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Surgical Technology International XXVI contains 50 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
2015 - ISSN:1090-3941
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Wound Healing
Negative Pressure Wound Therapy with Instillation: Past, Present, and Future
Paul J. Kim, DPM, MS, FACFAS, Associate Professor, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, Christopher E. Attinger MD, FACS, Professor, Interim Department Chair, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, John S. Steinberg DPM, FACFAS, Associate Professor, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, Karen K. Evans MD, FACS, Associate Professor, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
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Negative pressure wound therapy with instillation (NPWTi) is a novel treatment option that provides the combination of negative pressure with intermittent instillation of a solution. Standard Negative Pressure Wound Therapy (NPWT) is an established adjunctive treatment option that offers the ability to promote granulation tissue in wounds. However, there is limited evidence for its utility in the environment of active or senescent infection. Wounds that are acutely infected or that contain deleterious biofilm are a challenging problem, which require an intensive multimodal approach including antibiosis, surgical intervention, and local wound care. Adjunctive application of NPWTi can potentially expedite clearance of infection and wound closure. Although this technology has been commercially available for over a decade, its adoption has been limited. Recently, there has been a resurgence of interest in this therapy with emerging evidence from animal models as well as human clinical studies. There are remaining questions regarding NPWTi including the selection of the optimal instillation solution and device settings. This article discusses the past development, current knowledge, and future direction of NPWTi.
Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review
Kevin Y. Woo, PhD, RN, FAPWCA, Assistant Professor, School of Nursing, Queen’s University, Kingston, Canada, Wound Care Consultant, West Park Healthcare Center, Toronto, Canada, Enid Wai-Yung Kwong, PhD, Associate Professor, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China, Carolina Jimenez, Research Assistant, Queen’s University, Kingston, Canada, Richard Bishop RN, BScN, IIWCC, Professional Practice Clinician, Skin and Wound Care, Halton Healthcare Services, Oakville, Ontario
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Pilonidal disease (PD) is a chronic and debilitating condition. The overall aim of the scoping review is to map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention. Review of this cumulative body of evidence will inform care and guide dressing selection for PD related wounds and delineate future research priorities based on identified knowledge gaps and clinical practice issues. Overall, there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing. Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden. Finally, silver, honey, and hydrocolloid dressings may help alleviate wound related pain. However, evidence remains insufficient in light of methodological limitations and biases of the studies.
Gentian Violet and Methylene Blue Polyvinyl Alcohol Foam Antibacterial Dressing as a Viable Form of Autolytic Debridement in the Wound Bed
Andrew Joseph Applewhite, MD, Physician, Baylor Wound Center, Dallas, Texas, Paul Attar, PhD, MBA, President, Bridge PTS, San Antonio, Texas, Brock Liden, DPM, Staff, Circleville Foot & Ankle Center, Reynoldsburg Podiatry Center, Reynoldsburg, Ohio, Quyen Stevenson, ARNP, CWOCN, Wound and Ostomy Nurse Practitioner, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
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The objective of this article is to describe the results of a comparative porcine study that evaluated the effectiveness of a gentian violet and methylene blue (GV/MB) polyvinyl alcohol (PVA) antibacterial foam dressing in debriding eschar. The authors performed an in vivo, preclinical study on eschar-covered porcine wounds. Two clinical case studies are also included. Test products, GV/MB antibacterial foam dressing, collagenase ointment, collagenase ointment plus GV/MB antibacterial foam dressing, medical-grade honey, and moist gauze dressing (control), were applied to porcine wounds using a split-back study design. The percent of eschar removal and wound closure were measured and recorded at time points up to 14 days. Statistically significant reduction in eschar was observed with GV/MB dressing and with GV/MB dressing with collagenase. By day 14, the wounds with GV/MB dressing alone and GV/MB dressing with collagenase had eschar covering less than 25% of the wound bed area compared with collagenase alone, medical grade honey, or moist gauze control, which showed eschar still covering over 75% of the wound bed area. Autolytic debridement activity of GV/MB foam dressings was evident in the porcine eschar study, as well as in the cases described.
Glenn J. Butler, CEO, Technical Director, Hyperbaric Medicine CenterLife Support Technologies Group, Winthrop University Hospital, Westchester Medical Center, Tarrytown, NY, Minneola, NY, Valhalla, NY, David Kenyon, BME, Principal Engineer, Hamilton Research, Ltd., Tarrytown, NY, Scott Gorenstein, MD, Clinical Director, Division of Regenerative Medicine, Winthrop University Hospital, Mineola, NY, Thomas Davenport, MD, Attending Physician, Long Island Group for Plastic Surgery (LIPSG)., Garden City, NY, Director, Surgical Wound Care, inthrop University Hospital, Mineola, NY, Associate Professor, SUNY, Stony Brook, NY, Edward Golembe, MD, Director, Skin Integrity Service, Westchester Medical Center, Valahalla, NY, Bok Lee, MD, Professor, Department of Surgery, New York Medical College, Valhalla, NY, Clinical Research Chief, Life Support Technologies Group, Jacques Vieweq, Test Program Engineer, Life Support Technologies Group, Tarrytown, NY
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The development and management of pressure ulcers (PUs) among hospital and nursing home patients is one of the greatest preventable challenges to healthcare worldwide. For over 50 years, pressure mapping and subjective comfort has been the primary indicators for mattress selection. Our research demonstrates that mattress/patient interface pressure and relative blood/oxygen perfusion do not inversely correlate and pressure is not a meaningful, real-time indicator of tissue ischemia and risk of pressure ulcer development. Developed in our research is a real-time sensor system to simultaneously measure and record these parameters over the anatomical sites at risk for PUs. Measurements focused on the heel, sacrum, trochanter, ischium, scapula and occipital. A modified pressure mapping system is used for interface pressure measurements and integrated with multiple near-infrared sensors to measure specific deep tissue hemoglobin saturated oxygen or rSO2. Testing and mattress design development was done during the period of 2008 to present. Over 200 human tests of commercially available mattresses were conducted in supine, 30 degree, and 70 degree positions, ranging in times of up to four hours. During this time period, we utilized 20 test subjects—eight female and 12 male—with ages ranging from 18 to 65 years. The result of this proprietary off-loading device evaluation and design system shows that the new Oxy-Mat™ (Off-Loading Technologies, Tarrytown, NY) Non-Powered Mattress System consistently provides optimized tissue perfusion as measured by natural deep tissue oxygen saturation levels. In extensive laboratory and clinical evaluations, the Oxy-Mat™ was shown to be functionally superior to CMS Group 2 powered mattresses. Another outcome of our research was that a powered mattress system may not be appropriate for most sensate and semi-ambulatory patients. Further research is underway.
