Pioneering Technologies
Three technologies invented and developed by Dr. Topaz, TopClosure®, the RNPT/ROINPT negative-pressure family and CITA, and how they work together as one integrated protocol.
TopClosure® Tension Relief System
A purpose-built tension-relief system based on the viscoelastic properties of skin. By harnessing stress relaxation and mechanical creep, TopClosure® achieves immediate or gradual primary closure of large, high-tension wounds that once required skin grafts, flaps or tissue expanders.
The system is FDA cleared and was reviewed by the UK's National Institute for Health and Care Excellence (NICE, Medtech Innovation Briefing MIB97). It serves civilian medicine, military medicine and mass-casualty scenarios in hospitals around the world.
RNPT and ROINPT
RNPT (Regulated Negative Pressure Therapy) applies regulated negative pressure alone, and is the modality used in the treatment of infected cardiac implantable devices. ROINPT (Regulated Oxygen-enriched and Irrigation-assisted Negative Pressure Therapy) adds controlled irrigation and supplemental oxygen, and is used in contaminated and infected wounds.
ROINPT's indication is distinct from conventional negative-pressure wound therapy: rather than promoting granulation in an open wound, it seals the closed wound, suppresses anaerobic growth by raising wound oxygen tension (conventional negative pressure lowers it), and provides continuous irrigation-assisted decontamination and insulation from external and fecal contamination.
CITA
Controlled In-Situ Targeted ultra-high-concentration Antibiotic administration: culture-directed antibiotics delivered at ultra-high local concentrations within a defined wound compartment, with daily therapeutic drug monitoring keeping systemic exposure low.
Infected Sternal Wounds
Targeted delivery into the infected mediastinal and sternal compartment after cardiac surgery, combined with ROINPT and TopClosure®-assisted closure.
CIED Infection: CITA-MIS
The minimally invasive application, CITA-MIS (also referred to in the literature as the Topaz Procedure), preserves infected pacemakers and defibrillators in carefully selected patients, with wound sealing under RNPT.
Deep Tissue Pressure Injuries
A standard component of pressure-injury treatment: these wounds are never sterile, and CITA is delivered post-closure into the sealed compartment, within a sealed ROINPT environment.
Infected Diabetic Wounds
Targeted local antibiotic delivery as an adjunct to standard vascular and endocrinologic diabetic foot care, in carefully selected patients.
Not three parallel tools: one defining sequence
Conservative Debridement
Tissue-preserving debridement of the wound, without wide excision.
Primary Closure, Without Awaiting Sterility
The wound is closed primarily by TopClosure® tension-relieved approximation. Approximation collapses dead space, concentrating the delivered antibiotic into a smaller compartment: mechanical closure directly serves the antimicrobial objective.
Post-Closure CITA in a Sealed ROINPT Environment
Residual infection is treated inside the closed compartment: culture-directed ultra-high-concentration antibiotics under daily monitoring, within a sealed, oxygen-enriched, irrigation-assisted environment.
Physician or institution interested in the protocol?
See the Global Program for teaching, workshops and clinical implementation, or contact the clinic directly.