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Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

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Surgical Science 2023年第3期14卷 231-239页

作者： Linnea T. Mauro Courtney M. Janowski Mariah J. Janowski Adalberto C. Gonzalez Eugene J. Sidoti Luis G. Fernandez Paul J. Kim Marc R. Matthews Valleywise Medical Center Department of Surgery Phoenix Arizona Department of Surgery Division of Trauma Surgery/Surgical Critical Care University of Texas Health Science Center Tyler Texas The university of Texas Tyler School of Medicine Endowed Chair in Trauma Surgery Tyler Texas Trauma Wound Care UT Health East Tyler Texas Department of Surgery University of Texas Medical Branch Galveston Texas Medicine and Nursing University of Texas Arlington Texas Department of Medical education health Science Center Tyler Texas Department of Physician Assistant Studies School of Health Professions University of North Texas Fort Worth Texas ACS National Committee on Trauma Chicago USA Plastic Surgery Department of Surgery University of Texas Southwestern Dallas Texas university of arizona & creighton university Schools of Medicine The Arizona Burn Center Phoenix Arizona

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

关键词： Negative Pressure Wound Therapy with Instillation NPWT NPWTi NPWT with Dwell Hypochlorous Acid Vashe Wound Solution Sternal Dehiscence

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Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

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Surgical Science 2023年第5期14卷 388-397页

作者： Alexandra N. Dominianni Samantha A. Delapena Luis G. Fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews College of Medicine-Phoenix University of Arizona Phoenix AZ USA creighton university arizona health education alliance Phoenix AZ USA Department of Surgery Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler TX USA The university of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery Tyler TX USA Trauma Wound Care UT Health East Tyler TX USA Department of Surgery University of Texas Medical Branch Galveston TX USA Adjunct Clinical Professor of Medicine and Nursing University of Texas Arlington TX USA Past Commanding General TXSG Medical Brigade Austin TX USA Surgical Resident Abrazo Health Network General Surgery Residency Glendale AZ USA Area Sales Manager Miach Orthopedics Surgical Acute Account Manager 3M Minneapolis MN USA Clinical Professor of Surgery Banner University of Arizona/University Medical Center Tucson AZ USA

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

关键词： Emphysematous Cholecystitis Gangrenous Cholecystitis Cholecystocutaneous Fistula Necrotizing Fasciitis Sepsis

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