dijous, 28 d’agost de 2014

Ferides tractades amb cura de pressio negativa

Negative-Pressure Wound Therapy After Fasciotomy Reduces Muscle-Fiber Regeneration in a Pig Model
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Clinical Relevance: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
Acute compartment syndrome is a limb-threatening condition. As pressure rises inside a muscle fascial compartment, capillary perfusion pressure falls and causes cellular hypoxia. Untreated, the cascade of hypoxia, microvascular dysfunction, and increased capillary permeability results in irreversible ischemic injury. Prompt fasciotomy is the ideal treatment. Many patients who undergo fasciotomy require delayed skin-grafting and have long-term functional impairment1.
Recently, negative-pressure wound therapy (NPWT) has been used on fasciotomy wounds. The results of this practice are variable. Some authors have reported decreased wound size2 and a shorter time to wound closure3, but a recent randomized controlled trial showed a longer time to wound closure and an increased need for skin grafts with NPWT4.
To our knowledge, no one has examined NPWT effects on the underlying skeletal muscle. NPWT increases microvascular circulation around the wound5-8, and this may be beneficial after ischemia. We assessed NPWT effects on skeletal muscle cellular morphology at different time points after compartment syndrome in an animal model and attempted to determine whether regional differences in fiber recovery occurred. The primary outcome that we investigated was the cross-sectional area occupied by normal-appearing muscle fibers and other cellular morphologies. A secondary outcome was the change in muscle weight as a marker of intramuscular fluid accumulation. We hypothesized that NPWT would improve muscle fiber regeneration after an acute compartment syndrome and would decrease muscle weight by enhancing edema clearance.

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