Study of negative pressure wound therapy in management of abdominal wound dehiscence

Background: Postlaparotomy Abdominal wound dehiscence (AWD) occurs in 0.25% to3%. Many technique are being used to manage AWD like surgical revision with open dressing/closed irrigation, temporary covering with ‘Bagota bag’, saline soak gause dressing, absorbable/permanent mesh. Negative-pressure wound therapy (NPWT) is a recent modality of treatment of wound. It involves controlled application of sub atmospheric pressure to local wound environment, using sealed wound dressing connected to vacuum pump. This study aimed at finding the effectiveness of negative pressure wound therapy in management of abdominal wound dehiscence over conventional methods of wound management.Methods: This was hospital based non randomised comparative prospective interventional study carried between July 2017 to November 2019, includes all patients admitted in GMCH, Nagpur Hospital having post laparotomy AWD, excluding the patients having enter ocutaneous fistula and patient not giving consent for VAC application. Total n=60 cases were included in study. Out of 60, 30 were taken as cases in whom intervention was done by applying vaccum assisted closure (VAC) therapy and 30 were control.Results: All 60 patients had undergone laparotomy of this patients 30 patients was applied NPWT and efficacy plotted on the parameter of, wound sepsis, wound contraction, length of hospital stay and extension of time therapy. It was found that 90% patients had negative c/s post VAC dressing, compared to 26% in post ns dressing, there was MWC of 0.86 cm in post VAC patients compared to 0.14 cm in post NS dressing, MHS was 18.9 days in cases and was 28 days in controls,13 patients had complete fascial closure in cases whereas none in controls.Conclusions: NPWT significantly reduces the hospital stay of patients, it causes faster and higher degree of wound contraction, reduces wound sepsis thereby reducing morbidity of patients.

Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effect of vacuum sealing drainage(VSD) with anterolateral thigh perforator flap for repair foot soft tissue defect.</p><p><b>METHODS</b>From September 2014 to September 2016, 45 patients with foot soft tissue defect repaired by VSD with anterolateral thigh perforator flap, including 31 males and 14 females aged from 17 to 55 years with an average of 36 years old. Thirty patients were dorsal soft tissue defects, and 15 patients were plantar soft tissue defects. Sizes of soft tissue defect ranged from 7 cm×10 cm to 11 cm×18 cm, the wound was contaminated seriously and assisted with deep soft tissue exposure. Emergency surgical wound debridement with VSD treatment were performed, and wound surface was cleaned after 5 to 7 days, free anterolateral thigh flap were repaired. Sizes of flap ranged from 9 cm×12 cm to 13 cm×21 cm. Appropriate method was used to repair flap donor area.</p><p><b>RESULTS</b>All 45 free propeller flap were survived without skin edge necrosis, ulcerative infection. Forty patients were followed up from 3 to 24 months with an average of 13 months. Flap showed good color, beautiful appearance, good elasticity, soft texture, but without obvious bloated, the wood of leg healed well.</p><p><b>CONCLUSIONS</b>VSD with anterolateral thigh perforator flap for repair foot soft tissue defect could effective control wound soft tissue infection, receive reliable flap blood supply and skin flap could repaired at stage I. It is an effective method for repairing foot soft tissue defects.</p>

Clinical application of vaccum sealing drainage in plasma cell mastitis / 中华内分泌外科杂志

Objective To study the clinical value of vaccum sealing drainage in plasma cell mastitis.Methods 59 patients with plasma cell mastitis admitted in our hospital were treated with vaccum sealing drainage (the experimental group) from Jan.2011 to Apr.2014.59 plasma cell mastitis patients were treated with traditional vaseline gauze drainage (the control group).Clinical data like hospitalization length,healing time,healing grade,scar size,dressing change frequency,one year recurrence rate and breast deformity were retrospectively analyzed.Results Patients treated with vaccum sealing drainage had shorter hospitalization length and healing time,lower one year recurrence rate and less breast deformity compared to patients treated with traditional Vaseline gauze drainage (P＜0.01),while there was no significant difference in terms of healing grade (P＞0.05).Conclusions Vaccum sealing drainage can significantly shorten the hospitalization time and incision healing time,reduce dressing change frequency and one year recurrence rate in patients with plasma cell mastitis.Because of the smaller scar caused by vaccum sealing drainage,the breast deformity is also less.It is of clinical value for plasma cell mastitis.

A prospective study of immediate maternal and neonatal effects of forceps and vacuum assisted deliveries

Introduction: Chronic sinusitis is a very common problem in ENT practice. Variations have an anatomic and surgical significance, each and every case should be individually studied in detail before surgery to maximize patient benefit and avoid serious complications. Aim: To study the anatomical variations in relation to radiological findings occurring in nose and PNS in chronic sinusitis patients using CT scan PNS and DNE (Diagnostic nasal endoscopic examination). Materials and methods: Study done on 50 patients in duration of study 2 years, cases of chronic sinusitis chronic sinusitis with symptoms such as purulent rhinorrhea, nasal congestion, headache, facial pain or pressure persisting beyond 12 weeks who had not demonstrated symptom resolution despite 3-6 weeks antibiotic therapy, with systemic steroids, decongestants and nasal saline irrigation were included in the study. Results: In this study 42 cases showed anatomical variations out of 50 cases (ranging from 2.3% to 57.1%). Mixed signs and symptoms are most common observation, Incidence of Symptoms ranges from 20% to 90% and Signs ranges from 10% to 90%. More than one sinus bilaterally involved (68%). Conclusion: CT scan of the paranasal sinuses is the investigation of choice. Diagnostic nasal endoscopic examination is the clinical guide to evaluate the disease and the severity of the anatomical abnormality

Study on the wound healing efficacy of negative pressure wound therapy combined with topical oxygen therapy on the traumatic chronic wounds / 医学研究生学报

Objective To evaluate the wound healing efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy ( TOT ) on the traumatic chronic wounds , and to explore new conception and method for traumatic chronic wounds . Methods Sixty-four patients with traumatic chronic wounds were randomized into two groups ( n=32 ) .Patients in the control group were treated by NPWT , and those in the intervention group were treated by NPWT and NPWT with TOT 3L/min.The treatment time lasted 12 days, and the dressing and tubes were changed every three days in the two groups .After 12 days, all the pa-tients were treated by standard moist therapy or surgery until healing or three months .Indicators of observation: The pressure ulcer scale for healing (PUSH) scores and granulation covered rate at 0, 3, 6, 9, and 12 days were measured, and healing rate and healing time during three months were calculated in the two groups . Results The PUSH scores were declined with intervention time during 12 days in the two groups , indicating the treatment was effective , but there was no significant difference between the two groups ( P>0 .05 ) .The granulation covered rate was increased with intervention time , and the granulation covered rate was higher in the intervention group than in the control group(P<0.001).The healing rate was higher in the intervention group than in the control group (87.50%vs 59.38%, P<0.05 ).The healing time of 14 days was shortened in the intervention group compared with the control group (P<0.001). Conclusion NPWT combined with TOT is an effective and feasible method for complicated traumatic chronic wounds , which can en-hance granulation growth , rise healing rate and shorten healing time .

Fístula enteroatmosférica y uso del VAC: a propósito de un caso / Enteroatmospheric fistula and vaccum assited closure: report of a case

Las fístulas gastrointestinales asociadas con abdomen abierto posterior a cirugía abdominal mayor son una complicación grave. El manejo es extremadamente difícil y la mortalidad bastante alta a pesar de los modernos avances médicos. Aquellos pacientes que sobreviven al daño metabólico y fisiopatológico inicial, requieren en su mayoría cierre quirúrgico de la fístula lo cual es técnicamente complejo. Presentamos el caso de un paciente con una neoplasia de rectosigma que se abordó por laparoscopia y desarrolló una fístula enteroatmosférica sobre la incisión de Pfannestiel que se utilizó para la extracción de la pieza. Conclusión: El cierre asistido por vacío artesanal y el manejo nutricional adecuado permiten la mejoría en pacientes con fístulas complejas logrando las condiciones adecuadas para el cierre definitivo.

The gastrointestinal fistula associated to posterior open abdominal trauma or abdominal surgery implies severe complications. The handling of these cases is extremely hard and mortality is very high despite medical advances. Those patients who survive the initial metabolic and phisycopathological damages require, on most cases, a surgical closure of the fistula which is a very complex procedure technically. We describe the case of a patient with a rectosigmoid neoplasm that was addressed laparoscopically and enteroatmospheric fistula just developing on phannestiel incision was used to extract the neoplasm. Conclusion: The closure assisted by “hand made vacuum” and adequate nourishment allows recovering patients with complex fistulas to achieve adequate conditions for definitive closure.

Staging treatment of severe complicated injuries in pahnar forearm and wrist / 中华显微外科杂志

Objective To investigate the therapeutic effect of stage treatment of severe complicated injuries in palmar forearm and wrist.Methods From March 2008 to Novemler 2011, eleven cases with skin lost combined with fracture and lost of flexor tendon, ulnar radial arteries, median and ulnar nerves,and some of them had fracture of ulnar and radius were treated in the first stage with vacuum sealing drainage after emergency debridement and tissue repair. Secondary microsurgical repair was performed after the VSD was removed. The lost of median and ulnar nerves was repaired with transplantation of sural nerve,and the wound was repaired with free flaps and complex tissue flaps. Results Eleven cases were treated with vacuum sealing drainage for 7 to 10 days.Infections were under control,wound areas reduced and most wound areas were covered by granulation tissues.Flaps and skin grafts were survived.After postoperative follow-up for 3 to 36 months (average 13 months),three cases was received flexor tendolysis.As result,the blood circulation of hand was good, the sensor of injured nerve was higher than S3, and there was a good functional rehabilitation of hand muscles. Conclusion Using vacuum sealing drainage after emergency debridement and tissue repair, there was a good repairing effect of secondary repair with flaps and skin grafts for severe complicated tissue defect in palmar forearm and wrist,and it is an effective choice of operation.

Estudio comparativo de dos técnicas de plastinación / Two different plastination techniques comparative study

La técnica de plastinación es utilizada ampliamente para la mejor preservación de las piezas cadavéricas utilizadas en docencia. Nuestra unidad la está utilizando desde el año 2002, pero hemos notado que la calidad de las muestras no es la óptima, produciéndose gran retracción de éstas. Por tal motivo, se diseñó una trabajo que compara la técnica de plastinación de nuestra unidad, con otro proceso, el cual se basa en el protocolo utilizado por la Universidad de Murcia. Utilizamos 24 muestras frescas de riñones y hemiencéfalos de vacuno, riñones y corazones de cerdo y miembro inferior humano, las cuales fueron fijadas con alcohol etílico, formalina y solución fijadora Universidad de los Andes. Fueron aplicadas dos diferentes técnicas de plastinación: una basada en el protocolo utilizado hasta ese momento en nuestro laboratorio de plastinación (técnica A) y otro proceso similar al publicado por la Universidad de Murcia (técnica B). Se evaluaron los porcentajes de variación de peso, ancho, largo, espesor y perímetro de las diferentes piezas plastinadas. También se procedió a fijar las muestras en diferentes soluciones (alcohol, formalina 10 por ciento y solucion fijadora Universidad de los Andes), pesar y medir sus dimensiones. El porcentaje de pérdida de peso promedio fue 63,1 por ciento para la técnica A y 37,9 por ciento para la técnica B (p<0,01); las mediciones de las disminuciones en el largo, ancho y grosor de las muestras también fueron mayores en las piezas sometidas a la técnica A, siendo todos los porcentajes de pérdidas estadísticamente significativos. Al comparar las muestras según los diferentes métodos de fijación con la técnica B no hubo diferencias estadísticamente significativas. La plastinación de muestras basadas en la técnica de Murcia obtiene muestras de mejor calidad y menos retracción. No influiría en el proceso de plastinación el método de fijación.

The plastination technique is used extensively for the improved preservation of cadavers used for teaching. Our unit has been using this technique since 2002, but we have noticed that sample quality is not optimal, given the large retraction of samples. Therefore, a project was designed that compares our department's plastination technique, with another process, based on the protocol used by Murcia University. We used 24 fresh bovine kidneys and brain samples, pigs' kidneys and hearts and human lower limbs; all of which were fixed with ethyl alcohol, formalin and De los Andes University's fixation solution. Two different plastination techniques were applied: one based on the protocol used in our laboratory (technique A) and another one similar to that published by Murcia University (technique B). We evaluated the body weight percentage, width, length, thickness and perimeter of the different plastinated pieces, as well as measuring the same variables in each fixation solution (alcohol, formalin fixative solution 10 percent and Universidad de los Andes). The average weight loss percentage was 63.1 percent for technique A and 37.9 percent for technique B (p <0.01). The decrease measurements in length, width and thickness were also higher under technique A, all percentages being statistically significant. When comparing the samples according to different fixation methods, there were no significant differences. Plastination based on Murcia University's technique obtained better quality samples with less shrinkage. The plastination process was not influenced by the fixation method.

Treating Gynecomastia with Ultrasound-guided Vacuum-assisted Biopsy Device as a Cosmetic Method / 한국유방암학회지

PURPOSE: Gynecomastia can cause severe emotional phobia for breast cancer in elderly male and physical distress in young men. To select the appropriate cosmetic surgical approach for gynecomastia, I evaluated the usefulness of performing ultrasound-guided vacuum-assisted device excision of it. METHODS: Twenty-two cases of gynecomastia in 18 male were treated by vacuum-assisted biopsy device excision from November 2005 to June 2007. Their age range was 14-72 years old (mean, 34). The vacuum-assisted biopsy device excision was performed by 11G needle in 7 cases and 8G needle in 15 cases. I checked the number of extracted tissue pieces, the duration time of the procedure, immediate complications, and breast ultrasound after 3 months. RESULTS: The mean number of extracted tissue pieces was 69, and the average procedure duration was 25 minutes. There were no significant immediate complications such as bleedings and skin necrosis, and there were no clinically serious complications on 3 months follow-up examinations. During operation under local anesthesia, all patients tolerated the procedure. After vacuum-assisted biopsy device procedure, the cosmetic results were good to excellent for all the patients. CONCLUSION: Vacuum-assisted biopsy device excision was an effective surgical option, especially for small and glandular gynecomastia. I suggest this is a useful alternative procedure to surgery and liposuction, or it could be used effectively as a co-operative procedure with liposuction.

External fixator combined with vaccum sealing drainage for the infection after internal fixation in tibial and fibular fracture / 中国矫形外科杂志

[Objective]To explore the effect of external fixator combined with vaccum sealing drainage(VSD) for the treatment of infection after internal fixation in tibial and fibular fracture.[Method]Thirty-six patients with infection after internal fixation in tibial and fibular fracture were treated by external fixator combined with VSD from June 2004 to June 2008.[Result]During the following-up period from 8-30 months in thirty-two patients,the infection in all cases were controlled effectively,no case of recurrence was found in all patients,and satisfactory healing were found in 32 cases.The average time of fracture union were 4.5 months;the removal time of external fixation were 5 months on average.[Conclusion]The combined operative procedure is simple,reliable and less traumatic and allow to early functional exercises.Therefore,it is a satisfactory measure for the infection after internal fixation in tibial and fibular fracture.

Vacuum-assisted Closure in Orthopedics / 中华医院感染学杂志

OBJECTIVE To observe the effect of vacuum-assisted closure in clinical persistent infection patients.METHODS Thirty two sufferers infected in soft tissue,bones and joints were treated by general methods but without durable concrescence.It lasted averagely 138 days.In our department it treated by vacuum-assisted closure in 23 days.Thereby a comparison of self-control came into being.RESULTS Thirty two cases were cured after following at least one year except for one case with recrudescence.CONCLUSIONS Vaccum-assisted closure is the most effective surgery therapy measurement and is a kind of unidirectional drainage.If we can use it felicitously then we can treat infection in orthopedics′ effectively.

Influences of methods of drying on total anthraquinones in Radix et Rhizoma Rhei Dispensing Granules / 中成药

AIM: To compare the influences of drying methods on Radix et Rhizoma Rhei in Dispensing Granu- les . METHODS: The vaccum and spray methods were studied by determination of total anthraquinones and the sum of aloe-emodin, rhein, emodin, chrysophanol and physcion. RESULTS: When in spray drying conditions re- lative density of extract was 1.06 - 1.10 (60 ?C) and entering wind temperature was at 140-150 ?C, outlet wind temperature was at 85-90 ?C. Radix et Rhizoma Rhei dispensing granules appearance was good, the total anthraquinones was destroyed least. CONCLUSION: Spray drying method for dispensinp granules has superiorily ever vaccum one.