انجمن شرکت های دانش بنیان

صبحانه کاری با حضور اعضای انجمن شرکت های دانش بنیان استان اصفهان( ۵ بهمن ۱۴۰۱)

صبحانه کاری با حضور اعضای انجمن شرکت های دانش بنیان استان اصفهان در روز چهارشنبه ۵ بهمن ماه ۱۴۰۱ در محل شرکت دانش بنیان طب تجهیز پایا برگزار گردید.

در این دورهمی صمیمانه دغدغه ها و چالش های شرکت ها و راه های همکاری و عبور از مشکلات شرکت های دانش بنیان مطرح گردید.

کنگره ترمیم زخم و بافت

گزارش تصویری حضور شرکت طب تجهیز پایا در نهمین کنگره بین المللی زخم و ترمیم بافت

نهمین کنگره بین المللی زخم و ترمیم بافت در محل تالار ابوریحان دانشگاه شهید بهشتی تهران در تاریخ ۲۱ تا ۲۳ دی ماه ۱۴۰۱ برگزار گردید.

غرفه ی شرکت طب تجهیز پایا مورد توجه و استقبال خوب بازدیدکنندگان قرار گرفت.

پانسمان ابدووک

کیت ابدووک، محصول منحصر به فرد شرکت طب تجهیز پایا

” مقاله “بسته شدن شکم با تکنیک فشار منفی در زخم های شکم باز

The most common indications for an open abdomen (OA) are abdominal compartment syndrome, damage control surgery, diffuse peritonitis and wound dehiscence, and often require a temporary abdominal closure (TAC). The different TAC methods that are currently available include skin closure techniques, mesh products and negative pressure therapy (NPT) systems. For this study, we retrospectively reviewed records of 115 OA patients treated with the commercially available NPT systems (V.A.C.® Abdominal Dressing System and ABThera™ Open Abdomen Negative Pressure Therapy System) using a new method of applying the system – the narrowing technique – over a 5‐year period. Endpoints included fascial closure and 30‐day mortality rates and presence of enteroatmospheric fistulas. Secondary closure of the fascia was obtained in 92% (106/115) of the patients with a mortality rate of 17% (20/115) and a fistula rate of 3·۵% (۴/۱۱۵). The use of the narrowing technique to apply NPT may explain the high closure rates observed in the patient population of this study. Further studies are necessary to compare the different methods and to evaluate the long‐term outcomes.

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استفاده از پانسمان ابدووک

temporary closure with negative pressure therapy technique in open abdomen cases

Abstract

The most common indications for an open abdomen (OA) are abdominal compartment syndrome, damage control surgery, diffuse peritonitis and wound dehiscence, and often require a temporary abdominal closure (TAC). The different TAC methods that are currently available include skin closure techniques, mesh products and negative pressure therapy (NPT) systems. For this study, we retrospectively reviewed records of 115 OA patients treated with the commercially available NPT systems (V.A.C.® Abdominal Dressing System and ABThera™ Open Abdomen Negative Pressure Therapy System) using a new method of applying the system – the narrowing technique – over a 5‐year period. Endpoints included fascial closure and 30‐day mortality rates and presence of enteroatmospheric fistulas. Secondary closure of the fascia was obtained in 92% (106/115) of the patients with a mortality rate of 17% (20/115) and a fistula rate of 3·۵% (۴/۱۱۵). The use of the narrowing technique to apply NPT may explain the high closure rates observed in the patient population of this study. Further studies are necessary to compare the different methods and to evaluate the long‐term outcomes.

Keywords: Open abdomen, Temporary abdominal closure

Introduction

Abdominal compartment syndrome, damage control surgery in traumatology, diffuse peritonitis and wound dehiscence are the most common indications for applying the open abdomen (OA) treatment concept. The requirements for the ideal temporary abdominal closure (TAC) are numerous and include the following: to protect and keep the abdominal content in place, to prevent adherences to the abdominal wall, to reduce oedema of the intestinal wall and to drain the abdominal cavity. In addition, the TAC must prevent lateral retraction of the fascia in order to obtain early secondary closure, and finally it should not lead to serious complications, such as enteroatmospheric fistula formation.

Several methods have been developed to meet the criteria of the ideal TAC. Overall, they can be divided into three different types. The first is skin‐closing techniques that include the simple running suture of the skin and the Bogota Bag. The major concerns with this method are the lateral retraction of the abdominal fascia, which later may lead to large incisional hernias. Furthermore, it does not allow effective drainage of the abdominal cavity. The second includes Wittmann Patch (WP) and polypropylene mesh, which provide high fascial closure rates and are often recommended when using long‐term OA treatment; however, they do not provide effective drainage. The third is negative pressure applications using Barker’s vacuum packing technique (BVPT) and the commercial abdominal dressing systems, V.A.C.® Abdominal Dressing System and ABThera™ Open Abdomen Negative Pressure Therapy (OA NPT) System. When properly used, these systems provide high rates of secondary fascial closure and provide effective drainage of the abdominal cavity. However, there has been some concern on the development of enteroatmospheric fistulas.

This study is a review of our results with the commercially available NPT systems (V.A.C.® Abdominal Dressing System and ABThera™ OA NPT System) using a new method of applying the system, called the narrowing technique. The primary endpoints were fascial closure rate, presence of enteroatmospheric fistulas and 30‐day mortality rates.

Patients and methods

The records of all the patients treated with an OA in the surgical departments at the Odense University Hospital and at the Esbjerg Hospital during a 5‐year period between May 2008 and October 2012 were retrospectively reviewed. The hospital at Odense provides primary medical care for approximately 350 ۰۰۰ inhabitants and is a tertiary referral centre for 1·۳ million inhabitants. The Esbjerg Hospital provides primary medical care for approximately 400 ۰۰۰ inhabitants. Patients were identified from the hospitals’ central patient register systems (register was searched for NPT treatment and all patients who were not treated with an OA were excluded). Demographic data including age and the American Society of Anesthesiologists (ASA) Physical Status classification score were registered. The indications for using NPT, number of dressing changes and the duration of treatment were registered. Secondary closure of the fascia at the end of treatment and development of fistula during the treatment were also registered. Death within 30 days of initiating the OA treatment was also noted. In the observation period, we used both commercialised NPT systems (V.A.C.® Abdominal Dressing System and ABThera™ OA NPT System, KCI, San Antonio, TX). We did not differentiate between the two systems used in this study, as we have been using both systems as standard at different times in the observation time.

NPT application

Using either system, the intestines, including the lateral aspects, were covered by a visceral protective layer (protective non‐adherent and/or fenestrated layer). For the narrowing technique, the first layer of foam was placed flat in the wound, which included 5 cm underneath the fascia. A minimum of one piece of foam was folded and placed in the laparostoma prolapering above the laparostoma. Then we applied the occlusive drape loosely in 10–۱۵ cm wide strips. During the application of the negative pressure, the fascial edges were approximated manually towards the midline. This was done to make the laparostoma opening as narrow as possible. We used a standard negative pressure of −۱۲۵ mmHg, but when an anastomosis was performed, the negative pressure was sometimes reduced to as low as −۲۵ mmHg, because lowering the pressure will protect the anastomosis, and a pressure of −۲۵ mmHg was high enough to prevent the lateralisation of fascial edges. The dressing was changed with an intended interval of 48 hours depending on the clinical condition, with earlier changes as an option. Each dressing change was performed at the operation theatre, and the patient was in general anaesthesia at maximum relaxation. When the patient attained an improvement in general condition as judged by gastrointestinal and renal functions and a decline in inflammatory parameters, the fascia was successively closed with non‐resorbable single stitch sutures starting from the proximal to distal ends of the wound.

IWJ-12281-fig-0001-c

Schematic of negative pressure therapy (NPT) application.

IWJ-12281-fig-0002-c

Demonstration of the placement of first foam underneath the fascia.

IWJ-12281-fig-0003-c

Demonstration of the pushing of the fascial edges towards the midline when negative pressure was applied.

IWJ-12281-fig-0004-c

Final result of narrowing technique after the application of negative pressure therapy (NPT).

Results

In the period from May 2008 to October 2012, a total of 115 (72 males and 43 females) patients were treated with an OA. The median age was 68 years (range: 15–۸۷). The median ASA score was 4 (range: 1–۴) (Table ​(Table1).۱). The median of length of stay in hospital was 25 days (range: 1–۱۳۰) and that of an intensive care unit stay was 3 days (range: 0–۸۳).

Table 1

Patient demographics

Patients۱۱۵ (۷۲ males/43 females)
Median age (years)۶۸ (range: 15–۸۷)
Median ASA score۴ (range: 1–۴)
Peritonitis۶۴ patients
Second look۲۲ patients
Wound dehiscence۱۹ patients
Abdominal compartment syndrome۱۰ patients

ASA, American Society of Anesthesiologists.

The indications for an OA were diffuse peritonitis in 64 patients, scheduled second look in 22 patients, wound dehiscence in 19 patients and abdominal compartment syndrome in 10 patients. Our definition of abdominal compartment syndrome is intraabdominal pressure (IAP) of >20 mmHg and new organ dysfunction. We measured the IAP by bladder pressure. The median number of dressing changes before closure was 4 (range: 1–۳۶) and the median duration of NPT before closing the fascia was 7 days (range: 1–۷۵). The mortality rate was 17% (20/115). Of the 20 patients who died, 10 patients had been treated with an OA because of severe peritonitis, 6 patients because of second look, 2 patients with abdominal compartment syndrome and 2 patients with wound dehiscence. Secondary closure of the fascia was obtained in 92% (106/115) of the patients. However, none of the patients had undergone clinical, CT scan or ultrasonography as follow‐up. In nine patients, it was not possible to obtain closure of the fascia, and they received therapy for a median of 14 days (range: 7–۷۵) and a median of 5 (range: 2–۳۷) dressing changes. An enterosphincteric fistula had developed in 3·۵% (۴/۱۱۵) of the patients.

Discussion

It is important to keep in mind that this group of patients was critically ill and needed special attention with a multidisciplinary approach to stabilise the patient. This allowed us to obtain the earliest closure possible, which appears necessary for a high success rate of fascial closure and a low mortality rate. Another important factor was the progression in the stepwise closure at each NPT dressing change.

We found that using the narrowing NPT technique without any use of mesh or soft sutures during NPT to prevent the retraction of the abdominal wall gave high rates of fascial closure compared with the results of other studies that used NPT. Although sutures were used for closing the abdominal wall, we found that applying NPT without using soft sutures or mesh is easier and faster. Compared with other studies that used only NPT to prevent lateralisation of the abdominal wall, it was found that this study had higher closing rates. However, the patient population of this study was a very heterogeneous group treated for wound dehiscence and second look; one would expect it to be easier to close these wounds than those of severe peritonitis. The fistula rate of this study was also comparable to that of other studies that used NPT. A prospective observational study by Cheatham et al. showed a fistula development rate of 4% in 111 patients treated with NPT. In addition, Franklin et al. reported only 1 out of 19 patients developing a fistula. However, this patient spent 90 days in the intensive care unit and was critically ill (history of anastomotic leak, development of large ventral hernia, previous hernia repair with biological mesh and a protective ileostomy) and may have developed a fistula regardless of TAC method. A review article by Boele van Hensbroek et al. reported an overall fistula rate of 2·۹% for NPT compared with the higher rates of other TACs: 5·۷% (BVPT), 13·۸% (zipper) and 28% (loose packing). Furthermore, a more recent prospective observational study of 578 patients by Carlson et al. found that NPT patients were not more likely to develop a fistula compared with non‐NPT patients.

We found that it is easy to apply the NPT system with the narrowing technique, and also that this method caused less damage to the abdominal wall. The narrowing technique with the foam underneath the fascia was a new method to apply the NPT systems and may explain the high closure rates (92%) observed in the patient population of this study. Other NPT studies have reported closure rates between 69% and 89·۵%. Further studies need to be conducted to compare the different methods and to evaluate the long‐term outcomes.

Conflicts of Interest

Dr UTH presented as a faculty member during the 2013 International Surgical Wound Forum (ISWF), an annual educational event sponsored by Kinetic Concepts, Inc. (KCI). The article is part of a KCI‐funded educational supplement based on 2013 ISWF faculty presentations about wound care strategies using Negative Pressure Wound Therapy (V.A.C.® Therapy and Prevena™ Incision Management System) over closed surgical incisions and Negative Pressure Therapy (V.A.C.® Abdominal Dressing System and ABThera™ Open Abdomen Negative Pressure Therapy) to treat OAs. KCI assisted with the editorial review of the manuscript. Drs HTH, ME and NQ have no conflict of interest and have no financial relationship with KCI.

پانسمان اگزوکر

What you need to know about hydrocolloid dressings

Description

A hydrocolloid dressing is a wafer type of dressing that contains gel-forming agents in an adhesive compound laminated onto a flexible, water-resistant outer layer. Some formulations contain an alginate to increase absorption capabilities. The wafers are self-adhering and available with or without an adhesive border and in various thicknesses and precut shapes for such body areas as the sacrum, elbows, and heels.

Actions

Hydrocolloid dressings are occlusive, so they provide:
• a moist healing environment
• autolytic debridement
• insulation

Advantages

• Impermeable to bacteria and other contaminants
• Self-adherent and mold well (don’t adhere to the wound, only to the intact skin around the wound)

• May be used under venous compression products
• Easy to apply
• Minimally disrupt healing (the dressing can be worn for several days before it needs to be changed. See “Frequency of dressing changes” for more information.)

Disadvantages

• Not recommended for wounds with heavy exudate, sinus tracts, or when infection is present
• Must be used with caution on the feet of patients with diabetes. It’s suggested that hydrocolloid dressings can be used safely on diabetic foot ulcers if 1) they are used only on appropriate wounds after a thorough patient assessment, 2) the wound is superficial with no signs of infection, 3) there is low to moderate exudate, 4) there are no signs or symptoms of ischemia, and 5) dressings are changed frequently
• Assessment can be difficult if the hydrocolloid dressing is opaque
• May become dislodged if the wound produces heavy exudate
• May curl or roll at the edges
• Upon removal, dressing residue may adhere to the wound bed and there may be an odor
• May cause periwound maceration (see photo)
• May cause trauma/injury to fragile skin upon removal
• May cause hypergranulation

When to use

A hydrocolloid dressing is appropriate for these situations:
• noninfected wound with scant to moderate drainage
• necrotic or granular wound
• dry wound
• partial- or full-thickness wound
• protection of intact skin or a newly healed wound.

Frequency of dressing changes

• Change the dressing every 3 to 7 days depending upon exudate and manufacturer guidelines.
• If daily dressing changes are required, reconsider the appropriateness of this approach because these dressings are designed for extended wear for up to 7 days.

How to apply a hydrocolloid dressing

۱ Wash your hands and put on gloves.
۲ Remove the soiled dressing (noting the date it was applied) and place it in a trash bag.
۳ Remove your gloves, wash your hands, and put on new gloves.
۴ Clean the wound with normal saline
solution or prescribed cleanser.
۵ Use clean gauze to pat dry the tissue surrounding the wound.
۶ Remove your gloves, wash your hands, and put on new gloves.
۷ Apply liquid barrier film or moisture barrier to the periwound area.
۸ For deep wounds, apply wound filler or packing materials as indicated.
۹ Before applying the hydrocolloid dressing, warm it by holding it between your hands to increase adhesive ability.
۱۰ Remove the paper backing from the dressing.
۱۱ Gently fold the dressing in half lengthwise and apply it from the center of the wound outward.
۱۲ Smooth the dressing in place from the center outward. Hold the dressing in place for a few seconds to improve
adhesion.
۱۳ The dressing should be at least 1 inch larger than the wound. (Some manufacturers may require a 2-inch border.)
۱۴ You may apply tape around the edges to secure the dressing.
۱۵ Dispose of the waste.
۱۶ Remove your gloves and discard.

How to remove a hydrocolloid dressing

۱ Press down on the skin and carefully lift an edge of the dressing. Continue lifting around the dressing until all adhesive edges are free.
۲ Gently peel away the dressing from
the skin in the direction of the hair growth.

Selected references
European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Treatment of pressure ulcers: Quick reference guide. Washington, DC: National Pressure Ulcer Advisory Panel; 2009.

Hess CT (ed). Clinical Guide to Wound Care. ۷th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.

Nancy Morgan, cofounder of the Wound Care Education Institute, combines her expertise as a Certified Wound Care Nurse with an extensive background in wound care education and program development as a nurse entrepreneur.

آموزش کیت ابدووک

گزارش تصویری کنگره لاپاراسکوپی یزد در تاریخ ۱۴۰۱/۰۷/۲۵

دوره ی آموزشی کیت Abdovac در تاریخ ۱۴۰۱/۰۷/۲۵ توسط شرکت پایا با حضور پزشکان و جراحان برگزار گردید.

در این دوره کیت Abdovac محصول شرکت طب تجهیز پایا آموزش داده شد.

پانسمان

پانسمان هیدروکلوئید اگزوکر محصول شرکت طب تجهیز پایا

“مقاله “آنچه باید در مورد پانسمان هیدروکلوئیدی بدانید

Description

A hydrocolloid dressing is a wafer type of dressing that contains gel-forming agents in an adhesive compound laminated onto a flexible, water-resistant outer layer. Some formulations contain an alginate to increase absorption capabilities. The wafers are self-adhering and available with or without an adhesive border and in various thicknesses and precut shapes for such body areas as the sacrum, elbows, and heels.

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پانسمان اگزوکر

افزایش ظرفیت پانسمان اگزوکر

پانسمان اگزوکر

با توجه به افزایش درخواست همکاران، ظرفیت پانسمان اگزوکر افزایش یافت.
پانسمان اگزوکر یک پانسمان هیدروکلوئید به سایز ۱۰*۱۰ سانتی متر می باشد. پانسمان هیدروکلوئید برای کمک به حفظ محیط مرطوب زخم طراحی شده است.

 

ویژگی ها:

  • قابلیت نصب آسان با توجه به بستر زخم
  • قابلیت جذب ترشحات کم تا متوسط زخم
  • قابلیت برداشتن پانسمان بدون درد (چون پانسمان به زخم نمی چسبد)
  • گسترش محیط درمانی مرطوب
  • سد محافظ در برابر باکتری ها
  • توانایی تشخیص بهترین زمان تعویض پانسمان به دلیل تغییر رنگ پانسمان هنگام جذب ترشحات زخم

 

کاربردها:

۱. زخم وریدی و شریانی

۲. زخم دیابتی

۳. زخم فشاری

۴. زخم بعد از عمل جراحی

۵. لیکیج گیری پانسمان وکیوم تراپی زخم

۶. محافظت از پوست در بیماران کلستومی

۷. سوختگی سطحی

۸. زخم با ضخامت جزئی

۹. تاول و خراشیدگی

۱۰. برش های سطحی جراحی و دانرسایت

۱۱. زخم با درناژ کم تا متوسط

۱۲. زخم تازه التیام یافته، پوست نازک و پوست سالم