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• W626699994 abstract "Surgical wounds dehiscence is a serious post-operatory complication, with an incidence between 0.4% and 3.5%. Mortality is more than 45%. Complex wounds treatment may require a multidisciplinary management. VAC Therapy could be an alternative treatment regarding complex wound. VAC therapy has been recently introduced on skin's graft tissue management reducing skin graft rejection. The use of biological prosthesis has been tested in a contaminated field, better than synthetic meshes, which often need to be removed. The Permacol is more resistant to degradation by proteases due to its cross-links. Surgery is still considered the best treatment for digestive fistula. A 58 years old obese woman come to our attention, she was operated for an abdominal hernia. She had a post-operatory entero-cutaneous fistula. She was submitted to bowel resection, the anastomosis has been tailored and the hernia of the abdominal wall has been repaired with biological mesh for managing such condition. She had a wound dehiscence with loss of substance and the exposure of the biological prosthesis, nearly 20 cm diameter. She was treated first with antibiotic therapy and simple medications. In addiction, antibiotic therapy was necessary late associated to 7 months with advanced medications allowed a small reduction's defect. Because of its, treatment went on for two more months using VAC therapy. Antibiotic's therapy was finally suspended. The VAC therapy allowed the reduction of the gap, between skin and subcutaneous tissue, and the defect's size preparing a suitable ground for the skin graft. The graft, managed with the vac therapy, was necessary to complete the healing process.post-operatoria severa, con un’incidenza descritta in letteratura tra 0.4% e 3.5%. Il tasso di mortalità riportato è superiore al 45% 1,2. Il trattamento delle ferite complesse può richiedere una gestione multidisciplinare 1,2. È ormai consolidato l’uso della VAC Therapy nella gestione delle ferite complesse e recente è l’uso nella gestione degli innesti tissutali, riducendo il tasso di rigetto 3,6. È stato più volte testato l’uso delle protesi biologiche in campo contaminato. In campo infetto, queste protesi, risultano migliori delle protesi sintetiche, che spesso richiedono la loro rimozione. Il Permacol è reso più resistente alla degradazione dai suoi crosslinks 7,8. La chirurgia è ancora considerata miglior trattamento chirurgico per le fistole digestive. Una paziente di 58 anni, obesa, veniva sottoposta ad intervento di plastica di laparocele. Nel post-operatorio veniva diagnosticata una fistola entero - cutanea. La paziente veniva sottoposta ad intervento chirurgico di resezione intestinale con anastomosi e plastica della parete con protesi biologica. Nell’immediato post-chirurgico la paziente presentava deiscenza della ferita chirurgica con ampia perdita di sostanza, di circa 20 cm di diametro, ed esposizione della protesi. L’antibiotico-terapia e la presenza della protesi biologica impedivano la diffusione sistemica dell’infezione. La terapia antibiotica mirata associata alle medicazioni avanzate per circa 7 mesi consentivano una piccola riduzione delle dimensioni del difetto. Il trattamento proseguiva con l’utilizzo della VAC therapy per circa 2 mesi, ottenendo la riduzione del gap tra cute e sottocute, la riduzione delle dimensioni del difetto e preparando così un terreno idoneo per un innesto cutaneo. Il trattamento veniva completato con un innesto cutaneo, riparando definitivamente il difetto." @default.
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• W626699994 date "2015-05-09" @default.
• W626699994 modified "2023-09-27" @default.
• W626699994 title "Recurrent incisional hernia, enterocutaneous fistula and loss of the substance of the abdominal wall: plastic with organic prosthesis, skin graft and VAC therapy. Clinical case." @default.
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