scholarly journals Clinical Applications and Benefits of Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management: A Novel Approach for Comorbid Wounds

Cureus ◽  
2020 ◽  
Author(s):  
Treesa W Gomez ◽  
Justus W Gomez ◽  
Rajesh Gopal
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Clinical Applications ◽  
Negative Pressure Therapy ◽  
Soft Tissue Management ◽  
Pressure Therapy ◽  
Surrounding Soft Tissue ◽  
Novel Approach

Closed-Incision and Surrounding Soft Tissue Negative Pressure Dressings in Post-Mastectomy Pre-Pectoral Direct-to-Implant Breast Reconstruction: A Pilot Study

2021 ◽  
pp. 229255032110196
Author(s):  
Udai S. Sibia ◽  
Devinder Singh ◽  
Kathryn M. Sidrow ◽  
Luther H. Holton
Keyword(s):  
Soft Tissue ◽  
Breast Reconstruction ◽  
Negative Pressure ◽  
Skin Flap ◽  
Acellular Dermal Matrix ◽  
Dermal Matrix ◽  
Pressure Therapy ◽  
Surrounding Soft Tissue ◽  
Superficial Skin ◽  
The Mean

Background: Closed-incision and surrounding soft tissue negative pressure therapy (cistNPT) is theorized to decrease infection, reduce tissue edema, and promote healing of the mastectomy skin flap. We report our early experience with this dressing in pre-pectoral direct-to-implant (pDTI) breast reconstruction. Methods: We retrospectively reviewed all patients who underwent post-mastectomy pDTI breast reconstruction with cistNPT between July 2019 and February 2020. All reconstructions utilized smooth round silicone gel implants and human acellular dermal matrix. Results: Thirty-five female patients underwent 58 mastectomies. Mean age and body mass index were 49.9 years and 28.9 kg/m2, respectively. Eleven (31.4%) patients had neoadjuvant chemotherapy. The mean sternal notch-to-nipple distance was 27.0 cm. The median specimen weight was 483 g, while the median implant volume was 495 cc. The mean implant-to-specimen ratio was 1.4 for nipple-sparing, 1.1 for skin-sparing, and 0.7 for skin-reducing mastectomy. Total drain volume was 483.1 cc from each breast. Post-operative complications included seroma (5.2%), peri-incisional necrosis (8.6%), and superficial skin epidermolysis (13.8%). There were no cases of surgical site infection, dehiscence, or hematoma. Rate of return to the operative room was 3.4%. Mean follow-up was 90 days. Conclusions: In our series of pDTI breast reconstructions with cistNPT, no patients experienced hematoma, dehiscence, or infection complications. Rates of seroma, skin necrosis requiring operative debridement, and total drain volumes were lower than those reported in literature.

Coverage of Exposed Bones and Joints in Critically Ill Patients: Lower Extremity Salvage with Topical Negative Pressure Therapy

2008 ◽  
Vol 12 (5) ◽  
pp. 223-229 ◽  
Author(s):  
Raymund E. Horch ◽  
Adrian Dragu ◽  
Werner Lang ◽  
Paul Banwell ◽  
Mareike Leffler ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Critically Ill Patients ◽  
Skin Grafting ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Topical Negative Pressure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Extremity Amputation

Background: Soft tissue defects of the limb with exposure of tendons and bones in critically ill patients usually lead to extremity amputation. A potential treatment with topical negative pressure may allow split-thickness skin grafting to the bone, which leads to limb salvage. Materials and Methods: We report on 21 multimorbid patients, 46 to 80 years of age, with severe lower limb soft tissue loss and infection with exposed bone following débridement with critical limb ischemia. Attempts to salvage the extremities were undertaken with repeated surgical débridement followed by vacuum-assisted closure therapy and subsequent split-thickness skin grafting procedures. Results: Infection control and limb salvage were achieved in all cases with multiple débridements, topical negative pressure therapy, and skin grafts. In all patients, the exposure of tendons and bones was reversible by this strategy without a free flap transfer. Discussion: The patients described in this study were severely compromised by systemic and vascular disorders, so extremity amputation had been considered owing to the overall condition and the exposure of tendons and bones. Since it was possible to salvage the affected limbs with this straightforward and simple procedure, this type of treatment should be considered as a last attempt to prevent amputation.

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