Skin graft fixation with negative pressure wound therapy with instillation and dwelling (NPWTi-d) for contaminated complex wounds of the extremities

Danno, Kanako; Narushima, Mitsunaga; Banda, Chihena H.; Okada, Yoshimoto; Mitsui, Kohei; Sasaki, Yuta; Shiraishi, Makoto; Sugioka, Kyoko; Yokota, Naho; Yamamoto, Shinya; Ishiura, Ryohei

doi:10.1016/j.jpra.2022.09.009

JPRAS Open

2022

DOI: 10.1016/j.jpra.2022.09.009

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Skin graft fixation with negative pressure wound therapy with instillation and dwelling (NPWTi-d) for contaminated complex wounds of the extremities

Kanako Danno

Mitsunaga Narushima

Chihena H. Banda

et al.

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“…6 Compared to spontaneous closure, STSG surgery leads to more rapid recovery and fewer medical expenses and provides the wound with more durable barriers. 7 Skin grafts fail if they are applied to the wound bed with insufficient blood supply, if the tissue has a bacterial infection, or if the patient has a serious inflammatory response. Therefore, wound bed preparation prior to STSG surgery is very important for skin grafts.…”

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Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers

Wu,

Shen,

Hao

2023

SMJ

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Objectives: To compare the efficacy of negative pressure wound therapy (NPWT) and alginate dressings on wound bed preparation prior to split thickness skin graft (STSG) surgery for patients with chronic diabetic foot ulcers (DFUs).Methods: Between September 2022 and March 2023, we completed a randomized controlled trial in Nanjing First Hospital and PLA 454 Hospital. Patients were divided into 2 groups: i) the NPWT group (with vacuum-assisted closure, n=50); ii) the control group (with alginates dressings, n=50). Once DFU wound was filled with healthy granulation tissues, STSG Original Article surgery was performed. The time to STSG surgery was regarded as the primary outcome. The survival rates of skin graft, the wound blood perfusion, the wound neutrophil extracellular traps (NETs) formation, and polarization of M1 and M2 macrophages in DFU wounds were regarded ad secondary outcomes.Results: Patients in the NPWT group had less time to STSG surgery than the control group. The patients in the NPWT group had prominently increased survival rates of skin graft, increased wound blood perfusion, and decreased NET formation in comparison with the control group. The macrophages in DFU wounds switched from M1 to M2 phenotype in the NPWT group. Conclusion:Negative pressure wound therapy is superior to conventional moist dressings in wound bed preparation prior to STSG surgery for patients with chronic DFUs.

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confidence: 99%

Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers

Wu,

Shen,

Hao

2023

SMJ

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Immediate foot reconstruction and revascularization of toes using an interposition superficial circumflex iliac artery perforator flow‐through flap: A case report

Mitsui,

Banda,

Danno

et al. 2024

Microsurgery

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Foot injuries, particularly degloving injuries, can lead to segmental loss of neurovascular structures in the toes, making simultaneous reconstruction of both the foot and toes challenging. This case report presents a technique using the superficial circumflex iliac artery perforator (SCIP) flap for immediate reconstruction of the dorsal foot and revascularization of multiple toes. A 28‐year‐old man suffered a degloving injury on the dorsum of his foot resulting in a 9 × 6cm skin defect, open fracture dislocations, exposure of tendons, and neurovascular injury, which included a 6–7.5 cm segmental defect of the vessels supplying the first, second, and third toes leaving all three toes ischemic. Immediate reconstruction was performed by harvesting a 12.5 × 5cm SCIP flap including both the superficial and deep branches and incorporating the superficial inferior epigastric vein (SIEV). The SCIP deep branch was used to revascularize the third and second toes and the SIEV vein graft used for the first toe. The patient recovered well, no complications were observed at the 2‐year follow‐up, preserving all three toes and regaining mobility. The use of the SCIP flap as a flow‐through flap provides thin skin flap cover, good vessel caliber size match with digital vessels and reduces the need for vein grafts from distant sites improving surgical efficiency. These attributes make the flow‐through interposition SCIP flap an excellent choice for reconstructing foot defects and revascularizing toes. We report this case to demonstrate the utility of the SCIP flap in immediate soft tissue cover and digit revascularization.

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Skin graft fixation with negative pressure wound therapy with instillation and dwelling (NPWTi-d) for contaminated complex wounds of the extremities

Cited by 2 publications

References 7 publications

Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers

Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers

Immediate foot reconstruction and revascularization of toes using an interposition superficial circumflex iliac artery perforator flow‐through flap: A case report

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