Surgical management of the infected�orthopedic�implant�

This presentation will concentrate on the use of NPT on post-operative surgical wounds following high energy skeletal trauma. There will be three major sections of the talk concerning NPT. Initially we will discuss the proposed mechanisms of action of NPT, and how those relate the prophylaxis of closed incisions.

Microbes, in particular bacteria, are known to cause various types of infections in humans. Antibiotics can be used either to kill or inhibit the growth of unwanted microbes, and they are usually the treatment of choice for infections. However, the worldwide increase in antibiotic-resistant microbes has limited the effect of traditional treatments, making it very difficult to combat infections that were once treatable. A particular problem is infections where the bacteria are capable of forming a ?biofilm? as such infections typically tolerate the highest deliverable doses of antibiotics given systemically or even topically (1). Such infections which commonly develop in wounds and subsequently develop into chronic wounds.

Debridement of devitalized tissue along with irrigation has become the gold standard in trauma surgery for the initial treatment of open fractures and prevention of infection. The method of wound irrigation is still an area of much debate. Low pressure pulsatile lavage (LPPL) is suitable for relatively clean wounds less than three hours from time of injury, while at 6 hours High pressure pulsatile lavage (HPPL) may result in greater removal of bacteria and debris. Main principle of infection surgery has always been radical debridement. ?Ubi pus, ibi evacua?, often cited by surgeons is not enough. All necrotic and infected tissue should be resected in case of limb or life threatening infections. Surgical and sharp debridement has become the gold standard, especially in complicated skin and soft tissue infections, whereas in chronic wounds alternative techniques (mechanical, enzymatic, autolytic and biological debridement, honey) may be more appropriate. Wound irrigation can be helpful, but has no effect on remaining pathogens. HPPL may be deleterious by causing bacterial penetration into depth of tissues, while instillation of antiseptic fluids into a wound has an ongoing effect, when it is used for a longer time, and when the antiseptic agent remains in the wound for at least 20 minutes.

Is there a role for NPWT and Instillation technology in the innovation of the future daily surgical clinical practice?

Background

In many clinics no specific budget is allocated to wards to treat patients with Negative Pressure Wound Therapy (NPWT). Often there is also no funding or referral guidance from Primary Care Trust?s (PCT?s) to support this therapy upon discharge.

Conclusion: Transition of patients from in-patient setting to home(-care) can reduce costs and can help to create time for treatment of new patients.

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The Economics of Wound Management with focus on Patients with chronic ulcers and impact on the health care system.�

The Economics of Wound Management is a topical issue in Australia and internationally.

Dr Jan Apelqvist from Lund University in Sweden provides a comprehensive yet practical insight into the current challenges faced in the treatment of wounds from both a clinical and economic perspective.

Using the model of hard-to heal diabetic foot ulcers, Dr Apelqvist discusses the increasing demand for quality outcome data as part of the economic decision-making process and turns our attention to resource utilization efficiency and assessment of consequence rather than simplistic cost arguments. Viewers of this presentation are invited to consider the impact of current models of care that are often fragmented in their delivery and reflect on intervention vs cost over time. The information offered within the presentation is wide ranging, evidence based and succinctly melds clinical practice, economic evidence and multidisciplinary models that result in quality outcomes and effective resource utilization.

VAP in the ICU ? how to prevent?

Ventilator associated pneumonia (VAP) is a common infectious complication in patients admitted to the intensive care unit (ICU) and it is associated with several risk factors such as duration of mechanical ventilation and factors facilitating microaspiration. VAP is associated with substantially increased morbidity, increased duration of mechanical ventilation and length of stay, as well as increased mortality. Prevention of VAP is therefore one of the foremost aims in mechanically ventilated critically ill patients.�

Aim: Critical care patients are at elevated risk of developing pulmonary complications