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Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival

Negative-pressure wound therapy (NPWT) has improved split-thickness skin graft (STSG) survival rates, but prolonged application increases bacterial bioburden. Antimicrobial NPWT adjuncts have demonstrated efficacy, but strong evidence is lacking. We hypothesized that simultaneously replacing NPWT dr...

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Autores principales: Liao, Christopher D., Deccico, John-Brandon, Cuzzone, Daniel, George, Finny, Xipoleas, George D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780109/
https://www.ncbi.nlm.nih.gov/pubmed/36569245
http://dx.doi.org/10.1097/GOX.0000000000004724
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author Liao, Christopher D.
Deccico, John-Brandon
Cuzzone, Daniel
George, Finny
Xipoleas, George D.
author_facet Liao, Christopher D.
Deccico, John-Brandon
Cuzzone, Daniel
George, Finny
Xipoleas, George D.
author_sort Liao, Christopher D.
collection PubMed
description Negative-pressure wound therapy (NPWT) has improved split-thickness skin graft (STSG) survival rates, but prolonged application increases bacterial bioburden. Antimicrobial NPWT adjuncts have demonstrated efficacy, but strong evidence is lacking. We hypothesized that simultaneously replacing NPWT dressings within 48–72 hours and cleansing with Dakin's solution—a well-known antimicrobial agent—would increase STSG take. METHODS: We performed a controlled retrospective case series on three groups of STSG patients treated between January 2014 and December 2020: bolster dressings, continuous NPWT (C-NPWT), and Dakin's NPWT (D-NPWT). Patients with documented measurements of STSG survival were included. The primary outcome was the percentage of STSG take calculated by survival area using surgical tape measures 2 weeks after surgery. RESULTS: Fifty-nine patients were followed up for greater than or equal to 3 months. Average wound size for bolsters was smaller than that for D-NPWT (83 cm2 versus 204 cm2; P < 0.05). Average treatment time was 6.4 ± 2.4 days (bolsters), 6.5 ± 0.9 days (C-NPWT), and 2.8 ± 0.9 days (D-NPWT; P < 0.01). Average percentage of STSG take was 92% ± 0% (bolsters), 82% ± 0% (C-NPWT), and 99% ± 0% (D-NPWT; P < 0.01); there were significant differences between bolsters versus C-NPWT (P < 0.05) and C-NPWT versus D-NPWT (P < 0.05), but not between bolsters and D-NPWT. CONCLUSIONS: Interrupting NPWT with 0.125% Dakin’s solution cleansing is associated with increased STSG survival compared with standard NPWT protocols, but not bolster dressings. These findings warrant further investigation due to limitations of this retrospective case series.
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spelling pubmed-97801092022-12-23 Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival Liao, Christopher D. Deccico, John-Brandon Cuzzone, Daniel George, Finny Xipoleas, George D. Plast Reconstr Surg Glob Open Reconstructive Negative-pressure wound therapy (NPWT) has improved split-thickness skin graft (STSG) survival rates, but prolonged application increases bacterial bioburden. Antimicrobial NPWT adjuncts have demonstrated efficacy, but strong evidence is lacking. We hypothesized that simultaneously replacing NPWT dressings within 48–72 hours and cleansing with Dakin's solution—a well-known antimicrobial agent—would increase STSG take. METHODS: We performed a controlled retrospective case series on three groups of STSG patients treated between January 2014 and December 2020: bolster dressings, continuous NPWT (C-NPWT), and Dakin's NPWT (D-NPWT). Patients with documented measurements of STSG survival were included. The primary outcome was the percentage of STSG take calculated by survival area using surgical tape measures 2 weeks after surgery. RESULTS: Fifty-nine patients were followed up for greater than or equal to 3 months. Average wound size for bolsters was smaller than that for D-NPWT (83 cm2 versus 204 cm2; P < 0.05). Average treatment time was 6.4 ± 2.4 days (bolsters), 6.5 ± 0.9 days (C-NPWT), and 2.8 ± 0.9 days (D-NPWT; P < 0.01). Average percentage of STSG take was 92% ± 0% (bolsters), 82% ± 0% (C-NPWT), and 99% ± 0% (D-NPWT; P < 0.01); there were significant differences between bolsters versus C-NPWT (P < 0.05) and C-NPWT versus D-NPWT (P < 0.05), but not between bolsters and D-NPWT. CONCLUSIONS: Interrupting NPWT with 0.125% Dakin’s solution cleansing is associated with increased STSG survival compared with standard NPWT protocols, but not bolster dressings. These findings warrant further investigation due to limitations of this retrospective case series. Lippincott Williams & Wilkins 2022-12-22 /pmc/articles/PMC9780109/ /pubmed/36569245 http://dx.doi.org/10.1097/GOX.0000000000004724 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Liao, Christopher D.
Deccico, John-Brandon
Cuzzone, Daniel
George, Finny
Xipoleas, George D.
Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
title Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
title_full Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
title_fullStr Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
title_full_unstemmed Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
title_short Interrupting Negative-pressure Wound Therapy with Dakin’s Solution Is Associated with Increased Skin Graft Survival
title_sort interrupting negative-pressure wound therapy with dakin’s solution is associated with increased skin graft survival
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780109/
https://www.ncbi.nlm.nih.gov/pubmed/36569245
http://dx.doi.org/10.1097/GOX.0000000000004724
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