and the wound was kept in the state of negative pressure. The instrument could give out alarm in case of bad tightness, over-high pressure and blocked negative-pressure pipeline.Results Peristaltic pump and central negative pressure were involved in to complete wound perfusion and irrigation, with perfusate controlled quantitatively and negative pressure kept reliable. The pressures in the wound and pipeline could be monitored at real time by the pressure receptor, and timely alarm was implemented when unexpected conditions occurred.Conclusion The instrument behaves well in automation, intelligence and safety, and thus is worth popularizing clinically.

Approach to Complex Wound Management and Adjunct Therapy

The ageing of our population and rise in chronic diseases has resulted in the complex profile of the patients in the community. Complex wounds such as diabetic foot ulcers, infected pressure ulcers and other complications of non-healing wounds are common encounters in the primary health settings. The challenges of these complex wounds lie in its multi-factorial nature of the person, the wound and the environment. This requires a team approach to care within the limited resources boundary. As part of the care continuum, it is essential for primary care physicians to be familiarized with the approach to care of complex wounds and the adjunct therapy. This article seeks to provide a broad framework using the systematic assessment framework via T.I.M.E (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge of wound) for wound bed preparation to guide primary care physicians/clinicians in their approach to complex wounds. It also highlighted the complexities of chronic wound management pertaining to the person, the wound and the environment as well as the recent advances adjunct therapy in chronic wound care. In addition, it seeks to enable primary care physician and wound clinicians to translate wound-healing principles into effective management strategies to provide better clinical care to our patients.

Fechamento sequencial da parede abdominal com tração fascial contínua (mediada por tela ou sutura) e terapia a vácuo / Sequential closure of the abdominal wall with continuous fascia traction (using mesh or suture) and negative pressure therapy

Na última década multiplicaram-se as publicações e a utilização da cirurgia de controle de danos, resultando num número crescente de pacientes deixados com o abdome aberto (ou peritoneostomia). Uma das consequências nefastas do abdome aberto são as hérnias ventrais gigantes que resultam da impossibilidade de se fechar o abdome durante a internação hospitalar do paciente. Para minimizar esta sequela têm surgido na literatura diferentes tipos de abordagem. Para abordar este tópico, a reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) optou por não analisar sistemas comerciais de fechamento abdominal dinâmico, com exceção da terapia de pressão negativa ou vácuo. O grupo fez uma avaliação crítica dirigida de três artigos mais relevantes publicados recentemente sobre fechamento sequencial da parede abdominal (com tela ou sutura) mais vácuo. Nesta avaliação foram incluídos dois estudos retrospectivos mais um estudo prospectivo. Baseados na análise crítica desses 3 estudos mais a discussão que contou com a participação de representantes de 6 Universidades e realizada via telemedicina, são feitas as seguintes recomendações: (1) a associação de terapia de pressão negativa com tração fascial constante mediada por tela ou sutura, ajustada periodicamente, parece ser uma ótima estratégia cirúrgica para o tratamento de peritoneostomias. (2) O fechamento abdominal primário dinâmico com sutura e mediada por tela parece ser mais econômico e eficiente do que deixar o paciente com uma hérnia gigante e planejar uma reconstrução complexa tardiamente. Novos estudos com grupos maiores de pacientes separados de acordo com as diferentes apresentações e doenças são necesários para definir qual o melhor método cirúrgico para o tratamento de peritoneostomias.

The last decade was marked by a multiplication in the number of publications on (and usage of) the concept of damage control laparotomy, resulting in a growing number of patients left with an open abdomen (or peritoneostomy). Gigantic hernias are among the dreaded consequences of damage control and the impossibility of closing the abdomen during the initial hospital admission. To minimize this sequela, the literature has proposed many different strategies. In order to explore this topic, the "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT -TACS) conducted a literature review and critically appraised the most relevant articles on the topic. No commercially available systems for the closure of peritoneostomies were analyzed, except for negative pressure therapy. Three relevant and recently published studies on the sequential closure of the abdominal wall (with mesh or sutures) plus negative pressure therapy were appraised. For this appraisal 2 retrospective and one prospective study were included. The EBT-TACS meeting was attended by representatives of 6 Universities and following recommendations were generated: (1) the association of negative pressure therapy and continuous fascia traction with mesh or suture and adjusted periodically appears to be a viable surgical strategy to treat peritoneostomies. (2) the primary dynamic abdominal closure with sutures or mesh appears to be more efficient and economically sound than leaving the patient with a gigantic hernia to undergo complex repair at a later date. New studies including larger number of patients classified according to their different presentations and diseases are needed to better define the best surgical treatment for patients with peritoneostomies.

Negative-Pressure Therapy for Pre-and Post-grafting after Wide Extirpation Excision of Melanoma of the Toe / 대한피부과학회지

Surgical management of acral lentiginous melanoma on the toe poses a difficult challenge because of the lack of surrounding tissue. A full-thickness skin graft after excision may provide a good cosmetic outcome, but graft failure can occur due to limited blood flow of the toe and the thin skin covering over the deep fascia in the pressure bearing area may cause gait disturbance. A negative-pressure device can be beneficial for fixing the graft and stimulating the growth of granulation tissue. A 55-year-old woman diagnosed with malignant melanoma on the right third toe underwent wide excision, after which secondary intention healing was initiated using negative-pressure therapy. When the wound had regenerated enough granulation tissue after 2 weeks, a full-thickness skin graft was performed, which was secured with negative-pressure therapy. The graft was successfully taken after a week thereafter. Accordingly, the use of negative-pressure therapy in the surgical management of acral lentiginous melanoma may be a good option because it facilitates full-thickness skin graft survival in an avascular surface area and aids in the thickening of the pressure bearing area, where acral lentiginous melanoma is likely to occur.

The Management of Chronic Wound with Modified Portable Negative Pressure Therapy

PURPOSE: V.A.C. is a new concept which is closed dressing with negative pressure to promote wound healing. It has been widely used as the treatment of chronic and acute wounds such as pressure sores, burns, stasis ulcers, and other complicated wounds. However It has disadvantages such as high cost and the need of specific equipment. In this article, we described new method to overcome these disadvantages. METHODS: We made newly innovated equipment with 50cc syringe and spring to create negative pressure. From May 2006 to May 2007, we applied it to two patients with chronic wound. RESULTS: The treatment period was 5 weeks for one case and 3 weeks for the other case. Both patients were healed completely without admission and wound healing was accelerated. During follow-ups, there were no complications. The mean cost for single dressing was 9,590 won. CONCLUSION: Modified portable negative therapy using newly innovated equipment could accelerate wound healing better than conventional dressing. It lowers the number of dressings, saves cost of treatment, and enables treatment as outpatient basis.

Application of Medifoam B(R) & Negative Pressure Therapy for the Auxiliary Treatment of Pressure Sore

Pressure sore is usually developed by repeated or persistent pressure given to fixed regions. Due to increase in old ages, paraplegia or quadriplegia by traffic accidents and industrial accidents, the incidence of pressure sore is increasing. V.A.C.(R)(vacuum assisted closure, KCI Inc, U.S.A.) has been highly effective for accelerating wound healing, however, high cost and the use of special equipment have been preventing it from popular use. We applied the negative pressure of wall suction (100-150mmHg) with Medifoam B(R)(Hydrophilic polyurethane foam, Ildong Pharm, Co., Korea) on pressure sore wound instead of expensive dressing foam of V.A.C.(R) So, we could accelerate wound healing without special equipment or incurring high cost. We were able to reduce the cost to 10% with Medifoam B(R) and wall suction dressing compared with V.A.C.(R) In this aspect, the technique explained above seems to be clinically useful.

Vacuum-assisted closure for chronic wounds: An analysis of 12 cases / 医学研究生学报

Objective: Vacuum-assisted closure(VAC) is a new technique for wound treatment,whose clinical application at home is but at the initial stage.The aim of this study was to investigate the procedure,therapeutic course and the effectiveness of the technique in the treatment of chronic wounds.Methods: This study included 12 cases of chronic or infected wound,which were more than 100 cm2 in size,either undermined,or drainage-obstructed,or difficult to heal despite over a month of previous treatment.We used the Freedom Negative Pressure Wounds Therapy Machine and the Ten-Step Management Procedure for a regular course of 30-50 days.We recorded and analyzed the pre-and post-treatment PUSH(pressure ulcer scale for healing) scores,healing modes,healing time and cure rate of all the cases.Results: The 12 cases were treated by VAC for(27.7 ? 22.6) days,of which 9 were cured,1 improved and 2 healed after moisture therapy followed by further treatment in the surgical department.The average healing time was(59.36 ? 22.88) days and the total cure rate was 91.7%.Age is positively correlated with healing time,but other factors showed no significant correlation with healing time and cure rate.Conclusion: The VAC technique is applicable to chronic wounds in patients of all ages,and the best therapeutic course is 30-50 days,which helps to raise the cure rate of intractable wounds.

Simple and Effective Negative Pressure Therapy in Chronic Wound

Wounds with exposed tendon or bone and chronic wounds present a difficult treatment challenge. Vacuum- assisted closure technique and device has become a widely accepted technique in the management of difficult and chronic wounds. But, the cost is still relatively high and the treatment is not fully covered by insurance. We designed the simple modality of continuous negative therapy using wall suction for the wound treatment. The sterile foam filled the entire wound and the tube was placed in the foam. The site was covered with an adhesive sheet. The tube was then connected to the wall suction, and negative pressure(125 mmHg) was applied to the wound site. Wounds were inspected and the dressings were changed every other day. This continuous negative pressure therapy using wall suction reduced the amount of tissue edema and increased localized blood flow, and the applied forces resulted in enhanced formation of granulation tissue. The wounds could be closed primarily or covered with split thickness skin grafting. We conclude that this continuous negative pressure therapy using a wall suction is an efficient modality for treating difficult and chronic wounds with a moderate cost.

Simple and Effective Negative Pressure Therapy in Chronic Wound

Wounds with exposed tendon or bone and chronic wounds present a difficult treatment challenge. Vacuum- assisted closure technique and device has become a widely accepted technique in the management of difficult and chronic wounds. But, the cost is still relatively high and the treatment is not fully covered by insurance. We designed the simple modality of continuous negative therapy using wall suction for the wound treatment. The sterile foam filled the entire wound and the tube was placed in the foam. The site was covered with an adhesive sheet. The tube was then connected to the wall suction, and negative pressure(125 mmHg) was applied to the wound site. Wounds were inspected and the dressings were changed every other day. This continuous negative pressure therapy using wall suction reduced the amount of tissue edema and increased localized blood flow, and the applied forces resulted in enhanced formation of granulation tissue. The wounds could be closed primarily or covered with split thickness skin grafting. We conclude that this continuous negative pressure therapy using a wall suction is an efficient modality for treating difficult and chronic wounds with a moderate cost.