Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos

Las fístulas y dehiscencias anastomóticas postoperatorias gastrointestinales se presentan de forma frecuente y muchas son manejadas quirúrgicamente, sin embargo, las intervenciones endoscópicas han mostrado mejorar desenlaces de curación y tiempo de estancia hospitalaria. Se describe la experiencia de la terapia de cierre asistida por vacío (E-VAC), en el manejo de fístulas y dehiscencias anastomóticas postoperatorias, en un centro de referencia gastrointestinal en Colombia. Se realizó un estudio serie de casos en pacientes con dehiscencia de anastomosis y fístula a diferentes niveles del tracto digestivo, tratados mediante E-VAC, por el servicio de gastroenterología de la clínica universitaria Colombia, en Bogotá, durante un periodo comprendido de febrero 2019 y noviembre 2021. Se describieron variables sociodemográficas, clínicas y quirúrgicas. Se describen 6 casos, 4 de tracto digestivo inferior y 2 de tracto digestivo superior. El 83% fueron hombres, la edad media fue de 51,8 años (+/-17,5). La indicación de E-VAC fue fístula anastomótica colorrectal en el 66%, siendo la ubicación anatómica más frecuente la anastomosis colorrectal (66%), con menor frecuencia a nivel de los cardias (16%) y esófago (16%). El tamaño del defecto se describió entre el 20 y el 80% en pacientes sometidos a terapia E-VAC, siendo el tiempo promedio de hospitalización 22.5 días con un número de recambios promedio de siete por paciente. Las fugas y fístulas anastomóticas son complicaciones potencialmente mortales en pacientes llevados a intervenciones quirúrgicas gastrointestinales, en las que la terapia E-VAC ha mostrado ser eficaz y segura, promoviendo el cierre del defecto y el drenaje de colecciones presentes, igualmente disminuyendo el tiempo de estancia hospitalaria.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulasand postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulasat different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulasare potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy / Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica

Introduction: Negative pressure therapy gains ground in surgical practice as an intervention to improve healing. Post-bariatric patients undergoing abdominal dermolipectomy are at increased risk of local complications. There is a notable dearth of current Brazilian studies on this. This study aims to analyze the presence of complications in patients undergoing post-bariatric dermolipectomy surgery with negative pressure dressing in closed surgical incisions. Method: Descriptive study that evaluated complications of surgical incisions in 20 patients undergoing post-bariatric dermolipectomy surgery with negative pressure therapy. Data tabulated in Windows Excel software and analyzed in the Statistical Package for the Social Sciences 18.0 program. Qualitative variables were presented in simple frequency and quantitative as mean, standard deviation, and amplitude. CEP-UNISUL approved the study. Results: 20 patients undergoing negative pressure therapy, 80% (n=16) female, mean age 39.55 years (±9.08). Anchor incision was chosen in 70% (n=14) of the surgeries, with an average tissue removal of 1940 grams (±710.37) and hospitalization time of 40.20 hours (±19.18), corresponding to 1,66 daily. Only 15% (n=3) of patients had complications (dehiscence, seroma, and hematoma, which occurred in the same proportion). There was no case of necrosis. Conclusion: The use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy seems to contribute to reducing postoperative complications.

Introdução: Terapia de pressão negativa ganha espaço na prática cirúrgica como intervenção para melhorar cicatrização. Pacientes pós-bariátricos submetidos a dermolipectomia abdominal apresentam maior risco de complicações locais. Há uma notável escassez de estudos brasileiros atuais acerca disso. O objetivo desse estudo é analisar a presença de complicações em pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com curativo de pressão negativa em incisões cirúrgicas fechadas. Método: Estudo descritivo que avaliou complicações de incisões cirúrgicas de 20 pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com terapia de pressão negativa. Dados tabulados no software Windows Excel e analisados no programa Statistical Package for the Social Sciences 18.0. Variáveis qualitativas foram apresentadas em frequência simples e quantitativas através de média, desvio padrão e amplitude. O estudo foi aprovado pelo CEP-UNISUL. Resultados: 20 pacientes submetidos a terapia de pressão negativa, sendo 80% (n=16) do sexo feminino, com idade média de 39,55 anos (±9,08). Incisão em âncora foi escolha em 70% (n=14) das cirurgias, com retirada média de tecido de 1940 gramas (±710,37) e tempo de hospitalização de 40,20 horas (±19,18), correspondendo a 1,66 diárias. Apenas 15% (n=3) dos pacientes apresentaram complicações (deiscência, seroma e hematoma, que aconteceram na mesma proporção). Não houve caso de necrose. Conclusão: Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica parece contribuir na redução das complicações pós-operatórias.

Application of vacuum sealing drainage technique in high-risk incision of bone and soft tissue tumors / 中国医师进修杂志

Objective:To investigate the efficacy and application value of vacuum sealing drainage (VSD) in high-risk incision after bone and soft tissue tumor surgery.Methods:From January 2020 to September 2022, 22 patients with high-risk incisions after bone and soft tissue tumor resection in Shengjing Hospital, China Medical University were treated with VSD. The postoperative negative pressure was set at 0.025 MPa (188 mmHg, 1 mmHg = 0.133 kPa), and the VSD device was removed on the 7th day after operation. After removal, the wound healing and the incidence of related complications were observed.Results:After removing the VSD, 20 patients with high-risk incisions reached the standard of grade A healing, the rate of grade A healing was 90.91%, and 2 patients had incision wound necrosis, and the incision healed were improved after dressing change. The patients were followed up for 6 - 12 months, with an average time of 10 months. The wound healing of all patients reached the standard of grade A healing, and no long-term complications occurred.Conclusions:VSD technique has good clinical effect and can be applied to various high-risk incisions after bone and soft tissue tumor surgery, which can effectively prevent the occurrence of incision complications.

Application of self-made negative pressure suction in the treatment of auricle subluxation and avulsion injury / 中国医师进修杂志

Objective:To explore the effect of self-made negative pressure suction in auricle subluxation and avulsion injury.Methods:The clinical data of 7 patients with auricle subluxation and avulsion injury from January 2017 to February 2022 in the First People′s Hospital of Lianyungang City were retrospectively analyzed. The 7 patients were treated with self-made simple negative pressure drainage device for negative pressure suction after suture.Results:Among the 7 patients, 1 patient suffered from severe contusion and local skin necrosis, and the scar healed after local application of erythromycin eye ointment, while the other patients healed in the first stage without obvious auricular deformity.Conclusions:The negative pressure drainage is the key factor to ensure the blood supply and shape of patients with auricle subluxation and avulsion injury. The application of self-made negative pressure drainage in the treatment of subtotal auricle avulsion injury has the advantages of simple operation, improved survival rate of auricle and improved satisfactory auricle shape.

Role of incisional vacuum therapy in endoprosthetic bone reconstruction surgery / Papel da terapia a vácuo incisional em cirurgia de reconstrução óssea com endoprótese

ABSTRACT Reconstructive surgery with endoprostheses is the chosen method for treating bone malignancies. Postoperative infections are frequent complications, and their treatment involves prolonged hospital stays and antibiotic therapy. Among the advancements aimed at reducing the rate of postoperative infection, the use of incisional negative pressure therapy (iNPT) has shown promising results, with no reports in the literature regarding its use in patients with such conditions. Objective: To evaluate the effectiveness of iNPT in reducing postoperative complications in surgeries for resection of bone tumors associated with modular endoprosthesis reconstruction. Methods: Retrospective case series of 16 patients diagnosed with osteosarcoma, who underwent resection and reconstruction with endoprosthesis associated with iNPT during the postoperative period. Follow-up was performed for a period of six months, and the evaluated outcomes were the incidence of postoperative infection and complications of the surgical wound. Results: The use of iNPT for a postoperative period of seven days resulted in only three (18.7%) cases of postoperative infection. No cases of wound dehiscence, seroma formation, or hematoma at the surgical site were observed. Conclusion: The rate of surgical wound complications in our case series is lower than that reported in most of the literature, and iNPT appears to be an efficient way to reduce the rate of local complications in reconstructive surgeries with endoprosthesis after resection of bone malignancies. Level of Evidence III, Retrospective Study.

RESUMO A cirurgia reconstrutiva com endopróteses é o método escolhido no tratamento de malignidades ósseas. As infecções pós-operatórias são complicações frequentes, e seu tratamento envolve internações e antibioticoterapia prolongadas. Entre os avanços que visam reduzir a taxa de infecção pós-operatória, o uso da terapia com pressão negativa incisional (TPNi) vem mostrando resultados promissores, não havendo relatos na literatura de seu emprego em pacientes com tal quadro. Objetivo: Avaliar a eficácia da TPNi em reduzir complicações pós-operatórias em cirurgias de ressecção de tumores ósseos associadas à reconstrução com endopróteses modulares. Métodos: Série de casos retrospectiva de 16 pacientes diagnosticados com osteossarcoma, submetidos à ressecção e reconstrução com endoprótese associada à TPNi durante o pós-operatório. Foi realizado seguimento por um período de seis meses e os desfechos avaliados foram incidência de infecção pós-operatória e complicações da ferida operatória. Resultados: O uso da TPNi por um período pós-operatório de sete dias resultou em apenas três (18,7%) casos de infecção pós-operatória. Não foram observados casos em que ocorreu deiscência da ferida operatória, formação de seromas ou hematomas no sítio cirúrgico. Conclusão: A taxa de complicações de ferida operatória em nossa série de casos é menor que a da maior parte da literatura, e a TPNi parece ser uma forma eficiente de reduzir a taxa de complicações locais em cirurgias reconstrutivas com endoprótese após ressecção de malignidades ósseas. Nível de Evidência III, Estudo Retrospectivo.

Effects of autologous platelet-rich plasma combined with negative pressure wound therapy for chronic refractory wounds: a Meta-analysis / 中国输血杂志

【Objective】 To systematically evaluate the therapeutic efficacy of autologous platelet-rich plasma combined with negative pressure wound therapy on chronic refractory wounds, and to provide reference for clinical treatment. 【Methods】 Randomized controlled trials of autologous platelet-rich plasma combined with negative pressure wound therapy for the treatment of chronic refractory wounds were included in the databases of CNKI, Wan fang, VIP, PubMed, Embase and Cochrane Library from the time of database construction to November 2022. After literature screening, data extraction and quality evaluation, Meta analysis was performed using Stata 15.1 software. 【Results】 After screening, a total of 11 Chinese literatures that met the criteria of this paper were retrieved, involving a total of 359 patients with chronic refractory wounds. The observation group was treated with autologous platelet-rich plasma combined with negative pressure wound therapy, and the control group was treated with negative pressure wound therapy alone. Meta-analysis suggested that compared with negative pressure wound therapy alone, autologous platelet-rich plasma combined with negative pressure wound therapy shortened wound healing time [WMD=-6.08, 95%CI (-7.77, -4.40), P<0.05]. The hospitalization was shortened [WMD=-8.24, 95%CI (-11.55, -4.94), P<0.05], the pain score was decreased [WMD=-1.73, 95%CI (-2.06, -1.40), P<0.05], and the positive rate of bacterial culture on the wound was decreased [RR=0.28, 95%CI(0.16, 0.49), P<0.05], the wound treatment effect was good [RR=1.28, 95%CI(1.17, 1.41), P<0.05]. 【Conclusion】 Based on current studies, compared with the negative pressure wound therapy alone, autologous platelet-rich plasma combined with negative pressure wound therapy can effectively promote the healing of chronic refractory wounds, shorten the hospital stay, reduce pain and infection, and the clinical treatment effect is better.

Manejo de defeitos complexos do couro cabeludo após excisão de tumores malignos / Management of complex scalp defects after excision of malignant tumors

Introdução: A reconstrução do couro cabeludo após a ressecção oncológica continua sendo um desafio para o cirurgião, especialmente considerando a incidência crescente de câncer de pele entre pacientes idosos. A matriz dérmica (MD) é um grupo heterogêneo de materiais de cobertura de feridas que auxiliam no fechamento da ferida e substituem algumas das funções da pele, temporária ou permanentemente. Pacientes com maior risco cirúrgico podem se beneficiar do uso de MD, que ajuda a gerar uma nova derme, oferecendo grandes melhorias na cobertura de defeitos complexos e extensos. Métodos: É um trabalho retrospectivo com análise de prontuário e relato de dois casos de pacientes do A.C.Camargo Cancer Center-SP, Brasil. Resultados: Relatamos dois casos de defeitos complexos e extensos de couro cabeludo em um centro único usando MD associada a enxerto cutâneo e terapia de pressão negativa (TPN) na cirurgia reconstrutiva após ressecção de neoplasia maligna da pele com resultados funcionais e estético satisfatório. Conclusões: As lesões extensas do couro cabeludo são um desafio na prática clínica e um tratamento multidisciplinar é fundamental. Os resultados obtidos indicam que a MD associada com a enxertia de pele parcial e com a TPN tem enorme potencial para aumentar as opções terapêuticas disponíveis para o cirurgião e possivelmente beneficiando os pacientes, especialmente aqueles que não têm condições clínicas para uma cirurgia extensa de cobertura com retalho microcirúrgico.

Introduction: Scalp reconstruction after cancer resection remains a challenge for surgeons, especially considering the increasing incidence of skin cancer among elderly patients. Dermal matrix (DM) is a heterogeneous group of wound covering materials that aid in wound closure and replace some of the skins functions, either temporarily or permanently. Patients at higher surgical risk can benefit from the use of DM, which help to generate a new dermis, offering great improvements in coverage of complex and extensive defects Methods: It is a retrospective study with analysis of medical records and report of two cases of patients at the A.C.Camargo Cancer Center-SP, Brazil. Results: We report two cases of complex and extensive scalp defects at a single center using DM associated with skin grafting and negative pressure therapy (NPT) in reconstructive surgery after resection of malignant skin neoplasm with satisfactory functional and esthetic results. Conclusions: Extensive lesions of the scalp are a challenge in clinical practice and a multidisciplinary treatment is essential. The results obtained indicate that DM associated with partial skin grafting and NPT have enormous potential to increase the therapeutic options available to the surgeon and possibly benefit patients, especially those who do not have the clinical conditions for extensive coverage surgery with microsurgical flap.

NEGATIVE PRESSURE WOUND THERAPY (NPWT): OUR EXPERIENCE USING HOSPITAL WALL SUCTION

Study Design: Prospective case series Delayed wound healing is a significant concern, particularly in Introduction: complex wounds and the elderly with co-morbidities. It leads to pain, morbidity, prolonged treatment, and requires major reconstructive surgery, which imposes an enormous social and financial burden. Negative Pressure Wound Therapy (NPWT) was used to cover large wounds, decubitus ulcers, and open fractures that cannot be closed either primarily or secondarily and often require a complex reconstructive procedure to protect the injury. NPWT is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. We applied NPWT on pa Materials and Methodology: tients with open fractures, decubitus ulcers, neglected wounds, fasciotomies, and large wounds. Compared to the patented VAC system, ours include pre-sterilized PVA foam, cling drape (Surgiwear TM), nasogastric tube or an infant feeding tube, and a hospital wall suction. There Results: were three cases of soft tissue injury of the foot with wound defect, one case of fasciotomy for compartment syndrome, one case of the decubitus ulcer, one case of open fractures, and three cases of degloving injuries of the foot. In our study, the NPWT was changed every five days, the average number of NPWT changes was 3-4, length of time NPWT applied before the closure was 14-21 days. The most frequent coverage mode is Split Thickness Skin Graft obviating the need for more complex flaps and microvascular reconstructive procedures. Negative Conclusion: pressure therapy stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis. NPWT appears to be simple and more effective than conventional dressings for managing complex wounds, reducing wound volume, depth, treatment duration, and cost.

A clinical study of management of wounds using vacuum assisted dressings

Background: The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. Vacuum assisted closure (VAC) has proved its efficacy for wound dressing leading to faster wound healing and shorter hospital stay. The aim of the study was to determinethe advantage of vacuum assisted closure over conventional dressing in SCBMCH hospital.Methods:The study was conducted at general surgery wards of SCB Medical College hospital. After debridement of the wound vacuum assisted dressing was applied. Control group was given conventional dressing.Results:In the study sample 10% patients were less than 40 years,76% belonged to 41-60 age group and 7% were more than 61 years of age, 60% male and 40% female. Wounds were located in the foot 27 (54%), leg 19 (38%), sole 2 (4%) and forearm 2 (4%). Patients with sterile pre (VAC), culture and sensitivity was not turning non sterile after VAC, but 90% non-sterile turns sterile after vacuum assisted dressing. In 5 days 25% of granulation tissue formed in VAC dressing whereas only 10% in case control. Similarly, in 10 days it was 40% for VAC and 25% in case of control. Finally, in 15 days it was 70% in case of VAC and 40% in case of control.Conclusions:VAC results in better healing, with few serious complications, and a promising alternative for the management of various wounds.

Antibiotic-loaded bone cement combined with debridement and vacuum sealing drainage for treatment of diabetic foot ulcer wounds / 中国基层医药

Objective:To investigate the efficacy of antibiotic-loaded bone cement combined with debridement and vacuum sealing drainage in the treatment of diabetic foot ulcer wounds.Methods:Sixty-four patients with diabetic foot ulcers who received treatment in Zhejiang Rongjun Hospital from January 2018 to January 2020 were included in this study. They were randomly assigned to undergo either debridement treatment + vacuum sealing drainage (control group, n = 32) or antibiotic-loaded bone cement + debridement + vacuum sealing drainage (observation group, n = 32). The number of patients positive for bacterial culture at different time points and treatment-related indices were compared between the two groups. Results:At 3, 6 and 9 days after admission, the positive rates of bacterial culture in the observation group were 37.50%, 15.63% and 0.00%, respectively, which were significantly lower than 62.50%, 40.62% and 12.50% in the control group ( χ2 = 4.00, 4.95, 4.27, all P < 0.05). The number of operations in the observation group was significantly lower than that in the control group [(2.96 ± 0.38) vs. (3.63 ± 0.69), t = 4.81, P < 0.001). The length of hospital stay in the observation group was significantly shorter than that in the control group [(34.74 ± 3.03) days vs. (45.18 ± 2.41) days, t = 15.25, P < 0.001). The duration to wound healing in the observation group was significantly shorter than that in the control group [(58.23 ± 10.12) days vs. (72.69 ± 11.21) days, t = 6.06, P < 0.001]. Conclusion:Antibiotic-loaded bone cement combined with debridement and vacuum sealing drainage is effective in the treatment of diabetic foot ulcer. The combined treatment can effectively prevent infection of ulcer wounds, reduce the number of operations, and thereby shorten the length of hospital stay.

Aplicação de terapia por pressão negativa adaptada em lesão por queimadura no norte do Brasil: Relato de caso / Application of low cost negative pressure therapy in burn injury in northern Brazil: Case report

OBJETIVO: Relatar um caso clínico ocorrido em um Centro de Referência de Tratamento de Queimados, submetido a terapia por pressão negativa (TPN) adaptada com materiais hospitalares durante o período de internação, visando a cicatrização mais eficaz da lesão. RELATO DE CASO: Paciente de 47 anos de idade, sexo masculino, vítima de queimadura por descarga elétrica, apresentando lesão em pé direito, região submetida há 16 dias de tratamento por TPN adaptada, tendo como resultado a cicatrização da lesão sem necessidade de enxertia. CONSIDERAÇÕES FINAIS: A aplicação de TPN adaptada demonstrou ser um importante alicerce na cicatrização da lesão, permitindo como resultados a redução da planimetria da lesão, aumento do tecido de granulação, redução do esfacelo, além da aproximação das bordas.

OBJECTIVE: To report a clinical case that occurred in Reference Center for Burn Treatment, submitted to negative pressure therapy (NPT) adapted with hospital materials during the period of hospitalization, aiming at a more effective wound healing. CASE REPORT: 47-year-old male patient, victim of burns caused by electrical discharge, presenting a lesion in the right foot, region submitted to 16 days of treatment with adapted NPT, resulting in healing of the lesion without the need for grafting. FINAL CONSIDERATIONS: the application of adapted not proved to be an important foundation in the healing of the lesion, resulting in a reduction in the planimetry of the lesion, an increase in granulation tissue, a reduction in slough, in addition to approximation of the edges.

Simplified vacuum dressing system: effectiveness and safety in wounds management

Purpose: Negative pressure wound therapy (NPWT) has revolutionized wound care, but its high cost reduces the procedure's availability. To solve the problem, streamlined vacuum dressings systems have been proposed, but the utility of these devices has been poorly studied. The objective of this study was to evaluate a simplified vacuum dressing system model (SVDM). Methods: Randomized clinical trial in which wounds were treated with SVDM compared to a complex occlusive dressing (silver hydrofiber, SHF). The analyzed outcomes were cleaning, presence of granulation tissue, clinical appearance, and indication for surgical closure of wounds. Results: Fifty injuries were treated (25 in each group), most located on lower limbs. SVDM proved to be more effective than SHF in the evaluated outcomes. Wound recalcitrance reduced the effectiveness of the equipment used. Despite its efficacy, complications occurred, the most frequent related to dressing changes: minor bleeding, foam adherence to a wound bed, and pain. Only for bleeding no favorable risk-benefit ratio was found. There were no severe complications, worsening conditions of injuries, or deaths. Conclusions: SVDM proved to be an effective and acceptably safe device for managing studied wounds.

Negative pressure wound therapy combined with a retrograde sural neurovascular flap for repair of foot and ankle wounds / 中国基层医药

Objective:To investigate the efficacy of negative pressure wound therapy (NPWT) combined with a retrograde sural neurovascular flap for the repair of foot and ankle wounds.Methods:Eighty-eight patients with foot and ankle wounds who received treatment in Shandong Wendeng Osteopathic Hospital from July 2019 to January 2020 were included in this study. They were randomly assigned to undergo either NPWT combined with retrograde sural neurovascular flap repair (observation group, n = 44) or retrograde sural neurovascular flap repair alone (control group, n = 44). Clinical efficacy, flap survival, wound healing, and postoperative ankle function scores were compared between the two groups. Results:Total response rate was significantly higher in the observation group than in the control group [97.73% (43/44) vs. 81.82% (36/44), χ2 = 6.07, P = 0.014]. Flap survival rate was significantly higher in the observation group than in the control group [100.00% (44/44) vs. 86.36% (38/44), χ2 = 4.47, P = 0.034]. Wound healing rate was significantly higher in the observation group than in the control group [97.73% (43/44) vs. 79.55% (35/44), χ2 = 7.22, P = 0.007]. Half a year after surgery, pain score, gait score, foot and ankle swelling score, range of motion of the tibiotalar joint, range of motion of the ankle joint were (1.81 ± 0.45) points, (1.40 ± 0.41) points, (1.98 ± 0.38) points, (0.41 ± 0.35) points, and (0.84 ± 0.51) points, respectively in the observation group, which were significantly lower than those in the control group ( t = 2.63, 2.62, 2.15, 2.09, 2.02, all P < 0.05). Conclusion:NPWT combined with a retrograde sural neurovascular flap greatly increases flap survival rate and wound healing rate and improves the ankle function of patients with foot and ankle wounds.

Treatment and Chest Reconstruction for Mediastinitis Following Sternotomy for Cardiac Surgery at the Heart Institute of the University of São Paulo Medical School

Abstract This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of São Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.

Damage control in penetrating cardiac trauma / El control de daños en el trauma cardíaco penetrante

Abstract Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.

Resumen El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico. Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.

Evolution of damage control surgery in non-traumatic abdominal pathology: a light in the darkness / Evolución de la cirugía de control de daños en patología no traumática abdominal: un faro en medio de la tormenta

Abstract Damage control surgery is based on temporal control of the injury, physiologic recovery and posterior deferred definitive management. This strategy began in the 1980s and became a formal concept in 1993. It has proven to be a strategy that reduces mortality in severely injured trauma patients. Nevertheless, the concept of damage control in non-traumatic abdominal pathology remains controversial. This article aims to gather historical experiences in damage control surgery performed in non-traumatic abdominal emergency pathology patients and present a novel management algorithm. This strategy could be a surgical option to treat hemodynamically unstable patients in catastrophic scenarios such as hemorrhagic and septic shock caused by peritonitis, pancreatitis, acute mesenteric ischemia, among others. Therefore, damage control surgery is light amid better short- and long-term results.

Resumen La cirugía de control de daños es una estrategia de control temporal del daño tisular y recuperación fisiológica para un manejo definitivo diferido. Esta estrategia tiene antecedentes en el mundo del trauma desde la década de 1980, hasta su formalización conceptual en 1993. Hasta el momento ha demostrado ser una estrategia factible y que reduce la mortalidad en los pacientes críticamente enfermos. Sin embargo, el manejo de patologías abdominales no traumáticas aun es tema de discusión sobre su factibilidad y seguridad. El presente articulo tiene como objetivo realizar un relato histórico y experiencias en la aplicación de la cirugía de control de daños en emergencias quirúrgicas abdominales no asociadas a trauma y presentar un algoritmo de manejo usando los principios de la cirugía de control de daños. La aplicabilidad del control de daños en no trauma se enfrenta a los contextos de shock hemorrágico y séptico para patologías como peritonitis generalizada, peritonitis postquirúrgica, pancreatitis, isquemia mesentérica aguda, entre otras. Se ha demostrado que el uso de control de daños representa una luz para el cirujano ante la tormenta de la incertidumbre de la descompensación metabólica en el manejo de emergencias abdominales, para crear un puente para su manejo definitivo y permitir anastomosis como estrategia de reconstrucción intestinal y mejorar los resultados a corto y largo plazo.

Primary repair: damage control surgery in esophageal trauma / El reparo primario: el control de daños en el trauma de esófago

Abstract Esophageal trauma is a rare but life-threatening event associated with high morbidity and mortality. An inadvertent esophageal perforation can rapidly contaminate the neck, mediastinum, pleural space, or abdominal cavity, resulting in sepsis or septic shock. Higher complications and mortality rates are commonly associated with adjacent organ injuries and/or delays in diagnosis or definitive management. This article aims to delineate the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia, on the surgical management of esophageal trauma following damage control principles. Esophageal injuries should always be suspected in thoracoabdominal or cervical trauma when the trajectory or mechanism suggests so. Hemodynamically stable patients should be radiologically evaluated before a surgical correction, ideally with computed tomography of the neck, chest, and abdomen. While hemodynamically unstable patients should be immediately transferred to the operating room for direct surgical control. A primary repair is the surgical management of choice in all esophageal injuries, along with endoscopic nasogastric tube placement and immediate postoperative care in the intensive care unit. We propose an easy-to-follow surgical management algorithm that sticks to the philosophy of "Less is Better" by avoiding esophagostomas.

Resumen El trauma esofágico es un evento poco frecuente pero potencialmente mortal. Una perforación esofágica inadvertida puede ocasionar la rápida contaminación del cuello, el mediastino, el espacio pleural o la cavidad abdominal, lo cual puede resultar en sepsis o choque séptico. Las complicaciones y la mortalidad aumentan con el retraso en el diagnóstico o manejo definitivo, y la presencia de lesiones asociadas. El objetivo del presente artículo es describir la experiencia adquirida por el grupo de cirugía de Trauma y Emergencias (CTE) de Cali, Colombia en el manejo del trauma de esófago de acuerdo con los principios de la cirugía de control de daños. Las lesiones esofágicas deben sospecharse en todo trauma toraco-abdominal o cervical en el que el mecanismo o la trayectoria de la lesión lo sugieran. El paciente hemodinámicamente estable se debe estudiar con imágenes diagnósticas antes de la corrección quirúrgica del defecto, idealmente por medio de tomografía computarizada del cuello, tórax y abdomen con contraste endovenoso. Mientras que en el paciente hemodinámicamente inestable se debe explorar y controlar la lesión. El reparo primario es el manejo quirúrgico de elección, con la previa colocación de una sonda nasogástrica y el seguimiento postoperatorio estricto en la unidad de cuidado intensivo. Se propone un algoritmo de manejo quirúrgico que resulta fácil de seguir y adopta la premisa "Menos es Mejor" evitando realizar derivaciones esofágicas.

Damage control surgery for splenic trauma: "preserve an organ - preserve a life" / Control de daños en trauma esplénico: "preserva un órgano, preserva la vida"

Abstract The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

Resumen El bazo es uno de los órganos sólidos comprometidos con mayor frecuencia en el trauma abdominal y el diagnóstico oportuno disminuye la mortalidad. El manejo del trauma esplénico ha cambiado considerablemente en las últimas décadas y hoy en día se prefiere un abordaje conservador incluso en casos de lesión severa. Sin embargo, la estrategia óptima para el manejo del trauma esplénico en el paciente severamente traumatizado aún es controvertida. El objetivo de este artículo es proponer una estrategia de manejo para el trauma esplénico en pacientes politraumatizados que incluye los principios de la cirugía de control de daños en base a la experiencia obtenida por el grupo de Cirugía de Trauma y Emergencias (CTE) de Cali, Colombia. La decisión entre un abordaje conservador o quirúrgico depende del estado hemodinámico del paciente. En pacientes hemodinámicamente estables, se debe realizar una tomografía axial computarizada con contraste endovenoso para determinar si es posible un manejo conservador y si requiere angio-embolización. Mientras que los pacientes hemodinámicamente inestables deben ser trasladados inmediatamente al quirófano para empaquetamiento esplénico y colocación de un sistema de presión negativa, seguido de angiografía con embolización de cualquier sangrado arterial persistente. Es nuestra recomendación aplicar conjuntamente los principios del control de daños y las tecnologías endovasculares emergentes para lograr la conservación del bazo, cuando sea posible. Sin embargo, si el sangrado persiste puede requerirse una esplenectomía como medida definitiva para salvaguardar la vida del paciente.

Artificial dermis combined with KCI negative pressure suction device in repair of skull exposure after scalp malignant tumor surgery / 中华医学美学美容杂志

Objective:To investigate the effect of artificial dermis combined with KCI negative pressure suction device in the repair of scalp defect with skull exposure after the operation of scalp malignancy.Methods:From January 2016 to June 2018, 18 patients with scalp defect and skull exposure after scalp malignant tumor surgery were treated with artificial dermis combined with KCI negative pressure suction device.Results:Eighten patients had good wound healing after the first stage of surgery, and no infection occurred. The time for artificial dermis to complete granulation was 10-14 days, with an average of 12.1 days. After the second stage of skin grafting, the skin graft had a survival rate of 100%, with uniform color and good elasticity, without obvious scar hyperplasia or contracture. The postoperative follow-up period was 6 to 2 months, all the patients healed well without tumor recurrence, with good skin elasticity and friction-resistant, and they were satisfied.Conclusions:Artificial dermis combined with KCI negative pressure suction device is an effective and simple method to repair the scalp defect with skull exposure after tumor surgery.

Temporary abdominal closure combined with continuous negative pressure drainage in management of patients with severe pancreatic trauma / 中华肝胆外科杂志

Objective:To study the use of temporary abdominal closure combined with continuous negative pressure drainage in management of patients with severe pancreatic trauma.Methods:A retrospective analysis was conducted on the data of 33 patients with severe pancreatic trauma treated at the 908th Hospital of the Joint Logistics Support Force of PLA from June 2014 to June 2020. There were 28 males and 5 females, with an average age of 43.1 years. Sixteen patients were treated with temporary abdominal closure combined with continuous negative pressure drainage (the combined group), and 17 patients with direct abdominal closure and traditional drainage (the control group). The body temperature, heart rate, intra-abdominal pressure, length of hospital stay and postoperative complications were compared between groups.Results:There was no significant difference in the preoperative intra-abdominal pressure between the two groups ( P>0.05). The intra-abdominal pressure on the first, second and third postoperative days in the combined group were (11.7±2.6) mmHg (1 mmHg=0.133 kpa), (11.1±3.2) mmHg and (10.2±3.7) mmHg respectively, which were significantly lower than those in the control group of (18.1±5.3) mmHg, (15.6±6.2) mmHg, and (15.0±6.7) mmHg, respectively (all P<0.05). The total in-hospital and ICU stays in the combined group were (29.2±17.8) days and (7.1±3.2) days respectively, which were significantly less than those in the control group of (49.5±26.3) days and (11.8±7.6) days (both P<0.05). The decreases in body temperature and heart rate in the combined group were (-0.1±0.9)℃ and (18.2±17.2) times/min respectively, which were significantly more than those in the control group of (-1.2±0.7)℃ and (-5.9±17.2) times/min respectively (both P<0.05). The incidence of postoperative complication in the combined group was 18.8% (3/16), which was significantly lower than that in the control group of 52.9% (9/17)(χ 2=4.164, P=0.041). Conclusion:Significant advantages were obtained by using temporary abdominal closure combined with continuous negative pressure drainage to treat patients with severe pancreatic trauma. There were significantly lower abdominal pressure, less abdominal complications, and shorter hospital and ICU stays. This treatment is worthy of promotion in management of patients with severe pancreatic trauma.