[Wound treatment by negative pressure: specific uses and limits]

[ALGINATE versus negative-pressure therapy: Comparison of the clinical effectiveness, tolerance and costs in management of patients after surgical excision. Multicenter, randomized non-inferiority clinical trial on 113 patients]

INTRODUCTION

Pure calcium alginate dressing (ALGINATE) and Negative Pressure Wound Therapy (NPWT) are frequently used for the preparation of skin excisions for a split thickness skin graft take. The trial compared the healing efficacy, safety and cost of patient care for these two treatments.

PATIENTS AND METHODS

This randomized, non-inferiority trial enrolled 113 patients who underwent skin excision (>30 cm²) and received ALGINATE or NPWT. The primary outcome was the time to obtain optimal granulation tissue for a split thickness skin graft take. Secondary outcomes were the occurrence of adverse events (AEs) and the impact of the patient care cost on the Social Security budget.

RESULTS

The mean time to optimal granulation was similar between ALGINATE and NPWT: approximately 20 days. No AE was reported with ALGINATE while 24 % of patients treated with NPWT presented an AE. Following hospitalization, 94 % of ALGINATE patients were cared for at home by a private nurse, while 90 % of NPWT patients were followed up in aftercare and rehabilitation facilities or home hospitalization. Therefore, the cost of treatment per patient for the French Social Security was 498 € with ALGINATE and 2104 € with NPWT.

CONCLUSION

This trial has demonstrated that ALGINATE has a similar healing efficacy to that of NPWT, and that it is markedly better with regard to patient safety and cost savings. ALGINATE should therefore be preferred to NPWT in this indication.

Which medical technology and/or local treatment is most conducive, as of 2012, to pressure sore debridement ? Developing French guidelines for clinical practice

INTRODUCTION

Implementation of a curative strategy at the debridement stage associates systemic therapy with local therapy.

OBJECTIVES

To determine which medical devices and technology other than support surfaces and what kinds of drugs to use in order to cleanse a pressure ulcer in 2012.

METHOD

A systematic review of the literature querying the databases PASCAL Biomed, Cochrane Library and PubMed from 2000 to 2010 along with a compendium of prevailing professional practices.

RESULTS

Pressure sore debridement is based on local care and on the use of alginates, hydrogels and hydrocolloids.

DISCUSSION

The analyzed articles do not take into account any specific stage of pressure ulcer debridement. Data that might favor some kinds of dressings show a low level of evidence. Were it possible to decide on the dressing to be used for a given indication, professionals would be better able to orient and narrow down their choices.

CONCLUSION

Use of alginates and hydrogels in pressure ulcer debridement is of real interest. According to expert opinion, other dressings (irrigo-absorbents, for instance) seem promising, but have yet to receive adequate scientific validation.