Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: L’utilizzo della pressione negativa associato ad instillazione nel trattamento delle grandi cavità infette e nell’addome aperto

Negative Pressure Wound Therapy is a quiet recent technique which can be applied specifically in infected wounds, both acute and chronic, that are difficult to manage with conventional methods. The system in known with several acronyms: TNP (topical negative pressure), SAP (sub-atmospheric pressure), VST (vacuum sealing technique), SSS (sealed surface wound suction) and VAC ® (vaccum assisted closure ®, the most famous commercial device). The equipment is composed by a sponge (or gauze) with a honeycomb-like structure, which is inserted into the infected cavity (wound); an adhesive drape is then applied above, thus creating a sealed circuit; the whole system is connected to a suction pump through a drain tube. The parameters of suction are set by a specific software embedded into the unit. In the last few years, instillation of fluids was added to the traditional treatment (NPTWi®, Negative Pressure Wound Therapy with instillation): this system differs from traditional VAC therapy because it allows the clinician to add solutions to the wound, as well as apply negative pressure. The most appropriate parameters, according to the current consensus guidelines, are shown and investigated. We present a case series of patients affected by major infected wounds trated with iNPWT, including patients with “open abdomen” and enteroatmospheric fistulas. These patients were all treated at Santa Maria Goretti Hospital in Latina, Italy, General and Emergency Surgery Division. Besides clinical and therapeutical effects, social and economical aspects are treated and analyzed. This paper, which is affected by the limits of a retrospective study, must be considered as a starting point for further randomized trial.