Wound Dehiscence After Achilles Tendon Trauma and Repair: Treatment With Ultraportable Negative Pressure Wound Therapy and Compression Therapy.

INTRODUCTION: Achilles tendon rupture is a common injury requiring surgical repair. Re-ruptures, infections, delayed wound healing, and hematomas have been reported postoperatively. OBJECTIVE: This case series described the use of ultraportable negative pressure wound therapy (NPWT) and compression bandaging following postoperative dehiscence of Achilles tendon repair. MATERIALS AND METHODS: Retrospective records were reviewed to identify patients who underwent wound management for Achilles tendon dehiscence between January 2014 and January 2018. Patient demographics, wound size at first and last visit, number of visits, and previous treatment data were extracted. Wound management included wound irrigation, surgical debridement, and application of silver dressings, as needed. Therapy was transitioned to ultraportable NPWT with twice-weekly dressing changes. When possible, patients with an ankle-brachial index greater than 0.8 received multilayer, multicomponent compression. Treatment response was evaluated using a wound imaging system at 2-week to 4-week intervals for a total of 24 weeks. RESULTS: Nine male patients with a mean age of 69.7 years presented for care. One patient sustained injury during sports activities, and the other 8 patients sustained injuries resulting from household accidents. Six patients achieved complete wound closure. Three patients achieved a mean 90% wound closure. No adverse effects were observed during treatment with NPWT and compression therapy. CONCLUSIONS: In the current study, ultraportable NPWT and compression bandaging were found to be effective in the management of wounds with critical local vascularity. Larger, randomized controlled studies are necessary to fully assess the potential clinical benefit of NPWT and compression therapy in the management of postoperative wounds of the Achilles tendon.

Epidermal skin grafting in vitiligo: a pilot study.

Vitiligo is a multifactorial acquired dermatosis characterised by achromic or hypochromic macules and by the absence of functioning melanocytes. Treatment depends on the extent of the affected areas and on disease activity. Surgical techniques have proven to be effective in stable cases but can be time-consuming and, in some cases, aesthetically unsatisfying or painful for the patients. The aim of the study was to assess the clinical safety and effectiveness of a new automatic epidermal skin harvesting device in patients with stable localised vitiligo over a minimum 12-month period. This new system (CELLUTOME™ Epidermal Harvesting System, KCI, an ACELITY Company, San Antonio, TX) is a commercially available epidermal skin harvesting system that can be used without local anaesthesia or other pre-treatments and has been shown to have low rates of donor site morbidity. Epidermal skin grafts can used in patients with acute and hard to heal chronic wounds, burns and stable vitiligo. The use of advanced therapies may improve the quality of life, have cost benefits and accelerate re-pigmentation of patients with vitiligo. In our preliminary study, this system was seen to be a safe and efficacious means of harvesting epidermal micrografts containing melanocytes for use in patients with stable vitiligo unresponsive to standard therapies.

Clinical evaluation of the efficacy and safety of a medical device in various forms containing Triticum vulgare for the treatment of venous leg ulcers - a randomized pilot study.

This study was carried out to assess the efficacy and tolerability of the topical application of an aqueous extract of Triticum vulgare (TV) in different vehicles (cream, impregnated gauzes, foam, hydrogel, and dressing gel) for the treatment of venous lower leg ulcers. Fifty patients were randomized to receive one of the five investigational vehicles. Treatment was performed up to complete healing or to a maximum of 29 days. The wound size reduction from baseline was the primary efficacy variable, which was measured by means of a noninvasive laser scanner instrument for wound assessment. In all groups, apart from the foam group, a similar trend toward the reduction of the surface area was observed. The cream showed the greatest effect on the mean reduction of the lesion size. At last visit, six ulcers were healed: two in the cream group, three in the gauze group, and one in the dressing gel group. In the patients treated with the cream, the gauzes, the hydrogel, and the dressing gel, the reduction of lesion size was 40%-50%; the reduction was smaller in the foam group. No impact in terms of age on the healing process was found. The Total Symptoms Score decreased in all groups during the study; a greater efficacy in terms of signs/symptoms was observed in the patients treated with the gauzes. In the dressing gel group, one patient had an infection of the wound after 3 weeks of treatment and 2 of colonization, leading to a systemic antibiotic treatment. The events were judged as nonrelated to the device used. On the basis of the results, it could be argued that the medical device may be useful in the treatment of chronic venous ulcers.