Synergistic clinical application of synthetic electrospun fiber wound matrix in the management of a complex traumatic wound: degloving left groin and thigh auger injury.

BACKGROUND: Managing complex traumatic soft tissue wounds involving a large surface area while attempting to optimize healing, avoid infection, and promote favorable cosmetic outcomes is challenging. Regenerative materials such as ECMs are typically used in wound care to enhance the wound healing response and proliferative phase of tissue formation. CASE REPORT: The case reported herein is an example of the efficacious use of an SEFM in the surgical management of a large complex traumatic wound involving the left lower extremity and lower abdominal region. The wound bed was successfully prepared for skin grafting over an area of 1200 cm2, making this among the largest applications of the SEFM reported in the literature. CONCLUSION: This case report demonstrates the clinical versatility of the SEFM and a synergistic approach to complex traumatic wound care. The SEFM was successfully used to achieve tissue granulation for a successful skin graft across a large surface in an anatomic region with complex topography.

Predictors of salvage therapy for parasagittal meningiomas treated with primary surgery, radiosurgery, or surgery plus adjuvant radiotherapy.

OBJECTIVE: Parasagittal meningiomas (PM) are treated with primary microsurgery, radiosurgery (SRS), or surgery with adjuvant radiation. We investigated predictors of tumor progression requiring salvage surgery or radiation treatment. We sought to determine whether primary treatment modality, or radiologic, histologic, and clinical variables were associated with tumor progression requiring salvage treatment. METHODS: Retrospective study of 109 consecutive patients with PMs treated with primary surgery, radiation (RT), or surgery plus adjuvant RT (2000-2017) and minimum 5 years follow-up. Patient, radiologic, histologic, and treatment data were analyzed using standard statistical methods. RESULTS: Median follow up was 8.5 years. Primary treatment for PM was surgery in 76 patients, radiation in 16 patients, and surgery plus adjuvant radiation in 17 patients. Forty percent of parasagittal meningiomas in our cohort required some form of salvage treatment. On univariate analysis, brain invasion (OR: 6.93, p < 0.01), WHO grade 2/3 (OR: 4.54, p < 0.01), peritumoral edema (OR: 2.81, p = 0.01), sagittal sinus invasion (OR: 6.36, p < 0.01), sagittal sinus occlusion (OR: 4.86, p < 0.01), and non-spherical shape (OR: 3.89, p < 0.01) were significantly associated with receiving salvage treatment. On multivariate analysis, superior sagittal sinus invasion (OR: 8.22, p = 0.01) and WHO grade 2&3 (OR: 7.58, p < 0.01) were independently associated with receiving salvage treatment. There was no difference in time to salvage therapy (p = 0.11) or time to progression (p = 0.43) between patients receiving primary surgery alone, RT alone, or surgery plus adjuvant RT. Patients who had initial surgery were more likely to have peritumoral edema on preoperative imaging (p = 0.01). Median tumor volume was 19.0 cm3 in patients receiving primary surgery, 5.3 cm3 for RT, and 24.4 cm3 for surgery plus adjuvant RT (p < 0.01). CONCLUSION: Superior sagittal sinus invasion and WHO grade 2/3 are independently associated with PM progression requiring salvage therapy regardless of extent of resection or primary treatment modality. Parasagittal meningiomas have a high rate of recurrence with 80.0% of patients with WHO grade 2/3 tumors with sinus invasion requiring salvage treatment whereas only 13.6% of the WHO grade 1 tumors without sinus invasion required salvage treatment. This information is useful when counseling patients about disease management and setting expectations.

Definitive Closure Using an Ovine Reinforced Tissue Matrix in Contaminated Penetrating Abdominal Trauma.

BACKGROUND Cases involving penetrating abdominal trauma may be complex and often involve damage to multiple organ systems. Synthetic, biologic, and reinforced biologic matrices/reinforced tissue matrices (RBMs/RTMs) are frequently used in hernia repair and other surgical procedures requiring reinforcement, including trauma cases that require abdominal repair. CASE REPORT The first case was a 35-year-old male patient with a stab wound (SW) to the right side of the chest and the abdomen resulting in damage to the diaphragm, epicardium, liver, and duodenum. The second case was a 22-year-old male patient who suffered multiple traumas after an automated trencher accident, including a skull fracture with exposed brain and major lacerations to the shoulder and abdomen causing a large right-flank hernia. In both cases, OviTex® (TELA Bio, Inc., Malvern, PA), a reinforced tissue matrix (RTM), was used to help obtain and maintain abdominal wall closure. We also present an institutional economic analysis using data from the author's institution with average case cost and future projections for procedure volume and product usage volume through 2021. CONCLUSIONS We report favorable outcomes in a series of patients with contaminated (CDC Wound Class III) surgical fields who underwent abdominal wall closure and reinforcement with OviTex RTM. Our work adds to the growing body of literature suggesting that reinforced biologics offer a potential alternative to biological meshes in the setting of a contaminated surgical field. Additionally, in comparison to other commonly available biologic matrices, use of OviTex RTM may be a cost-effective option to achieve abdominal wall closure even in complex cases.

Visual outcomes after treatment of craniopharyngioma in children: A systematic review.

OBJECTIVE: Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to preserve visual function in these patients remains controversial. We sought to investigate visual outcomes of children with craniopharyngiomas based on treatment modality. METHODS: A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Scopus databases were searched in December 2022 for relevant articles. Articles were screened by title/abstract for relevance, then by full-text. Relevant demographic, intervention, and outcome data were extracted from included studies. RESULTS: A total of 59 studies were included, representing 2655 patients. The overall visual status (OVS) of patients receiving surgery alone was improved in 27.6% of reported outcomes, unchanged in 50.3%, and deteriorated in 22.1%. The OVS for patients receiving radiation alone was improved in 21.1%, unchanged in 42.1%, and deteriorated in 36.8%. Patients receiving surgery plus adjuvant radiotherapy had OVS improvement in 27.4%, unchanged in 63.2%, and deteriorated in 9.4%. Of those receiving intracystic bleomycin, 23.1% had improvement in OVS, 46.2% remained unchanged, and 30.8% deteriorated. Of patients receiving interferon-α, 34.8% improved, 54.5% remained unchanged, and 10.6% deteriorated. CONCLUSION: OVS most frequently remained unchanged regardless of intervention. The greatest improvement in OVS was seen in those receiving interferon-α or surgery alone. The greatest OVS deterioration was noted with radiation alone. Future standardized, randomized, large-scale studies with focused assessment of ophthalmologic findings are key to further understanding the impact different interventions have on visual outcomes in these children.

Treatment of Complex Thoracic and Abdominal Trauma Patients: A Review of Literature and Negative Pressure Wound Therapy Treatment Options.

Significance: In trauma care, extensive surgical intervention may be required. Damage control surgery (DCS) is applicable to patients with life or limb-threatening conditions that are incapable of tolerating a traditional surgical approach. Recent Advances: The current resuscitation strategy for complex trauma patients includes limiting crystalloid fluids, balanced mass transfusion protocols, permissive hypotension, and damage control resuscitation. Recent technological advancements in surgical critical care have improved outcomes in these critically ill patients. Critical Issues: DCS, which is often required in patients with trauma injuries, is typically followed by surgical correction of the injury once the immediate patient survival procedures have been completed. However, DCS and the subsequent injury repair procedures have a high risk for postsurgical complication development. Future Directions: Negative pressure therapy modalities can offer clinicians additional adjunctive and cost-effective tools for the management of the trauma care patient, as these systems can be utilized during both the DCS and the postoperative injury management phases of trauma care.

A synthetic hybrid-scale fiber matrix for complex surgical wounds: consensus guidelines.

Based on their own clinical experience and review of the available peer-reviewed data, the authors developed a consensus opinion on the use of an SHSFM for open wounds. The matrix has features such as varying pore sizes and fibers (ie, hybrid-scale) and is indicated for the treatment of open wounds. This report describes the design and utility of the SHSFM, its mechanism of action, and the methods of application, as well as clinical outcomes. The authors discuss their own experience and review of the published literature, then describe their protocols and rationale for the use of the SHSFM. These consensus statements include recommendations regarding appropriate wounds for use of the SHSFM, use of other wound therapies in conjunction with the SHSFM, reapplication rates, preparation methods, and additional discussions of appropriate use. This report is not a literature review, but rather is a statement of preliminary clinical experience. The consensus statements indicate that the SHSFM may be used to treat a variety of wounds and can be used to stage wounds to closure via skin grafts or by secondary intention.

Ventriculopleural shunt outcomes for pediatric hydrocephalus: a single-institution experience.

PURPOSE: The aim of this study is to analyze rates of ventriculopleural (VPL) shunt failure and complications among patients with pediatric hydrocephalus, and to analyze which factors may predict early (< 1 year) or late (> 1 year) VPL shunt failure in this sample. METHODS: A retrospective chart review was conducted of all consecutive VPL shunt placements from 2000 to 2019 at our institution. Data was collected on patient characteristics, shunt history, and shunt type. Primary endpoints include rates of VPL shunt survival and rates of symptomatic pleural effusion. The Kaplan-Meier method was used to calculate shunt survival, and Fisher's exact test and t-test were used to compare differences between categorical variables and means, respectively (p < 0.05). RESULTS: Thirty-one patients with pediatric hydrocephalus underwent VPL shunt placement (mean age 14.2 years). Of the 27 patients with long-term follow-up (mean 46 months), VPL shunt revision was required in 19, seven of which were due to pleural effusion. Overall shunt survival rates at 1, 3, 5, and 7 years were 76%, 62%, 55%, and 46%, respectively. Mean duration of shunt survival was 26.74 months. Overall pleural effusion rate was 26%. No patient-specific factors, including shunt valve type, were significantly associated with shunt survival, risk of early revision, or risk of pleural effusion. CONCLUSIONS: Our results are comparable to those reported in the literature and represent one of the largest case series on the topic. VPL shunts are a viable second-line option when ventriculoperitoneal (VP) shunt placement is not possible or desirable, though there are high rates of shunt revision and pleural effusion.

The sandwich technique for quick and efficient application of negative pressure wound therapy to the feet and hands: a case report.

INTRODUCTION: NPWT is a surgical dressing that combines polyurethane foam with the subsequent application of continuous or intermittent negative pressure. NPWT facilitates granulation tissue production by macrostrain, microstrain and, if desired, fluid instillation. Sealing the polyurethane foam over the wound bed is achieved using acrylic drapes; however, this can be difficult to use in some anatomic sites. Failure to achieve an effective seal can necessitate additional supplies, which has led to increased innovation in developing a more effective NPWT seal over the target wound bed. Obtaining an effective pressure seal on the feet or hands can be difficult because these anatomic sites have distinct curvature for each digit, with multiple interdigital web spaces and independent mobility. In this case report, the authors propose a technique to apply either an acrylic drape or combination acrylic and soft silicone drape utilizing the "sandwich technique" to seal NPWT foam quickly and efficiently to the feet or hands.

Endoplasmic Reticulum Stress in the Brain Tumor Immune Microenvironment.

Immunotherapy has emerged as a powerful strategy for halting cancer progression. However, primary malignancies affecting the brain have been exempt to this success. Indeed, brain tumors continue to portend severe morbidity and remain a globally lethal disease. Extensive efforts have been directed at understanding how tumor cells survive and propagate within the unique microenvironment of the central nervous system (CNS). Cancer genetic aberrations and metabolic abnormalities provoke a state of persistent endoplasmic reticulum (ER) stress that in turn promotes tumor growth, invasion, therapeutic resistance, and the dynamic reprogramming of the infiltrating immune cells. Consequently, targeting ER stress is a potential therapeutic approach. In this work, we provide an overview of how ER stress response is advantageous to brain tumor development, discuss the significance of ER stress in governing antitumor immunity, and put forth therapeutic strategies of regulating ER stress to augment the effect of immunotherapy for primary CNS tumors.

Endoscopic endonasal optic nerve decompression: treatment of fibrous dysplasia in a pediatric population.

OBJECTIVE: Patients with fibrous dysplasia (FD) of the anterior skull base can experience progressive visual loss and impairment. The authors reviewed their experience with endonasal decompression of the optic nerve (ON) in this patient population. Endoscopic ON decompression (EOND) is a feasible surgical approach for children with FD and visual deficit due to structural ON compression. METHODS: Electronic medical records of children between 1 and 17 years of age with unilateral FD of the anterior skull base and concomitant ON compression, who required EOND between 2017 and 2022 (n = 4), were reviewed for demographic data, both pre- and postoperative imaging, and evaluations by an otolaryngologist, neurosurgeon, and ophthalmologist in a multidisciplinary fashion. RESULTS: EOND was found to be a safe and effective surgery for children with FD. Visual acuity was stable in 80% of the eyes postoperatively. Visual fields improved in 40% of the eyes and remained stable in the rest. CONCLUSIONS: EOND is beneficial for progressive optic neuropathy that is unresponsive to steroid therapy and can prevent permanent disability if performed prior to irreversible damage to the nerve. EOND can decompress the edematous ON with proper exposure of the optic canal and orbital apex, without any major complications.

Use of a Modified ABTHERA ADVANCE™ Open Abdomen Dressing with Intrathoracic Negative-Pressure Therapy for Temporary Chest Closure After Damage Control Thoracotomy.

BACKGROUND Damage control surgery (DCS) is an established emergency operative concept, initially described and most often utilized in abdominal trauma. DCS prioritizes managing acute hemorrhage and contamination, leaving the abdominal wall fascia open and covering the existing wound with a temporary abdominal wall closure, most commonly negative-pressure wound therapy (NPWT). The patient undergoes aggressive resuscitation to optimize physiology. Once achieved, the patient is returned to the operating room for definitive surgical intervention. There is limited evidence suggesting that using damage control thoracotomy within the chest cavity improves mortality and morbidity rates. Our review failed to find a case in which NPWT using ABTHERA ADVANCE™ Open Abdomen Dressing has been successfully used in the setting of thoracic trauma. CASE REPORT This case series describes 2 examples of NPWT as a form of temporary chest closure in penetrating and blunt thoracic injury. The first case was a penetrating self-inflicted stab wound to the chest. The NPWT was applied as a form of temporary thoracotomy, closure at the index surgery. The second case was a blunt injury to the chest of a polytrauma patient following a motor vehicle accident. The patient sustained rib fractures on his left side and had a bilateral pneumothorax. An emergent thoracotomy was performed due to delayed intrathoracic bleeding noted on hospital day 11, and NPWT was applied as described above, in the first case. CONCLUSIONS These cases suggest that damage control thoracotomy with intrathoracic placement of a modified ABTHERA ADVANCE™ Open Abdomen Dressing negative-pressure system may be an effective and life-saving technique with the potential for positive outcomes in these high-risk patients.

Optimizing the patient handoff and progress note documentation efficiency in the EPIC EMR system within a neurosurgery residency: A quality improvement initiative.

BACKGROUND: Handoffs and documentation are a potentially modifiable source of medical error. However, little attention has been given toenhancementof these within the neurosurgical field. We aim to increase efficiency and accuracy of neurosurgical handoffs, including the neurological exam, thus decreasing medical documentation time within current duty-hour restrictions. METHODS: The existing Epic electronic medical record system was modified to include the neurological exam in the handoff: a tool used to generate lists including relevant patient clinical details and plans. The handoff tool was also converted into a subjective, objective, assessment, and plan (SOAP) format, which was leveraged to efficiently generate daily progress notes. A four-question survey was developed to assess the effectiveness of this new format. Mean note times were compared before and after the EPIC update using an independent samples t-test. RESULTS: All of the surveyed neurosurgery residents at our institution reported a decrease in documentation time per progress note, felt the notes were more accurate, and found it easier to recall the neurological exams of patients. 8/9 residents felt that the new handoff made in-house call less stressful. There was a significant difference in mean note time, with the mean note time of 37.9 s after the EPIC upgrade compared to 120 s prior the upgrade. We project that over 241 h of documentation will be saved annually at our institution. CONCLUSIONS: This QI project demonstrates how a low-effort initiative improved resident recall of patients' neurological exams while saving time spent documenting daily progress notes.

Secondary CNS myeloma with remission after systemic CNS-penetrating agents.

Background: CNS myeloma is a rare manifestation of multiple myeloma and is often associated with a dismal prognosis; however, cases are increasing in frequency as overall survival improves for MM. There is currently no standardized treatment for CNS myeloma; however, different chemotherapy and radiotherapy regimens have been described. Methods: We had previously reported on the efficacy of proton-based craniospinal irradiation in a patient with CNS myeloma; here we present a patient with a history of extramedullary plasmacytoma, 10 years in remission status post standard systemic chemotherapy, with biopsy-proven CNS myeloma successfully treated with systemic chemotherapy as a first-line treatment. Results: The patient achieved clinical and radiographic remission on 2 separate occasions with systemic chemotherapy alone. Conclusions: This case demonstrates that systemically administered agents may have activity in CNS myeloma. Further investigations are necessary to establish the optimal combination of agents and treatment schedules.

Applications of a new silicone-acrylic hybrid semiocclusive drape with negative pressure wound therapies in a burn center.

It is essential that occlusive drapes provide both an airtight, watertight seal and prevent intrusion of the external environment into a healing wound bed. Removal of an acrylic drape, however, may result in pain, reflex erythema, and a denuding of the epidermis, including the stratum corneum. Recently, a new silicone-acrylic hybrid drape was introduced for use with negative pressure wound therapy. Five unique and varied clinical cases from a burn center that used such negative pressure wound therapy dressings with the silicone-acrylic hybrid drape are presented. These cases highlight the excellent sealing capabilities of this new occlusive drape and minimal pain upon its removal. In addition, this hybrid drape may decrease waste of dressing supply because it is easily reconfigured to its original form and can be repositioned if the initial placement is suboptimal. The drape also maintains a tight seal with repositioning, making it more user-friendly to the clinical provider.

Clinical Observations in Patients With Open Abdomens Managed With Negative Pressure Therapy Using a Perforated Foam Dressing: A Limited Case Series With Brief Literature Review.

INTRODUCTION: Emergency laparotomy has become an increasingly more frequent and expensive general surgery procedure in terms of cost and resource utilization. Primary fascial closure at the index procedure may not be feasible in many patients, requiring use of the open abdomen (OA) technique. Patients with OA are most often managed with temporary abdomen closure (TAC). Open abdomen negative pressure therapy (OA-NPT) has been shown to be an effective TAC technique, which facilitates re-exploration, protects visceral organs, mitigates fascial retraction, prevents loss of abdominal domain, and provides effective volumetric abdominal fluid management. OBJECTIVE: This study assessed the clinical use and outcomes of a next-generation perforated polyurethane foam dressing that has been developed for use with OA-NPT. MATERIALS AND METHODS: The authors evaluated a next-generation OA-NPT foam dressing to provide TAC in 4 patients who required OA management. Two surgeons at different facilities exercised their independent surgical discretion in selecting the patients who would receive the next generation OA-NPT foam dressing. Surgical interventions to resolve the underlying pathology were completed using the OA technique. Postoperatively, all patients had intermittent urinary bladder pressures recorded as an indirect method for approximating intra-abdominal pressure (IAP) and to monitor clinical evidence of intra-abdominal hypertension (IAH) or abdominal compartment syndrome. RESULTS: In these patients, primary fascial closure was achieved and no appreciable increase in IAP was noted. No gastrointestinal complications related to the next generation perforated OA-NPT foam dressing were noted. CONCLUSIONS: Based on the authors' clinical assessment of the 4 patients who required OA management, the new, perforated OA-NPT foam dressing was effective in providing increased medial tension and contraction without an appreciable increase in IAP.

Use of Reticulated Open Cell Foam Dressings With Through Holes During Negative Pressure Wound Therapy With Instillation and Dwell Time: A Large Case Study.

INTRODUCTION: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been utilized in wounds with positive clinical benefits. A reticulated open cell foam dressing with through holes (ROCF-CC) was developed to assist with wound cleansing by removing thick wound exudate and infectious materials, and it may be used when debridement is not possible or appropriate. Use of NPWTi-d with ROCF-CC dressings has been reported with positive outcomes in complex wounds. OBJECTIVE: The present study reports the authors' experience using NPWTi-d with ROCF-CC dressings in 19 patients with complex wounds. MATERIALS AND METHODS: Of the 19 patients, 8 underwent sharp debridement. Oral and/or intravenous antibiotic treatment was initiated as needed prior to NPWTi-d. All patients received NPWTi-d with ROCF-CC dressings with instillation of quarter-strength Dakin's solution, hypochlorous acid solution, or saline with a dwell time of 5 to 10 minutes, followed by 2 to 3.5 hours of continuous negative pressure at -125 mm Hg. Dressing changes occurred every 2 to 3 days. Measurements and assessments of wound progression were done as per institutional protocols. RESULTS: The 19 treated patients consisted of 10 males and 9 females, with an average age of 58.2 ± 15.1 years. Common patient comorbidities included hypertension, diabetes, obesity, and paraplegia. Wound types included pressure injuries, traumatic wounds, and surgical wounds. The average length of NPWTi-d use was 9.5 ± 4.1 days. In all of the patients, the wound beds showed development of healthy granulation tissue following NPWTi-d with ROCF-CC. All patients were discharged to one of the following: another hospital facility, skilled nursing facility, long-term acute care facility, or home. CONCLUSIONS: In the authors' clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of thick exudate and infectious materials and promoted development of granulation tissue.

Use of a novel silicone-acrylic drape with negative pressure wound therapy in anatomically challenging wounds.

Negative pressure wound therapy (NPWT) utilises a polyurethane drape with acrylic adhesive over foam dressings to create a seal. In anatomically challenging areas, ancillary products are frequently used. Additionally, health care providers are unable to reposition the drape once placed. A novel hybrid drape consisting of polyurethane film with acrylic adhesive and silicone perforated layer has been developed to allow for repositioning after initial placement and easy removal. This six-patient case series evaluates the use of NPWT with hybrid drape over anatomically challenging wounds. Three males and three females were treated. Dressing changes occurred every 2 to 3 days. Drape application, repositioning, and ability to maintain a seal were evaluated. During application, the drape was repositioned 1 to 2 times without periwound skin irritation in 4/6 wounds. Prior to initial application, ancillary products were applied to help create a seal. However, by the second or third application, ancillary products were no longer used in 4/6 wounds. None of the dressing applications resulted in negative pressure seal leaks. In these patients, health care providers could reposition the hybrid drape after initial placement without periwound skin irritation and successfully create a negative pressure seal without ancillary products in anatomically challenging wound locations.

Intraabdominal Lavage of Hypochlorous Acid: A New Paradigm for the Septic and Open Abdomen.

INTRODUCTION: Management of the open abdomen (OA) has rapidly evolved over the last several decades due to the improved understanding of the underlying pathophysiology of patients with an OA, adoption of damage control surgery, and the use of temporary abdominal closure (TAC) techniques for this patient population. The TAC utilizing negative pressure has been successful for managing patients with an OA with improved time to closure. Recent studies have started to examine the use of TAC in conjunction with negative pressure wound therapy with instillation and dwell time (NPWTi-d) for the management of the OA. OBJECTIVE: This case series illustrates the capability, safety, and clinical effectiveness of TAC/NPWTi-d with hypochlorous acid (HOCl) solution. MATERIALS AND METHODS: Three successfully treated cases describe the use of NPWTi-d using HOCl solution for the management of patients with a septic OA. RESULTS: This initial experience suggests instillation of HOCl through the tubing set, in conjunction with the TAC device, is safe and easy to use. This technique decreased the need for more frequent OA lavages in the operating room (OR) after the index procedure, as well as the associated concomitant risks of transporting patients who are critically ill between the SICU and OR. No acute complications related to the TAC device with HOCl were noted. CONCLUSIONS: Based on the results of this study, the authors believe instillation through the TAC device may be the next evolution in the use of abdominal NPWT and programmed intermittent lavage of the peritoneal cavity represents an effective method in the care of patients with a septic OA.

Negative Pressure Wound Therapy With Instillation and Dwell Time for the Management of Complex Wounds: A Case Series.

INTRODUCTION: Negative pressure wound therapy (NPWT) dressings are beneficial tools for promoting granulation tissue and wound healing. An NPWT dressing with instillation and dwell time (NPWTi-d) is becoming more frequently used to provide daily, effective wound cleansing between surgical debridement procedures. Either saline or other wound solutions, such has hypochlorous acid wound solution, can be instilled in small volume aliquots to irrigate the wound periodically. OBJECTIVE: This case series describes the effective use of NPWTi-d in conjunction with hypochlorous acid (HOCl) solution in 10 patients with necrotizing soft tissue infections (NSTIs). MATERIALS AND METHODS: The hospital registry of patients between July 2018 and June 2020 was queried to identify patients older than were 18 years or older, whose wounds were managed intermittently with NPWTi-d using HOCl wound solution, regardless of wound etiology. Wound and patient demographics were reported. RESULTS: A total of 10 cases in which NPWTi-d was utilized in conjunction with HOCl were identified. Of the 10 patients, 6 were admitted for NSTIs, 2 were admitted for sacral decubitus ulcers, and 2 were admitted for burn injuries. The patients' wounds ranged from 30 cm2 to 1000 cm2, and 80% of patients ultimately underwent skin grafting for wound closure. CONCLUSIONS: This case series highlights the spectrum of wounds that can be managed with NPWTi-d dressings to yield a clean wound environment to promote healing and preparation for wound closure.

Application of Negative Pressure Wound Therapy with Instillation and Dwell Time of the Open Abdomen: Initial Experience.

Recent therapeutic advances in the management of severe abdominal sepsis (SAS) have improved patient mortality and morbidity. However, SAS and its impact on multiple organ failure remain a serious, life-threatening condition with a high mortality rate. The open abdomen (OA) technique has become an effective alternative to repeat laparotomy. The use of OA negative pressure wound therapy (OA NPWT) has been a significant advancement in the management of the open abdomen. Similarly, negative pressure wound therapy (NPWT) with instillation and dwell time (NPWT-i) has been used in patients with multiple comorbidities, with an American Society of Anesthesiology Classification ≥ 2, severe traumatic wounds, diabetic foot infections, and wounds complicated by invasive infection or extensive biofilm. Controlled instillation of saline during NPWT-i may further enhance healing by facilitating automatic and contained volumetric wound irrigation and cleansing and diluting local levels of inflammatory cytokines, improving the local as well as the systemic response to infection. Although the soft tissue and intra-abdominal compartments differ anatomically, they share very similar biologic responses to infections. Therefore, from a biologic and physiologic aspect, intraperitoneal instillation therapy may play a role as an adjunctive treatment of abdominal compartment inflammation from trauma or infection. The addition of saline solution instillation to OA NPWT (OAI) in a programmed, controlled manner may offer the clinician an effective adjunctive therapy for the treatment of the complex septic abdomen. The technical aspects of instillation into the OA and a pooled multicenter case study cohort utilizing OAI with saline solution, bacitracin, or hypochlorous acid in the management of the septic abdomen is presented.