Negative pressure wound therapy (NPWT) has been used in various wound management as a method to promote wound healing. Three randomized controlled trials that verified the effectiveness of prophylactic primary wound closure in 2019 was reported. The systematic review and meta-analysis were performed by adding pieces of evidence to the conventional results. The incidence of SSI compared with the standard wound closure method in NPWT was a risk ratio of 0.55, 95％ confidence interval was 0.33–0.92 (P＝0.02), and the SSI reduction effect by NPWT were statistically significant. The funnel plot showed asymmetry, with an I2 value of 65％ (P＝0.009), indicating a high degree of heterogeneity. In primary wound closure, prophylactic NPWT re-examined the SSI prevention effect. On the other hand, heterogeneity was observed, and further research that makes the target disease uniform is also necessary for future.

Objectives: We assessed the risk factors for in-hospital death caused by deep sternal wound infection (DSWI) and the available treatments for DSWI. Methods: Between January 1991 and August 2019, we retrospectively reviewed 84 patients who developed DSWI after cardiovascular surgery via median sternotomy. Treatment of DSWI consisted of open daily irrigation (up to 2006) or negative pressure wound therapy (NPWT) (2007 onward), followed by primary closure or reconstruction of tissue flaps. Results: We observed 17 patients (20.2％) who died caused by DSWI. Multivariate analysis identified age, female, hemodialysis, postoperative cerebral disease, and MRSA infection as independently associated with increased in-hospital mortality after DSWI, whereas NPWT and tissue flaps as independently associated with reduced in-hospital mortality. Tissue flaps significantly reduced the in-hospital mortality caused by DSWI (Tissue flaps vs non-Tissue flaps, 13.0％ vs 53.3％, P＝0.002). In DSWI infected by MRSA, NPWT significantly reduced the in-hospital mortality caused by DSWI (NPWT vs non-NPWT, 0％ vs 52.0％, P＝0.003). Conclusions: NPWT and tissue flaps may be favourable factors associated with reduced in-hospital mortality attributable to DSWI. NPWT as bridge therapy to tissue flaps may play a major role in treating DSWI with improving the prognosis for patients with DSWI.

In the field of plastic surgery, treatment such as flap surgery or conservative treatment was the main treatment for wound, but the introduction of NPWT has made it possible to shorten the treatment period and achieve minimally invasive wound treatment. Because we plastic surgeons are both wound surgeons and reconstructive surgeons, we plan treatment for trauma, soft tissue infections, and postoperative wound infections with a vision of the path to ultimate cure at the time of initial treatment. This paper outlines our strategy for wound treatment.

We report the actual state of negative pressure wound therapy (NPWT) for patients undergoing digestive surgery in our hospital since May 2013 to December 2019. And, we considered the appropriate treatment in order to shorten duration of therapy for surgical site infection including NPWT. In addition, we compare the effect of negative pressure wound therapy with instillation and dwelling (NPWTi–d) with NPWT. 52 patients were divided into two groups: delayed primary suture group (n=9) and secondary healing group (n=43) after NPWT. The period from setout of NPWT to wound healing was 11 days (5〜27) and 25 days (6〜286) in delayed primary suture group and secondary healing group, respectively. In our hospital, NPWTi–d has been brought in since November 2018. Patients divided into two groups：traditional NPWT group (n=43) and NPWTi–d group (n=9). The period from SSI diagnosis to setout of NPWT was 6 days (0〜45) and 1 day (0〜15), respectively. The period from the diagnosis to the wound healing was 31 days (11〜297) and 25 days (5〜66), respectively. The delayed primary suture after NPWT might be a suitable therapeutic strategy, because the duration of SSI therapy in the delayed primary suture group is shorter than that in secondary healing group. NPWTi–d might enable early medical treatment for SSI and become foreshortened the total length of treatment.

Negative pressure wound therapy (NPWT) is useful not only for intractable open wounds but also for the prevention of surgical site infections (SSI), and its use is expanding. Bleeding is one of the adverse events of NPWT, and anticoagulants and antiplatelet drugs must be administered with caution. With the recent aging of the population, the number of patients receiving these drugs is increasing, and the chances of administering these drugs during NPWT is expected to increase. In this case, we experienced anticoagulant treatment during NPWT and managed 6 wounds safely. We reduced the negative pressure of NPWT, paid attention to the properties of drainage, and carefully removed the foam when replacing these drugs. In one case, the drainage of NPWT became pale-blooded, but the spontaneous hemostasis was stopped. Although the administration of anticoagulants during NPWT is warned, it was thought that the wound could be safely managed by careful monitoring of the setting of negative pressure, strict monitoring, and friendly treatment.

[Purpose] We examined the usefulness of patients who underwent purse string skin closure and negative pressure wound therapy (NPWT) for stoma closure. [Subjects and Methods] 10 patients who used NPWT after stoma closure from January 2017 to April 2019 were included in this study. Closure of the colostomy was performed with annular skin suture, and NPWT was started the day after surgery and replaced as appropriate until the wound was closed. Results: The subjects were 10 cases of 8 males and 2 females, with an age of 61years old (41〜75). The colostomy site was 6 in the transverse colon, 3 in the sigmoid colon, and one in the ileum. NPWT was changed on 3 times (2〜5). There was one case (10％) of postoperative closed wound infection. The median length of hospital stay after surgery was 13 days (9〜43), and the median time to closure was 20 days (13〜30). [Conclusion] The results suggest that skin annular suture and NPWT for colostomy wounds may be useful in shortening the length of wound closure period.

Our patient was a 70-year old man with chronic renal disease, who was on dialysis. He developed acute abdominal pain and received emergency laparotomy because of panperitonitis. The intraoperative finding revealed perforation of the small intestine with a fecal impaction. The resection of small intestine was performed, and the artificial respirator was used after surgery. Deep surgical site infection was seen 5 days after surgery, and wound bleeding subsequently occurred. The dehiscence of the wound was prolonged. He had a medical history of emphysema and gastrectomy due to gastric cancer, and we concerned more delayed wound healing because of comoebidities and malnutirition. To improve the wound dehiscene, administration of ornithine-containing food with low nitrogen load and negative pressure wound therapy (NPWT) with appropriate pressure adjustment were used, which result in safe and early wound healing. We report this successful care of wound healing by ornithine─containing food NPWT with a review of the literature.

Aeromonas hydrophila and Shewanella algae infections can cause necrotizing soft tissue infection (NSTI) and sepsis in the patients with malignancy and immunocompromised state, which are sometimes fatal because of progressively deteriorating within hours. A 66-year-old man, who underwent open distal gastrectomy for advanced gastric cancer and adjuvant chemotherapy, was alive without recurrence. Three years after gastric surgery, he was diagnosed as early esophageal cancer, and underwent video-assisted subtotal esophageal resection, 3 field lymph node dissection, and reconstruction with the ileo-colic intestine. In the evening of the first post-operative day, amount of abdominal drainage fluid increased and it had the putrid odor. Anastomotic leakage was suspected by the ischemia and/or necrosis of intestine, and emergency surgery was performed. However, the intestine was normal, so the operation was over only with drainage. He was diagnosed as septic shock caused by an unknown bacterium and treated with broad-spectrum antibiotics and cardiopulmonary support, but he was not getting better. The inflammation and necrosis of the skin and the subcutaneous tissue around the surgical wound appeared and spread, so NSTI was suspected and the abnormal skin and fascia was incised. However, the patient’s condition significantly deteriorated within a few hours, and he died on the next day after re-operation because of multiple organ failure. Autopsy was performed and A. hydrophila and S. algae ware isolated from the subcutaneous exudate.