The effectiveness of negative pressure therapy in burns: scoping review / A efetividade da terapia por pressãonegativa em queimaduras: revisão de escopo / La efectividad de la terapia de presiónnegativa en quemaduras: revisión del alcance

Objetivo: Mapear a produção científica a respeito do uso da terapia de pressão negativa no tratamento de queimaduras, em pacientes adultos e idosos hospitalizados. Método: Revisão de escopo seguindo o método da JBI com busca da produção científica na PubMed, Scientific Electronic Library Online, Biblioteca Virtual de Saúde e Banco de Teses da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior nos meses de março a maio de 2021. Foram incluídos estudos com pacientes adultos e idosos com queimaduras, submetidos à terapia por pressão negativa no hospital. Não houve restrição de idioma, nem período de tempo. Resultados: Foram identificadas 106 publicações e, após o processo de seleção, cinco estudos compuseram a amostra final. Os resultados demonstraram que a aplicação da terapia por pressão negativa em queimaduras constituiu-se como uma ferramenta efetiva na cicatrização de queimaduras térmicas, químicas e elétricas, destacando-se a otimização do tempo de cicatrização, formação de um tecido de granulação saudável, diminuição do edema, redução da infecção, drenagem e monitorização do edema. Conclusão: O tratamento de queimaduras utilizando a pressão negativa tem se mostrado um método efetivo, visto os benefícios que promove no processo cicatricial. Sugere-se que a temática seja mais difundida, aprofundando-se o conhecimento sobre o uso desta tecnologia. (AU)

Objective: To map the scientific production regarding the use of negative pressure wound therapy in burn treatment of hospitalized adult and aged patients. Method: Scope review following the JBI method with a search for scientific production in PubMed, the Scientific Electronic Library Online, the Virtual Health Library, and the Thesis Database of the Coordination for the Improvement of Higher Education Personnel from March to May 2021. Studies with adult and aged burn patients undergoing negative pressure wound therapy in hospitals were included. There was no language or time frame restriction. Results: 106 publications were identified and 5 studies made up the final sample after the selection process. The results demonstrated that applying negative pressure wound therapy to burns was effective in healing thermal, chemical, and electrical burns, esoecially regarding healing time optimization, healthy granulation tissue formation, edema and infection reduction, and edema drainage and monitoring. Conclusion: Burn treatment using negative pressure has proven effective, given the benefits it promotes in the healing process. The theme should be more widely spread to deepen the knowledge about the use of this technology. (AU)

Objetivo: Mapear la producción científica sobre el uso de la terapia de presión negativa en el tratamiento de quemaduras en pacientes adultos y ancianos hospitalizados. Método: Revisión de alcance siguiendo el método JBI con búsqueda de producción científica en PubMed, Biblioteca Científica Electrónica en Línea, Biblioteca Virtual en Salud y Banco de Tesis de la Coordinación para el Perfeccionamiento del Personal de Educación Superior en los meses de marzo a mayo de 2021. Se incluyeron estudios con adultos y pacientes ancianos quemados sometidos a terapia de presión negativa en el hospital. No hubo restricción de idioma ni período de tiempo. Resultados: Se identificaron 106 publicaciones y luego del proceso de selección, 5 estudios conformaron la muestra final. Los resultados demostraron que la aplicación de la terapia de presión negativa en quemaduras constituyó una herramienta eficaz en la curación de quemaduras térmicas, químicas y eléctricas, destacándose la optimización del tiempo de curación, formación de tejido de granulación sano, reducción de edema, reducción de infección, drenaje y seguimiento del edema. Conclusión: El tratamiento de quemaduras mediante presión negativa ha demostrado ser un método efectivo, dados los beneficios que promueve en el proceso de cicatrización. Se sugiere que el tema sea más difundido, profundizando el conocimiento sobre el uso de esta tecnología. (AU)

Negative Pressure Wound Therapy After Intestinal Anastomosis: A Risk Factor Analysis for Dehiscence.

INTRODUCTION: Negative pressure wound therapy (NPWT) is part of the temporary abdominal closure in the treatment of patients with traumatic, inflammatory, or vascular disease. However, the use of NPWT when performing an intestinal anastomosis has been controversial. This study aimed to describe the patients managed with NPWT therapy and identify the risk factors for anastomotic dehiscence when intestinal anastomosis was performed. METHODS: A single-center cohort study with prospectively collected databases was performed. Patients who required NPWT therapy from January 2014 to December 2018 were included. Patients were stratified according to the performance of intestinal anastomosis and according to the presence of dehiscence. Bivariate and multivariate analyses were performed for anastomotic dehiscence and mortality. RESULTS: A total of 97 patients were included. Median age was 52 y old [interquartile range 24.5-70]. Male patients corresponded to 75.6% (n = 34) of the population. Delayed fascial closure was performed in 80% (n = 36). The risk of anastomotic dehiscence was higher in females (odds ratio (OR) 11.52 [confidence interval (CI) 1.29-97.85], P = 0.030), delayed fascial closure (OR 18.18 [CI 2.02-163.5], P = 0.010) and use of vasopressors (OR 12.04 [CI 1.22-118.47], P = 0.033). NPWT pressures >110 mmHg were evidenced in the dehiscence group with statistically significant value (OR 1.2 [0.99-2.26] p 0.04) CONCLUSIONS: There is still controversy in the use of NPWT when performing intestinal anastomosis. According to our data, the risk of dehiscence is higher in females, delayed fascial closure, use of vasopressors, and NPWT pressures >110 MMHG.

Open or closed abdomen post laparotomy to control severe abdominal sepsis: a survival analysis / Abdome aberto ou fechado pós-laparotomia para controle de sepse de foco intra-abdominal severa: uma análise de sobrevivência

ABSTRACT Introduction: severe abdominal sepsis, accompained by diffuse peritonitis, poses a significant challenge for most surgeons. It often requires repetitive surgical interventions, leading to complications and resulting in high morbidity and mortality rates. The open abdomen technique, facilitated by applying a negative-pressure wound therapy (NPWT), reduces the duration of the initial surgical procedure, minimizes the accumulation of secretions and inflammatory mediators in the abdominal cavity and lowers the risk of abdominal compartment syndrome and its associated complications. Another approach is primary closure of the abdominal aponeurosis, which involves suturing the layers of the abdominal wall. Methods: the objective of this study is to conduct a survival analysis comparing the treatment of severe abdominal sepsis using open abdomen technique versus primary closure after laparotomy in a public hospital in the South of Brazil. We utilized data extracted from electronic medical records to perform both descriptive and survival analysis, employing the Kaplan-Meier curve and a log-rank test. Results: the study sample encompassed 75 laparotomies conducted over a span of 5 years, with 40 cases employing NPWT and 35 cases utilizing primary closure. The overall mortality rate observed was 55%. Notably, survival rates did not exhibit statistical significance when comparing the two methods, even after stratifying the data into separate analysis groups for each technique. Conclusion: recent publications on this subject have reported some favorable outcomes associated with the open abdomen technique underscoring the pressing need for a standardized approach to managing patients with severe, complicated abdominal sepsis.

RESUMO Introdução: a sepse abdominal grave, com peritonite difusa, é um grande desafio para o cirurgião geral, sendo muito frequente as reintervenções cirúrgicas e complicações desta doença, que apresenta morbimortalidade elevada. A proposta do abdome aberto, aplicando-se a terapia por pressão negativa (TPN), reduz o tempo operatório da primeira abordagem cirúrgica, reduz o acúmulo de secreções e mediadores inflamatórios no sítio abdominal, diminui a possibilidade de síndrome compartimental abdominal e suas complicações. A outra técnica é a síntese primária, quando é optado por fechar a parede por completo. Métodos: o objetivo do estudo foi realizar uma análise de sobrevivência comparando os tratamentos de sepse intra-abdominal severa com Abdome Aberto e Fechado após laparotomia em um hospital universitário no sul do Brasil. As variáveis foram obtidas a partir de prontuários eletrônicos de pacientes submetidos à intervenção cirúrgica e realizou-se uma análise descritiva e de sobrevivência usando a curva de Kaplan-Meier e o teste de log-rank. Resultados: a amostra incluiu 75 laparotomias em 5 anos (40 TPN e 35 sínteses primárias), com mortalidade de 55%. A sobrevida entre os métodos de fechamento não demonstrou significância estatística, mesmo após a divisão em um grupo de análise de cada técnica. Conclusão: recentes publicações destacam resultados favoráveis do abdome aberto, enfatizando a necessidade urgente de uma sistematização na assistência de pacientes com sepse abdominal complicada grave.

Outcomes and associated factors of open abdomen after urgent laparotomy at a University Hospital in Southern Brazil: a retrospective study / Desfechos e fatores associados em pacientes submetidos ao abdome aberto após laparotomia de urgência em um Hospital Universitário no sul do Brasil: um estudo retrospectivo

ABSTRACT Introduction: The technique of open abdomen refers to a surgical procedure that intentionally involves leaving an opening in the abdominal wall. This study aimed to evaluate the clinical outcomes, mortality, and morbidity of patients undergoing open abdomen in a public hospital in Brazil and investigate associated risk factors associated with the outcome. Methods: Data from electronic medical records were collected from 2017 to 2022. The variables were used for descriptive analyses, association analysis, and survival analysis using the Kaplan-Meier curve. Results: The sample included 104 patients, with 84 presenting with acute abdomen and 20 with trauma, having highly variable ages and comorbidities. Peritonitis and the need for early reoperation were the most common indication for the procedure, each accounting for 34%, and negative pressure wound therapy was the most commonly used technique. Fistula was the most frequent complication, with the majority forming in the early days after the surgery. The number of interventions and open abdomen time obtained statistical significance in comparison with the outcome. The overall mortality rate was 62,5%. Conclusion: Despite open abdomen being a technique that can have benefits in controlling intraabdominal contamination and preventing abdominal compartment syndrome, its implementation is associated with complications. The mortality and complication rates were high in this sample. The decision to use the technique should be individualized and based on several factors, including the indications and the patient's clinical status.

RESUMO Introdução: A técnica de abdome aberto refere-se a um procedimento cirúrgico que envolve deixar deliberadamente uma abertura na parede abdominal. Este estudo teve como objetivo avaliar o desfecho clínico, mortalidade e morbidade de pacientes submetidos ao abdome aberto em um hospital público do Brasil e investigar fatores de risco associados ao desfecho. Métodos: Dados a partir de prontuários eletrônicos foram coletados de 2017 a 2022. As variáveis foram utilizadas para análises descritivas, análise de associação e de sobrevivência pela curva Kaplan-Meier. Resultados: A amostra correspondeu a 104 pacientes, sendo 84 por abdome agudo e 20 por trauma, com idade e número de comorbidades variados. A peritonite e a necessidade de reabordagem precoce foram as causas mais comuns para a indicação do procedimento, 34% cada, e a terapia de pressão negativa foi a mais utilizada neste estudo, seguindo a técnica de Barker. Fístula é a complicação mais frequente (41%), sendo que a maioria se formou nos primeiros dias após a realização da cirurgia. O número de intervenções e o tempo de abdome aberto obtiveram significância estatística na comparação com o desfecho. A mortalidade geral foi de 62,5%. Conclusão: Apesar de o abdome aberto ser uma técnica que pode trazer benefícios no controle da contaminação intra-abdominal e prevenção de síndrome compartimental abdominal, sua realização está associada a complicações. A taxa de mortalidade e morbidade foram elevadas nesta amostra. A decisão para uso da técnica deve ser individualizada e baseada em vários fatores, incluindo as indicações e o estado clínico do paciente.

Effectiveness of a new endodontic irrigation system for removing smear layer and dissolving simulated organic matter.

OBJECTIVES: The study aimed to evaluate the potential for the dissolution of organic tissue in areas of simulated complexity and cleaning of root canal walls of the new iVac® endodontic irrigation system. MATERIAL AND METHODS: Thirty mandibular premolars were evaluated by scanning electron microscopy before and after biomechanical preparation. Then, they were distributed according to the final irrigation protocol into groups with conventional irrigation, ultrasonic agitation with metallic insert (UA), and iVac® system, and new photomicrographs were obtained. For tissue dissolution analysis, glass capillaries filled with catgut were attached to the cervical and apical thirds of twenty-one prototyped upper incisors. They were weighed before and after the previously mentioned irrigation protocols. The data were statistically compared with a significance level of 5%. RESULTS: The final irrigation provided greater cleaning of the root canal walls in the cervical, middle, and apical thirds of the root canals (P < 0.05), with no statistically significant difference between UA and iVac®, regardless of the analyzed thirds. Both ultrasonic irrigation protocols dissolved a significantly greater volume than the conventional irrigation protocol (P < 0.05), with no difference between the two protocols (P < 0.05). CONCLUSIONS: The iVac® system showed root canal wall cleaning and tissue dissolution similar to UA with a metallic insert, and both were superior to conventional irrigation. CLINICAL RELEVANCE: The new irrigation system iVac is more effective than conventional irrigation and has similar root canal wall cleaning and tissue dissolution to UA.

Enteroatmospheric fistulas in open abdomen in trauma associated with abdominal reintervention and VAC therapy.

BACKGROUND: Open abdomen is an alternative for the management of trauma patient, and negative pressure therapy of the wound using VAC® device is a genuine sort of treatment. Although the device poses technical advantages, risks are present and a critical complication is the enteroatmospheric fistula formation (EAF). OBJECTIVE: To analize the role of negative pressure therapy length and VAC® device number of changes on the EAF formation in trauma patients udergoing open abdomen. METHOD: Cut-off points were calculated using receiver operational characteristics curve. Values were compared with Student's t or Mann-Withney U tests, considering statistically significant p < 0.05. RESULTS: EAF were present in 39 cases (5.9%). A significant difference in the presence of EAF was present in patients with negative pressure therapy of the wound length ≥ 11.2 days (46.9 vs. 1.3%; relative risk [RR]: 3.67; 95% confidence interval [95% IC]: 2.4-6.68; p = 0.017) and when ≥ 2.6 VAC® device changes were performed (34.6 vs. 0.5%; RR: 6.92; 95% IC: 1.1-4.3; p < 0.001). CONCLUSIONS: At our institution, the practice of >3 VAC® device changes and length of therapy > 11 days should be carefully considered leading to reduce the risk of EAF formation.

INTRODUCCIÓN: El abdomen abierto es una alternativa para manejar al paciente traumatizado, y una variante para instituirlo es la terapia de presión negativa de la herida con el dispositivo VAC®. Aunque tiene ventajas técnicas, no está exento de riesgos y una complicación crítica es la formación de fístulas enteroatmosféricas (FEA). OBJETIVO: Analizar el papel de la duración de la terapia de presión negativa y del número de cambios del dispositivo VAC® sobre la aparición de FEA en pacientes traumatizados manejados con abdomen abierto. MÉTODO: Se establecieron puntos de corte con curva de características operacionales del receptor. Los valores se compararon con la prueba t de Student o U de Mann-Whitney, considerando p < 0.05 como valor estadísticamente significativo. RESULTADOS: La FEA se presentó en 39 casos (5.9%). Hubo una diferencia significativa en la aparición de FEA en pacientes con duración de la terapia de presión negativa de la herida ≥ 11.2 días (46.9 vs 1.3%; riesgo relativo [RR]: 3.67; intervalo de confianza del 95% [IC95%]: 2.4-6.68; p = 0.017) y cuando se practicaron ≥ 2.6 cambios del dispositivo VAC® (34.6 vs. 0.5%; RR: 6.92; IC95%: 1.1-4.3; p < 0.001). CONCLUSIONES: En nuestra institución, la práctica de más de tres cambios del dispositivo VAC® y el mantenimiento de la terapia por más de 11 días debe ser cuidadosamente considerado para reducir el riesgo de formación de FEA.

Surgical treatment of sacral pressure wounds in patients with COVID-19: A case series.

INTRODUCTION: The COVID 19 pandemic has resulted in an increased number of patients requiring intubation and intensive care. This has led to an increased incidence of sacral pressure ulcers requiring surgical management. We report our experience of COVID 19 related sacral pressure ulcers requiring surgical reconstruction. METHODS: A case series study was performed with 12 patients who presented grade IV sacral pressure ulcers after hospitalization for COVID-19 in a single institution. The mean age was 49.8 years and the most frequent comorbidities were arterial hypertension, diabetes and obesity, each present in 6 patients. All of them were submitted to surgical reconstruction with fasciocutaneous flaps after improvement of their clinical status. Follow up time was of at least 30 days after reconstruction. Preoperative laboratory tests and surgical outcomes were compared to data available in the literature. RESULTS: No major dehiscence was observed and minor dehiscence happened in 2 cases (16.7%). Out of the 12 patients, 8 (66.7%) had hemoglobin levels less than 10.0 and 5 (41.7%) had albumin levels less than 3.0, though this did not lead to a higher rate of complications. CONCLUSION: This study showed that ambulating patients with grade IV pressure ulcer after COVID- 19 infection may undergo debridement, negative-pressure wound therapy and closure with local flaps with adequate results and minimal complication rate.

Sistema de presión negativa como tratamiento de la venta torácica: informe de caso / Negative pressure system as a thoracic window treatment: a case report

Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.

Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.

ROLE OF INCISIONAL VACUUM THERAPY IN ENDOPROSTHETIC BONE RECONSTRUCTION SURGERY.

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.

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.

Sistema de presión negativa en loxoscelismo cutáneo-visceral. Reporte de un caso

Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).

Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.

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.

One-year monitoring SARS-CoV-2 RNA surface contamination in hospitals reveals no correlation with organic material and negative pressure as a limiting factor for contamination.

Understanding transmission routes of SARS-CoV-2 is crucial to establish effective interventions in healthcare institutions. Although the role of surface contamination in SARS-CoV-2 transmission has been controversial, fomites have been proposed as a contributing factor. Longitudinal studies about SARS-CoV-2 surface contamination in hospitals with different infrastructure (presence or absence of negative pressure systems) are needed to improve our understanding of their effectiveness on patient healthcare and to advance our knowledge about the viral spread. We performed a one-year longitudinal study to evaluate surface contamination with SARS-CoV-2 RNA in reference hospitals. These hospitals have to admit all COVID-19 patients from public health services that require hospitalization. Surfaces samples were molecular tested for SARS-CoV-2 RNA presence considering three factors: the dirtiness by measuring organic material, the circulation of a high transmissibility variant, and the presence or absence of negative pressure systems in hospitalized patients' rooms. Our results show that: (i) There is no correlation between the amount of organic material dirtiness and SARS-CoV-2 RNA detected on surfaces; (ii) SARS-CoV-2 high transmissible Gamma variant introduction significantly increased surface contamination; (iii) the hospital with negative pressure systems was associated with lower levels of SARS-CoV-2 surface contamination and, iv) most environmental samples recovered from contaminated surfaces were assigned as non-infectious. This study provides data gathered for one year about the surface contamination with SARS-CoV-2 RNA sampling hospital settings. Our results suggest that spatial dynamics of SARS-CoV-2 RNA contamination varies according with the type of SARS-CoV-2 genetic variant and the presence of negative pressure systems. In addition, we showed that there is no correlation between the amount of organic material dirtiness and the quantity of viral RNA detected in hospital settings. Our findings suggest that SARS CoV-2 RNA surface contamination monitoring might be useful for the understanding of SARS-CoV-2 dissemination with impact on hospital management and public health policies. This is of special relevance for the Latin-American region where ICU rooms with negative pressure are insufficient.

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.

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.

Combined use of progressive tension suture and negative pressure wound therapy in large torso degloving wounds.

OBJECTIVE: To demonstrate the associated use of progressive tension sutures (PTS) with negative pressure wound therapy (NPWT) in large torso degloving wounds. METHODS: This is a case report of two patients with large torso degloving wounds caused by trauma, both of whom were treated with combined PTS and NPWT. Statistics related to wound treatment responses are presented. RESULTS: Initial wound area for Patient 1 was 2400cm2 and 900cm2 for Patient 2. Within 21 and 12 days, respectively, using the combined method, the following data were observed: wound reduction of 94% and 99%, respectively; a closing speed rate of 98cm2/day and 75cm2/day, respectively; and a closing percentage of 4.45% per day and 8.25% per day, respectively. CONCLUSION: The use of combined PTS and NPWT techniques may be useful in the treatment of traumatic degloving injuries, reducing the wound area and facilitating reconstruction.

[Conservation surgery and early rehabilitation in massive necrotizing fasciitis of the lower limbs] / Cirugía de conservación y rehabilitación temprana en fascitis necrotizante masiva de miembros inferiores.

Necrotizing fasciitis is a life-threatening infection. Early diagnosis and treatment are essential. Reconstruction techniques and rehabilitation protocols have been poorly described. The objective of this work is to describe the results of timely treatment for limb preservation and early rehabilitation in a case of massive necrotizing fasciitis of the lower limbs. We present a case of necrotizing fasciitis in the lower limbs, treated surgically with a negative aspiration system, muscle flaps, and skin graft. We describe his rehabilitation protocol and the results at one year of follow-up.

La fascitis necrotizante es una infección potencialmente letal. Es esencial un diagnóstico y tratamiento temprano. Las técnicas de reconstrucción y los protocolos de rehabilitación han sido escasamente descritos. El objetivo de este trabajo es describir los resultados del tratamiento oportuno para la conservación de miembros y la rehabilitación temprana en un caso de fascitis necrotizante masiva de miembros inferiores. Presentamos un caso de fascitis necrotizante en miembros inferiores, tratado quirúrgicamente mediante sistema de aspiración negativa, colgajos musculares e injerto cutáneo. Describimos su protocolo de rehabilitación y los resultados al año de seguimiento.

Use of collagen and negative pressure wound therapy on a diabetic foot ulcer: a case study.

This case study describes the combined use of a wound contact layer dressing containing collagen with negative pressure wound therapy (NPWT) on a diabetic foot ulcer (DFU). The patient was treated at a university hospital in Santiago, Chile. A wound size reduction of 58% was observed within the first 10 weeks of treatment, and the wound went on to heal fully over the next 14 weeks. The combined use of collagen and NPWT helped to initiate healing and prevent amputation of the foot. At 64, the patient was able to maintain his independence and quality of life.

Vacuum assisted closure for defects of the abdominal wall after intestinal transplantation.

Background: Isolated intestinal transplantation (IT) is indicated in cases of intestinal failure (IF) in the absence of severe liver dysfunction. Short bowel syndrome (SBS) is the most frequent IF etiology, and due to the absence or considerable reduction of intestinal loops in the abdominal cavity in these patients, there is atrophy and muscle retraction of the abdominal wall, leading to loss of the abdominal domain and elasticity and preventing the primary closure of the abdominal wall. This study aimed to describe a technique for the closure of the abdominal wall after IT without using prostheses. Methods: Four patients underwent IT with the impossibility of primary closure of the abdominal wall. We describe a novel technique, associating a series of vacuum-assisted closure dressings, components separation, and relaxation incisions. Results: All patients presented a successful closure of the abdominal wall with the described technique, with no complications related to the abdominal wall. Conclusion: The technique proved to be safe, effective, and reproducible as an option for abdominal wall closure after IT. Employing this technique in a greater number of cases is necessary to confirm these results.