1.
Antiseptic negative pressure instillation therapy for the treatment of septic wound healing deficits in oral and maxillofacial surgery.
Eckstein, FM, Pinsel, V, Wurm, MC, Wilkerling, A, Dietrich, EM, Kreißel, S, von WIlmowsky, C, Schlittenbauer, T
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2019;(3):389-393
Abstract
INTRODUCTION Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option. MATERIAL AND METHODS In this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction. RESULTS The use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases. CONCLUSION The negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.
2.
Vitamin D-binding protein in cervicovaginal fluid as a non-invasive predictor of intra-amniotic infection and impending preterm delivery in women with preterm labor or preterm premature rupture of membranes.
Kook, SY, Park, KH, Jang, JA, Kim, YM, Park, H, Jeon, SJ
PloS one. 2018;(6):e0198842
Abstract
OBJECTIVE To determine whether vitamin D-binding protein (VDBP) in cervicovaginal fluid (CVF) is independently predictive of intra-amniotic infection and imminent spontaneous preterm delivery (SPTD, delivery within 48 hours) in women with preterm labor with intact membranes (PTL) or preterm premature rupture of membranes (PPROM). METHOD This was a single-center retrospective cohort study. CVF samples for VDBP assays were obtained along with serum C-reactive protein (CRP) levels immediately after amniocentesis in consecutive women with PTL (n = 148) or PPROM (n = 103) between 23.0 and 34.0 weeks of gestation. VDBP levels in CVF were determined by enzyme-linked immunosorbent assay kits. The primary outcome measures were intra-amniotic infection [defined as positive amniotic fluid (AF) culture] and SPTD within 48 hours after sampling. RESULTS In the multivariable analysis, elevated VDBP levels in CVF samples of PTL women were significantly associated with intra-amniotic infection and imminent preterm delivery, even after adjusting for potential confounders (e.g., gestational age at sampling, parity, and serum CRP). However, these relationships were not found in women with PPROM. In women with PTL, the areas under receiver operating characteristic curves of CVF VDBP level for predicting intra-amniotic infection and imminent preterm delivery were 0.66 and 0.71, with cut-off values of 1.76 μg/mL (sensitivity of 64.3% and specificity of 78.4%) and 1.37 μg/mL (sensitivity of 65.4% and specificity of 72.6%), respectively. The CVF VDBP levels were significantly higher in women with PPROM than in those with PTL. CONCLUSIONS VDBP in the CVF independently predicts intra-amniotic infection and imminent preterm delivery in women with PTL, whereas in women with PPROM, an elevated VDBP level in CVF is not associated with increased risks of these two outcome variables.