Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication;while sepsis remains the leading cause of death in se...Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication;while sepsis remains the leading cause of death in severe burns. The research guided integration of new and effective techniques in burn wound management is mandatory. Negative pressure wound therapy (NPWT) is an effective and widely used technique in the management of problematic wounds. Previously existing indications include soft tissue traumas and chronic wounds such as diabetic, arterial, venous and pressure ulcers. The characteristics and challenges of these wounds have a lot in common with burns. Since the early 2000’s there are experiences with the use of NPWT for the healing of second degree burn wounds. Our clinical experience shows that it is a minimally invasive and effective way of improving burn wound management. In this article we give a review of the literature showing the mechanisms, unmapped future opportunities, financial issues, and possible adverse effects of NPWT in burn therapy.展开更多
AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage. METHODS: Between May and November 2012, three male patients who developed...AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage. METHODS: Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker's diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week.RESULTS: The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy. CONCLUSION: E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.展开更多
BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantag...BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.展开更多
文摘目的：探讨简易封闭式负压引流技术在糖尿病足溃疡治疗中的辅助疗效。方法利用中心负压、吸痰管、湿性敷料、Opsite 透明膜等制成简易封闭式负压引流装置，对68例糖尿病足溃疡患者进行持续封闭负压引流治疗。统计68例的溃疡创面自接受简易封闭式负压引流治疗开始，至可以施行手术缝合、加压疗法或皮瓣转移的创面床准备时间，并观察有无出现治疗相关并发症及不良反应。结果68例糖尿病足溃疡经封闭负压引流治疗7-14 d （中位时间9 d）后创面床准备良好，有肉芽生长，呈颗粒状，湿润且具有光泽，渗液量较前明显减少。在此创面基础上34例行加压疗法，23例行二期手术缝合，11例行皮瓣转移，溃疡创面均完全愈合，愈合率达100％。未发现简易封闭式负压引流治疗相关的并发症和不良反应。结论简易封闭式负压引流技术能有效辅助治疗糖尿病足溃疡，且取材方便，操作简单易掌握。
文摘Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication;while sepsis remains the leading cause of death in severe burns. The research guided integration of new and effective techniques in burn wound management is mandatory. Negative pressure wound therapy (NPWT) is an effective and widely used technique in the management of problematic wounds. Previously existing indications include soft tissue traumas and chronic wounds such as diabetic, arterial, venous and pressure ulcers. The characteristics and challenges of these wounds have a lot in common with burns. Since the early 2000’s there are experiences with the use of NPWT for the healing of second degree burn wounds. Our clinical experience shows that it is a minimally invasive and effective way of improving burn wound management. In this article we give a review of the literature showing the mechanisms, unmapped future opportunities, financial issues, and possible adverse effects of NPWT in burn therapy.
基金Supported by The Deutsche Forschungsgemeinschaft in the framework of the "Open Access Publishing" Program
文摘AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage. METHODS: Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker's diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week.RESULTS: The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy. CONCLUSION: E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.
文摘BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.
