Faculty Bibliography

Background Negative pressure wound dressings have revolutionized the treatment of open wounds by stimulating the formation of granulation tissue and hastening wound closure. We hypothesized that negative pressure therapy in the immediate postoperative period after total knee arthroplasty (TKA) in high-risk patients would also hasten the time to a dry wound. Methods This prospective, randomized trial compared the number of days to a dry wound after TKA with application of a negative pressure dressing compared with sterile gauze dressing in 51 patients undergoing 60 TKA surgeries (9 bilateral). Patients undergoing primary TKA who were obese (BMIZ30) and received enoxaparin were randomized to receive either a negative pressure dressing or sterile gauze for 48 hours postoperatively. The days to a dry wound, total weight of drainage, number of gauze dressings used, duration of hospital stay and infection rate were recorded. Results Twenty-four knees received negative pressure therapy and 36 knees had sterile gauze placed. There was no significant difference in the primary endpoint of days to a dry wound (4.3 days with negative pressure and 4.1 days with sterile gauze). There were two postoperative infections, one in each arm of the study. The study was stopped prematurely when 15 of 24 knees (63%) treated with the negative pressure wound dressing developed skin blisters. Conclusions Negative pressure wound therapy did not appear to hasten wound closure and was associated with blisters. There does not appear to be a benefit to the routine use of negative pressure wound dressings in the immediate postoperative TKA period. 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins

Wound care clinicians have a wide array of available treatment options to manage and help heal acute and chronic complex wounds that require a systematized and comprehensive approach to address the complexity of wound care and to optimize patient outcomes. The treatment of wounds represents a major cost to society. Public policies increasingly focus on quality of care, patient outcomes, and lowering costs. Wound care clinicians are not immune to these pressures. Wound care clinicians must ensure that their assessments, treatment pathways, and product selections are both clinically and economically sound. Negative pressure wound therapy (NPWT) has been demonstrated to be an efficacious option to promote healing in a variety of acute and chronic complex wounds. Previous guidelines on the use of NPWT have focused on application but have not provided recommendations on when it is most appropriate to use NPWT; there are few criteria for 1) when to initiate NPWT based on various wound types, 2) pre-application management to optimize treatment outcomes, 3) identification of appropriate candidates for NPWT, 4) benchmark indicators for treatment response, and 5) recommendations on when to transition between NPWT and moist wound healing (MWH) or another treatment mooality. In September 2009, an international panel of wound care experts from multiple disciplines convened to develop a document to guide clinicians in making decisions about the appropriate use of NPWT within the spectrum of wound healing. Where empirical research was lacking, clinical experiences and patient factors were considered to ensure the clinical utility of the document. The goal of these guidelines is to encourage responsible wound management across the healthcare continuum and spectrum of wound pathologies to achieve positive, cost-effective patient outcomes

Background: When challenged with extremity wounds that require further debridement, edema reduction and decreased bacterial content, temporarily implanting vacuum-assisted closure reticulated open-cell foam dressings is an effective adjunct for temporary wound closure and results in enhanced flap tissue survival. Methods: A retrospective review was performed in 13 consecutive patients with a lower extremity surgical wound and exposed hardware, joint, tendon or bone who received the two-stage wound closure treatment. Primary endpoints included time to closure, total wound duration, and wound closure status upon discharge. Results: Mean time from the initial procedure until definitive closure was 4 days (range, 2-8 days). Mean wound duration before the procedure was 54 days (range, 5-120 days). All 13 wounds had delayed primary closure or random pattern flap upon discharge and remained closed throughout the length of follow-up. Conclusions: Temporarily implanted vacuum-assisted closure may be a safe and effective adjunctive therapy when applied to the undersurface of newly developed flaps

The use of TNP on infected open wounds with exposed orthopaedic implants has not yet been described in the literature. Here, its application on these wounds accelerated healing and enabled definitive wound closure to be undertaken

Nine patients (7 men, 2 women) with external nasal deviation underwent corrective procedures using a monobloc nasal osteotomy technique. The deformities ranged from mild to severe. Eight patients had post-traumatic deviations, whereas 1 had a unilateral cleft nasal deformity. For this monobloc technique, osteotomies were performed at unequal levels to correct the height difference, no periosteal undermining was performed, and septal dissection was undertaken only after monobloc repositioning. There was no need for grafts or microplate fixation. Minimum follow-up was 8 months. All patients had improvement in their external deviation, 1 patient was mildly undercorrected, and only 1 patient (cleft nasal) required a radical submucosal resection