Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study

Moris Topaz; Itamar Ashkenazi; Oren Barzel; Seema Biswas; Dan Atar; Nurit Shadmi; Itzhak Siev-Ner

doi:10.1093/burnst/tkab007

您当前的位置：

首页 >

文章列表页 >

Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study

更新时间：2022-06-14

- Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study
- Burns & Trauma Vol. 9, Issue 1, (2021)
- 作者机构：
  
  1. Sheba Medical Center
  2. Hillel Yaffe Medical Center
  3. Rambam Medical Center
  4. Galilee Medical Center
  5. Soroka Medical Center
  6. Adi Negev Rehabilitation Hospital
- 作者简介：
- 基金信息：
- DOI：10.1093/burnst/tkab007
  CLC：
- Published：2021，
  
  Published Online：25 May 2021，
扫描看全文
Moris Topaz, Itamar Ashkenazi, Oren Barzel, Seema Biswas, Dan Atar, Nurit Shadmi, Itzhak Siev-Ner, Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study, Burns & Trauma, Volume 9, 2021, tkab007, https://doi.org/10.1093/burnst/tkab007
DOI：

Moris Topaz, Itamar Ashkenazi, Oren Barzel, Seema Biswas, Dan Atar, Nurit Shadmi, Itzhak Siev-Ner, Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study, Burns & Trauma, Volume 9, 2021, tkab007, https://doi.org/10.1093/burnst/tkab007 DOI：

摘要

Abstract

BackgroundFollowing combat-related

extensive soft tissue injury from gunshot wounds or blasts

prolonged duration from injury to full wound closure is associated with infection

increased morbidity and mortality

failure to mobilize

poor functional outcome and increased cost. The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds.MethodsThis was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries (5 gunshot wounds

5 blasts) treated using the TopClosure® Tension Relief System (TRS) with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy (ROINPT) via the Vcare α® device.ResultsNine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction. Two patients had upper limb injury and the rest lower limb injury. With the aid of the TRS and/or ROINPT

immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three. Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure. Wound closure was achieved within 0–37 days (median: 12.5 days

interquartile range: 2.75–19.75) from injury.ConclusionsThe TRS is a novel device for effective

early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep

achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders. Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy

mitigating anaerobic contamination and reducing infection. Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration. The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.

关键词

Keywords

Soft tissue injuryCombat injuriesLimb injuriesStress relaxationMechanical creepTension relief systems

references

1.Hoencamp R, Vemetten E, Tan EC, Putter H, Leenan LP, Hamming JF. Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan. Injury. 2014;45:1028–34.

2.Belmont PJ Jr, McCriskin BJ, Sieg RN, Burks R, Schoenfeld AJ. Combat wounds in Iraq and Afghanistan from 2005 to 2009. J Trauma Acute Care Surg. 2012;73:3–12.

3.Giannou C, Baldan M. War Surgery. Working with limited resources in armed conflict and other situations of violence. Vol 1. Geneva: International Committee of the Red Cross, 2020, 211–28.

4.Biswas S, Peleg K, Clond M, Radomislensky I, Veen H, Bala M, et al. Landmine injuries: treatment and rehabilitation. Funct Neurol Rehabil Ergon. 2016;6:153–65.

5.Li J, Topaz M, Tan H, Li Y, Li W, Xun W, et al. Treatment of infected soft tissue blast injury in swine by regulated negative pressure wound therapy. Ann Surg. 2013;257:335–44.

6.Hirshowitz B, Kaufman T, Ullman J. Reconstruction of the tip of the nose by load cycling of the nasal skin and harnessing of extra skin. Plast Reconstr Surg. 1986;77:316–21.

7.Ji P, Zhang Y, Hu D, Zhang Z, Li X, Tong L, et al. Clinical effect of combined application of skin-stretching device and vacuum sealing drainage in repairing the diabetic foot wounds. Zhonghua Shao Shang Za Zhi. 2020;36:1035–9.

8.Biermann N, Geissler EK, Brix E, Schiltz D, Prantl L, Kehrer A, et al. Oxygen levels during negative pressure wound therapy. J Tissue Viability. 2019;28:223–6.

9.Topaz M, Bisker O, Litmanovitch M, Keren G. Application of regulated oxygen-enriched negative pressure-assisted wound therapy in combating anaerobic infections. Eur J Plast Surg. 2011;34:351–8.

10.Li YZ, Hu XD, Lai XM, Li YF, Lei Y. Improvement of wound healing by regulated oxygen-enriched negative pressure-assisted wound therapy in a rabbit model. Clin Experim Dermatol. 2018;43:11–8.

11.Motiei M, Sadan T, Zilony N, Topaz G, Popovtzer R, Topaz M. Gold nanoparticles for tracking bacteria clearance by regulated irrigation and negative pressure-assisted wound therapy. Nanomedicine. 2018;13:1835–945.

12.Topaz M, Kazazker M, Oron Y, Keren G, Carmel NN, Silberman A, et al. A novel therapy for salvage of infected permanent pacemakers and implantable cardioverter defibrillator. Heart Rhythm. 2012;9(5 Supplement):S108.

13.Jacobsen F, Fisahn C, Sorkin M, Thiele I, Hirsch T, Stricker I, et al. Efficacy of topically delivered moxifloxacin against wound infection by Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2011;55:2325–34.

14.U.S. Food and Drug Administration: Medical Devices. Update on Serious Complications Associated with Negative Pressure Wound Therapy Systems: FDA Safety Communication. 2011; Available at: https://wayback.archive-it.org/7993/20170722215801/https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm244211.htm. Accessed 29 Dec 2019.

15.Topaz M, Carmel NN, Topaz G, Li M, Li YZ. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept. Medicine. 2014; https://doi:10.1097/MD.0000000000000234.

16.Topaz M. Role of regulated negative pressure therapy in wound healing. In: Sarabani S, Tiwari VK (eds). Principles and Practice of Wound Care. New Delhi:Jaypee Brothers Medical Publishers, 2012, 401–31.

17.Ezra S. Novel methods for management of complicated wounds. Ph.D. Thesis. Department of Health Systems Management, Ariel University 2019.

18.Holler JT, MacKechnie MC, Albright PD, Morshed S, Shearer DW, Terry MJ. The impact of inadequate soft-tisssue coverage following severe open tibia fractures in Tanzania. Plast Reconstr Surg Glob Open. 2020. https://doi:10.1097/GOX.0000000000003272.

19.Datli A, Karasoy I, Genc Y, Pilanci O. Challenges of setting up a lower extremity reconstruction practice in a constrained environment. J Reconstr Microsurg. 2021;37:67–74.

20.Topaz M, Kazatsker M, Ashkenazi I, Schwartz AL, Carmel-Neiderman NN, Topaz G, et al. A novel antibiotic delivery approach enhances salvage of infected cardiovascular-implantable electronic devices. Circulation. 2020. https://DOI:10.1161/circ.142.suppl_3.15682.

查看原文

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰