A clinical case of the successful VAC therapy in a patient with surgical wound infection after kidney transplantation

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Abstract

Surgical wound infection is the most common complication after kidney transplantation. It is associated with a prolonged hospital stay, repeated surgical procedures, significant costs, which explains the constant search for optimized treatment for wound infections. We describe a clinical case of a patient with an infected lymphocele of the upper pole of the renal graft at Day 29 after kidney transplantation from a donor after brain death. The infected lymphocele was opened and VAC system was installed without the removal of the graft. With antibiotic therapy and modification of the immunosuppressive therapy, the graft function remained stable and no generalization of the infection occurred. The wound was completely clean at Day 28 of VAC therapy, with subsequent tight closure of the wound. The patient was discharged with a functioning graft.

About the authors

A. V. Shabunin

Russian Medical Academy of Continuous Professional Education; S.P. Botkin Municipal Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-0522-0681

Alexey V. Shabunin – MD, PhD, Professor, Correspondent Member of Russian Academy of Sciences, Head of Chair of Surgery; Chief Physician

2/1–1 Barrikadnaya ul., Moscow, 125993;

5 2-y Botkinskiy proezd, Moscow, 125284

Россия

I. P. Parfenov

Russian Medical Academy of Continuous Professional Education

Email: fake@neicon.ru
ORCID iD: 0000-0003-2441-872X

Igor P. Parfenov – MD, PhD, Professor, Chair of Surgery

2/1–1 Barrikadnaya ul., Moscow, 125993

Россия

O. D. Podkosov

S.P. Botkin Municipal Clinical Hospital

Email: fake@neicon.ru

Oleg D. Podkosov – MD, PhD, Head of Department of Purulent Traumatology

5 2-y Botkinskiy proezd, Moscow, 125284

Россия

P. A. Drozdov

S.P. Botkin Municipal Clinical Hospital

Author for correspondence.
Email: dc.drozdov@gmail.com
ORCID iD: 0000-0001-8016-1610

Pavel A. Drozdov – MD, PhD, Head of Department of Organ and/or Tissue Transplantation

15–8 Brusilova ul., Moscow, 117148

Tel.: +7 (962) 985 04 41

Россия

D. A. Eremin

S.P. Botkin Municipal Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-5381-7127

Dmitry A. Eremin – MD, PhD, Clinical Pharmacologist

5 2-y Botkinskiy proezd, Moscow, 125284

Россия

I. V. Nesterenko

S.P. Botkin Municipal Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-3995-0324

Igor V. Nesterenko – MD, PhD, Surgeon, Department of Organ and/or Tissue Transplantation

5 2-y Botkinskiy proezd, Moscow, 125284

Россия

D. A. Makeev

S.P. Botkin Municipal Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-5237-4387

Dmitry A. Makeev – Surgeon, Department of Organ and/or Tissue Transplantation

5 2-y Botkinskiy proezd, Moscow, 125284

Россия

References

  1. Shrestha A, Shrestha A, Basarab-Horwath C, McKane W, Shrestha B, Raftery A. Quality of life following live donor renal transplantation: a single centre experience. Ann Transplant. 2010;15(2): 5–10.
  2. Сайдулаев ДА, Милосердов ИА, Готье СВ. Профилактика и хирургические методы лечения урологических осложнений у реципиентов почки. Вестник трансплантологии и искусственных органов. 2019;21(3): 166–73. doi: 10.15825/1995-1191-2019-3-166-173.
  3. Nashan B, Citterio F. Wound healing complications and the use of mammalian target of rapamycin inhibitors in kidney transplantation: a critical review of the literature. Transplantation. 2012;94(6): 547–61. doi: 10.1097/TP.0b013e3182551021.
  4. Kanakaris NK, Thanasas C, Keramaris N, Kontakis G, Granick MS, Giannoudis PV. The efficacy of negative pressure wound therapy in the management of lower extremity trauma: review of clinical evidence. Injury. 2007;38 Suppl 5:S9–18. doi: 10.1016/j.injury.2007.10.029.
  5. Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE. Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma. 2009;23(8): 552–7. doi: 10.1097/BOT.0b013e3181a2e2b6.
  6. Stevens P. Vacuum-assisted closure of laparostomy wounds: a critical review of the literature. Int Wound J. 2009;6(4): 259–66. doi: 10.1111/j.1742-481X.2009.00614.x.
  7. Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg. 2006;117(7 Suppl):127S–142S. doi: 10.1097/01.prs.0000222551.10793.51.
  8. Blume PA, Key JJ, Thakor P, Thakor S, Sumpio B. Retrospective evaluation of clinical outcomes in subjects with split-thickness skin graft: comparing V.A.C.® therapy and conventional therapy in foot and ankle reconstructive surgeries. Int Wound J. 2010;7(6): 480–7. doi: 10.1111/j.1742-481X.2010.00728.x.
  9. Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. Br J Plast Surg. 1998;51(1): 79. doi: 10.1016/s0007-1226(98)80142-2.
  10. Timmers MS, Le Cessie S, Banwell P, Jukema GN. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg. 2005;55(6): 665–71. doi: 10.1097/01.sap.0000187182.90907.3d.
  11. Jones SM, Banwell PE, Shakespeare PG. Advances in wound healing: topical negative pressure therapy. Postgrad Med J. 2005;81(956): 353–7. doi: 10.1136/pgmj.2004.026351.
  12. Sheehan P. Early change in wound area as a predictor of healing in diabetic foot ulcers: knowing "when to say when". Plast Reconstr Surg. 2006;117(7 Suppl):245S–247S. doi: 10.1097/01.prs.0000222566.56432.22.
  13. Shrestha BM. Systematic review of the negative pressure wound therapy in kidney transplant recipients. World J Transplant. 2016;6(4): 767–73. doi: 10.5500/wjt.v6.i4.767.
  14. Anderson DJ, Kaye KS, Classen D, Arias KM, Podgorny K, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 Suppl 1:S51–61. doi: 10.1086/591064.
  15. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, Dudeck MA, Pollock DA, Horan TC. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10): 783–805. doi: 10.1016/j.ajic.2009.10.001.
  16. Harris AD, Fleming B, Bromberg JS, Rock P, Nkonge G, Emerick M, Harris-Williams M, Thom KA. Surgical site infection after renal transplantation. Infect Control Hosp Epidemiol. 2015;36(4): 417–23. doi: 10.1017/ice.2014.77.
  17. Lam S, Lau NS, Laurence JM, Verran DJ. Surgical Site Infections Complicating the Use of Negative Pressure Wound Therapy in Renal Transplant Recipients. Case Rep Transplant. 2019;2019:2452857. doi: 10.1155/2019/2452857.
  18. Lau NS, Ahmadi N, Verran D. Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit. BMC Surg. 2019;19(1): 10. doi: 10.1186/s12893-019-0468-x.
  19. Focássio CCM, Gamboa RAB, de Marco LFS, Fukasawa DM, Parente TDS, Dornas VLBL. Treatment of lymphocele with negative pressure wound therapy post inguinal mass excision: A case-report. Int J Surg Case Rep. 2020;66:43–7. doi: 10.1016/j.ijscr.2019.11.017.

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Copyright (c) 2020 Shabunin A.V., Parfenov I.P., Podkosov O.D., Drozdov P.A., Eremin D.A., Nesterenko I.V., Makeev D.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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