First Middle East Experience with Novel Foam Dressing Together with Negative Pressure Wound Therapy and Instillation.

We describe our early experience with a novel foam dressing together with negative pressure wound therapy and instillation (NPWTi-d) for cleansing and removal of infectious materials. This is a prospective review of the clinical outcomes of three patients using V.A.C. VERAFLO™ Therapy with the V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. This novel foam dressing has been designed in a unique way to help facilitate the removal of infectious material, thick fibrinous exudate, slough, and other wound bioburden. To our best knowledge, this is the first reported case series using this dressing in the Middle East. Our preliminary results suggest that adjunctive use of NPWTi-d using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing can clean large or complex wounds when complete surgical debridement is not possible or when areas of non-viable tissue remain present on the wound bed after surgical debridement.

Cyclic negative pressure wound therapy: an alternative mode to intermittent system.

The purpose of this study was to develop and test a novel mode of negative pressure wound therapy (NPWT) that minimises pain while preserving the efficacy in wound healing. A porcine model was used in this study. Wounds were generated in animals and treated with either simple dressing or various treatment modes of NPWT. The wound volume, perfusion level and vasculature status were analysed and compared among different groups. Clinical application was performed to evaluate the level of pain occurring when negative pressure is applied. Among the NPWT groups, the Cyclic-50 group showed most decrement in wound volume, even though statistical relevance was not found (P = 0·302). The perfusion level was significantly increased in the Cyclic-50 group compared with the Intermittent group (P < 0·001) and the Cyclic-100 group (P = 0·004). Evaluation of blood vessel formation revealed that the Cyclic-50 group showed the highest number of vasculature with statistical significance (P < 0·001). In clinical application, the cyclic group showed significant decrease in pain compared with the intermittent group (P = 0·001). The cyclic NPWT mode decreased patient discomfort while maintaining superior wound healing effects as the intermittent mode.

Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects.

The superficial circumflex iliac artery perforator (SCIP) flap is an evolved form of groin flap. It overcomes the inherent disadvantages of the groin flap by preserving the deep fascia but still requires challenging skills because of short pedicles and small caliber of vessels. The use of SCIP flap was evaluated for lower extremity use.From June of 2009 to August of 2011, a total of 79 cases were performed (age range, 4-80 years) on the lower extremity using supermicrosurgical approach. All flaps were harvested above the deep fat and the pedicles were taken above or just below the deep fascia to reconstruct the defects throughout the lower extremity.Supermicrosurgery technique was used in 71 cases. A total of 75 cases were performed successfully; 1 case underwent revision but failed and 2 cases were lost within 2 days of surgery. Average size of the flap was 75.5 cm, thickness 7 mm, average length of pedicle was 5 cm, and the average caliber of artery was 0.7 mm. Donor sites were all closed primarily but complications were noted with 1 dehiscence and prolong drainage of lymphatics. Flaps provided good functional coverage and appearance. The average follow-up was 12 months.With the modification of elevating the flap on the superficial fascia, we can harvest a thin flap without additional debulking and avoid complications such as lymphorrhea. Furthermore, with the perforator to perforator or perforator to small distal vessel approach, we can apply this flap on all regions of the lower extremity overcoming the difficulties with short pedicle and small vessel caliber. In our hands, the modified SCIP flap is the flap of choice for small to moderate size defects in the lower extremity.

Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients.

Pediatric reconstruction using microsurgery is accepted normal practice, and the use of perforator flaps is slowly increasing. This study presents clinical work using various perforator free flaps by free style approach to reconstruct lower extremity soft tissue defects in pediatric patients and evaluates its efficacy. Between June 2002 and February 2011, 32 cases (mean age: 10.1 years) were reconstructed with free style perforator free flaps. Retrospective evaluations for flap survival, growth character, and other associated morbidities were performed. Flaps used in this series are anterolateral thigh (ALT) perforator, superficial circumflex iliac artery perforator (SCIP), upper medial thigh perforator, and posterior interosseous perforator free flaps. The free style approach for pedicle dissection was successful in all cases. Early postoperative complications were 15.6% from hematoma collection to partial loss of flap. Although there was no total loss in this series, one case needed additional flap coverage to cover the partial loss of the flap. The long-term follow-up showed contracture along the margin, with 16% needing a releasing procedure. Bone growth was not affected by flap contracture. The overall results show perforator flaps using the free style approach to be a reliable and feasible approach for lower extremity reconstruction in the pediatric population.

Selenium is significantly depleted among morbidly obese female patients seeking bariatric surgery.

BACKGROUND: The aim of this study was to compare serum levels of trace elements in morbidly obese female patients seeking bariatric surgery with those of age-matched females with body mass index (BMI) less than or equal to 30. METHODS: Blood samples were collected from 66 morbidly obese female patients seeking bariatric surgery prior to undergoing surgery. Blood was collected also from 44 female patients (with BMI less than or equal to 30) prospectively from April 2009 till February 2010. Exclusion criteria in both groups were the presence of any co-morbidities on medication, patients receiving any vitamin supplement or any herbal product intake, smoking, and alcohol consumption. Serum zinc, magnesium, copper, and selenium were measured and compared between the two groups. RESULTS: The mean age and BMI for morbidly obese female patients was 28.5 years (21.5-35.5) and 45.26 kg/m(2) (40.3-50.22). The control group had a mean age and BMI of 30.75 years (21.35-40.15) and 25.88 kg/m(2) (22.73-29.03). For morbidly obese patients, the serum level of copper, zinc, selenium, and magnesium was 1,623.84, 698.34, 86.08, and 17,830 µg/l, respectively, compared to 1,633.36, 734.82, 101.14, and 18,260 µg/l for the control group. The serum levels of the trace elements were not statistically significantly different between the two groups except for selenium, which was significantly reduced among morbidly obese female patients (p < 0.0001). CONCLUSIONS: Serum selenium level is significantly reduced among morbidly obese female patients seeking bariatric surgery.

Risk factors of spontaneous pneumothorax in Kuwait.

OBJECTIVES: To determine the risk factors of spontaneous pneumothorax (SP) in Kuwait. SUBJECTS AND METHODS: From January 2002 through December 2003, 254 consecutive cases with a diagnosis of SP were reviewed. Analyses of pneumothorax rates by age, sex, smoking, body mass index (BMI) and climatic conditions were evaluated. RESULTS: Of the 254 patients, 242 (95%) were male and 12 (5%) were female; a larger proportion of 180 (88%) were Kuwaitis and 74 (12%) were expatriates. Two hundred and eight (82%) episodes were regarded as primary SP and 46 (18%) as secondary SP. The mean age was 24.5 +/- 5.8 years for primary SP and 45.7 +/- 14.5 years for secondary SP. One hundred and ninety-six (77%) individuals were current smokers. BMI in primary and secondary SP was 19.3 and 22.4, respectively (p < 0.001). There was no relationship between SP and climatic conditions (a rise or fall in temperature, humidity or atmospheric pressure). However, a slight increase in SP occurred in July, probably the hottest month in Kuwait. CONCLUSIONS: The data indicate that the most important risk factors of SP in Kuwait are smoking, low BMI and the male gender.