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The second case of NPWT monitoring system in diabetic foot patient accompanied with necrotizing fasciitis. (A) Photographic findings of 74-year-old female patient who was diagnosed with diabetic foot accompanied with necrotizing fasciitis on right lower extremity (B) Harvested ALT free flap (C) Immediate postoperative photographic finding (D) Postoperative photographic finding; 7 months.
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Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer. However, flap reconstruction for diabetic foot ulcer treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperative...
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Background: Various types of flaps are considered as reconstructive options for patients with diabetic foot ulcer (DFU). However, flap reconstruction for DFU treatment is particularly challenging because of the relatively limited collateral perfusion in the distal lower extremity. This study evaluated the efficacy and safety of a novel postoperativ...
Citations
... In the studies carried out by Wynn M, et al., 18 and Yafeng Yan, et al., 28 it was observed that after the use of negative pressure therapy in diabetic foot ulcers the incidence of amputations was very close to 2% compared to with a significantly higher incidence in diabetic foot treated with conventional cures. ...
Diabetic foot ulcers represent an increase in recent years in the cures to be carried out by nursing staff. For this reason, the new negative pressure therapy has been chosen, which involves an increase in granulation tissue, leading to complete healing in a minimum time, highlighting the few complications derived from said therapy. Objective: To demonstrate the effectiveness of negative pressure therapy in patients with diabetic foot. Methodology: A narrative review was carried out between December 2022 and November 2023 in the databases of Pubmed, Dialnet, Google Scholar, WOS, Scopus and Cochrane, following a search string, which combines keywords derived from the thesauri “Health Sciences Descriptors” (DeCS) and “Medical Subject Headings” (MeSH), being combined with the Boolean operators “NOT”, “OR” and “AND”. Results: Negative pressure therapy offers a number of significant benefits for adult patients with diabetic foot, improving wound healing, reducing the risk of serious complications and contributing to a better quality of life. It is important to highlight that the implementation of this therapy must be guided by health professionals and adapted to the specific needs of each patient. Conclusion: After comparing the different selected articles, it was determined that the application of negative pressure therapy in diabetic foot ulcers is beneficial in relation to the reduction in healing time compared to conventional wound healing dressings. The associated complications being minimal. Furthermore, treatment with this therapy turns out to be cost-effective by reducing patients' hospital stays, leading to an increase in quality of life.
... The rate of surgical site infection was decreased by 50% in the ciNPT group compared with the control group, according to a recent meta-analysis. NPWT over local transpositional flaps reduces skin tension, prevents seroma and hematoma under the flap, and enhances tissue perfusion without pedicle compression [25]. Although the same flap survival rate (100%) was observed in the NPWT and conventional dressing groups in our study, NPWT resolves venous congestion of flap surgery by promoting local circulation and facilitating revascularization through neoangiogenesis, which is especially beneficial given that venous congestion is a common cause of flap failure [26,27]. ...
Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.
... NPWT has also been shown to decrease wound edema, increase the rate of vascular ingrowth and fibroblast migration, and possibly reduce local bacterial proliferation [26]. The incisional NPWT (iNPWT) after flap technique is efficient and safe for comorbidities patients [27,28]. The iNPWT after RSAF flap may be considered a practical alternative technique in promoting wound healing and reducing the risk of complications in patients with comorbidities. ...
Background:
The reverse sural artery fasciocutaneous (RSAF) flap is a popular option for patients with soft tissue defects of the distal lower extremities. However, most studies have focused on young patients without comorbidities. This study aimed to report the clinical application of the RSAF flap and to evaluate its reliability in older adult patients.
Methods:
A retrospective study of fifty-one patients who underwent RSAF flap was included in this study between September 2016 and October 2021. Reconstruction outcomes and wound complications were compared between groups A (21 patients over 60 years of age) and B (30 patients under 60 years of age).
Results:
Overall, 74.5% of the flaps healed primarily. The demographics of the two groups were similar, except for comorbidities (P = 0.01). The risk factors that affected the survival of RSAF flaps were not significantly different between the two groups (P > 0.05). The rate of wound complications in group A (42.85%) was significantly higher than that in group B (13.3%) (P = 0.04). However, all wound complications were treated using a simple procedure (skin grafting or simple suturing).
Conclusions:
The RSAF flap can be a reliable salvage option to repair soft tissue defects of the lower extremities in older adult patients. It is safe and easy to harvest and transfer the flap; however, surgeons should be aware of the possibility of wound complications in older patients with comorbidities.
... The repair of diabetic wounds remains a major concern in clinic ( Zhang et al., 2022). The healing of skin wound is mainly depending on the proliferation and migration of several kinds of cells surrounding wounds and/or the survival of transplanted skin random flaps (Park and Park, 2022). However, due to diabetes, patients usually suffer from metabolic disorders, impaired immune functions, and slow nerve activity that causes excessive inflammation, cellular dysfunction, and other problems (Thomas et al., 2020). ...
The tissue reconstruction of diabetic wounds mainly depends on the proliferation and remodelling of cutaneous cells around wounds and the transplantation of random skin flaps, however, the proliferation of cells or survival of skin flaps are difficult due to the severe inflammation and other problems caused by diabetes. The stem cell-derived exosomes loaded with miRNA can be an effective therapeutic strategy for promoting diabetic wound healing. Therefore, in this study, the engineered exosomes derived from miR-132-overexpressing adipose stem cells (miR-132-exo) was obtained for promoting the healing of diabetic wounds and skin flaps. In vitro, the miR-132-exo promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs). In vivo, streptozotocin (STZ) induced diabetic mice were used to create full-thickness skin wounds and random skin flaps to further investigate the healing effect of miR-132-exo. The results showed miR-132-exo evidently enhanced the survival of skin flaps and promote diabetic wound healing, through reducing local inflammation, promoting angiogenesis and stimulating M2-macrophages polarization mediated by NF-κB signaling pathway. These novel findings demonstrated that engineered miR-132-exo can be a potent therapeutic for treating diabetic wounds and inflammatory-related disease.
