Negative Pressure Wound Therapy (Wound VAC) in the Treatment of Chylous Fistula After Neck Dissection

2019 ◽  
Vol 128 (6) ◽  
pp. 569-574 ◽  
Author(s):  
Ashley Dorneden ◽  
Garth Olson ◽  
Nathan Boyd
Keyword(s):  
Neck Dissection ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Neck Surgery ◽  
Wound Therapy ◽  
Hospital Stays ◽  
Chylous Fistula ◽  
Complex Wounds

Objectives: Cervical chylous fistula is an uncommon but potentially severe occurrence associated with neck surgery. Methods for treating this problem have inconsistent efficacy and may result in lengthy hospital stays. Negative pressure wound therapy (NPWT) is a highly effective tool in the management of complex wounds. We report 3 cases where NPWT was successfully used to treat chylous fistulas following neck dissection. Methods: This is a retrospective chart review of 3 patients who developed chylous fistulas after neck dissection and were successfully treated with NPWT. Results: Chylous ouput ceased within 2 to 8 days of proper wound VAC placement. Hospital stays ranged from 6 to 47 days. Patients received altered diets, including TPN for 1 patient with high-flow output and nil-per-os (NPO) or clear liquids for the others. Patients received octreotide throughout their hospitalization. Conclusion: NPWT shows potential as a treatment option for both high-volume and low-volume chylous fistulas following neck dissection.

659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Soft Tissue ◽  
Cell Suspension ◽  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Case Series ◽  
Dermal Substitute ◽  
Wound Therapy ◽  
Skin Cell ◽  
Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

Negative Pressure Wound Therapy in Head and Neck Surgery

2014 ◽  
Vol 16 (2) ◽  
pp. 120-126 ◽  
Author(s):  
Scott A. Asher ◽  
Hilliary N. White ◽  
Joseph B. Golden ◽  
J. Scott Magnuson ◽  
William R. Carroll ◽  
...  
Keyword(s):  
Head And Neck ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Wound Therapy

scholarly journals Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds

2020 ◽  
Vol 16 (1) ◽  
pp. 13-20
Author(s):  
Ji Yoon Sung ◽  
Yong Chan Bae ◽  
Su Bong Nam ◽  
Joo Hyoung Kim
Keyword(s):  
Clinical Outcomes ◽  
Negative Pressure ◽  
Surgical Procedure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Infection Type ◽  
Adjunctive Treatment ◽  
Wound Therapy ◽  
Infected Wounds ◽  
Complex Wounds

Background: Negative-pressure wound therapy with instillation (NPWTi) is an adjunctive treatment modality for complex and infected wounds. However, commercial devices are expensive and not readily available in many countries. The objective of this study is to introduce an NPWTi method that is applicable where commercial NPWTi devices are not available and to report the clinical outcomes of the NPWTi method for the adjunctive treatment of complex wounds.Methods: This prospective clinical experimental study included 51 patients who had wounds on which operative debridement was performed between January 2017 and March 2019. A negative-pressure wound therapy (NPWT) device was applied with an intravenous (IV) line for continuous instillation of 0.9% normal saline plus 1% povidone-iodine solution for chronic wounds. The outcomes measured were the number of operating room visits, time to final surgical procedure, number of infected wounds, time to resolution of infection, type of reconstruction operation, and occurrence of complications.Results: The average number of operations performed was 2.5±0.8, and the time to final surgical procedure was 28.4±15.4 days. The number of infected wounds was 35 (68.6%), and the time to resolution of infection was 15.0±14.6 days. All wounds were closed or covered. Though partial graft failure occurred in two cases, they healed completely by secondary healing in 2 weeks.Conclusion: A continuous-instillation NPWT system using an IV line could be an adjunctive modality in treating complex wounds at institutions where commercial NPWTi systems are not readily available.

Utility of negative‐pressure wound therapy for orocutaneous and pharyngocutaneous fistula following head and neck surgery

Head & Neck ◽  
2019 ◽  
Vol 42 (1) ◽  
pp. 103-110 ◽  
Author(s):  
Yusuke Inatomi ◽  
Hideki Kadota ◽  
Sei Yoshida ◽  
Kenichi Kamizono ◽  
Ryo Shimamoto ◽  
...  
Keyword(s):  
Head And Neck ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Pharyngocutaneous Fistula ◽  
Wound Therapy

The use of negative pressure wound therapy in the primary setting for high-risk head and neck surgery

2020 ◽  
Vol 41 (4) ◽  
pp. 102470
Author(s):  
Quinn F. O'Malley ◽  
John R. Sims ◽  
Mykayla L. Sandler ◽  
Hannah Spitzer ◽  
Mark L. Urken
Keyword(s):  
High Risk ◽  
Head And Neck ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Wound Therapy

scholarly journals Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions

2020 ◽  
Vol 53 (01) ◽  
pp. 090-096
Author(s):  
Ravikiran Naalla ◽  
Smriti Bhushan ◽  
Minhaj Ul Abedin ◽  
Ashish Dhanraj Bichpuriya ◽  
Maneesh Singhal
Keyword(s):  
Dead Space ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Wound Dehiscence ◽  
Suture Line ◽  
Wound Therapy ◽  
Flap Coverage ◽  
The Mean ◽  
Complex Wounds

Abstract Background Persistent dead space following flap cover is a frequently encountered challenge following the reconstruction of complex wounds. It may lead to a hematoma, seroma, wound infection, and wound dehiscence. Wound dehiscence could be a devastating complication. Closed incisional negative pressure wound therapy (ciNPWT) over the surgical incisions was found to reduce surgical site infection (SSI) and wound dehiscence. We applied this principle at the closed flap suture line and through this article, we share the indications, technique, and outcomes. Methods A retrospective analysis (January 2018–June 2019), in which selected high-risk patients who underwent ciNPWT at the flap suture following complex reconstruction (pedicled or free flap) were included in the study. The indications include deep incisional/organ SSI after debridement and flap coverage, persistent dead space following flap coverage, chronic osteomyelitis. Patients were analyzed in the follow-up period in terms of complications, wound healing. Results Nine patients underwent ciNPWT over the flap suture line. The mean age was 32.2 years (range: 10–48 years). The mean duration of the NPWT application was 7.3 days (range: 3–21 days). Three of the nine patients had flap-related minor complications. One patient had marginal flap necrosis and required skin grafting, one patient had minor wound dehiscence (1 cm) which required secondary skin suturing and one patient had chronic discharging sinus related to osteomyelitis of ischium, which subsequently healed with antibiotics and local wound care. None of the patients had NPWT-related complications. Conclusion Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.

scholarly journals False vocal cord perforation with abscess treated by negative pressure wound therapy

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091541
Author(s):  
Seiichiro Makihara ◽  
Shin Kariya ◽  
Tomoyuki Naito ◽  
Kensuke Uraguchi ◽  
Junya Matsumoto ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Neck Surgery ◽  
Retropharyngeal Abscess ◽  
Pharyngocutaneous Fistula ◽  
Wound Therapy ◽  
Pedicle Flap ◽  
False Vocal ◽  
Chyle Fistula

Perforation of the larynx is very rare but may result in severe airway complications that include pneumothorax, pneumonia, mediastinitis, and retropharyngeal abscess. If conservative treatment fails, aggressive treatments including reconstructive surgery with pedicle flap are considered. Negative pressure wound therapy has been used for large skin defects, necrotizing fasciitis, pharyngocutaneous fistula, stoma dehiscence, osteoradionecrosis of the mandible, chyle fistula, flap failure, and lymphangioma in the field of head and neck surgery. We report a case of false vocal cord perforation with abscess successfully treated by negative pressure wound therapy after abscess treatment. The result suggests that negative pressure wound therapy can be an alternative or adjunctive approach for larynx perforation when the perforation is difficult to close after conservative therapy.

Negative-Pressure Wound Therapy in Foot and Ankle Surgery

2019 ◽  
Vol 41 (3) ◽  
pp. 364-372
Author(s):  
Kyle N. Kunze ◽  
Kamran S. Hamid ◽  
Simon Lee ◽  
Jason J. Halvorson ◽  
Jeffrey S. Earhart ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Free Flaps ◽  
Foot And Ankle ◽  
Bacterial Concentration ◽  
Wound Therapy ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Tissue Grafts ◽  
Complex Wounds

Negative Pressure Wound Therapy (NPWT) is frequently utilized to manage complex wounds, however its mechanisms of healing remain poorly understood. Changes in growth factor expression, micro- and macro-deformation, blood flow, exudate removal, and bacterial concentration within the wound bed are thought to play a role. NPWT is gaining widespread usage in foot and ankle surgery, including the management of traumatic wounds; diabetic and neuropathic ulcers; wounds left open after debridement for infection or dehiscence; high-risk, closed incisions; tissue grafts and free flaps. This article reviews the rationale for NPWT, its proposed mechanisms of action, and the evidence regarding its clinical applications within the field of foot and ankle surgery. Level of Evidence: Level V, expert opinion.

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