To the Editor

Abstract

We would like to congratulate our colleagues, Musab U. Saeed and Donald J. Kennedy, on publication of their article "A retained sponge is a complication of vacuumassisted closure therapy." 1 In the August issue of Wounds, we published a similar article about a patient with a chronic fistula in the lower leg 5 years after vacuumassisted closure therapy. 2 On a magnetic resonance imaging scan a 4.5-cm sinus tract was identified. The sinus tract led to a sinus in the center in which a roughly shaped structure was identified, which was suspected to be a foreign body. On exploration in the theater, this turned out to be an old polyurethane sponge.We agree with the authors that a retained sponge is a serious complication and can generate morbidity to the patient. In addition to thorough inspection of the wound cavity and using radio-opaque markers, we suggest not only to note and count the number of pieces of sponge used for a dressing but also to connect separate pieces together. This can be performed with either stitching or stapling different pieces together. Using this method, the loss of foam dressings will be reduced to a minimum because it is impossible to remove 1 dressing piece without removing the other. When all pieces are identified, the staples or stitches can be removed.By performing these simple safety measures, the loss of pieces of sponges can be reduced; thus, avoiding unnecessary physical and psychological discomfort to the patient.

Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients

“…(28) Over half of the patients suffered new-onset or worsening infections related to retained dressing pieces. Further studies have demonstrated that bleeding (29)(30)(31)(32)(33)(34), infection or sepsis related to retained sponges (35)(36)(37)(38)(39)(40)(41), and fistula formation (37,(41)(42)(43) are potential complications of NPWT. We sought, therefore, to determine the new-onset complications within 30 days of NPWT initiation in the outpatient versus inpatient settings.…”