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Die Prävalenz venöser Abflussstörungen als Ursache einer chronischen Wundheilungsstörung wird je nach Veröffentlichung mit bis zu 80% aller chronischen Ulzerationen am Unterschenkel angegeben. Somit ist die venöse Abflussstörung die häufigste Ursache von Ulcera cruris.

BACKGROUND

The simultaneous use of abdominal and endoscopic vacuum therapy in a case of an abdominal abscess caused by gastric perforation is demonstrated and innovative operative endoscopic management is described.

CASE REPORT

A computed tomography scan performed on a 67-year-old female patient showed a large abscess of the upper abdominal cavity where laparoscopic fundoplication had been performed 6 months previously. Endoscopy showed a transmural perforation of the dorsal wall of the stomach. The gastric perforation was closed and drained using intracavitary endoscopic vacuum therapy. Open pore polyurethane foam drainage was inserted through the defect into the extraluminal cavity for 3 days. A second period of therapy followed using intraluminal therapy with total drainage of the stomach, simultaneous enteral nutrition via a jejunal tube and a vacuum pressure of - 125 mmHg was applied with an electronic vacuum device. The abdominal abscess was drained via laparotomy and intra-abdominal vacuum therapy was performed with an open pore double-layered film using a vacuum pressure of - 75 mmHg. The perforation defect was not treated by operative means. Abdominal vacuum therapy ended 3 days postoperatively and the abdominal wall was closed by suture. Endoscopic vacuum therapy of the gastric perforation was terminated after 7 days and primary wound healing could then be achieved.

CONCLUSION

Use of endoscopic and abdominal vacuum therapy as well as new open pore material is an innovative option for operative management.

BACKGROUND AND STUDY AIMS

Endoscopic Vacuum Therapy (EVT) has been reported as a novel treatment option for esophageal leakage. We present our results in the treatment of iatrogenic perforation with EVT in a case series of 10 patients.

PATIENTS AND METHODS

An open pore polyurethane drainage was placed either intracavitary through the perforation defect or intraluminal covering the defect zone. Application of vacuum suction with an electronic device (continuous negative pressure, -125 mmHg) resulted in defect closure and internal drainage.

RESULTS

Esophageal perforations were located from the cricopharyngeus (4/10) to the esophagogastric junction (2/10). EVT was feasible in all patients. Eight patients were treated with intraluminal EVT, one with intracavitary EVT, and one with both types of treatments. All perforations (100 %) were healed in within a median of (3 - 7) days. No stenosis occurred, no complications were observed, and no additional operative treatment was necessary.

CONCLUSIONS

Our study suggests that intraluminal EVT will play an important role in endoscopic management of esophageal perforation.

Antibacterial activity of dressings containing antimicrobials is mostly evaluated using in vitro tests. However, the various methods available differ significantly in their properties and results obtained are influenced by the method selected, micro-organisms used, and extraction method, the degree of solubility or the diffusability of the test-compounds. Here, results on antimicrobial activity of silver-containing dressings obtained by agar diffusion test (ADT), challenge tests (JIS L 1902, AATCC 100), and extraction-based methods (microplate laser nephelometry (MLN), luminescent quantification of bacterial ATP (LQbATP)) using Staphylococcus aureus and Pseudomonas aeruginosa were evaluated. Furthermore, the effect of the pH on antibacterial efficacy of these dressings was investigated. All silver-containing dressings exerted antimicrobial activity in all in vitro tests and results correlated considerably well. Differences were observed testing the agent-free basic materials. They did not exhibit any antimicrobial effects in the ADT, MLN or LQbATP, since these methods depend on diffusion/extraction of an active agent. However, they showed a strong antimicrobial effect in the challenge tests as they possess a high absorptive capacity, and are able to bind and sequester micro-organisms present. Therefore, it seems recommendable to choose several tests to distinguish whether a material conveys an active effect or a passive mechanism. In addition, it could be shown that release of silver and its antimicrobial efficacy is partially pH-dependent, and that dressings themselves affect the pH. It can further be speculated that dressings' effects on pH and release of silver ions act synergistically for antimicrobial efficacy.

This document is a practical guide to the management of hyperkeratosis of the lower limb for all healthcare professionals involved in the care of patients with hyperkeratosis or those who are at risk of developing the condition, such as specialist nurses, district nurses, practice nurses, GPs, and podiatrists.

It offers pragmatic clinical recommendations for all aspects of care and introduces a novel, stepped approach to management, covering assessment, treatment and management of patients with hyperkeratosis, prevention of recurrence, and prophylactic measures for patients who may be at risk of developing the condition. The document also presents outcome measures that can be used to assess the efficacy of prevention and treatment interventions.

There is currently no standardised strategy or evidence-based national guideline for the management of hyperkeratosis and the condition is poorly represented generally in the medical literature. This document is therefore based on the best available evidence, supported by the consensus opinion of an expert working group of key opinion leaders from a wide range of disciplines, including lymphoedema, wound care, diabetes, dermatology and general practice. It aims to build on the success of the All Wales guidance on hyperkeratosis, which drew largely from the experience of its Tissue Viability Nurse Forum (AWTVNF, 2014).

In producing consensus recommendations, the expert working group recognises the many challenges facing healthcare professionals in this field, such as time constraints hindering a holistic approach, lack of cohesive national or local strategies for managing hyperkeratosis, and limited experience with newer, more efficacious technologies.

With these issues in mind, this document seeks to improve understanding of hyperkeratosis and equip healthcare professionals with the knowledge and skills necessary to recognise and treat this chronic condition effectively.

Caroline Dowsett, Chair