ABSTRACT
INTRODUCTION: Standard negative pressure wound therapy (NPWT) has been shown to help close wounds despite increasing planktonic bioburden. Both planktonic and biofilm critical colonization are associated with delayed wound healing; therefore, reducing microbial colonization is thought to aid wound healing. The use of NPWT with topical antimicrobial irrigation solution has previously shown reduction in quantitative planktonic bioburden when combined with sharp debridement in chronic wounds. OBJECTIVE: The goal of this study was to evaluate the effectiveness of NPWT with instillation (NPWTi) on biofilm of chronic wounds. MATERIALS AND METHODS: A prospective, randomized trial was conducted. Following sharp debridement, 20 patients with chronic wounds were randomized to 1 week of either NPWTi with 0.125% sodium hypochlorite solution (n = 10) or NPWT without instillation (n = 10). Serial wound biopsy was performed predebridement, postdebridement, and after 1 week of study therapy to test for quantitative nonplanktonic or biofilm-protected bacteria. RESULTS: As expected, there was no difference in change in wound size between the 2 groups at 1 week. The NPWTi group had a mean reduction in quantitative biofilm-protected bacteria of 48%, while the NPWT without instillation group had a mean increase of 14% (P < .05). DISCUSSION: Consistent with previous studies, this trial demonstrates that NPWTi with dilute sodium hypochlorite solution is effective at reducing nonplanktonic bioburden of chronically, critically colonized wounds. CONCLUSION: Therefore, based on this and previously published work, this therapy provides both planktonic and nonplanktonic bioburden reduction as well as NPWT benefits and may be a tool for the preparation of infected wound beds prior to definitive closure.
Subject(s)
Debridement , Negative-Pressure Wound Therapy , Therapeutic Irrigation/methods , Wound Healing/physiology , Wound Infection/therapy , Aged , Chronic Disease , Debridement/methods , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Prospective Studies , Treatment Outcome , Wound Infection/microbiologyABSTRACT
OBJECTIVE: The preponderance of existing literature for the treatment of Paget-Schroetter syndrome (PSS) advocates clot lysis followed by thoracic outlet decompression (TOD). We postulate that long-term anticoagulation has equal outcomes to more invasive and costly surgical intervention, and review our experience with non-operative management of PSS. METHODS: A retrospective review was conducted, examining patients between 1994-2014. Forty patients were identified with PSS, and 27 of these patients had sufficient follow-up for this analysis. Charts were reviewed for details of clinical presentation, disease course, interventions, duration of oral anticoagulation, ultrasound reports, and symptoms at long-term follow-up. RESULTS: With a mean follow-up of 54.3 months, 23/27 patients (85%) were asymptomatic after non-operative therapy. In this cohort, 16/27 patients (59%) underwent catheter-directed thrombolysis. Average treatment course with oral anticoagulation was 8.6 months. Four patients (15%) remained symptomatic at follow-up. Two patients (7%) underwent thoracic outlet decompression at another institution, with good results. At least partial recanalization of vessels was documented in 25/27 patients (93%), although recanalization did not correlate with symptoms at long-term follow-up. CONCLUSIONS: Based upon equivalent functional results, non-operative management appears to offer similar outcomes for some patients with PSS. We propose a patient-tailored approach to the treatment of PSS, in which patients presenting acutely undergo catheter-directed thrombolysis, followed by a 6-12 month course of oral anticoagulation. Persistent symptoms, recurrent disease, lengthy duration of symptoms prior to diagnosis, and identifiable structural abnormalities may be factors predictive of poor outcomes after non-operative intervention.
Subject(s)
Anticoagulants , Conservative Treatment , Thrombolytic Therapy , Upper Extremity Deep Vein Thrombosis , Administration, Oral , Adult , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Conservative Treatment/adverse effects , Conservative Treatment/economics , Conservative Treatment/methods , Conservative Treatment/statistics & numerical data , Female , Humans , Long Term Adverse Effects/diagnosis , Long Term Adverse Effects/etiology , Long Term Adverse Effects/physiopathology , Male , Outcome and Process Assessment, Health Care , Patient Selection , Retrospective Studies , Risk Adjustment , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/economics , Thrombolytic Therapy/methods , United States , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/etiology , Upper Extremity Deep Vein Thrombosis/physiopathology , Upper Extremity Deep Vein Thrombosis/therapyABSTRACT
The chronic wound environment and the ideal way in which to regenerate healthy tissue remain enigmas in the field of wound healing. There are multiple modalities that have been evaluated in an attempt to discern the most clinically beneficial and cost-effective treatment strategies for the millions of individuals who suffer from chronic wounds and their associated morbidity. Engineered skin substitutes represent one of the novel and continuously evolving approaches to providing wound coverage and regenerating functional skin. Herein we describe a number of the products available and the literature to date on their use and efficacy. We will close with a discussion of the cost-reimbursement structure for these products, which is currently undergoing an important shift.
