Abstract:ObjectiveTo present our institution's experience with negative-pressure wound therapy (NPWT) as an adjuvant in wound healing of patients who have undergone revision total hip arthroplasty (THA) due to septic loosening in the presence of active fistula.MethodsWe prospectively assessed patients presenting with THA infection, associated with the presence of fistula, treated with a PICO® device for NPWT, in combination with the standard treatment for prosthesis infection in our institution. Resolution of the infec… Show more
“…Despite that, a higher incidence of wound problems or haematoma formation in our population was not confirmed. Wound healing problems are more frequent in RHA 21 . Our results stay in line with Ashraf et al, who showed that in RHA suction drainage did not protect against wound oozing and haematoma formation 22 .…”
Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.
“…Despite that, a higher incidence of wound problems or haematoma formation in our population was not confirmed. Wound healing problems are more frequent in RHA 21 . Our results stay in line with Ashraf et al, who showed that in RHA suction drainage did not protect against wound oozing and haematoma formation 22 .…”
Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.
“…Despite that, a higher incidence of wound problems or haematoma formation in our population was not con rmed. Wound healing problems are more frequent in RHA [20].…”
Background:Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA.Material and Methods:A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up.Results:Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p=0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p=0.0496). In terms of the other analyzed parameters, statistical differences were not found. Conclusion:Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.
“…Another study focused on the interest of CiNPWT after post-SSI revision of orthopedic implants [26] for total hip arthroplasty (THA) due to septic loosening in the presence of active fistula. They were treated with a PICO® device for NPWT, in combination with the standard treatment for prosthesis infection.…”
Mechanotherapy of postoperative scarring is considered an effective measure to prevent pathological scars. Tension increases suture line enlargement, opening the way to infection. Several options have been proposed since decades and are currently used in practice, from adhesive sutures to adhesive dressings, reapproximation devices, and postoperative negative pressure. Closed incision negative pressure therapy (ciNPT) was recently proposed in at-risk patients, showing a significant difference in prevention of infection. These technologies offer a double effect of mechanical stabilization and aspiration of exudates and have recently been extended to different clinical indications. This chapter describes the recently developed technologies to diminish scar enlargement on a suture line and to prevent infection after extensive surgical procedures in thoracic, abdominal, plastic and orthopedic surgery.
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