Abstract:
BACKGROUND:Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested. QUESTIONS/PURPOSES:Does a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition? METHODS:We evaluated 42 patients with massive (> 200 cm(2)) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing. RESULTS:Hospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033). CONCLUSIONS:Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies. LEVEL OF EVIDENCE:Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Siegel HJ,Herrera DF,Gay Jdoi
10.1007/s11999-013-3123-3subject
Has Abstractpub_date
2014-03-01 00:00:00pages
830-5issue
3eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章abstract:BACKGROUND:Periprosthetic joint infection (PJI) is a leading cause of revision arthroplasty. Considerable controversy still exists whether single- or two-stage exchange is the better approach for patients with chronic PJI. Historically, single-stage exchange arthroplasty was thought to have an unacceptably high risk of...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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doi:10.1097/01.blo.0000182247.37454.fb
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abstract::The cells of cartilage are constantly remodeling the matrix in which they are suspended. The stimulus to initiate remodeling is probably the chondrocyte's response to physical and or chemical changes in the environment. Heat, pressure, friction, load, pH, and growth are examples of such factors, which, if altered, wou...
journal_title:Clinical orthopaedics and related research
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abstract::A case of an osteoid osteoma occurring in the cervical spine and presenting as scapular and arm pain has been described. Correct diagnosis was delayed for 2 years. Plain radiographs may fail to demonstrate a lesion in the spine. Radiographic evaluation, when osteoid osteoma is a possibility, should include bone scanni...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,meta分析,评审
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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doi:
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-08-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1990-05-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1980-10-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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doi:10.1007/s11999-012-2602-2
更新日期:2013-02-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-11-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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更新日期:2012-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1986-11-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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doi:10.1007/s11999-010-1713-x
更新日期:2011-08-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1988-09-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:2018-06-01 00:00:00
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更新日期:2003-02-01 00:00:00
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