1. The document discusses negative pressure wound therapy (NPWT), including its history, mechanisms of action, clinical applications, and future perspectives.
2. NPWT uses subatmospheric pressure to promote wound healing through mechanisms like hemostasis, modulation of inflammation, angiogenesis, and granulation tissue formation.
3. Studies show NPWT can effectively treat wounds in complex areas like the head and neck region, and may help close submandibular fistulas. However, wounds with pockets or deep shapes are more prone to infection with NPWT.
Negative pressure wound therapy: A promising weapon in the therapeutic wound ...KETAN VAGHOLKAR
Negative pressure wound therapy or vacuum assisted wound therapy is an excellent therapeutic option for chronic wounds which are just refusing to heal. The principles and practical applications of this optio are discussed in the article.
Triage Meditech is one of the leading Indian medical technology companies acquired a respectable position in Advanced Wound Care arena. We are the leading manufacturers and suppliers of Negative Pressure Wound Therapy (NPWT) products in Indian subcontinent. We have further enhanced our portfolio with Advance Wound Dressings, Colostomy Products, Solutions for Venous Insufficiency, and Surgical Disposables and Consumables. Our R&D team is dedicated to continuous advancement in offerings to create effective products at an affordable cost and helping healthcare professionals and caregivers to offer best practice solutions to their patients. Triage Meditech is an ISO 9001:2008, 13485:2003 certified and DCGI regulated company. We follow WHO Good Manufacturing Practice (GMP) and our products are CE Certified. We have Pan India presence through direct and dealers network and currently we export our products to more than 11 countries.
Negative pressure wound therapy: A promising weapon in the therapeutic wound ...KETAN VAGHOLKAR
Negative pressure wound therapy or vacuum assisted wound therapy is an excellent therapeutic option for chronic wounds which are just refusing to heal. The principles and practical applications of this optio are discussed in the article.
Triage Meditech is one of the leading Indian medical technology companies acquired a respectable position in Advanced Wound Care arena. We are the leading manufacturers and suppliers of Negative Pressure Wound Therapy (NPWT) products in Indian subcontinent. We have further enhanced our portfolio with Advance Wound Dressings, Colostomy Products, Solutions for Venous Insufficiency, and Surgical Disposables and Consumables. Our R&D team is dedicated to continuous advancement in offerings to create effective products at an affordable cost and helping healthcare professionals and caregivers to offer best practice solutions to their patients. Triage Meditech is an ISO 9001:2008, 13485:2003 certified and DCGI regulated company. We follow WHO Good Manufacturing Practice (GMP) and our products are CE Certified. We have Pan India presence through direct and dealers network and currently we export our products to more than 11 countries.
VAC therapy also known as negative pressure wound therapy (NPWT) is a method of delayed wound closure, where in primary closure is not possible. this PPT details the make & model of the device, its modifications, principle , mechanism , advantages and disadvantages
A power point on the various types of flaps and their respective indications. This presentation briefly describes the various flaps and how to care for flaps.
Negative Pressure Wound Therapy also widely known as NPWT, WOUND VAC or TNP(Tropical Negative Pressure) is a widely accepted advanced wound management modality today
VAC therapy also known as negative pressure wound therapy (NPWT) is a method of delayed wound closure, where in primary closure is not possible. this PPT details the make & model of the device, its modifications, principle , mechanism , advantages and disadvantages
A power point on the various types of flaps and their respective indications. This presentation briefly describes the various flaps and how to care for flaps.
Negative Pressure Wound Therapy also widely known as NPWT, WOUND VAC or TNP(Tropical Negative Pressure) is a widely accepted advanced wound management modality today
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Npwt
1.
2.
3. • Introduction
• History of negative pressure therapy
(The VAC system)
• Mechanisms of action
• Clinical applications of NPWT
• Clinical considerations
• Future perspectives
• Cross references
• Summary
• References
4. • Vacuum-assisted closure (VAC), sometimes referred to
as microdeformational wound therapy (MDWT) or
negative pressure wound therapy (NPWT), has
revolutionized wound care over the last 15 years.
• This monograph describes the current understanding of
these technologies, the questions that remain, and what
the future may hold for technologies based on
mechanotransduction principles.
5. • Dressings to treat complex wounds have traditionally
been made of cotton gauze which could be soaked with
a variety of chemicals including normal saline and
sodium hypochlorite solutions.
• In the 1960s, the importance of keeping the wound
moist was discovered and a wide array of hydrogels,
alginates, and other polymeric and biologically based
dressings were developed.
• More recently, these dressing materials have been
combined with antimicrobial compounds such as
silver. Collectively, there are approximately 1500
dressing types available.
6. Any device that applies
differential suction (ie,
reduced local pressure) to
wounds.
Type of NPWT
systems that create
microdeformations
(appearing as
microdome like
structures) at the
wound surface
These novel
therapies have
been shown to
facilitate the
healing of various
types of wounds
derived from
trauma,
infection,
congenital
deformities, and
tumors.
7. • Bier described the use of suction cups for a variety of ailments that
have been largely abandoned.
• Typically, these devices have been designed to apply low levels of
suction (<40 mmHg).
• In 1993 Fleischmann et al initially developed the vacuum sealing
drainage technique and successfully used it to treat limb open-
fracture injuries.
• In 1997 Argenta and Morykwas introduced a vacuum-assisted
closure (VAC) system to manage complicated wounds.
Argenta LC, Morykwas MJ: Vacuum-assisted closure: A new method for wound
control and treatment: Clinical experience. Ann Plast Surg 38:563, 1997
FleischmannW, StreckerW, Bombelli M, et al: Vacuum sealing as treatment of
soft tissue damage in open fractures. Unfallchirurg 96:488, 1993
8.
9. 1. A filler material or sponge
placed into the wound
2. A semipermeable dressing to isolate the
wound environment and allow the vacuum
system to transmit subatmospheric
pressures to the wound surface
4. Vacuum system
3. Connecting tube
A fluid
collection
canister
An alarm
sounds
11. Therefore, we use the term MDWT for devices that deform wounds on the micron-to-
millimeter scale, incurring morphologic and functional changes in cells that further improve
wound healing.
The most popular clinical
systems use open-pore
foam dressings, which
result in the formation of
tiny, domelike structures
at the wound surface that
cause microdeformations
to the wound surface.
12. 1. Hemostasis
2. Modulation of inflammation
Cellular responses—division, migration and differentiation
SECONDARY
19. • The FDA has approved NPWT for managing poorly healing
wounds.
• Manufacturer guidelines for the widely used KCI V.A.C. therapy
systems list chronic, acute, traumatic, subacute, and dehisced
wounds, partial thickness burns, ulcers (such as diabetic, pressure
or venous insufficiency), flaps and grafts as indications for use.
Contraindications
1. Necrotic tissue with eschar present
2. Untreated osteomyelitis
3. Nonenteric and unexplored fistulas
4. Malignancy in the wound
5. Exposed vasculature
6. Exposed nerves
7. Exposed anastomotic site
8. Exposed organs
20. Potential risks
1. High risk of bleeding and hemorrhage
2. Ongoing treatment with anticoagulants or platelet aggregation
inhibitors
3. Friable or infected blood vessels, vascular anastomosis, infected
wounds, osteomyelitis, exposed organs, vessels, nerves, tendon or
ligaments, sharp edges at the wound, spinal cord injury and eteric
fistulas
4. Patient requires magnetic resonance imaging or hyperbaric chamber
or defibrillation
5. Patient weight and size
6. Proximity of foam to vagus nerve
7. Circumferential dressing application
8. Mode of therapy (continuous or intermittent suction )
23. • From January 2004 to December 2009
• 13 male patients (mean age: 50 years)
• 12 patients (92%) had complicated wounds with infection
and one patient (8%) with partial loss of the free flap.
• Eight of these 13 patients (62%) had saliva leakage and
fistula formation.
• The average duration of the NPWT usage was 10.8 days (4 -
24 days); most of the wounds healed within 1 week after the
NPWT application.
24. J Oral Maxillofac Surg 74:401-405, 2016
• Nine patients with submandibular fistulas after reconstruction for osteoradionecrosis
treated with NPWT between 2011 and 2014 were included in the study.
• The NPWT device was removed postoperatively between days 7 and 12 (mean
duration, 9.6 days).
• The wound bed was filled with healthy
granulation tissue, and successful healing by
second intention was observed in all patients
within 2 weeks.
• No complications were observed. The follow-up
ranged from 4 to 27 months (mean, 18 months);
the fistulas exhibited excellent healing, and no
recurrence or infection was observed.
26. A total of 55 patients with wounds were treated using NPWT in 2011. 8 whose
wounds formed a pocket, 7 whose wounds were deep, and 40 whose wounds did
not come under the above 2 types were eligible for this retrospective study.
15 patients (27.3%) - relapse of local infection. 6/8 patients (75.0%) - wound
with pocket group, 5 of the 7 (71.4%) in the deep wound group, and 4 /40
(10.0%) - wounds developed infection. The wound infection development ratio
of the wound with pocket and deep wound groups was significantly higher than
that of the other wound group.
27. Wound shape in patients who received NPWT.
Mechanism of infection development in
wounds with a pocket during NPWT.
Mechanism of infection development
in deep wounds during NPWT.
Fujioka M, Kenji Hayashida K, Chikako Senjyu K.
Wounds with complicated shapes tend to develop
infection during negative pressure wound therapy.
Wound Medicine 4 (2014) 5–8.
28. • The efficacy of NPWT in promoting wound healing has been largely
accepted by clinicians, yet the number of high-level clinical studies
demonstrating its effectiveness is small and much more can be learned
about the mechanisms of action.
• In the future, hopefully we will have the data to assist clinicians in
selecting optimal parameters for specific wounds including interface
material, waveform of suction application, and the amount of suction
to be applied.
• Further investigation into specific interface coatings and instillation
therapy are also needed.
29. 1. Yang YH, Jeng SF, Hsieh CH, Feng GM, Chen CC. Vacuum-assisted
closure for complicated wounds in head and neck region after
reconstruction. J Plast Reconstr Aesthet Surg. 2013 Aug;66(8):e209-16.
2. Zhang DM, Yang ZH, Zhuang PL, Wang YY, Chen WL, Zhang B. role
of negative pressure wound therapy in the management of
submandibular fistula after reconstruction for osteoradionecrosis. J Oral
Maxillofac Surg. 2016 Feb;74(2):401-5.
3. Fujioka M, Kenji Hayashida K, Chikako Senjyu K. Wounds with
complicated shapes tend to develop infection during negative pressure
wound therapy. Wound Medicine 4 (2014) 5–8.
Editor's Notes
Suction is frequently used for many indications including evacuation of purulence, closed suction drainage of surgical wounds, removal of gastric fluids, and collapse of the pleural space.
Pedicle is near the dead space and fistula. Watertight suturing at mucosal side; NPWT application into the dead space. With negative-pressure suctioning on, mid-portion of fistula closes (two pink arrows). With time, granulation tissue grows and fills the dead space. Eventually, granulation tissue closes the fistula from the inside out. NPWT is removed; wound is left for secondary healing or covered with a skin graft.