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Negative Pressure Wound Therapy (NPWT) has been widely adopted in wound healing strategies due to its multimodal mechanism of action. While NPWT’s positive impression on wound healing is well-established, its effect on bacterial load reduction remains equivocal. This study investigates NPWT’s efficacy in reducing bioburden using an in vitro porcine skin model, focusing on the impact of Staphylococcus aureus and Staphylococcus epidermidis. Custom-made negative pressure chambers were employed to apply varying negative pressures. Porcine skin was cut into 5 × 5 cm squares and three standardized wounds of 6 mm each were created using a biopsy punch. Then, wounds were infected with S. aureus and S. epidermidis bacterial suspensions diluted 1:10,000 to obtain a final concentration of 1.5 × 104 CFU/ml and were placed in negative pressure chambers. After incubation, bacterial counts were expressed as colony-forming units (CFU) per ml. For S. aureus at 120 hours, the median CFU, mean area per colony, and total growth area were notably lower at −80 mmHg when compared to −250 mmHg and −50 mmHg, suggesting an optimal negative pressure for the pressure-dependent inhibition of the bacterial proliferation. While analyzing S. epidermidis at 120 hours, the response to the negative pressure was similar but less clear, with the minor CFU at −100 mmHg. The influence of intermittent negative pressure on the S. epidermidis growth showed notably lower median CFU with the interval therapy every hour compared to the S. aureus control group. This study contributes valuable insights into NPWT’s influence on the bacterial load, emphasizing the need for further research to reformulate its role in managing contaminated wounds.

Negative Pressure Wound Therapy (NPWT) is a contemporary and dynamically evolving intervention used in the management of complex wounds. The head and neck region is a common site for infected wounds, which can be challenging to manage. Furthermore, due to the complex anatomy of this area, clinicians may face difficulties in securing standard wound dressings. NPWT appears to be a promising treatment option for patients when conventional methods have failed. However, its use remains limited and requires specific approaches to optimize its application in the head and neck region. This paper aims to present several modifications to NPWT techniques designed to enhance its efficacy in the specialized anatomical region of the head and neck. [ABSTRACT FROM AUTHOR]

Introduction: In some clinical scenarios, a stoma site may be located close to the edge of the abdominal wound, impeding optimal wound management and stoma care. We present a novel strategy of using NPWT to manage both abdominal wound and stoma simultaneously. Material and methods: A retrospective analysis of 17 patients treated with a novel wound care strategy was conducted. The application of NPWT within the wound bed, around the stoma site, and the skin between helps in 1) separating the wound from the stoma site, 2) maintaining an optimal environment for wound healing, 3) protecting the peristomal skin, and 4) facilitating the application of ostomy appliances. Results: The study group was comprised of 12 women (70.6%) and 5 men (29.4%) with a mean age of 49.1 ±18.4 years. The most common underlying pathology was Crohn’s disease (n = 5; 29.4%). After the implementation of NPWT, patients underwent from 1 to 13 surgeries. Thirteen patients (76.5%) required admission to the intensive care unit. The mean time of hospital stay was 65.3 ±28.6 days (range: 36–134). The mean number of NPWT sessions was 10.8 ±5.2 (range: 5–24) per patient. The negative pressure ranged from –80 to –125 mmHg. Progress in wound healing was achieved in all patients, resulting in granulated tissue formation, minimal wound retraction, and thus reduction of the wound area. As a result of NPWT, the wounds were granulated entirely, tertiary intension closure was achieved, or patients were qualified for reconstructive surgery. Discussion: NPWT is a safe and useful therapy for complicated abdominal wounds with the presence of a stoma close to the wound’s edge. A novel care strategy allows for simultaneous technical opportunity to separate the stoma from the wound bed and facilitate wound healing. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Anastomotic leaks remain the most fearful complications. Aim: We present a novel endoscopic salvage therapy known as endoscopic vacuum therapy with instillation (iEVT) as a combination of standard endoscopic vacuum therapy (EVT) and negative pressure wound therapy with instillation (iNPWT). Material and methods: A case series of 6 consecutive patients treated with iEVT is presented. A Redon drain and a central venous catheter were introduced within polyurethane foam used as a self- made device for iEVT and antimicrobial solution was instilled. Results: A total of 6 patients with the mean age of 29.5 ±8.9 were treated with iEVT. The mean number of iEVT sessions was 5.8 ±2.3. The mean time of iEVT management was 20.7 ±8.8 days. Locally, a reduction in purulent discharge and defect's dimension with contraction were revealed confirmed with imaging studies. Conclusions: iEVT is a very encouraging, novel method for complicated perianal diseases and anastomotic leak. [ABSTRACT FROM AUTHOR]

Aim: An ileal pouch anal anastomosis (IPAA) leak is one of the most severe complications after restorative proctocolectomy (RPC). We present a rare case of successful management of IPAA leak after RPC without defunctioning stoma with the use of endoscopic vacuum therapy. Methods: A 57-year-old male with an ileal pouch anal anastomosis leak after RPC due to ulcerative colitis with a presacral abscess was qualified for endoscopic vacuum therapy (EVT). The abscess of the left buttock was drained and secured with suction drain (redon drain). Due to the lack of defunctioning stoma, a system to contain and divert fecal matter was placed within an afferent limb of the J-pouch and EVT was placed directly within IPAA dehiscence. EVT was changed every third day. Results: The patient underwent a total of five EVT sessions. Improvement of patient's general condition characterized with a lack of pelvic pain, fever and reduction of inflammatory markers was achieved. Locally, anastomosis dehiscence was healed with prominent reduction in the defect's dimension, contraction and revascularization. Based on imaging studies no chronic presacral sinus or any other perianal disturbances were revealed in the five-month follow-up. Conclusions: EVT is a promising method for management of IPAA leak. Although it remains extremely difficult, EVT may serve as a method of choice in early pouch-related septic complications after RPC performed without defunctioning stoma. [ABSTRACT FROM AUTHOR]

Introduction: Negative pressure wound therapy (NPWT) in the open abdomen (OA) is recognized as a gold standard management method. Currently minimally invasive procedures are implemented in many clinical scenarios. Aim: To demonstrate the feasibility of using negative pressure wound therapy in a laparoscopic approach for OA management in a porcine model termed as a laparoscopic vacuum (LapVac). Material and methods: An adult female swine underwent a laparoscopic procedure. Briefly, a small incision was made and secured with a wound protector, pneumoperitoneum was created and two additional ports were placed. Then, a non-adhesive layer was precisely placed within the abdominal cavity. Results: Finally, polyurethane foam and adhesive drape were applied. A volume of 200 ml of saline solution was instilled and drained completely within 30 min. We did not observe any technical problems with NPWT application. Conclusions: This study confirmed the technical feasibility of NPWT application in the laparoscopic approach. LapVac seems to be a promising technique which may minimize the trauma and lead to better outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The management of enteroatmospheric fistula ( EAF) in open abdomen (OA) therapy is challenging and associated with a high mortality rate. The introduction of negative pressure wound therapy ( NPWT) in open abdomen management significantly improved the healing process and increased spontaneous fistula closure. Retrospectively, we analysed 16 patients with a total of 31 enteroatmospheric fistulas in open abdomen management who were treated using NPWT in four referral centres between 2004 and 2014. EAFs were diagnosed based on clinical examination and confirmed with imaging studies and classified into low (<200 ml/day), moderate (200-500 ml/day) and high (>500 ml/day) output fistulas. The study group consisted of five women and 11 men with the mean age of 52·6 years [standard deviation ( SD) 11·9]. Since open abdomen management was implemented, the mean number of re-surgeries was 3·7 ( SD 2·2). There were 24 EAFs located in the small bowel, while four were located in the colon. In three patients, EAF occurred at the anastomotic site. Thirteen fistulas were classified as low output (41·9%), two as moderate (6·5%) and 16 as high output fistulas (51·6%). The overall closure rate was 61·3%, with a mean time of 46·7 days ( SD 43·4). In the remaining patients in whom fistula closure was not achieved ( n = 12), a protruding mucosa was present. Analysing the cycle of negative pressure therapy, we surprisingly found that the spontaneous closure rate was 70% (7 of 10 EAFs) using intermittent setting of negative pressure, whereas in the group of patients treated with continuous pressure, 57% of EAFs closed spontaneously (12 of 21 EAFs). The mean number of NPWT dressing was 9 ( SD 3·3; range 4-16). In two patients, we observed new fistulas that appeared during NPWT. Three patients died during therapy as a result of multi-organ failure. NPWT is a safe and efficient method characterised by a high spontaneous closure rate. However, in patients with mucosal protrusion of the EAFs, spontaneous closure appears to be impossible to achieve. [ABSTRACT FROM AUTHOR]

Open abdomen technique is a surgical treatment in which the fascia and skin are left open in order to reduce the value of the intra-abdominal pressure. According to the World Society of the Abdominal Compartment Syndrome (WSACS) normal values of the intra-abdominal pressure are between 5 and 7 mm Hg. Intra-abdominal hypertension occurs when the pressure value is equal to or exceeds 12 mm Hg. The aim of the study was to compare the results of the open abdomen treatment using standard methods and negative pressure wound therapy. Material and methods. The study was in the form of a retrospective analysis of the documentation of the patients treated with open abdomen technique. The study included 37 patients treated in the Department of General and Endocrine Surgery and Gastroenterological Oncology and in the Department of Anesthesiology and Intensive Care of the Medical Sciences since 2009-2012. Patients were divided into two groups: group 1 (n = 20) was treated with standard surgical procedures (laparostomy, repeated peritoneal cavity lavage) and group 2 (n =17) was treated using negative pressure wound therapy (NPWT). The analysed clinical data included the period of hospitalization and clinical outcome (survival vs death), the occurrence of enteroatmospheric fistulae, cyclical determination of the quantitative C-reactive protein levels. Results. The number of deaths during hospitalization in the group treated with NPWT was lower than in the group treated with standard methods (3 vs 9). The number of fistulae during hospitalization in the group treated with NPWT dropped as compared to the group treated using standard procedures (18% vs 70%). The decrease in the CRP levels was recorded in the group treated with NPWT and its increase - in the group treated with standard methods. Conclusions. The use of NPWT in patients requiring open abdomen treatment is reasonable due to the positive results with respect to survival rates and the decrease in the number of gastrointestinal fistulae. It is necessary to train the physicians in using this type of therapy in the form of workshops and in the clinical setting. [ABSTRACT FROM AUTHOR]