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

Selina Summers1  · Natasha Faye Daniels1  · Azeem Thahir1,2 · Matija Krkovic2

Received: 6 July 2021 / Accepted: 24 September 2021 / Published online: 2 October 2021 © The Author(s) 2021

Abstract

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.

Keywords Saline solution · Vacuum-assisted closure · Negative pressure wound therapy · Infected orthopaedic metalwork · Hardware salvage

Selina Summers

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1 School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0SP, UK

2 Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK

Prophylactic negative‑pressure wound therapy for prevention of surgical site infection in abdominal surgery: a nationwide cross‑sectional survey

Elin Roos1,4 · Jonathan Douissard2,3 · Ziad Abbassi2,3 · Nicolas C. Buchs2,3 · Christian Toso2,3 · Frédéric Ris2,3 · Jeremy Meyer2,3

Received: 4 February 2021 / Accepted: 1 March 2021 / Published online: 10 April 2021 © The Author(s) 2021

Abstract

Our objective was to determine current practice in Switzerland regarding the use of pNPWT in abdominal surgery. An online survey was carried out to evaluate the use of pNPWT among abdominal surgeons in Switzerland. One hundred and ten participants replied to the survey from 16.12.2019 to 15.01.2020. Eleven were excluded, leaving 99 responders for analysis. Seventy participants (70.7%) were using pNPWT, 3 (3%) have stopped using it and 26 (26.3%) have never used it. pNPWT was used on midline laparotomy by 63 responders (90%), closed stoma wounds by 21 (30%), closed perineal wounds by 20 (28.6%), Pfannenstiel incisions by 18 (23.7%), groin incisions by 16 (22.9%), subcostal incisions by 13 (18.6%), Mc Burney incisions by 3 (4.3%) and other incisions by 18 (25.7%). Forty-eight participants (68.6%) used pNPWT on less than 10% of patients, 14 (20%) on 10–25% of patients, six (8.6%) on 25–50% of patients and two (2.9%) on 75–100% of patients. Suggestions for improvement to pNPWT were: better sealing, recyclable system, better adaptation to the perineum, smaller device, reduced cost and possibility to check the surgical wound through the dressing. In conclusion, pNPWT is widely used among Swiss surgeons, mostly on midline incisions. However, most of them apply pNPWT on a small proportion of patients only. Suggestions for improvement were a better sealing for complex wounds, reduced cost and possibility to check the wound during the therapy.

Keywords Negative therapy · Negative-pressure therapy · PREVENA · PICO

Abbreviations

pNPWT Prophylactic negative-pressure wound therapy

SSI Surgical site infection

Jeremy Meyer

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1 Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden

2 Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland

3 Medical School, University of Geneva, 1205 Genève, Switzerland

4 County Council of Östergötland, Linköping University, Linköping, Sweden

Severe wound infection by MRCNS following bilateral inguinal herniorrhaphy

Yao Du1,2†, Song Han1†, Yue Zhou1†, Hai Feng Chen3†, Yao Liang Lu1 , Zhi Yuan Kong1 and Wei Ping Li1*

† Yao Du, Song Han, Yue Zhou and Hai Feng Chen contributed equally to this

*Correspondence:

Wei Ping Li

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1 Department of General Surgery, The First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City 215400, Jiangsu Province, China

2 Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang City 330006, Jiangxi Province, China

3 Department of Gastroenterology, The First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City 215400, Jiangsu Province, China

Abstract

Background Wound infection after inguinal hernia surgery is not uncommon in the clinical setting. The common microbial aetiology of postoperative inguinal hernia wound infection is Gram-positive bacteria. Staphylococcus aureus is a common pathogen causing wound infection while Staphylococcus epidermidis and Pseudomonas are rare. Staphyococcus epidermidis as a cause of severe wound infection is rarely described in literature. We herein present a case of a 79-year-old man with a rare wound infection after bilateral inguinal herniorrhaphy caused by MRCNS (Methicillin Resistant Coagulase Negative Staphylococcus).

Case presentation We present a case of wound infection accompanied by fever with a temperature of 38.8 °C after bilateral inguinal herniorrhaphy in a 79-year-old man. Bilateral inguinal wounds were marked by redness and swelling, with skin necrosis. In addition, an abscess of approximately 1.5 cm×1.5 cm was seen on the left wrist. A small amount of gas under the skin in the wound area was observed after pelvic computed tomography (CT) scans. No bacteria were cultured from the inguinal wound discharge, while blood culture detected MRCNS, and Acinetobacter lwoffi was cultured from the pus in the left wrist. We chose appropriate antibiotics based on the results of the bacterial culture and the drug susceptibility results. Vacuum assisted closure (VAC) therapy was used after debridement. The patient was discharged after the wounds improved. He was followed up for ten months and showed no signs of complications. We are sharing our experience along with literature review.

Conclusions We are presenting a rare case of MRCNS wound infection following open inguinal hernia surgery. Although a rarity, clinicians performing inguinal hernia surgery must consider this entity in an infected wound and follow up the patient for complications of MRCNS.

Keywords MRCNS, Wound infection, Hernia, Inguinal

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Study protocol for a cluster randomised trial of sterile glove and instrument change at the time of wound closure to reduce surgical site infection in low- and middleincome countries (CHEETAH)

NIHR Global Health Research Unit on Global Surgery

Abstract

Background: Surgical site infection (SSI) represents a major burden for patients, doctors, and health systems around the world. The aim of this trial is to assess whether the practice of using separate sterile gloves and instruments to close wounds at the end of surgery compared to current routine hospital practice can reduce surgical site infection at 30-days post-surgery for patients undergoing clean-contaminated, contaminated, or dirty abdominal surgery.

Methods: This study protocol describes a pragmatic, international, multi-centre, 2-arm, cluster randomised controlled trial, with an internal pilot. Clusters are defined as hospitals within low- and middle-income countries (LMICs) defined by the Development Assistance Committee (DAC) Official Development Assistance (ODA) list, where there are at least 4 eligible hospitals per country. Hospitals (clusters) must be in LMICs where glove and instrument change are not currently routine practice. Patients (adults and children) undergoing emergency or elective abdominal surgery for a clean-contaminated, contaminated, or dirty operation are eligible for inclusion. Before closing the abdominal wall, surgeons and the scrub nurse will change gloves and use separate, sterile instruments (intervention), versus no changing gloves or using separate, sterile instruments (standard practice, control). The primary outcome is SSI within 30 days after surgery, using the Centre for Disease Control (CDC) criteria. Secondary outcomes are SSI before point of hospital discharge, and readmission, reoperation, length of hospital stay, return to normal activities, and death up to 30-days after surgery. A 12-month internal pilot, including 12 clusters and approximately 600 participants, aims to assess adherence to allocation and follow-up of patients. The main trial is powered to detect a minimum reduction in the primary outcome from 16 to 12%. A total of 12,800 participants will be recruited from 64 clusters (hospitals) each including at least 200 participants.

Discussion: Change of gloves and sterile instruments prior to fascial closure in abdominal surgery is a low-cost, simple, intraoperative intervention which involves all members of the surgical and scrub team. If effective at reducing SSI, this practice could be readily implemented across all contexts. The findings of this trial will inform future guideline updates from international healthcare organisations, including the World Health Organization.

Trial registration: ClinicalTrials.gov NCT03980652. Registered on 9 July 2019

Keywords: Surgical site infection, Sterile gloves and instruments, Infection control, Cluster randomised trial, Study protocol, Abdominal surgery, Gastrointestinal surgery

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NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B152TH, UK

© The Author(s). 2022, corrected publication 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/ licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Surgical site infection after wound closure with staples versus sutures in elective knee and hip arthroplasty: a systematic review and meta-analysis

A. van de Kuit1 , R. J. Krishnan2 , W. H. Mallee3 , L. M. Goedhart4 , B. Lambert4 , J. N. Doornberg4*, T. M. J. S. Vervest5 and J. Martin2

Abstract

Purpose: This systematic review and meta-analysis aimed to study surgical site infection of wound closure using staples versus sutures in elective knee and hip arthroplasties.

Methods: A systematic literature review was performed to search for randomized controlled trials that compared surgical site infection after wound closure using staples versus sutures in elective knee and hip arthroplasties. The primary outcome was surgical site infection. The risk of bias was assessed with the Cochrane risk of bias assessment tool. The relative risk and 95% confidence interval with a random-effects model were assessed.

Results: Eight studies were included in this study, including 2 studies with a low risk of bias, 4 studies having ‘some concerns’, and 2 studies with high risk of bias. Significant difference was not found in the risk of SSI for patients with staples (n= 557) versus sutures (n= 573) (RR: 1.70, 95% CI: 0.94–3.08, I 2 =16%). The results were similar after excluding the studies with a high risk of bias (RR: 1.67, 95% CI: 0.91–3.07, I 2= 32%). Analysis of studies with low risk of bias revealed a significantly higher risk of surgical site infection in patients with staples (n=331) compared to sutures (n= ( 331) (RR: 2.56, 95% CI: 1.20–5.44, I 2=0%). There was no difference between continuous and interrupted sutures P> 0.05). In hip arthroplasty, stapling carried a significantly higher risk of surgical site infection than suturing (RR: 2.51, 95% CI: 1.15–5.50, I 2 I 2=22%; P>0.05). =0%), but there was no significant difference in knee arthroplasty (RR: 0.87, 95% CI: 0.33–2.25,

Conclusions: Stapling might carry a higher risk of surgical site infection than suturing in elective knee and hip arthroplasties, especially in hip arthroplasty.

Keywords: Surgical site infection, Wound closure, Total knee replacement, Total hip replacement, Arthroplasty, Systematic review

*Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 4 Department of Orthopaedics, University Medical Center Groningen, Postbus 30.001, 9700 RB Groningen, The Netherlands Full list of author information is available at the end of the article

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or

other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound comparative efectiveness trial

Jayne Joo1  · Aunna Pourang1  · Catherine N. Tchanque‑Fossuo2  · April W. Armstrong3  · Danielle M. Tartar1  · Thomas H. King4  · Raja K. Sivamani1,5,6,7 · Daniel B. Eisen1

Received: 28 May 2021 / Revised: 28 August 2021 / Accepted: 3 September 2021 / Published online: 21 September 2021 © The Author(s) 2021

Abstract

Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older,

undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of≥3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P=.60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.

Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859.

Keywords Cutaneous closure technique · Cutaneous surgery · Scar evaluation · Undermining · Wound tension

Jayne Joo and Aunna Pourang have contributed equally to this * Daniel B. Eisen 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA 95816, USA

2 Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, NM, USA

3 Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA

4 Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, CA, USA

5 Department of Biological Sciences, California State University, Sacramento, CA, USA

6 College of Medicine, California Northstate University, Elk Grove, CA, USA

7 Pacific Skin Institute, Sacramento, CA, USA