Marco Ruggiero

The effectiveness of negative pressure therapy on infected wounds: preliminary results

Vacuum‐assisted closure (VAC) therapy is a sophisticated system that maintains a closed, humid, sterile and isolated environment. Wound infection is considered a relative contraindication. The objective of this study is to extend the indications for VAC therapy to include infected wounds by demonstrating its ability to increase the antibiotic concentration in the damaged and infected tissues. Patients who presented with ulcers infected with daptomycin‐sensitive bacteria were eligible to be enrolled in this prospective study. They were given antibiotic therapy with daptomycin with a specific protocol. A biopsy of the lesion was carried out to detect tissue concentration of the drug at time 0. Afterwards, the patients were subjected to VAC therapy. At the end of VAC therapy, a second lesion biopsy was performed and analysed to detect tissue concentration of the drug at time 1. A control group was enrolled in which patients followed the same protocol, but they were treated with traditional dressings. Fishers exact test was used to compare the two groups. The results highlighted a significant increase in the concentration of antibiotics in the study group tissue; the improvement was sensibly lower in the control group. Statistical differences were not found between the two groups. The preliminary analysis of the data showed an important increase of antibiotic concentration in the tissue after VAC therapy. Despite the encouraging data, it is necessary to broaden the sample of patients and perform the same study with other antibiotics.

A horizontal V-Y advancement lower eyelid flap: our experience performing a bilateral suspension to the periosteum.

tific basis; thus, the evidence level is none. The authors also mention the complications of polyacrylamide gel in women who were treated with polyacrylamide gel injections for breast augmentation in Ukraine.3 Again, the citation does not apply to our study because the injected polyacrylamide gel was not the same as that used in our population (Aquamid; Contura International A/S, Soeborg, Denmark), the anatomical region is not comparable (breast tissue versus face), the indications are different (breast augmentation versus human immunodeficiency virus–related lipodystrophy), and the volumes injected were much larger (mean, 230 ml versus 7 ml). The second case reported by Wang et al. describes a patient who was continuously treated with polyacrylamide gel for 8 years and who developed facial ulcers and infection. The skin ulcers and scars shown in Figure 1 could have been caused by an inadequate injective technique (too superficial an injection), excessive volume of injected material per cubic millimeter (repeated injections for 8 years are certainly suspicious), inadequate filler (not all polyacrylamide gels are the same), inadequate patient behavior and, in some cases, injection in areas different from those used in patients with human immunodeficiency virus–related lipodystrophy. More information should be provided to correctly interpret this case report. Finally, Dr. Wang presents a case of the deleterious effects of golden threads. Golden threads are not used for human immunodeficiency virus lipodystrophy; therefore, the example has no relevance to our case. Regarding the necessity of a follow-up longer than 5 years, it should be noted that in our series, 5 years was the minimal duration of follow-up, with some patients being followed for up to 6.85 years, the longest follow-up reported in the literature to date. The previously described complications of polyacrylamide gel (localized accumulation, material migration, and infection) had a low incidence in our study where a correct injective technique and careful avoidance of contamination were meticulously followed. Side effects of fillers should certainly be monitored carefully, with well-designed (if possible, blind and randomized) studies. Conversely, unsubstantiated hypotheses based on case reports will only create untoward panic in a community of already fragile patients. DOI: 10.1097/PRS.0b013e318254b639