• Plenary session: Use of NPWT in Open wounds

    Michael Sugrue (IE).

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    Michael Sugrue presented the state-of-the-art use of Negative Pressure Wound Therapy (NPWT) in open wounds, making an extensive review of the literature and sharing his clinical experience, particularly on the use of NPWT in the Open Abdomen. Prof. Sugrue reminded how, in the US, approximately 500,000 surgical site infections (SSI) occur per annum, 40-60% of which are considered preventable1. A SSI has been proven to affect long-term survival2, so the surgeons have to consider a multi-factorial strategy, including a precise timing of antibiotic administration, good bowel and skin preparation, double gloving, careful fascial closure technique, and the appropriate use of NPWT, in order to achieve better outcomes. Evidence-based recommendations for the treatment variables of Negative Pressure Wound Therapy3, the use of NPWT in chronic wounds4, in traumatic wounds and reconstructive surgery5, and most recently in open abdominal wounds6 have been published, and are now available in the public domain, but the awareness of this therapeutic option is still relatively limited. In the management of the OA, one of the most important improvements, so far, is the combination of NPWT with a mesh-mediated traction, which has been proven to achieve a reduced lateralisation and an increased closure rate7.

    1. Najjar PA, Smink DS Prophylactic Antibiotics and Prevention of Surgical Site Infections.Surg Clin North Am. 2015 Apr;95(2):269-283. doi: 10.1016/j.suc.2014.11.006. Epub 2015 Jan 10.
    2. Artinyan A, Orcutt ST, Anaya DA, Richardson P, et al. Infectious post-operative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer. Ann Surg. 2015. 261; (3):497-505.
    3. Birke-Sorenson H, Malmsjo M, Rome P, Hudson D et al., (2011) Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) Steps towards an international consensus. JPRAS 64, s1-s16.
    4. Vig S, Dowsett C, Berg L, Caravaggi C. Evidence-based recommendations for negative pressure wound therapy in chronic wounds: Steps towards an international consensus. Journal of Tissue Viability. 2011 20; s1-s18.
    5. Krug E, Berg L, Lee C, Hudson D, et al.., Evidence-based recommendations for negative pressure wound therapy in traumatic wounds and reconstructive surgery: Steps towards an international consensus. Injury. 2011 42; s1 – s12.
    6. Bruhin A, Ferreira F, Chariker M, Smith, J, et al., Systematic Review and Evidence Based Recommendations for the use of Negative Pressure Wound Therapy in the Open Abdomen. International Journal of Surgery. 2014. 12; (10):1105–1114.
    7. Acosta S, Bjarnason T, Petersson U, Pålsson B, et al., Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. BJS. 2011. 98; 5:735–743. 

  • Plenary session: Use of NPWT in Closed incisions

    James Stannard (US).

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    James Stannard began using incisional NPWT (iNPWT) on the premise that if it worked on trauma wounds by the mechanisms suggested - i.e., promoting perfusion, removing excess interstitial fluid or oedema, creating mechanical stress on tissues, and stabilising a closed incision - prophylactically, it should facilitate healing on closed incisional wounds. Prof. Stannard reviewed studies exploring iNPWT’s role in perfusion8,9 and the use of prophylactic iNPWT, an approach which seems to have demonstrable benefits such as faster healing (particularly in high-risk knee and ankle fracture repair areas), and quicker discharge. He reported success in management of haematoma and surgical incisions10 and reviewed a study which determined that using iNPWT for 6 to 7 postoperative days significantly reduces the incidence of SSI after median sternotomy in high-risk obese patients11. A further study from his own group12 demonstrated that using iNPWT facilitated faster discharge (2.5 days vs 3.0 days control), a 10% infection rate (19% control), and a 9% dehiscence rate (17% control). These results realised cost-savings which would pay for the additional cost of NPWT. A recent review13, written by a panel including Prof. Stannard, concludes that there is a growing body of evidence on the effect of iNPWT, with studies in orthopedic trauma surgery, abdominal, plastic and vascular surgery. Reduction in haematoma and seroma, accelerated wound healing, increased clearance of oedema and splinting of the incision and adjacent tissue, seems to play a role in why iNPWT is effective, but further studies are required to ascertain the exact mechanisms of action.

    8. Timmers MS. Le Cessie S, Banwell P, Jukema GN. The Effects of Varying Degrees of Pressure Delivered by Negative-Pressure Wound Therapy on Skin Perfusion. Annals of Plas Surg. 2005. 55; (6):665-671;
    9. Horch RE, Münchow S, Dragu A. Erste Zwischenergebnisse der Perfusionsbeeinflussung durch Prevena: gewebsperfusionsmessung. Z Wundheilung. 2011. A 16:19–20.
    10. Stannard JP, Robinson JT, Anderson ER, McGwin G, Jr, Volgas DA, Alonso JE. Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. J Trauma. 2006. 60; (6):1301–1306.
    11. Grauhan O, Navasardyan A, Hofmann M, Müller P, et al. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg. 2013. 45; (5):1387-92.
    12. Stannard J, Volgas DA, McGwin G 3rd, Stewart RL et al., Incisional NPWT After High Risk Lower Extremity Fractures; J Orthop Trauma. 2012 26: 37-42 13.
    13. Karlakki S, Brem M, Gianinni S, Khanduja V, et al., Negative Pressure Wound Therapy for management of the surgical incision in orthopaedic surgery. A review of evidence and mechanisms for an emerging indication. 2013. Bone Joint Res.2:76–84.

  • Plenary session: Use of NPWT with Adjunctive Therapies

    Lawrence Lavery (US).

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    Lawrence Lavery discussed animal, in vitro and clinical studies on adjunctive therapies, including silver dressings, irrigation/instillation and ultraviolet light. The aim of adjunct NPWT is to complement or negate the factors influencing or inhibiting wound healing – i.e. changing the healing profile. Animal studies have shown reduced bacterial load of bothPseudomonas and Staphylococcus when comparing silver impregnated gauze with standard sponges after six days (43% versus 21% Pseudomonas and 25% versus 11.5% in Staphylococcus aureus) and that combining topical negative pressure dressings and silver foam led to a synergistic inactivation in Pseudomonas species over three and five day treatment14 . Using a silver dressing with NPWT has resulted in fewer surgical procedures, shorter treatment times, and thus, shorter hospital stay.15

    Prof. Lavery went on to discuss instillation and intermittent irrigation (NPWTi). Phillips et al.,16 studied periodic instillation of antibacterial agents with NPWT in a swine model and concluded that NPWTi with active antimicrobial agents, enhances the reduction of CFUs by destruction and removal of biofilm bacteria. Conversely, Davis et al.,17 looked at continuous irrigation in a swine model and concluded that NPWT with simultaneous irrigation further reduced bioburden over control and NPWT-treated wounds; NPWT with simultaneous irrigation therapy (normal saline or PHMB), had a positive effect on bioburden in a porcine model. Prof. Lavery presented the unpublished data from his recent prospective, randomised, comparative effectiveness study comparing the instillation of saline with 1% polyhexanide (PHMB). There was a reduction in days to final surgery with NPWT (but only in normal saline group). A further study is underway using continuous instillation. Finally, he presented some data from an on-going study of pulsed UVA light (fibre-optic delivery system) under NPWT to reduce bioburden and accelerate granulation. Results to date show a 45% greater reduction in wound area, a 50% greater reduction in wound depth, and faster healing compared to control.

    14. Stinner DJ, Waterman SM, Masini BD, Wenk JC. Silver Dressings augment the ability of negative pressure wound therapy to reduce bacteria in a contaminated open fracture model. J Trauma. 2011. 71:S147–150.
    15. Valente PM, Deva A, NGO Q, Vickery K. The increased killing of biofilms in vitro by combining topical silver dressings with topical negative pressure in chronic wounds. I Wound Jnl. 2014. DOI: 10.1111/iwj.12248.
    16. Philips PL, Yang Q, Schultsz GS. The effect of negative pressure wound therapy with periodic installation using antimicrobial solutions on Pseudomonas aeruginosa biofilm on porcine skin explants. 2013. I Wound Jnl. 10; (S1):48-55.
    17. Davis KE, Lafontaine J, Bills J et al., The comparison of two negativepressure wound therapy systems in a porcine model of wound healing Wound Repair Regen. 2013. 21 740-745.

  • Plastic surgery: Main surgical techniques in breast surgery: type and...

    Giuseppe Catanuto (IT).

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    Giuseppe Catanuto outlined the main onco-plastic surgery techniques (simple wide local excision, simple wide local excision+/- nac [nipple-areola complex] repositioning, uni/bilateral therapeutic mammoplasty, conservative mastectomy). Surgeons must assess risk factors, oncological needs and patient expectation, and adapt their surgical strategy accordingly.

  • Plastic surgery: Mastectomy, reduction mammoplasty and conservative...

    Maurizio Nava (IT).

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    Maurizio Nava presented a workflow infographic to aid peri-operative surgery decision making. He outlined his practice for avoiding complications – short-term antibiotic treatment (in low risk patients), frequent glove changes during surgery, washing the pocket or the surgical bed with saline and Amikacine, and pre-medicated absorbable wires. 

  • Plastic surgery: Evidence based medicine: thinking critically,...

    Nicola Rocco (IT).

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    Given the plethora of both published and unpublished data to be presented at the meeting, Nicola Rocco injected a note of caution; knowing how to evaluate evidence is critical because randomised doesn’t always infer validity, and results do not necessarily apply to your patient group. Consider using the Consolidated Standards of Reporting Trials (CONSORT) statement as a guide18.

    18. Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010, 340:c332.

  • Plastic surgery: Single-patient use NPWT (PICO) in breast reduction:...

    Robert Galiano (US).

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    The unpublished results of a multi-national, prospective randomised clinical trial on the use of PICO to prevent post-surgical incision healing complications in 200 patients undergoing reduction mammoplasty were presented by Robert Galiano.They showed a statistically significant reduction of incision healing complications of 38% and a significantly better scar quality in the PICO group within the first three postoperative months. The latter outcome may suggest the use of PICO in surgeries where there may be a higher interest in the cosmetic outcome (i.e. in visible parts of the body). 

  • Plastic surgery: Main surgical techniques in breast reconstruction:...

    Risal Djohan (US).

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    Risal Djohan gave an overview of breast conservation and full or partial mastectomy (with or without reconstruction - implant or autologous) techniques. Early onset complications include dehiscence and skin necrosis; late complications include sensory loss and scar hypertrophy. These may be ameliorated by preoperative weight loss and a well–vascularised quality flap; vascularity can be assessed intra-operatively by the use of indocyanine green. 

  • Plastic surgery: Clinical experience with a single-patient use NPWT...

    John Murphy (UK).

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    Clinical experience of PICO in complex breast reconstructions was presented by John Murphy. He postulated that ‘simple’ wounds (T-junction, Wise pattern wounds) in high risk patients, and linear wounds in patients undergoing breast reconstruction where cost of failure is high (e.g. implant + Acellular Dermal Matrix or ADM), are actually complex wounds. Results from his study19 showed no wound breakdown nor adverse skin reactions, and high patient satisfaction with PICO, mainly driven by a scarring which seems subjectively better that the standard of care. PICO appears to be cost-effective, with an average cost in UK of £144 per dressing vs. the cost of a wound breakdown which ranges £840 - £1260, if the implant is not affected, while in case of loss of the implant, the price of a new reconstruction is over £10000 (over £13000, when ADM is used). 

    19. Holt R, Murphy JA. PICO incision closure in oncoplastic breast surgery: a case series. Jour Hosp Med. 2015. 76; (4):217-23.

  • Plastic surgery: Mastoplasty reduction and Pexy: challenges and...

    Risal Djohan (US).

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    The challenges of reduction mammoplasty and mastopexy were reviewed by Risal Djohan, comparing the patient satisfaction, the revision rate and the complications of the various technique, according to the literature.

  • Plastic surgery: Breast Augmentation: review of main techniques and...

    Maurizio Nava (IT).

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    Maurizio Nava outlined the surgical techniques appropriate to breast augmentation, emphasising the need to do a careful planning of the surgery and manage patient’s expectations. He concluded that breast augmentation is usually not associated with wound breakdown, except the mastopexy-augmentation technique which has some potential for poor wound healing, as well as vertical, inverted T and peri-areolar incisions, where the use of a device like PICO may provide some benefit.

  • Plastic surgery: Can the application of NPWT provide a better...

    Rene van der Hulst (NL).

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    Rene van der Hulst presented the results of an extension of the study presented by Dr. Galiano. Scar quality was assessed in 32 original study patients at 180 and 365 days, measuring viscoelasticity, skin surface hydration and trans-epidermal water loss. A significant improvement in VAS at day 180 was noted, although only a small difference was seen in elasticity, and no difference was seen in the other two parameters. PICO addresses the factors that ensure better scar appearance, minimising tension, dead space (preventing seroma formation), tissue injury, and contamination.

  • Cardiothoracic: Sternal complications after cardiac surgery:...

    Richard Ingemansson (SE).

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    Richard Ingemansson opened with an overview of the incidence of sternal wound complications such as deep sternal wound infection (DSWI), superficial sternal wound infection (SSWI), sternal dehiscence, pseudoarthrosis, sternal pain, subxyphoid hernia; DSWI has an incidence of 1-4% of cases with a 7-35% mortality, while SSWI has an incidence of 4-7%, with a mortality of 1-2%. He has proposed a practical classification for risk factors related to cardiothoracic surgery: major (diabetes mellitus, BMI<18 or >40, dialysis), intermediate (use of bilateral mammary arteries, chronic lung disease [GOLD class>2], longterm immunosuppressive therapy, previous chest wall radiotherapy, chronic kidey disease, 35<BMI<39), and minor (cardiac re-operation, female gender, age> 75 years, acute myocardial infarction, hospitalized for at least 7 days before surgery)

  • Cardiothoracic: Surgical site infections after cardiac surgery: risk...

    Johan Nilsson (SE).

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    Johan Nilsson explained how risk stratification can aid identification of patients at risk of post-operative complications (and associated costs), thereby ensuring they undergo the most appropriate intervention. This is important when comparing mortality rates; high rates may be considered to be a result of poor surgical skills, but the acuity of the patient pre-operatively is a key determinant of clinical outcome. Available risk calculators are based on database patient information, but few exist for sternal wound infection risk in cardiac patients. 

  • Cardiothoracic: Strategies to reduce incisional complications after...

    Örjan Friberg (SE).

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    To obtain a true picture of sternal wound infection rates, Örjan Friberg postulated that longer post-operative follow-up is required. Most organisations report a 1-2 % infection rate, whereas the real incidence is likely to be 5-8% at 30 days and 6-10% at 2-3 months. Prophylactic local placement on the incision of a collagen sponge with gentamycin can help reduce sternal infection20, as can meticulous surgical technique, minimising oedema and rigid fixation of the sternum.

    20. Friberg and Bodin L.”Collagen gentamicin for prevention of sternal wound infection: effective or not?” Thorac Cardiovasc Surg. 2013 61; (3): 185-93.

  • Cardiothoracic: Leg donor site infection: complication rates and...

    Örjan Friberg (SE).

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    Örjan Friberg presented on the infection of the leg donor site used in coronary artery bypass graft (CABG) procedures. The incidence is difficult to determine as often infection occurs some time after discharge from hospital and is managed by primary care. If this is considered, SSI can be as high as 20% in this indication. A review of the various strategies to minimise complications (endoscopic vein-graft harvesting, triclosan sutures, use of skin staples vs. sutures, use of microbial sealant) including the liberal use of NPWT at the first signs of disturbed wound healing, has been provided. 

  • Cardiothoracic: Effect of surgical incision management on wound...

    Onnen Grauhan (DE).

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    Onnen Grauhan presented his clinical experience of using NPWT prophylactically in high risk (obese) patients undergoing a sternotomy procedure; he concluded that NPWT over clean, closed incisions, for 6-7 postoperative days significantly reduces the wound infection incidence after median sternotomy11. His ‘all comers’ study observed 237 patients treated with prophylactic NPWT (192 ‘standard’; 45 ‘high risk’ – all treated with KCI Prevena™)21 with a total of 3 wound infections (one in the standard group, two in the high-risk one), which compared very favorably with their historical control group of 3508 patients, showing an incidence of 1.3% vs. an historical value of 3.4% (p<0.05). Professor Grauhan concluded that NPWT provides a “sterile” wound environment, supports improved wound healing through improved microcirculation, drainage, and stabilisation of the wound edges. 

    11. Grauhan O, Navasardyan A, Hofmann M, Müller P, et al. Preventionof poststernotomy wound infections in obese patients by negativepressure wound therapy. J Thorac Cardiovasc Surg. 2013. 145;(5):1387-92.
    21. Grauhan O, Navasardyan A, Tutkun B, Hennig F, et al. Effect of surgical incision management on wound infections in a poststernotomy patient population. International Wound Journal. 2014. 11: 6–9. doi: 10.1111/iwj.12294.

  • Cardiothoracic: Costs associated with surgical site infections after...

    Pascal Dohmen (DE).

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    Pascal Dohmen discussed the costs associated with SSI in cardiothoracic surgery, explaining that the more complex the procedure, generally, the greater the risk of SSI. Cardiothoracic procedures SSI rates are between 3.2 and 25%, with an incidence of mediastinitis between 0.3 and 3%, and mortality, if MRSA is present, around 75% within three years. An SSI will prolong patients’ hospital stay by up to 10 days, with associated direct costs to the European healthcare system of  €19.0 billion p.a.22

    22. Dohmen P. Economic Burden of Surgical Site Infections in CardiacSurgery. J Med Microb Diagn 2013, 2:3.

  • Cardiothoracic: Groin surgical incisions: specific challenges and...

    Stefan Acosta (SE).

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    Healing of groin incisions post femoral artery surgery is challenging as they are inherently ‘unclean’, according to Stefan Acosta. Complications include graft infection, SSI and amputation. Dr. Acosta presented the preliminary data from an RCT where iNPWT was compared to a standard dressing to prevent SSI. Early results show SSI rate of 4.7% (PICO) and 11% (standard care), even if not statistically significant at this point. 

  • Cardiothoracic: NPWT to reduce the incidence of incisional...

    Carlos Velasco (ES).

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    Carlos Velasco presented the preliminary results of a study testing the use of PICO™ to reduce the incidence of incisional complications after sternotomy compared to standard care (dry dressing). High risk patients (n=362) undergoing isolated or combined myocardial revascularisation surgery were included. Incisions were examined at day 7 and one month postsurgery. Analysis so far shows a reduction in both the severity and number of infections (5.8% vs 10.8). Total treatment costs (including treatments, antibiotic therapy, hospitalization and surgery) were estimated to be €81k in the PICO group and €255k in the control group.

  • Cardiothoracic: Use of NPWT to prevent post-surgical complications on...

    Martin Oberhoffer (DE).

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    Presentation recorded at the 6th International NPWT Expert Meeting, Berlin 20-21 March 2015.
    Cardiothoracic workstream


    Martin Oberhoffer outlined the complications of vascular graft failure in coronaryartery by pass graft (CABG). There is an increasing trend towards use of artery grafts rather than veins as these survive longer but there is a cost: the use of arteries often taken from the chest, increases the chance of SSWI. Skeletisation of the artery may reduce the chances of SSI but other strategies are needed. He presented preliminary results from a study of the use of PICO in the reduction of SSWI in patients undergoing total arterial revascularisation (BIMA). In the first 100 patients (control), SWI rate was 11.9%; in the following 100 patients (PICO), SWI was 6.9%. Dr. Oberhoffer concluded that based on these results to date, prophylactic use of PICO for the reduction of SWI in high- risk CABG patients is promising and the cost– effectiveness calculations may justify the use of PICO, although the patient number is too low to detect a statistically significant effect. 

  • General surgery: Intra-abdominal infections in the Open Abdomen and...

    Stefano Rausei (IT).

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    Stefano Rausei presented evidence based on 20 years experience in OA management23, concluding that NPWT in OA management is superior to other techniques as it allows easy observation of the abdomen, partially prevents fascial and wound margin retraction, and prevents intra-abdominal hypertension. 

    23. Rausei S, Dionigi G, Boni L, Rovera F et al., Open Abdomen Management of Intra-Abdominal Infections: Analysis of a Twenty-Year Experience. Surgical Infections. 2014. 15; (3):200-206.

  • General surgery: Use of NPWT in Open Abdomen – discussion of existing...

    Andreas Bruhin (CH).

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    The existing guidelines on the use of NPWT in the OA were presented by Andreas Bruhin based on a recent paper6. A common four – stage classification of the OA has been suggested24, and Dr. Bruhin discussed the management of each one. He concluded that NPWT is key to providing an individualised approach and provides different benefits at different stages, such as wound and fluid management, down-staging of pro-inflammatory cytokines, facilitation of primary fascial closure, splinting skin grafts, and avoiding / managing entero-atmospheric fistulas. 

    6. Bruhin A, Ferreira F, Chariker M, Smith, J, et al., Systematic Review and Evidence Based Recommendations for the use of Negative Pressure Wound Therapy in the Open Abdomen. International Journal of Surgery. 2014. 12; (10):1105–1114.
    24. Björck M, Bruhin A, Cheatham M, Hinck D, et al., Classification – Important step to improve management of patients with an open abdomen. World J Surg. 2009. 33; (6):1154-1157.

  • General surgery: Open Abdomen with NPWT and mesh-mediated fascial...

    Thordur Bjarnason (SE).

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    The use of mesh-mediated fascial traction with NPWT in the OA was presented by Thordur Bjarnason7. In general, the management of OA should provide a cover to retain and protect bowel, room for expansion of abdominal volume, removal of toxins, debris, bacteria and excess fluid from the wound, the prevention of abdominal wall adhesion, and retraction of edges. As many patients require prolonged OA, a novel technique was explored - vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). After treatment of 111 consecutive patients, the authors concluded that VAWCM provided a high fascial closure rate after long-term treatment of OA and should be considered when the anticipated duration of the OA is above one week. [Note that Smith & Nephew doesn’t promote the use of RENASYS AB with meshmediated fascial traction as there have been no studies yet to demonstrate use in combination] 

    7. Acosta S, Bjarnason T, Petersson U, Pålsson B, et al., Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. BJS. 2011. 98; 5:735–743.

  • General surgery: Open Abdomen and concomitant enteroatmospheric...

    Salomone Di Saverio (IT).

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    Salomone Di Saverio presented a paper which proposed a clinical algorithm for the management of the open abdomen and took the audience through an original technique for the management of concomitant enteroatmospheric fistulas. Incidence ranges from 2% - 50% depending on the underlying condition25

    25. Di Saverio S, Tarasconi A, Inaba K, Navsaria P, et al., Open Abdomen with Concomitant Enteroatmospheric Fistula: Attempt to Rationalize the Approach to a Surgical Nightmare and Proposal of a Clinical Algorithm. J Am Coll Surg. 2015. 220; (3):e23-33.

  • General surgery: Incidence of surgical site infection after...

    Gregory Sergeant (BE).

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    Gregory Sergeant outlined the incidence of SSIs in colorectal surgery. This is extremely high and varies between 15% and 30%26; the average time to diagnosis is 7 days (in-patient) and 14 days (post discharge). Procedure, environment and patient preventative interventions were presented, including NPWT for contaminated wounds.

    26. Fry DE. The Prevention of Surgical Site Infection in Elective Colon Surgery. Review Article. Scientifica. Volume 2013, http://dx.doi.org/10.1155/2013/896297.

  • General surgery: Post-discharge surveillance to identify colorectal...

    Judith Tanner (UK).

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    Judith Tanner in a post-discharge survey, found that of 105 patients, 27% developed a SSI, costing £8,960 (in-patient) and £1,406 (incommunity). A larger study showed that variation in data collection leads to underestimation of SSI rates27

    27. Tanner J, Padley W, Kiernan M, Leaper D, et al., A benchmark too far: findings from a national survey of surgical site infection surveillance. Journal of Hospital Infection 2013. 83; (2): 87-01.

     

  • General surgery: Mode of Action of NPWT on a closed incision

    Elizabeth Huddleston (UK).

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    Although the mechanisms of NPWT action used prophylactically on closed incisions are not fully understood, there is a good consensus in the existing literature that they relate to protection, reduction of lateral tension, reduction of oedema, and improved perfusion, as presented by Elizabeth Huddleston in a survey of animal studies, in vitro and clinical investigations. The mechanisms through which NPWT could influence contaminated wounds following colorectal surgery were also addressed.

  • General surgery: Prophylatic use of PICO™ NPWT to reduce surgical...

    Pauline Whitehouse (UK).

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    Pauline Whitehouse presented a pathway for high-risk laparotomy incisions which included the prophylactic use of PICO. Prior to the introduction of iNPWT, 7.69% of patients developed a SWI (estimated treatment cost £10k per patient); after PICO, incidence was 1.96% (p=0.049). The potential saving if PICO was used on all laparotomies is £45,760 (one hospital, performing about 102 laparotomies per year).

  • General surgery: Use of PICO Single-use NPWT to prevent post-surgical...

    Gianluca Pellino (IT).

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    Age is commonly cited as a risk-factor for colorectal SSI, which in elderly patients can affect mortality. Identifying those patients where prophylactic NPWT can be used may reduce SSI. Gianluca Pellino (IT) presented the results of a “NPWT in colorectal surgery” literature review (submitted for publication) which demonstrated that NPWT reduced the incidence of SSIs. Pellino et al’s 2013 study28 showed that using NPWT prophylactically significantly reduced the development of seroma and SSI, compared to conventional dressings. An extension to this study29 showed that PICO is safe and effective, and facilitates better closure and shorter hospital stay. Dr. Pellino closed with the results of his latest study, which assessed the efficacy of PICO in preventing SSC in patients undergoing breast or colorectal surgery, compared with conventional dressings30. The secondary aim of this open label controlled study was to assess the efficacy and safety in elderly patients. Results showed that PICO significantly reduced SSC in both arms of the study and no significant differences were observed according to age. The authors conclude that PICO is an effective tool to prevent SSC in patients undergoing general surgery and that its use may be recommended in frail, elderly patients, with a higher risk of complications. 

    28. Pellino G, Scuiadone G, Candilio G, Campitiello F, et al., Effects of a new pocket device for Negative Pressure Wound Therapy on surgical wounds of patients affected by Crohn’s disease: a pilot trial. Surgical Innovation. 2013. 21; (2):204–212.
    29. Selvaggi F, Pellino G, Candilio G, Scuiadone G, et al., New Advances in Negative Pressure Wound Therapy (NPWT) for Surgical Wounds of Patients Affected with Crohn’s Disease. Surgical Technology International XXIV: 83-89.
    30. Pellino G, Sciaudone G, Candilio G, Serena De Fatico G, et al., Preventive NPWT over closed incisions in general surgery: Does age matter? International Journal of Surgery. 2014. 12: s64 - 68 

  • General surgery: Combined use of antimicrobials and NPWT for high...

    Sebastian Smolarek (IE).

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    The preliminary results of a multi-centre RCT which explored the combined use of NPWT and antimicrobial (ACTICOAT™ Antimicrobial barrier silver dressing, Smith & Nephew) in colorectal and high risk surgery patients compared to standard treatment were presented by Sebastian Smolarek. The aim is a 50% reduction in SSI rate (CDC criteria). To date, 30% patients have developed an SSI across both groups (no statistical difference), and length of stay is the same in both, although very few patients have yet been recruited. 

  • Orthopaedics: Incisional complications in trauma surgery: incidence...

    James Stannard (US).

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    James Stannard presented an overview of the incidence and impact of incisional complications in trauma surgery. The aim of surgery is to get the soft tissue envelope to heal, particularly where fractures are in areas with minimal coverage over the bone and limited blood flow. Prof. Stannard presented his pioneering work undertaken in 249 patients to determine the effect of NPWT vs. standard care in high risk fracture repair sites12. He also discussed other studies that have used iNPWT in obese patients (excellent outcome), seroma/haematoma management (not conclusive), open fracture with immediate closure, fracture blisters (good healing) and soft tissue coverage. He concluded that prophylactic NPWT can be a useful adjunct in trauma surgery.

    12. Stannard J, Volgas DA, McGwin G 3rd, Stewart RL et al., Incisional NPWT After High Risk Lower Extremity Fractures; J Orthop Trauma. 2012 26: 37-42 13

  • Orthopaedics: The management of complications following Orthopaedic...

    Hans Goost (DE).

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    The management of complications following orthopaedic trauma surgery was outlined by Hans Goost. Firstly, identify complications (e.g. SSI, dehiscence, implant infection) and patient/environmental risk factors. Within Dr. Goost’s organisation, iNPWT is used on clean trauma incisions and for temporary wound closure and debulking. He presented six case studies where iNPWT had been used and concluded that post-operative tissue management can be improved by NPWT and PICO, and that NPWT is essential in trauma care.

  • Orthopaedics: Role of NPWT in major trauma surgery: clinical...

    Steven Jeffrey (UK).

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    While rarely seen in domestic theatres, war-zone trauma has facilitated the use of NPWT for the management of complex and traumatic wounds; in this session, Steven Jeffrey presented his experiences. Evacuation from the theatre of war to the operating theatre is much faster today, so patients survive extremely traumatic wounds. Management principles remain the same: debride, dress, and close at a later date (repeated debridement/dressings may be necessary before closure). Seemingly impossible trauma wounds have been healed with the use of NPWT. RENASYS is the system of choice in the British military in war-zone hospitals.

  • Orthopaedics: Clinical and economic challenges of incisional...

    Sudheer Karlakki (UK).

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    Sudheer Karlakki discussed the complications of total joint arthroplasty, a procedure which although ‘routine’, is challenging post-operatively; complications include SSI, wound dehiscence, and prosthesis infection. Pressure from patients to go home quickly (and safely) and from organisations to reduce costs requires risk assessment and prevention. Evidence is available for the use of NPWT prophylactically in orthopaedic surgical wounds13. iNPWT can minimise wound complications, facilitate a more predictable wound healing and therefore reduce length of staying (LOS).

    1.  Karlakki S, Brem M, Gianinni S, Khanduja V, et al., Negative Pressure Wound Therapy for management of the surgical incision in orthopaedic surgery. A review of evidence and mechanisms for an emerging indication. 2013. Bone Joint Res.2:76–84.

  • Orthopaedics: Perioperative medical management for total joint...

    Amerigo Balatri (IT).

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    The enhanced recovery after surgery (ERAS) approach to total joint arthroplasty (TJA)31 was discussed by Amerigo Balatri. ERAS, driven by patient and cost reduction factors, aims to achieve discharge (within three days) by optimising peri-operative care. In relation to the prevention of SSI, interventions include addressing factors which may affect healing, through speedy surgery, less tourniquet time, use of barbed sutures, and use of advanced wound care dressings and/or where wound drainage is high, NPWT.

    31.  Enhanced recovery after Surgery Society. ERAS care System. 2015 Available at: http://www.erassociety.org/index.php/eras-care-system/general-overview.

  • Orthopaedics: Single-patient use NPWT System (PICO) in primary...

    Mr Sudheer Karlakki (UK).

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    Sudheer Karlakki presented the preliminary results of a randomized controlled study evaluating the use of PICO in primary arthroplasty patients. After analysing the results, the authors concluded that iNPWT reduces the amount of wound exudate (statistically significant), may decrease length of stay (not statistically significant), reduces the number of dressing changes required (statistically significant), and minimises wound complications (statistically significant). 

  • Orthopaedics: Single-patient use NPWT System (PICO) in revision...

    Antonio Mazzotti (IT).

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    Antonio Mazzotti presented preliminary results of a prospective randomised trial of PICO in total hip and total knee revision arthroplasty, which carries a higher risk of complications compared to the primary procedure. Results so far show a dry wound at day seven, with lower ASEPSIS and VAS pain scores compared to control, which also had a higher number of dressing changes and blister prevalence. The authors conclude that PICO is comfortable and well tolerated by the patients, and that rapid wound healing can facilitate earlier risk-free discharge. 

  • Orthopaedics: Is the management of bleeding and thromboembolism in...

    Amerigo Balatri (IT).

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    Amerigo Balatri postulated that in order to ensure healing, the surgeon needs to balance the risk of bleeding against the risk of thrombo-embolism. A regimen of high dose anticoagulant is a risk factor for wound healing complications: guidelines for DVT prevention in primary joint arthroplasty allow low dose regimens for anticoagulants or pneumatic devices where an early mobilisation protocol is enforced. Finally, patients that require high dose prophylaxis for cardiac or increased DVT risk must be considered as patients at high risk of wound healing complications. 

  • Orthopaedics: NPWT for seroma prevention and surgical incision...

    Matthias Brem (DE).

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    Matthias Brem closed the session with the results of a prospective, randomised study of NPWT on spinal surgery incision management (in press, International Wound Journal, June 2015)32. Twenty patients with spinal fracture, scheduled for an open surgical procedure, were randomised to receive either PICO™ or standard care. The wound was examined for seroma on the 5th and 10th day post surgery using ultrasound. Results showed less wound drainage in the study group after two days, and fewer dressing changes in the study group, making it more time-efficient and cost-effective. The study group were seroma-free at day five, thereby reducing SSI risk. 

    32. Nordmeyer M, Pauser J, Biber R, Jantsch J, Lehrl S, Kopschina C, et al., Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care. International Wound Journal 2015 doi 10.1111/iwj.12436.