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Exudate management was better, and the average complete wound closure time was faster than with traditional dressings. The step-by-step closure protocol made it possible to accelerate wound healing; in synergy with NPWTi-d, tension at the edges of the middle third of the wound, especially in the xipho-pubic wounds, had reduced significantly.

The synergistic action of step-by-step closure and NPWTi-d obtain excellent results in management of wound dehiscence, even in patients with muscle fascia defect and loop exposure.

The synergistic action of step-by-step closure and NPWTi-d obtain excellent results in management of wound dehiscence, even in patients with muscle fascia defect and loop exposure.

Advanced wound management of complex surgical wounds remains a significant challenge as more patients are being admitted to the hospital with infected wounds. Reducing recurrent infections and promoting granulation tissue formation are essential to overall wound healing. Negative pressure wound therapy (NPWT) has been widely practiced for 2 decades for the management of such wounds, but NPWT with instillation and dwell time (NPWTi-d) is a relatively recent adjunctive treatment of wounds that require serial debridements.

This study evaluates the advantages and disadvantages of NPWTi-d alone as well as NPWTi-d as an adjunct to standard NPWT in the treatment of complex wounds in patients with serious comorbidities.

In this case series, the NPWTi-d group was given instillation therapy only. In the combined group, instillation therapy was applied and then, as the bioburden in the wound decreased, NPWT therapy was substituted. Repeated volumetric measurements and photographs of the wounds were taken. An approthis study, NPWTi-d proved to be more effective in clearing the bioburden and reducing the number of surgeries for debridement. Complementing it with NPWT led to reduced episodes of troubleshooting and proved to be more cost-effective. Thus, NPWT may be considered as an adjunct therapy in select cases of complex wounds. However, more evidence is required.

In reconstructive surgery, the latissimus dorsi (LD) muscle is known as a workhorse flap and is commonly used as a pedicled or free flap. Postoperative complications of a reconstructive procedure with an LD flap include seroma and hematoma formation at an early stage after LD transfer. Late-onset hematoma at the donor site are considered to be extremely rare postoperative complications; late, expanding pseudotumor-like hematoma can occur months or years after surgery. Shearing forces and poor coagulation are thought to be the primary reasons for these postoperative complications.

This report presents 2 cases of pseudotumors 12 and 29 years after LD transfer. Magnetic resonance imaging was performed prior to complete surgical excision. After surgical removal, patients received negative-pressure wound therapy with instillation and dwell time (NPWTi-d) for several days. After vacuum-assisted wound bed preparation, wound closure was performed with secondary sutures.

The case report presented 2 incidences of rare late-onset pseudotumors many years after the initial LD reconstruction. To the authors' knowledge, this late-onset occurrence (ie, after 3 decades) has not been reported in the literature to date. If solidification of the late hematoma makes aspiration impossible, surgical intervention is required. Negative pressure wound therapy with instillation and dwell time potentially minimizes the wound size and reduces shear forces at the back donor-site.

The case report presented 2 incidences of rare late-onset pseudotumors many years after the initial LD reconstruction. To the authors' knowledge, this late-onset occurrence (ie, after 3 decades) has not been reported in the literature to date. If solidification of the late hematoma makes aspiration impossible, surgical intervention is required. Negative pressure wound therapy with instillation and dwell time potentially minimizes the wound size and reduces shear forces at the back donor-site.

Necrotizing fasciitis is a devastating infectious process associated with high mortality and morbidity rates. Medical and surgical interventions are necessary for survival. Negative pressure wound therapy (NPWT) has been shown to be beneficial in wound and graft care in these patients. Recently, NPWT has evolved to include instillation and dwell time (NPWTi-d) with encouraging results. However, no studies have examined the efficacy of NPWTi-d in graft care. The authors report the first 2 cases of necrotizing fasciitis with resulting complex wounds in which NPWTi-d was utilized during all phases of care (including after graft transfer) with excellent outcomes.

Two patients presented with histories of sustaining external trauma to their lower extremities with subsequent development of erythema, edema, and pain. Diagnosis of necrotizing fasciitis was made through history and physical examination findings, supported by LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores of greater than or equages in caring for skin grafts and could aid in graft survivability and take in certain clinical scenarios. Higher level evidence is needed to determine the true indications and contraindications of NPWTi-d.

The advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d) of a topical solution that dwells on the wound have been shown to include removal of fibrinous and bacterial exudate and increased granulation tissue formation. click here The treatment is best suited for chronic, complex wounds with areas of nonviable tissue on the wound surface.

A 73-year-old female with spondylolisthesis and stenosis of the spinal canal experienced dehiscence formation of the postoperative wound with continuous exudate after fusion and decompression surgery (TLIF L4-L5) of the lumbar spine. As a result, she had a complicated clinical course with multiple revision surgeries. Negative pressure wound therapy with continuous negative pressure was utilized for about 6 weeks, and regular dressing changes (saline gauze and honey dressings) were performed every day until NPWTi-d treatment was initiated; this protocol was not successful, so NPWTi-d with saline solution was initiated (average instillation time, 4 hours; dwell time, 15 minutes; continuous negative pressure, -125 mm Hg).