Salvage of infected dermal collagen implants with topical negative pressure therapy.
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Biomedical subjects
Publications and source records attributed to P Banwell.
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Vacuum-assisted closure (V.A.C. Therapy) uses 2 distinct types of foams, with different physical characteristics: the black polyurethane (PU) foam and the white polyvinyl alcohol (PVA) foam. This prospective, randomized study evaluates the response of cutaneous blood flow (CBF) in healthy intact forearm skin to varying V.A.C. Therapy negative pressures and both foam types. Continuous negative pressure was used in the range of 25-500 mmHg. Skin blood flow was measured with noninvasive laser Doppler probes incorporated into the foam. Significant increase in CBF was found with both foams up to negative pressure of 300 mmHg, with over 5-fold increase (mean: 5.57; SD: 3.32) with the PU foam and nearly 3-fold increase (mean: 2.87; SD: 1.29) with the PVA foam. Comparison of blood flow at baseline and at a negative pressure of 300 mmHg showed a statistically significant difference (P < 0.001). No decrease in blood flow below baseline was observed during the experiments.
Meningococcal septicaemia can cause progressive necrosis of skin, soft tissue and bone. Successful limb reconstruction following the disease depends on an accurate assessment of the viability of these tissues and on a multidisciplinary team approach to ensure optimal care. However, bone scanning is not commonly performed in these patients. We present a case of meningococcal septicaemia where bone scanning significantly altered the management by demonstrating an extensive area of bone necrosis proximal to the soft-tissue necrosis. In view of this finding, we propose that bone scanning should be considered in all cases of meningococcal septicaemia where there is tissue necrosis affecting a limb, and that the radiologist should be considered a vital member of the multidisciplinary team.
The delivery of topical pressures at subatmospheric levels to heal acute and chronic wounds has been widely reported. This article reviews the role of this therapeutic modality to treat wounds of the lower extremity. Recent literature is re-viewed, and mechanisms of action of this process are also discussed.
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Epididymo-orchitis is a relatively common diagnosis in elderly men, often related to prostatic outflow obstruction. A 70-year-old man presented with a 4-day history of swelling and pain in the scrotum, fevers, dysuria and frequency. He had severe symptoms of prostatic hypertrophy. Physical examination and urine microscopy confirmed the diagnosis of left epididymo-orchitis and antimicrobial therapy was commenced. Subsequently, however, he developed severe necrotizing fasciitis (Fournier's gangrene) of the scrotum requiring surgical debridement, and at laparotomy, a perforated carcinoma of the sigmoid colon was found at the level of the left deep inguinal ring. Despite further radical surgery the gangrene extended, his condition deteriorated and he died. There has been no other similar case reported in the literature, and thus, although rare, intra-peritoneal causes of infection should be considered in patients with Fournier's gangrene.
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