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Surgical procedure for iSAP.



Check the area of the subcutaneous pocket to determine the placement of the iSAP. Trace the edge of the pocket with a sonde and mark it on the skin. If marking area is extensive, a2 or 3 tubes may be used. Design the pocket tip so that it is furthest from the infection foci in that area. Also, place a drain insertion site about 3 cm away from the marked area and guide it to the target position through the subcutaneous area using a pean or the like.



The pocket does not necessarily need to be completely opened. It is recommended to manage it in a closed space rather than open it. The 'dead space' can be used by CLAP as an 'active space' for antimicrobial agents to spread. It is expected that necrotic tissue will be discharged continuously after surgery using a tube as thick as possible. Therefore, it is not necessary to perform excessive debridement during surgery.


Tube Insertion

In early days,  the infusion tubes and drain tubes were separately placed, but since the injected solution does not circulate well and accumulates in unintended places, adopting a double lumen tube has reduced troubles. Even if there is some short circuit as a drain tube, clogging is more problem, so the double lumen Salem sump tube is strongly recommended. More than 20 Fr Salem sump tube is preferred to prevent clogging.

In general,  to irrigate the infected wound, it is not recommended to "inject cleaning saline from the open site into the dead space" because the liquid containing bacteria spreads deep. By indwelling the tube at the deepest part and flowing the washing saline from the sub-tube and recovering it from the main tube, it is possible to "wash the saline from the deep part to the opening".



When closing the wound, even if the wound cannot be closed in the end, it is often possible to close the wound easily if the swelling subsides later if the skin is pulled to some extent. Place the NPWT over the wound. It has the effect of sucking exudate from the wound and the effect of pressing the pocket from the surface, so put cotton on the marked area to cover it. Apply negative pressure and confirm that the seal is complete.



Connect the RENASYS suction tube to the Salem sump tube using a Y connector. Cut one of the Y connector and connect the Salem sump tube with the connecting tube. This operation is the most important, and the tube placed deep inside and the exudate leaking to the surface can be sucked continuously with the same suction pressure. Also, if the negative pressure is too high, air is taken in from the hole that adjusts the negative pressure to lower the negative pressure. In addition, if there is an air leak, increase the negative pressure and hope that the leak will disappear. By continuously injecting the liquid from the sub-tube, it seems that the sump effect can be expected and the clogging of the circuit can be prevented.


Final check

After confirming that the finally constructed route can be washed without obstruction, the surgery is completed. When using iMAP together, confirm that the liquid injected from iMAP is collected in iSAP.

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