Low-cost Negative-pressure Wound Therapy Using Wall Vacuum: A 15 Dollars by Day Alternative.

BACKGROUND: Negative-pressure wound therapy (NPWT) has been marketed for about 20 years and remains popular. The only real obstacle to NPWT is the cost; therefore, we designed an inexpensive NPWT connected to a wall vacuum. Here, we report the feasibility and safety of this product, which we call PROVACUUM (Z-Biotech, Saint-Avertin, France). METHODS: As a first step, the constraints imposed on the manufacturer were equipment quality similar to that of commercial NPWT systems, with an average treatment cost of $15/d. Then, we conducted a prospective study of patients with indications for NPWT from September 2013 to January 2015. Data collected included ease of use, quality of materials, and occurrence of complications during treatment. RESULTS: We enrolled 23 patients with a mean age of 50.8 years. The average duration of treatment was 8.5 days (range, 3-21 days). The dressings were changed every 3.3 days (range, 2-4 days). Two hematomas occurred that required surgical revision and the transfusion of 2 units after large debridement of pressure ulcer. No other adverse events or infections occurred. The surgeons found that our device was similar to commercial NPWT devices. CONCLUSIONS: We developed an inexpensive NPWT that costs an average of $15/d. Our process is not intended to replace portable or stand-alone devices with batteries, but rather offers a less expensive alternative for hospitalized patients and makes NPWT accessible to the most precarious countries and institutions.

Can we consider standard microsurgical anastomosis on the posterior tibial perforator network? An anatomical study.

PURPOSE: The main vessels in an injured leg can be spared with perforator-to-perforator anastomosis. However, supermicrosurgery is not a routine procedure for all plastic surgeons. Our objective was to establish if the diameter of the perforators of the leg could allow anastomosis with standard microsurgical procedures. METHODS: Twenty lower legs harvested from ten fresh cadavers were dissected. Arterial and venous vessels were injected with colored latex. The limbs were then dissected in a suprafascial plane. All the perforating arteries of a diameter >0.8 mm were located and their external diameter, the number and external diameter of the venae comitantes were reported. RESULTS: We found at least three tibial posterior artery perforators with diameters >0.8 mm per leg with a mean external diameter of 1.1 mm and one vena comitans in almost all cases (96 %). The vena comitans was usually bigger than the perforating artery with a mean diameter of 1.6 mm. After statistical analysis, we were able to locate two main perforator clusters: at the junctions of the upper two-thirds of the leg and of the lower two-thirds of the leg. CONCLUSION: The low-morbidity concept of perforator-to-perforator anastomosis can apply to posterior tibial artery perforators without using supermicrosurgical techniques. This is of high interest for open leg fractures where main vessels could be injured. We hope that the results of our study will incite surgeons to consider sparing of main vessels for coverage of open leg fractures whether surgical teams master supermicrosurgery or not.