Also we have gained additional experience with the use of HBO therapy for severe life-threatening infections such as clostridial myonecrosis and other aerobic and anaerobic NSTI. Regardless of the type of surgical strategy applied, the HBO therapy should never delay the emergency of the surgical intervention, including the treatment of Clostridium perfrigens causing gas gangrene [36, 54, 57]. Reconstructive surgery The reconstruction of skin defects either on the MLN4924 order extremities and torso, or on the abdominal or chest wall, should be performed using several different techniques and surgical materials on each patient.

As is often seen, a complete loss of skin or dermal structures needs a complex, multilayer reconstruction especially in functional areas of the body and on the extremities. Novel concepts of layer-specific reconstruction include biologic meshes, which are an alternative

to flap and skin graft surgery, especially in abdominal and chest wall reconstructions [58–61]. After the wound stabilizes and fresh granulation tissue without any signs of acute infection we perform staging reconstructions using simple to complex reconstructive methods. p38 inhibitors clinical trials The main contributing factor for reconstructive method-selection was the extent and the localization of the defect and the patient’s condition [51–53]. Topical negative pressure therapy has been reported to remove exudates, cover wounds securely, stimulate angiogenesis [6, 49] and reduce bacterial contamination [50]. It also reduces the surface area of the wound, improves the rate of granulation tissue formation, reduces the number of surgical

excision procedures needed, as well as enables better healing performance of skin grafts and biologic meshes. The cost benefit of that novel therapy is evident, but the complications of TNP still exist and include damage to surrounding tissue due to pressure effects, pain during dressing changes and discomfort because of very Depsipeptide clinical trial bulky dressing [52]. Newer data recommend the use of TNP in the acute traumatic military settings [58]. Leininger at all used TNP in the deployed military settings (at R3 stage of-NATO medical care) where they treated all Iraqi casualties with TNP dressing after their first debridement (77 cases) [59]. They reported that infection rates dropped from 81% to 0% after using the TNP management strategy. Our experience has shown the use of this wound management technique to remove exudates, improve the patient comfort, reduce the wound size and the time for wound RG7112 research buy stabilization, to allow the formation of fresh granulation tissue, and better healing of skin grafts and flaps [36].