Challenges and Management in Wound Care.

SUMMARY: Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a double action, fluid aspiration and mechanical stimulation of wound edges by a foam. Successive technical evolutions of negative pressure wound therapy were declined since 1997 when Argenta and Morykwas first presented their solution. The adjunct of instillation in 2009 was considered as the first interactive dressing, allowing topical wound solutions to sequentially reach the wound, in alternance with negative pressure. Other devices based on the same principle were designed to prevent postoperative infections when placed over a suture after surgery. This long evolution could enhance the armamentarium of possible solutions, considerably reducing the wound healing time.

Use of Negative-Pressure Wound Therapy With Instillation and Dwell in Breast Reconstruction.

SUMMARY: The use of negative-pressure wound therapy (NPWT) has expanded over the last 3 decades, paralleled and documented by an increase in research. This article discusses the evolution and current applications of NPWT in modern breast reconstruction. Negative-pressure wound therapy with instillation and dwell (NPWTi-d) technology can be used to remove infectious material, facilitate salvaging compromised tissue, and stabilize the soft-tissue environment. Published consensus NPWTi-d guidelines can aid in treatment selection and implementation of this new technology. The therapeutic approach of simultaneously removing infectious material and actively improving mastectomy flap perfusion and thickness is a burgeoning concept, and illustrative cases are presented. NPWTi-d preliminary use has led to reconstruction salvage with reproducible early experience and outcomes, and it is hoped that it will raise interest and awareness of this promising application of the technology to improve breast reconstruction outcomes.

Auricular Clyster, Otenchytes, and Pyoulcos: Precursors of the Ear Syringe.

OBJECTIVES/HYPOTHESIS: In Western medicine, the long history of the ear syringe dates back at least to the end of the 1st millennium BCE; but the corresponding Ancient Greek word surinx designates another tool. Other Greek and Latin words and phrases, in particular auricular clyster, otenchytes, and pyoulcos, were known as names of the ear syringe until modern times. The aim of this article is to study the Greek and Latin words and phrases referred to as names of the ear syringe up until modern times before syringe became the standard word. METHOD: Historical and philological review of ancient Greek and Latin medical literature dealing with the subject. RESULTS: Careful reading of ancient medical texts mentioning these tools shows a variety of shapes and uses: beside the piston-driven syringe, the system of a bladder attached to a catheter remained in use throughout Antiquity; the otenchytes, being a piston-driven syringe, obviously was not used to squirt the liquid when the remedy put inside was warmed by a flame; the piston-driven pyoulcos is most likely of greater size, and never linked with ear care in Antiquity. CONCLUSION: Latin auricular clyster and Greek otenchytes and pyoulcos, in the few ancient texts in which they occur, designate tools of a large variety of shapes and uses, significantly different from Heron's description of piston-driven pyoulcos.

A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine.

The management of patients with colonic diverticular perforation is still evolving. Initial lavage with or without simple suture and drainage was suggested in the late 19th century, replaced progressively by the three-stage Mayo Clinic or the two-stage Mickulicz procedures. Fears of inadequate source control prompted the implementation of the resection of the affected segment of colon with formation of a colostomy (Hartman procedure) in the 1970's. Ensuing development of the treatment strategies was driven by the recognition of the high morbidity and mortality and low reversal rates associated with the Hartman procedure. This led to the wider use of resection and primary anastomosis during the 1990's. The technique of lavage and drainage regained popularity during the 1990's. This procedure can also be performed laparoscopically with the advantage of faster recovery and shorter hospital stay. This strategy allows resectional surgery to be postponed or avoided altogether in many patients; and higher rates of primary resection and anastomosis can be achieved avoiding the need for a stoma. The three recent randomized controlled trials comparing laparoscopic peritoneal lavage alone to resectional surgery reported inconsistent outcomes. The aim of this review is to review the historical evolution and future reflections of surgical treatment modalities for diffuse purulent and feculent peritonitis. In this review we classified the various surgical strategies according to Krukowski et al. and Vermeulen et al. and reviewed the literature related to surgical treatment separately for each period.

Historical perspectives on the roots of the apical negative pressure irrigation technique in endodontics.

The removal of the infectious process caused by an abscess in the periapical tissues was a challenge to dentists in the early part of the 20th century. While they recognized the need to debride the periapical tissues, the process was slow, tedious, and often fraught with failure that resulted in tooth extraction. However, with some creative ingenuity, an irrigation-suction apparatus was developed in the 1930s that enabled rapid and thorough debridement. This appliance went through multiple developmental permutations and was successful in achieving the desired goal. Interestingly, while the purpose of this device was a controlled periapical debridement through the root canal, and not necessarily a focus on a cleaning of the intricacies of the root canal system, the basic concept purported was similar to contemporary approaches used in root canal debridement today.

History and development of suction-irrigation-reaming.

Excessive intramedullary pressure coincident to surgical procedures requiring entrance and surgical manipulation within the intramedullary canal is a problem that was recognized by Gerhard Küntscher, the godfather of intramedullary nailing. He expressed concern about this phenomenon in his early writings during the 1940's. Although he suggested certain technical methods to moderate the event while doing the surgical procedure he had no solution for absolutely preventing its occurrence. This became more of an issue after he introduced motorized reaming in the mid 1950's to improve the strength of intramedullary fixation. The first to demonstrate that pressure could be avoided during intramedullary surgeries were Lorenzi, Olerud and Dankwardt-Lillieström in the late 1960's. Using a method that employed suction evacuation of intramedullary content prior to reaming, and by introducing irrigation while reaming, they were able to achieve negative pressures during their intramedullary work. They proved that if an IM technique did not inject fat throughout the bone and into the organism there were significant benefits both locally and systemically. With impeccable methodology, they showed fat destroyed the vascularity of the bone and inhibited its revascularization. Systemically, its presence was associated with death and morbidity. K.M. Stürmer, using sheep in studies done in the 1980's, further validated the effectiveness of negative pressure reaming to prevent adverse effects associated with reaming. The attempt to create a device to provide these benefits clinically, however, has been challenging. The group in Muenster did work with a rinsing-suction-reamer (RSR) that showed fat introduction with reaming need not be significantly greater than when using an external fixator. In the US, the effort has focused on developing a reamer that integrated suction and irrigation into its design. This instrument has been given the acronym of RIA (reamer/irrigator/aspirator). The rationale and development of this system is detailed in this paper. Now that the intramedullary canal can be reamed using a negative pressure method this domain, as a unique source of biological material, is being increasingly investigated. The cells and tissue harvested from this space have tremendous therapeutic promise.

Nasogastric tubes: an historical context.

Nurses commonly care for patients with nasogastric tubes. Many authors have addressed the management of nasogastric tubes; however, discussion rarely considers the historical perspective. The purpose of this article is to provide an historical context on nasogastric tubes.

Colonic irrigations: a review of the historical controversy and the potential for adverse effects.

Colonic irrigations enjoy widespread popularity among alternative medicine practitioners, although they are viewed with considerable skepticism by the conventional medical community. Although proponents make claims of substantial health benefits, skeptics cite the lack of evidence for health benefits and emphasize the potential for adverse effects. Yet historically, there are clinical reports of effectiveness and virtually no research refuting these reports. Instead there was a campaign against exaggerated claims by nonmedical practitioners that resulted in a movement away from this form of therapy without any scientific study of efficacy. Given the current popularity of colonic irrigations, it is important that such research be performed, which will require a quantitative estimate of the potential for adverse effects. Although there is little specific literature on colonic irrigations, a review of the literature on related procedures such as enemas and sigmoidoscopies suggests that the risk of serious adverse effects is very low when the irrigations are performed by trained personnel using appropriate equipment.

Infectious insanities, surgical solutions: Bayard Taylor Holmes, dementia praecox and laboratory science in early 20th-century America. Part 2.

Part I of this article on Bayard Taylor Holmes (1852-1924), a Chicago physician and surgeon, detailed his laboratory research on dementia praecox and his presumed discovery in 1915 of evidence in support of a focal infection theory of its aetiology. In May 1916 he began to experiment with a rational therapy based on this theory: abdominal surgery and daily irrigations of the colon. He operated first on his own son, who had been afflicted with dementia praecox since 1905, but he died four days later. Part II deals with Holmes' continued surgical treatment of dementia praecox patients and the outcomes of the operations. It also describes how Holmes set up the short-lived Psychiatric Research Laboratory of the Psychopathic Hospital at Cook County Hospital in 1917, and discusses the dismissal of a key research colleague, H. M. Jones, whose experimental results directly contradicted those of Holmes.

Root canal irrigation--a historical perspective.

The concept of the germ theory of disease combined with the development of dentistry during the latter half of the 19th century had a direct effect on the practice of endodontics. The significance of root canal irrigation to endodontics strengthened in the period between 1859 when Taft recommended frequent syringing of the root canal to remove "irritants" until the mid-1940s when endodontics became a special field within dentistry and the American Endodontic Society was established. This paper reviews the role of irrigants and irrigation in root canal treatment during this period. A variety of recommendations on the use of solutions to clean root canals appeared in the dental literature, often innovative and at times entrepreneurial, but invariably empirically based. While it was widely assumed that by wiping the root canal with disinfectants sterilization would be achieved, many of the principles associated with cleaning the root canal published during this period, in particular by Willoughby Dayton Miller in the 1890s and Louis Grossman in the 1940s, remain equally relevant in the 21st century.

[The irrigator Eguisier]. / L'irrigateur du Docteur Eguisier.

Destinated, first, to cure gynecologic diseases, the irrigator Eguisier is the result of the work of two men: Maurice Eguisier (gynecologist) and François Libault (truss manufacturer). The patents and the trademark allowed the author to recall the commercial history of this machine which existed during the last fifteen years of the XIXe century.