Broad Utility of a Minimally Invasive Technique for Pediatric Wound Care: Simple and Effective
Emily H Steen1, Jill M Tuley, Alice King
1At Texas Children's Hospital in Houston, Texas, Emily H. Steen, MD, is Research Fellow; Jill M. Tuley, MS, is Laboratory Manager and Administrative Coordinator; Alice King, MD, is Fetal Surgeon and Instructor of Surgery and Pediatrics; Timothy C. Lee, MD, is Fetal Surgeon and Associate Professor of Surgery, Pediatrics, and Obstetrics; and Sundeep G. Keswani, MD, FACS, FAAP, is Surgical Director of Basic Science Research and Professor of Surgery, Pediatrics, and Obstetrics. The authors have disclosed no financial relationships related to this article. Submitted May 14, 2019; accepted in revised form August 29, 2019.
Insights
Skin closure over vessel loops offers a minimally invasive approach for managing contaminated wounds in children, showing no recurrent infections or wound issues within 30 days. This technique also reduces hospital stays and simplifies wound care.
Area of Science:
- Pediatric Surgery
- Wound Management
- Infectious Disease
Background:
- Historically, incision and drainage have been the standard for infected or contaminated wounds.
- Minimally invasive drainage strategies are being explored to reduce postoperative complications.
- Skin closure over vessel loops presents a novel approach for wound management.
Purpose of the Study:
- To review the experience with skin closure over vessel loops in pediatric patients.
- To assess the efficacy of this technique in various clinical scenarios.
- To hypothesize that minimally invasive drainage decreases postoperative complications.
Main Methods:
- Retrospective review of pediatric patients undergoing skin closure over vessel loops.
- Data collected included demographics, surgical indications, complications, and follow-up.
- Study period: September 2016 to September 2018.
Main Results:
- 33 children were treated with skin closure over vessel loops.
- Common indications included skin and soft tissue infections (64%) and trauma (15%).
- No patients experienced recurrent infection or wound dehiscence at 30 days post-operation.
Conclusions:
- Skin closure over vessel loops is a safe and effective minimally invasive technique for contaminated wounds.
- The method is associated with shorter hospital stays and easier wound maintenance.
- This approach shows promise in managing complex pediatric wound cases.
Objective:
Infected or contaminated wound sites have historically been managed with incision and drainage. Here, the authors review their experience with skin closure over vessel loops and assess the results of this technique in a variety of clinical situations, hypothesizing that minimally invasive drainage strategies are associated with a decrease in common postoperative complications.
Methods:
Investigators retrospectively reviewed the data of all children with infected or contaminated wound sites operated on by a single surgeon with skin closure over vessel loops from September 2016 to September 2018. Demographics, indications for surgery, complications, and follow-up were assessed.
Results:
Over a 2-year period, 33 children underwent skin closure over vessel loops. The majority were female (82%), Hispanic/Latino (40%), and younger than 5 years (58%; range, 4 months to 16 years). One-third were obese. Reasons for intervention included skin and soft tissue infection (64%), trauma (15%), and ostomy closure (6%). Median postoperative length of stay was 1 day. Three-quarters (76%) of the patients returned to the clinic for follow-up and/or vessel loop removal. At 30 days after operation, no patients in this cohort returned to the ED with recurrent infection or wound dehiscence.
Conclusions:
This minimally invasive technique for contaminated wound management demonstrates no evidence of subsequent infection in standard follow-up. These results are indicative of specific advantages related to vessel loop drainage, including shorter lengths of stay and ease of wound maintenance, in a variety of challenging clinical scenarios.
