Microdeformational wound therapy: A novel option to salvage complex wounds associated with the Nuss procedure

Jeffrey Lukish, Fray Dylan Stewart, Seth Goldstein, Alejandro Garcia, Howard Pryor, Daniel Rhee, Samuel M. Alaish, Paul Colombani

Research output: Contribution to journalArticle

Abstract

Background: Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair. Operative technique: We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics. Upon recognition of a complex wound, we recommend an initial operative wound debridement. This allows wound cultures, wound assessment and precise initiation of MDWT. It is not uncommon to have exposed hardware in the wound early in the course of therapy. Metal allergy must be excluded. The patient is transitioned to oral antibiotics following resolution of the acute process. MDWT is performed until the wounds are completely epithelialized with no clinical signs of drainage or infection. The average length of MDWT in our patients was 39 days. Following complete wound healing the patients are maintained on antibiotics until implant removal. Conclusions: The use of microdeformational wound therapy in complex wounds associated with the Nuss procedure is a safe and effective modality. The technique may reduce the likelihood of implant removal with potential recurrent pectus excavatum. Type of study: Operative technique. Level of evidence: Level IV, case series with no comparison group

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Wounds and Injuries
Therapeutics
Anti-Bacterial Agents
Device Removal
Funnel Chest
Debridement
Postoperative Period
Wound Healing
Drainage
Hypersensitivity
Metals
Morbidity
Infection

Keywords

  • Negative pressure wound therapy
  • Pectus excavatum
  • PICO vac

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Microdeformational wound therapy : A novel option to salvage complex wounds associated with the Nuss procedure. / Lukish, Jeffrey; Stewart, Fray Dylan; Goldstein, Seth; Garcia, Alejandro; Pryor, Howard; Rhee, Daniel; Alaish, Samuel M.; Colombani, Paul.

In: Journal of pediatric surgery, 01.01.2019.

Research output: Contribution to journalArticle

@article{364d3ee688c84496833fd50e1d026fe0,
title = "Microdeformational wound therapy: A novel option to salvage complex wounds associated with the Nuss procedure",
abstract = "Background: Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair. Operative technique: We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics. Upon recognition of a complex wound, we recommend an initial operative wound debridement. This allows wound cultures, wound assessment and precise initiation of MDWT. It is not uncommon to have exposed hardware in the wound early in the course of therapy. Metal allergy must be excluded. The patient is transitioned to oral antibiotics following resolution of the acute process. MDWT is performed until the wounds are completely epithelialized with no clinical signs of drainage or infection. The average length of MDWT in our patients was 39 days. Following complete wound healing the patients are maintained on antibiotics until implant removal. Conclusions: The use of microdeformational wound therapy in complex wounds associated with the Nuss procedure is a safe and effective modality. The technique may reduce the likelihood of implant removal with potential recurrent pectus excavatum. Type of study: Operative technique. Level of evidence: Level IV, case series with no comparison group",
keywords = "Negative pressure wound therapy, Pectus excavatum, PICO vac",
author = "Jeffrey Lukish and Stewart, {Fray Dylan} and Seth Goldstein and Alejandro Garcia and Howard Pryor and Daniel Rhee and Alaish, {Samuel M.} and Paul Colombani",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jpedsurg.2019.03.006",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Microdeformational wound therapy

T2 - A novel option to salvage complex wounds associated with the Nuss procedure

AU - Lukish, Jeffrey

AU - Stewart, Fray Dylan

AU - Goldstein, Seth

AU - Garcia, Alejandro

AU - Pryor, Howard

AU - Rhee, Daniel

AU - Alaish, Samuel M.

AU - Colombani, Paul

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair. Operative technique: We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics. Upon recognition of a complex wound, we recommend an initial operative wound debridement. This allows wound cultures, wound assessment and precise initiation of MDWT. It is not uncommon to have exposed hardware in the wound early in the course of therapy. Metal allergy must be excluded. The patient is transitioned to oral antibiotics following resolution of the acute process. MDWT is performed until the wounds are completely epithelialized with no clinical signs of drainage or infection. The average length of MDWT in our patients was 39 days. Following complete wound healing the patients are maintained on antibiotics until implant removal. Conclusions: The use of microdeformational wound therapy in complex wounds associated with the Nuss procedure is a safe and effective modality. The technique may reduce the likelihood of implant removal with potential recurrent pectus excavatum. Type of study: Operative technique. Level of evidence: Level IV, case series with no comparison group

AB - Background: Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair. Operative technique: We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics. Upon recognition of a complex wound, we recommend an initial operative wound debridement. This allows wound cultures, wound assessment and precise initiation of MDWT. It is not uncommon to have exposed hardware in the wound early in the course of therapy. Metal allergy must be excluded. The patient is transitioned to oral antibiotics following resolution of the acute process. MDWT is performed until the wounds are completely epithelialized with no clinical signs of drainage or infection. The average length of MDWT in our patients was 39 days. Following complete wound healing the patients are maintained on antibiotics until implant removal. Conclusions: The use of microdeformational wound therapy in complex wounds associated with the Nuss procedure is a safe and effective modality. The technique may reduce the likelihood of implant removal with potential recurrent pectus excavatum. Type of study: Operative technique. Level of evidence: Level IV, case series with no comparison group

KW - Negative pressure wound therapy

KW - Pectus excavatum

KW - PICO vac

UR - http://www.scopus.com/inward/record.url?scp=85063866111&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063866111&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2019.03.006

DO - 10.1016/j.jpedsurg.2019.03.006

M3 - Article

C2 - 30967247

AN - SCOPUS:85063866111

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -