Results of intra-wound continuous negative pressure irrigation treatment for mediastinitis

Abstract

Intra-wound continuous negative pressure irrigation treatment (IW-CONPIT) was administered to cases of mediastinitis as the therapy of choice, with satisfactory results being obtained in terms of improved survival rates and quick healing of wounds. Accordingly, these treatment results and efficacy were evaluated. After debridement, a sponge was trimmed to conform to the shape of the wound and then it was attached to the surface of the wound. Two tubes with several side holes were placed within the sponge. In cases in which the blood vessels and/or the heart are exposed, an artificial dermis was attached to cover the blood vessels and/or the heart in order to not come in direct contact with the sponge. Next, the top of the wound was covered with polyethylene film to create an air-tight wound seal. A bottle of saline solution was connected to one of the tubes and a continuous aspirator to the other, and continuous negative pressure irrigation of the wound was thus carried out. After performing this treatment for 2-3 weeks, and when wound granulation improved, either skin grafts or the transplantation of muscle flaps was performed as necessary to achieve wound healing. A combination of the continuous negative pressure method and the continuous irrigation method resulted in improved healing rates and lower mortality rates for mediastinitis. It also significantly reduced the number of dressings, as well as the degree of labour and medical materials required; therefore, a reduced hospital stay and shorter treatment period was thus achieved using this treatment method.

Indication and Usefulness of New Closed Intra-Wound Negative Pressure Treatment with Pinpoint Continuous Irrigation System

“…The authors have developed the IW-CONPIT because they believed that simultaneous cleaning and NPWT could have additive and synergistic effects on wound healing 1) . IW-CONPIT has been used for severe infectious wounds, such as severe limb trauma, intractable ulcers, pressure ulcers, postoperative mediastinitis, postoperative abdominal wall wound dissection, intestinal fistula, empyema, and intracranial infection, and excellent therapeutic effects have been reported [1][2][3][4][5][6][7][8] .…”

“…For example, if the brain parenchyma, including bone rot and artificial dura mater, is exposed after debridement, the wound must be closed in cases of cranial infection following brain surgery. In such cases, it is possible to prevent the relapse of infection by performing closed IW-CONPIT in order to continuously cleanse the inside of the wound while maintaining negative pressure after the wound is closed [1][2][3][4][5][6] . Furthermore, even for cases in which the artifacts cannot be removed or are preferably not removed, closed IW-CONPIT may be able to control and cure the infection with the artifacts left behind.…”

“…The intra-wound continuous negative pressure and irrigation treatment (IW-CONPIT) for infected wounds was developed and reported to have high usefulness in the treatment of infected wounds [1][2][3][4][5][6][7][8] . IW-CONPIT is a treatment method that promotes wound healing while dissipating infection by continuously cleaning the wound surface with physiological saline for 24 h while simultaneously applying negative pressure to the wound surface; this method that can be adapted to both open wounds and closed cavities 1,2) .…”

A Case of an Open Contaminated Shoulder Wound Managed by Intra-wound Continuous Negative Pressure and Irrigation Treatment

“…around the wound's surface, and in a wound with a complicated structure or a wound with a blind end, a space with inefficient perfusion is created. To compensate for this, a method of adding ingenuity to the existing products 9) or IW-CONPIT can be used [10][11][12] . In these methods, effective cleaning is performed by positioning the tube for continuous cleaning directly on the region of interest.…”