Blood Flow Responses in the Peristernal Thoracic Wall During Vacuum-Assisted Closure Therapy

Wackenfors, Angelica; Gustafsson, Ronny; Sjögren, Johan; Algotsson, Lars; Ingemansson, Richard; Malmsjö, Malin

doi:10.1016/j.athoracsur.2004.10.053

Cited by 189 publications

(208 citation statements)

References 25 publications

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“…9 Wound surface area reduction was significantly larger in NPWT treated wounds compared to conventionally managed wounds. 10 While close to the wound edge relative hypoperfusion was observed in muscular tissue, the distance from the wound edge to the position at which the blood flow was increased was shorter than that in subcutaneous tissue. The hypoperfused zone was larger at high negative pressures and was especially prominent in subcutaneous tissue.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12] In an experimental study conducted on rabbits, it was found that NPWT increased the blood circulation in the wounds by increasing the capillary calibre and blood volume and by stimulating angiogenesis. Further, it narrowed endothelial spaces and restored the integrity of capillary basement membranes causing a decrease in the permeability of blood vessels and wound oedema by removing excessive fluid from the wound bed.…”

Section: Discussionmentioning

confidence: 99%

“…It may be beneficial to tailor the negative pressure used for NPWT therapy according to the wound tissue composition. 10 Studies have shown that when NPWT therapy was terminated, blood flow increased multifold, which may be due to reactive hyperemia. A low negative pressure during treatment may be beneficial, especially in soft tissue, to minimize possible ischemic effects.…”

Section: Discussionmentioning

confidence: 99%

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Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

et al. 2017

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Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used. Most of the patients improved with the NPWT. No major complications were seen.Conclusions: NPWT is safe, effective and has proved to be revolutionary in managing difficult wounds. With the use of customized low cost NPWT the benefit can be extended to underprivileged population in under developed nations too.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

et al. 2017

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“…Although this is a small retrospective study (n = 40), it suggests that there may be a benefit to SR that is likely multifactorial in nature [20]. The other hypothetical local control benefits with SR include faster time to adjuvant RT [29,30] and a decrease in wound hypoxia with NPWT, which may lead to improved radiation efficacy [31,32]. Final margin status is considered the primary contributor to SR's local control benefit and likely played a role in the lower cost noted with SR.…”

Section: Discussionmentioning

confidence: 99%

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Naghavi

Gonzalez

Scott

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methods: A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.Results: Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).Conclusions: In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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“…182 Although there is no standard protocol yet, a negative pressure of 125 mm Hg has been suggested as the baseline setting for all wounds and lower negative pressure needs to be tailored for soft tissue to minimize potential ischemic effects. 183 Mechanisms that can be attributed to the benefits of TNP therapy have been investigated in basic research. The best described mechanisms are an increase in blood flow, 182,184 the promotion of angiogenesis, 185 and granulation tissue formation.…”

Section: Biophysical Cuesmentioning

confidence: 99%

Biochemical and Biophysical Cues in Matrix Design for Chronic and Diabetic Wound Treatment

Xiao

Ahadian

Radišić

2017

Tissue Engineering Part B: Reviews

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Progress in biomaterial science and engineering and increasing knowledge in cell biology have enabled us to develop functional biomaterials providing appropriate biochemical and biophysical cues for tissue regeneration applications. Tissue regeneration is particularly important to treat chronic wounds of people with diabetes. Understanding and controlling the cellular microenvironment of the wound tissue are important to improve the wound healing process. In this study, we review different biochemical (e.g., growth factors, peptides, DNA, and RNA) and biophysical (e.g., topographical guidance, pressure, electrical stimulation, and pulsed electromagnetic field) cues providing a functional and instructive acellular matrix to heal diabetic chronic wounds. The biochemical and biophysical signals generally regulate cell-matrix interactions and cell behavior and function inducing the tissue regeneration for chronic wounds. Some technologies and devices have already been developed and used in the clinic employing biochemical and biophysical cues for wound healing applications. These technologies can be integrated with smart biomaterials to deliver therapeutic agents to the wound tissue in a precise and controllable manner. This review provides useful guidance in understanding molecular mechanisms and signals in the healing of diabetic chronic wounds and in designing instructive biomaterials to treat them.

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Blood Flow Responses in the Peristernal Thoracic Wall During Vacuum-Assisted Closure Therapy

Cited by 189 publications

References 25 publications

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Biochemical and Biophysical Cues in Matrix Design for Chronic and Diabetic Wound Treatment

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