Surgical site infection and other common surgical site complications (dehiscence, hematoma, and seroma formation) can lead to serious and often life-threatening complications. Gauze, adhesive dressings, and skin adhesives have traditionally been utilized for incision management. However, the application of negative pressure wound therapy over clean, closed surgical incisions (closed incision negative pressure therapy, ciNPT), has become a recent option for incision management. A brief review of ciNPT clinical evidence and health economic evidence are presented. A brief literature review was performed using available publication databases (PubMed, Ovid®, Embase®, and QUOSA™) for articles in English reporting on the use of ciNPT between October 1, 2016, to March 31, 2019. The successful application of ciNPT over clean, closed wounds has been reported in a broad spectrum of patients and operative interventions, resulting in favorable clinical results. Four of the five studies that examined health economics following the use of ciNPT reported a potential reduction in the cost of care. The authors' own experience and published results suggest that patients at high risk for developing a surgical site complication may benefit from the use of ciNPT during the immediate postoperative period. Additional studies are needed across various surgical disciplines to further assess the safety, and cost-effectiveness of ciNPT use in patient populations.

BackgroundVarious treatment modalities are utilized to treat the open abdomen. The use of negative pressure wound therapy(NPWT)has been a great advancement and has become the preferred modality for temporary abdominal closure technique (TAC). Programmed instillation of the abdominal cavity with saline solution in conjunction with a commercial negative pressure system showed positive results in the management of severe abdominal sepsis in patients that were treated with an open abdomen. Severe abdominal sepsis continues to be an oftendifficult clinical problem for the general surgeon. The use of an open abdomen technique in this setting and the ideal TAC method continue to be debated. The failure to understand the biomechanical features/limitations of negative pressure devices are often contributing factors associated with therapeutic failures reported in the literature.ObjectivesTo describe the underlying principles behind negative pressure wound therapy with instillation in the context of abdominal sepsis, as well as its optimal usage in these conditions.MethodsA systematic review and two retrospective cohort studies, both published and unpublished performed by some of the authors were included to provide a basis form comparison between NPWT and NPWT-I outcomes in managing abdominal sepsis.ConclusionOur findings suggest that this technique appears to reduce morbidity, mortality, and hospital and critical care length of stay. This communication is intended to help inform general surgeons that manage complex abdominal infections on how to optimally apply this technique.

Candida mediastinitis is a rare complication of open heart surgery with high mortality and morbidity usually associated with C. albicans. We are reporting the case of a 57 year old male who after having a triple coronary artery bypass graft procedure, had mediastinitis caused by Candida famata, a yeast, that had only been reported once before as the causal agent of this condition. It is of vital importance, that future cases be reported, due to the fact that both reported cases have led to patient demise.

Recent therapeutic advances in the management of severe abdominal sepsis (SAS) have improved patient mortality and morbidity. However, SAS and its impact on multiple organ failure remain a serious, life-threatening condition with a high mortality rate. The open abdomen (OA) technique has become an effective alternative to repeat laparotomy. The use of OA negative pressure wound therapy (OA NPWT) has been a significant advancement in the management of the open abdomen. Similarly, negative pressure wound therapy (NPWT) with instillation and dwell time (NPWT-i) has been used in patients with multiple comorbidities, with an American Society of Anesthesiology Classification ≥ 2, severe traumatic wounds, diabetic foot infections, and wounds complicated by invasive infection or extensive biofilm. Controlled instillation of saline during NPWT-i may further enhance healing by facilitating automatic and contained volumetric wound irrigation and cleansing and diluting local levels of inflammatory cytokines, improving the local as well as the systemic response to infection. Although the soft tissue and intra-abdominal compartments differ anatomically, they share very similar biologic responses to infections. Therefore, from a biologic and physiologic aspect, intraperitoneal instillation therapy may play a role as an adjunctive treatment of abdominal compartment inflammation from trauma or infection. The addition of saline solution instillation to OA NPWT (OAI) in a programmed, controlled manner may offer the clinician an effective adjunctive therapy for the treatment of the complex septic abdomen. The technical aspects of instillation into the OA and a pooled multicenter case study cohort utilizing OAI with saline solution, bacitracin, or hypochlorous acid in the management of the septic abdomen is presented.