Negative pressure wound therapy in complex trauma of perineum.

OBJECTIVE: To review the experience (2011 and 2012) of Wound Center of Plastic Surgery Service, Clinics Hospital, Faculty of Medicine, University of São Paulo, with treatment of complex traumatic wounds in the perineal region with the association of negative pressure wound therapy followed by a surgical skin coverage procedure. METHODS: This was retrospective analysis of ten patients with complex wound in the perineum resulting from trauma assisted by the Department of Plastic Surgery in HC-USP. Negative pressure was used as an alternative for improving local conditions, seeking definitive treatment with skin grafts or flaps. RESULTS: Negative pressure was used to prepare the wound bed. In patients, the mean time of use of negative pressure system was 25.9 days, with dressing changes every 4.6 days. After negative pressure therapy, 11 local flaps were performed in nine patients, with fasciocutaneous anterolateral thigh flap used in four of these. Mean hospital stay was 58.2 days and accompaniment in Plastic Surgery was 40.5 days. CONCLUSION: The use of negative pressure therapy led to improvement of local wound conditions faster than traditional dressings, without significant complications, proving to be the current best alternative as an adjunct for the treatment of this type of injury, always followed by surgical reconstruction with grafts and flaps.

Terapia por pressão negativa na ferida traumática complexa do períneo / Negative pressure wound therapy in complex trauma of perineum

OBJETIVO: rever a experiência (2011 e 2012) do Centro de Feridas da Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo com tratamento de feridas traumáticas complexas na região perineal, pela associação da terapia com pressão negativa seguida de procedimento cirúrgico para cobertura cutânea. MÉTODOS: análise retrospectiva de dez pacientes com ferida complexa no períneo consequente a traumatismo atendidas pelo Serviço de Cirurgia Plástica no HC-FMUSP. A terapia por pressão negativa foi utilizada como alternativa para melhoria das condições locais visando o tratamento definitivo com enxertos de pele ou retalhos. RESULTADOS: a terapia por pressão negativa foi empregada para o preparo do leito da ferida. Nos pacientes atendidos, o tempo médio de utilização do sistema de pressão negativa foi 25,9 dias, com trocas de curativos a cada 4,6 dias. Após a terapia por pressão negativa, foram realizados 11 retalhos locais em nove pacientes, com o retalho fáscio-cutâneo antero-lateral da coxa utilizado em quatro destes pacientes. O tempo médio de internação hospitalar foi 58,2 dias e de acompanhamento no Serviço da Cirurgia Plástica foi 40,5 dias. CONCLUSÃO: a utilização da terapia por pressão negativa levou à melhoria das condições locais da ferida mais rapidamente do que curativos tradicionais, sem complicações significativas, demonstrando ser a melhor alternativa adjuvante atualmente para o tratamento deste tipo de lesão, seguida sempre por reconstrução cirúrgica com enxertos e retalhos.

OBJECTIVE: To review the experience (2011 and 2012) of Wound Center of Plastic Surgery Service, Clinics Hospital, Faculty of Medicine, University of São Paulo, with treatment of complex traumatic wounds in the perineal region with the association of negative pressure wound therapy followed by a surgical skin coverage procedure. METHODS: This was retrospective analysis of ten patients with complex wound in the perineum resulting from trauma assisted by the Department of Plastic Surgery in HC-USP. Negative pressure was used as an alternative for improving local conditions, seeking definitive treatment with skin grafts or flaps. RESULTS: Negative pressure was used to prepare the wound bed. In patients, the mean time of use of negative pressure system was 25.9 days, with dressing changes every 4.6 days. After negative pressure therapy, 11 local flaps were performed in nine patients, with fasciocutaneous anterolateral thigh flap used in four of these. Mean hospital stay was 58.2 days and accompaniment in Plastic Surgery was 40.5 days. CONCLUSION: The use of negative pressure therapy led to improvement of local wound conditions faster than traditional dressings, without significant complications, proving to be the current best alternative as an adjunct for the treatment of this type of injury, always followed by surgical reconstruction with grafts and flaps.

Biopsy-proven pulmonary determinants of heart disease.

Heart disease (HD) can stress the alveolar blood-gas barrier, resulting in parenchymal inflammation and remodeling. Patients with HD may therefore display any of the symptoms commonly attributed to primary pulmonary disease, although tissue documentation of corresponding changes through surgical lung biopsy (SLB) is rarely done. Intent on exploring the basis of HD-related alveolar-capillary barrier dysfunction, a retrospective analysis of SLB histopathology was conducted in patients with clinically diagnosed HD, diffuse pulmonary infiltrates, and no evidence of primary pulmonary disease. Patients eligible for the study had a clinical diagnosis of heart disease, acute or chronic, and presented with diffuse infiltrates on chest X-ray. All qualified subjects (N = 23) who underwent diagnostic SLB between January 1982 and December 2005 were subsequently examined. Specific biopsy parameters investigated included demonstrable edema, siderophage influx, hemorrhage, venous and lymphatic ectasia, vascular sclerosis, capillary congestion, and fibroblast proliferation. Based on observed alveolar-capillary barrier (ACB) alterations, three main morphologic groups emerged: one group (6 patients) with alveolar edema; a second group (11 patients) characterized by pulmonary congestion; and a final group (6 patients) showing microscopic foci of acute ACB lung injury. Alveolar-capillary stress due to acute high-pressure or volume overload often manifests as diffuse pulmonary infiltrates with variable but generally predictable histopathology. In patients with biopsy-proven alveolar edema, pulmonary congestion, or acute microscopic lung injury, the clinician must be alert for the possibility of primary heart disease, particularly if the patient is elderly or when a history of myocardial, valvular, or coronary vascular disease exists.