Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China

Liu, Weijiao; Gu, Wei; Jin, Xiaofeng; Wang, Jian

doi:10.2147/idr.s334203

Cited by 4 publications

(11 citation statements)

References 27 publications

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“…In head and neck NF, previous case series have reported success with both frequent wet-to-dry dressing changes [ 3 – 5 ] or NPWT [ 6 – 9 ]. NPWT is thought to promote wound healing by removing secretions from the wound, decreasing the nidus for infection, reducing bacterial burden, and promoting vascularization of the wound bed and the formation of healthy granulation tissue [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The original case series of this rare disease entity reported management of all types of wounds from NF with wet-to-dry dressing changes [ 3 – 5 , 15 ]. NPWT has only recently been applied for management of NF in the head and neck [ 6 – 9 ]. These series found acceptable wound healing outcomes without recurrent or worsening infection.…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, aggressive surgical debridement is still the standard of care, but is complicated by the proximity of infection to vital structures [ 2 , 3 ]. Between and following debridements, NF in the head and neck, as in other sites, is typically managed with either wet to dry dressings [ 3 – 5 ] or negative pressure wound therapy (NPWT) via wound vacuum (wound vac) [ 6 – 8 ] until the wound bed is considered sufficiently well-healed for reconstruction. NPWT has been shown to have improved outcomes in certain infectious settings [ 3 , 6 , 7 ], and inability to use wound vac is associated with prolonged wound care, as well as significant pain from daily or even more frequent dressing changes [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Between and following debridements, NF in the head and neck, as in other sites, is typically managed with either wet to dry dressings [ 3 – 5 ] or negative pressure wound therapy (NPWT) via wound vacuum (wound vac) [ 6 – 8 ] until the wound bed is considered sufficiently well-healed for reconstruction. NPWT has been shown to have improved outcomes in certain infectious settings [ 3 , 6 , 7 ], and inability to use wound vac is associated with prolonged wound care, as well as significant pain from daily or even more frequent dressing changes [ 9 , 10 ]. Difficulty in application of NPWT to complex facial wounds as well as the possibility of damage to the facial structures from negative pressure have limited its application to small case series in the head and neck [ 3 , 6 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…NPWT has been shown to have improved outcomes in certain infectious settings [ 3 , 6 , 7 ], and inability to use wound vac is associated with prolonged wound care, as well as significant pain from daily or even more frequent dressing changes [ 9 , 10 ]. Difficulty in application of NPWT to complex facial wounds as well as the possibility of damage to the facial structures from negative pressure have limited its application to small case series in the head and neck [ 3 , 6 , 8 , 9 ]. In the setting of complicated defects, point-of-care designed custom devices may be considered to maximize the preservation of surrounding vital structures while also promoting maximal wound healing.…”

Section: Introductionmentioning

confidence: 99%

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Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

et al. 2023

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Background Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. Case presentation A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. Conclusions Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

et al. 2023

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The efficacy of negative‐pressure wound therapy for head and neck wounds: A systematic review and update

Onderková,

Butler,

Kalavrezos

2023

Head & Neck

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Despite the established benefits of negative‐pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains under‐explored. This study aimed to systematically review its effectiveness, safety, and comparative efficacy. Thirty‐one studies from a systematic literature search were identified and analyzed for wound healing response, overall success rate, improvements compared to conventional wound care, and variation in pressure settings, treatment lengths, and dressing change frequency. NPWT showed enhanced outcomes across diverse head and neck wounds, particularly complex post‐reconstructive wounds and severe infections. Despite the predominantly case report/series evidence and lack of standardized NPWT protocols, its benefits over conventional care were clear. NPWT emerges as a promising approach for head and neck wound management, potentially improving patient outcomes and reducing complications. More randomized controlled trials are needed to solidify the evidence and standardize NPWT application protocols.

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Comparing vacuum‐assisted closure against conventional approach in severe deep neck infection: A retrospective case‐control study

Wang,

Yang,

et al. 2024

World j. otorhinolaryngol.-head neck surg.

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ObjectivesTo compare the effectiveness of vacuum‐assisted closure (VAC) against traditional drainage technique, using a retrospective case‐control study design, in terms of managing deep neck infections (DNIs).MethodsPatients presenting to Peking Union Medical College Hospital diagnosed with DNIs were recruited in this study. We analyzed the clinical characteristics of DNI patients and divided them into (a) VAC placement group (26 cases) and (b) traditional drainage group (57 cases) according to whether VAC was placed. The differences in length of stay (LOS), wound healing time, and debridement frequency were compared between the two groups.ResultsEighty‐three patients had multiple‐space infections, i.e. infection at two or more sites. The debridement frequency of the VAC group was significantly lower than that of the traditional drainage group (p = 0.001). The wound healing time of the traditional drainage group and VAC group was 38 days (a range of 13–98 days) and 40 days (a range of 11–106 days), respectively; the average LOS was 15 days (a range of 2–68 days) and 16 days (a range of 4–35 days), respectively; and the debridement frequencies were one time (a range of 0–3 times) and zero times (a range of 0–2 times), respectively. The two groups did not differ significantly in wound healing time and hospitalization duration (p = 0.319 and 0.937).ConclusionsVAC treatment of DNIs has significant advantages in reducing the frequency of debridement and patient suffering, but it does not show significant advantages in wound healing. Randomized trials are still needed to demonstrate its efficacy.

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Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China

Cited by 4 publications

References 27 publications

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

The efficacy of negative‐pressure wound therapy for head and neck wounds: A systematic review and update

Comparing vacuum‐assisted closure against conventional approach in severe deep neck infection: A retrospective case‐control study

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