Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers

Giri, Prakriti; Krishnaraj, Balamourougan; Sistla, Sarath Chandra; Sistla, Sujatha; Basu, Debdatta; Shankar, Gowri; Akkilagunta, Sujiv; Ruparelia, Jigish

doi:10.1016/j.amsu.2020.12.015

Cited by 14 publications

(14 citation statements)

References 26 publications

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“…Recent randomised controlled trials (RCTs) have directly compared standard NPWT with antiseptic or saline irrigation in complex foot infections and found no significant difference in outcomes [13,14]. Conversely, another RCT reported improved granulation tissue, reduced wound surface area and reduced bacterial load in extremity ulcers in NPWT with saline instillation over standard NPWT [4]. We highlight the paucity of controlled clinical studies for the use of NPWT irrigation in orthopaedic patients.…”

Section: Discussionmentioning

confidence: 87%

“…Both saline and antiseptic fluids have demonstrated a significant reduction in bacterial load over control in a porcine model [15], and similar effectiveness in NPWT instillation [16]. Additionally, saline has demonstrated a greater proportion of surgical wound closure, better wound healing, reduced hospital stay, reduced length of therapy and greater cost-effectiveness [4,5,17] and is recommended as first-line by the international consensus guidelines [18]. The guidelines also recommended an antiseptic solution if hardware is involved for the initial 24-48 h, followed by saline instillation, which avoids the cytotoxic effect that accompanies long-term use.…”

Section: Discussionmentioning

confidence: 99%

“…The local subatmospheric pressure and fluid drainage are proposed to aid the formation of granulation tissue, increase blood flow and reduce oedema to improve wound healing [3]. Modified NPWT techniques have been extensively used in wounds of mixed aetiologies such as laparotomy wounds, extremity ulcers and spinal wounds [4,5]. Some of these modified techniques are now being explored in orthopaedic wounds as an adjunct to antibiotic therapy and surgical debridement in implant salvage procedures.…”

Section: Introductionmentioning

confidence: 99%

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Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

Summers

Daniels

Thahir

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Infected orthopaedic metalwork is challenging to treat. Negative pressure wound therapy (NPWT) with irrigation is an emerging therapy for infected wounds as an adjunct to antibiotic therapy. The senior author had devised a modified technique to augment its efficacy, utilising high-flow rate irrigation and skin closure over the standard NPWT dressing. This novel technique was originally evaluated in a different centre and produced 100% success in metalwork retention. The present study is a reproducibility test of the same technique. Methods A retrospective review was performed on 24 patients with infected orthopaedic metalwork, including 3 upper limb and 21 lower limb cases, for outcomes relating to implant retention and infection resolution. Patients underwent a modified NPWT technique as an adjunct to antibiotic therapy and surgical debridement. Detailed medical and microbiology information were obtained from the patient records. Results 23 of 24 (96%) patients had successful metalwork retainment with healed wounds and resolution of infection, allowing fracture union. 27 infective organisms were identified in this cohort, and the antibiotic regimens for each patient are provided. The average follow-up was 663 days. No adverse effects were observed. Conclusion This series supports the modified NPWT technique as a safe, reliable and effective adjunct therapy to resolve metalwork infection. The same results have been reproduced as the previous cohort in a different centre.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

Summers

Daniels

Thahir

et al. 2021

Eur J Orthop Surg Traumatol

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“…Considering its anti‐virulence properties, we hypothesised that ace‐K could be applied directly on an established biofilm to disrupt it. To initially assess this, A. baumannii AB5075 colony biofilms were grown and subsequently exposed to a wash with an 8.85% ace‐K solution, simulating a wash/irrigation of a chronically infected wound (Giri et al , 2020 ; Lewis & Pay, 2022 ). This treatment, when compared to an untreated biofilm and to a water wash control, led to a 3.5 log reduction in the number of viable cells within an AB5075 biofilm (Fig 8A ).…”

Section: Resultsmentioning

confidence: 99%

Artificial sweeteners inhibit multidrug‐resistant pathogen growth and potentiate antibiotic activity

et al. 2022

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Antimicrobial resistance is one of the most pressing concerns of our time. The human diet is rich with compounds that alter bacterial gut communities and virulence-associated behaviours, suggesting food additives may be a niche for the discovery of novel anti-virulence compounds. Here, we identify three artificial sweeteners, saccharin, cyclamate and acesulfame-K (ace-K), that have a major growth inhibitory effect on priority pathogens. We further characterise the impact of ace-K on multidrug-resistant Acinetobacter baumannii, demonstrating that it can disable virulence behaviours such as biofilm formation, motility and the ability to acquire exogenous antibiotic-resistant genes. Further analysis revealed the mechanism of growth inhibition is through bulgemediated cell lysis and that cells can be rescued by cation supplementation. Antibiotic sensitivity assays demonstrated that at sublethal concentrations, ace-K can resensitise A. baumannii to last resort antibiotics, including carbapenems. Using a novel ex vivo porcine skin wound model, we show that ace-K antimicrobial activity is maintained in the wound microenvironment. Our findings demonstrate the influence of artificial sweeteners on pathogen behaviour and uncover their therapeutic potential.

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“…Results from several studies have demonstrated the selective effect of NPWT in eliminating non-fermentative gram-negative bacilli in wounds [36] . Additionally, NPWT can be combined with additional topical antimicrobial solutions, reducing bacteria load, stimulating wound closure and decreasing wound size faster than conventional NPWT [36,61,62].…”

Section: Negative-pressure Wound Therapymentioning

confidence: 99%

Current and advanced therapies for chronic wound infection

2022

Pharmaceutical Journal

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A wound is any injury that disrupts the structure of healthy skin tissue caused by chemical, mechanical, biological or thermal trauma. Wounds can be classified as acute or chronic, depending on their period of healing [1]. Acute wounds usually heal without complication within ten days; however, chronic wounds do not undergo normal healing processes, commonly have exaggerated inflammation, persistent infections or microbial biofilm formation and persist longer than six weeks [2][3][4]. The most frequent underlying causes of chronic wounds are pressure, diabetes and vascular diseases [5].

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Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers

Cited by 14 publications

References 26 publications

Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

Artificial sweeteners inhibit multidrug‐resistant pathogen growth and potentiate antibiotic activity

Current and advanced therapies for chronic wound infection

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