The use of negative pressure to promote healing

Efficacy of modified vacuum-assisted dressing versus conventional betadine dressing in wound healing of open fractures

Aim

This study aimed to compare the effectiveness of a customized vacuum-assisted dressing to traditional betadine dressings for wounds in open fractures.

Materials and methods

In this prospective comparative study, 30 patients from two groups-group A receiving V.A.C. while group B receiving traditional dressing-were given data from sixty participants with open fractures. Wound was evaluated on days 0, 3, 7, 11, and 15 of the study.

Results

In group A, there was a statistically significant decrease in the mean dimension of the wound overall (15.66 mm vs. 7.4 mm in group B), and it took an average of 9.83 days for healthy granulation tissue to emerge. In contrast to the 21 patients who had split skin grafting, five patients needed a flap as a final closure surgery. In group B, it took an average of 17 days for healthy granulation tissue to emerge. The authors used split skin grafting to close the wounds in 18 patients, and the wound was allowed to heal by secondary intention in 8 patients, while the flap was used in 4 patients.

Conclusion

On comparing the modified Vacuum-assisted dressing to the standard dressing, there was considerable wound contraction and accelerated healing. Therefore, the authors observed that vacuum-assisted dressing treatment is superior to traditional betadine dressing in open fractures.

Evaluation of Clinical Outcomes of Negative-Pressure Wound Therapy in Gustilo-Anderson Type IIIA/IIIB Open Fractures of Extremities

Background Open fractures are common and serious injuries that primarily affect young males. Fracture management has improved in the last decade. However, infections with their complications are still a concern, especially in open fractures for primary closure of the injured area. A newer technique called vacuum-assisted therapy has become a therapy of choice for many orthopedic surgeons. This study aimed to determine whether vacuum-assisted closure reduces the duration of wound healing and the frequency of infections after fixation of Gustilo-Anderson Type IIIA/IIIB fractures of the extremities. Methodology An observational analytical study was conducted among 34 patients with Gustilo-Anderson Type IIIA/IIIB fractures of the limbs who presented to the Department of Orthopaedics, R. L. Jalappa Hospital, Kolar, from December 2019 to July 2021. Negative-pressure wound therapy was employed for wound closure after fixation of fractures. Patients were followed up for one month. Results The mean age of the patients was 37.06 ± 10.340 years. The prevalence of infection before vacuum-assisted closure dressing was 80.6%, and the prevalence of infection after vacuum-assisted closure dressing was 19.4%. The difference in proportion before versus after the intervention was statistically significant (p < 0.001) according to the McNemar Test. Hence, vacuum-assisted closure dressing decreased the rate of infection. The mean dimension of the wound before vacuum-assisted closure therapy was 66.05 cm2 and the mean dimension of the wound after vacuum-assisted closure therapy was 27.97 cm2. The difference in the mean before and after the intervention was statistically significant according to the paired t-test (p < 0.001). Hence, vacuum-assisted closure dressing helped decrease the wound size which was proven statistically. Conclusions Vacuum-assisted closure is a viable and beneficial treatment option for complicated fractures with large soft-tissue abnormalities.

A Novel Wound Therapy Modality: Autologous Wound Edge Dotted Full-Thickness Skin Grafting Improving Diabetic Foot Ulcer Healing

Aim

To explore the therapeutic efficacy of autologous wound edge-dotted full-thickness skin grafting in improving diabetic foot ulcer healing.

Methods

Sixty-three patients were divided into three groups: conventional wound therapy (CWT) (n = 23), platelet-rich plasma (PRP) (n = 20), and graft (n = 20). All participants were followed up for 12 weeks. The therapeutic efficacy of the three different wound treatment modalities was analyzed.

Results

After follow-up, 37 (58.7%) patients showed complete wound re-epithelialization, of which 10 (43.5%) occurred in the CWT group, 14 (70.0%) in the PRP group, and 13 (65.0%) in the graft group. Multivariate Cox analysis showed that the independent predictive factors for ulcer healing were different treatment modalities (graft: HR = 3.214, 95% CI=1.300-7.945, P < 0.05; platelet-rich plasma: HR = 3.075, 95% CI=1.320-7.161, P < 0.01), ABI (HR = 9.917, 95% CI=2.675-36.760, P < 0.01), and TcPO2 (HR = 1.040; 95% CI=1.005-1.076; P < 0.05). Stratified analysis showed that higher ABI in graft group or PRP group had higher wound healing rate (graft group: HR = 3.748, 95% CI=1.210-11.607, P < 0.05; PRP group: HR = 5.029, 95% CI=1.743-14.509, P < 0.05); higher TcPO2 in the graft group had higher wound healing rate (HR = 15.805, 95% CI=4.414-56.594, P < 0.01). Additionally, the wound healing time (P < 0.0167) and cumulative healing rate (P < 0.05) in both the PRP group and graft group were more advantageous. The graft group promotes wound re-epithelialization earlier and faster than in the CWT group and PRP group (P < 0.05). Meanwhile, the graft group had lower medical costs (P < 0.0167).

Conclusion

Autologous wound edge dotted full-thickness skin grafting has a higher cost-performance ratio than traditional diabetic foot ulcer wound care and is worthy of further clinical application.

Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials

Surgical site infections are a common source of post-operative morbidity and contribute significantly to healthcare costs. Patients undergoing emergency laparotomy and/or bowel surgery are particularly at risk. Prophylactic negative pressure wound therapy (NPWT) has been shown to reduce wound infection. However, to date, there has been a lack of consensus around its use for closed laparotomy wounds. We conducted a systematic review of randomised controlled trials comparing the use of prophylactic negative pressure wound therapy with standard dressings for closed laparotomy incisions. The primary outcome was incidence of incisional surgical site infection (SSI) at 30 days post-operatively. Secondary outcomes included superficial and deep SSI, skin dehiscence, fascial dehiscence and length of stay. A total of 2182 publications were identified, of which, following review of titles, abstracts and full texts, five studies met the criteria for inclusion. Across these studies, 467 patients were randomised to NPWT and 464 to standard dressings. Overall SSI rate was 18.6% (n = 87/467) versus 23.9% (n = 111/464) in the NPWT and standard dressing groups, respectively (Odds ratio 0.71, 95% CI 0.52–0.99, p = 0.04*). Deep SSI incidence was the same in both groups (2.6%). Both skin dehiscence and fascial dehiscence were slightly higher in the standard dressing group ((4.2%, n = 11/263 versus 3.1% (n = 8/261) and (0.9% (n = 3/324) versus 0.6% (n = 2/323)), respectively. This study observed that NPWT reduces the overall SSI for closed laparotomy wounds. It supports data recommending the use of prophylactic NPWT dressings, especially in high-risk patients in both emergency and elective circumstances.

Prophylactic negative wound therapy in laparotomy wounds (PROPEL trial): randomized controlled trial

BACKGROUND

Superficial surgical site infections are a common post-operative complication. They also place a considerable financial burden on healthcare. The use of prophylactic negative pressure wound therapy has been advocated to reduce wound infection rates. However, there is debate around its routine use. The purpose of this trial is to determine if prophylactic negative pressure wound therapy reduces post-operative wound complications in patients undergoing laparotomy.

METHODS/DESIGN

This multi-centre randomised controlled trial will compare standard surgical dressings (control) to two competing negative pressure wound therapy dressings (Prevena™ and PICO™). All patients will be over 18 years, who are undergoing an emergency or elective laparotomy. It is intended to enrol a total of 271 patients for the trial.

DISCUSSION

The PROPEL trial is a multi-centre randomised controlled trial of patients undergoing laparotomy. The comparison of standard treatment to two commercially available NPWT will help provide consensus on the routine management of laparotomy wounds.

TRIAL REGISTRATION

This study is registered with ClinicalTrials.gov (NCT number NCT03871023).

Negative pressure wound therapy in complex cranio-maxillofacial and cervical wounds

The care and the management of the healing of difficult wounds at the level of the skull-facial face many problems related to patient compliance and the need to perform multiple dressings, with long periods of healing and, occasionally, a very long hospitalisation period. The introduction and evolution of negative pressure wound therapy (NPWT) in the treatment of difficult wounds has resulted in better healing, with a drastic reduction in terms of time and biological costs to the patient and cost to the health care system. The main aim of this study is to describe and discuss, using out our experience, the usefulness of NPWT in the cranial-facial-cervical region. We studied 16 patients with complex wounds of the cranial-facial-cervical region treated with NPWT. We divided clinical cases in four groups: cervicofacial infectious disease, healing complications in oncological-reconstructive surgery, healing complications of injury with exposure of bone and/or internal fixations and healing complications in traumatic injury with loss of substance. We evaluated complete or incomplete wound healing; application time, related also to hospitalisation time; days of intensive care unit (ICU) stay; management of the upper airways; timing of medication renewal; and patient comfort and compliance (on a scale of 1-5). Depression values were always between -75 and -125 mmHg in a continuous aspiration pattern. For every patient, we used the ActiVAC Therapy Unit, derived from the vacuum-assisted closure system (Kinetic Concepts Inc., San Antonio, TX). Medication renewals were performed every 48-72 hours. The NPWT application time ranged from 4 to 22 days (mean of 11·57 day). Therapy was effective to gain a complete restitutio ad integrum in every patient included in the group of cervicofacial infectious disease. Therapy has, however, been well tolerated in our series; this is probably due to the decreased number of applications, the ease of use and the comfort of the system relative to traditional dressing. Results were satisfactory for most of cases treated; faster and more effective wound healing was achieved. The lower number of NPWT applications, relating to standard dressings, led to an increase in patient comfort and compliance and a decrease in the use of medical, and in some cases economic, resources according to international literature.

Vacuum assisted closure technique: a short review

The management of difficult to heal wounds has always been a cause of concern for the treating clinicians. There has been a tremendous increase in the number patients presenting with difficult to heal wounds. The conventional techniques have been in use since the long time for the management of these wounds, yet desired results are not achieved always. Thus a newer novel technique which might be useful in the difficult to heal wounds and delivering at par or better results as compared to the conventional techniques is the need of the hour.

Systematic review of the negative pressure wound therapy in kidney transplant recipients

AIM

To review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.

METHODS

A systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.

RESULTS

No complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.

CONCLUSION

Negative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

Negative Pressure Wound Therapy in Maxillofacial Applications

Negative pressure wound therapy has greatly advanced the field of wound healing for nearly two decades, by providing a robust surgical adjunct technique for accelerating wound closure in acute and chronic wounds. However, the application of negative pressure wound therapy in maxillofacial applications has been relatively under utilized as a result of the physical articulations and contours of the head and neck that make it challenging to obtain an airtight seal for different negative pressure wound therapy systems. Adapting negative pressure wound therapies for maxillofacial applications could yield significant enhancement of wound closure in maxillofacial applications. The current review summarizes the basic science underlying negative pressure wound therapy, as well as specific maxillofacial procedures that could benefit from negative pressure wound therapy.

Early Definitive Closure of the Open Abdomen: A Quiet Revolution

Contrary to the management strategy recommended only 2-3 years ago, temporarily covering the open abdomen with an absorbable mesh or a plastic sheath without preserving the peritoneal space is no longer considered in the patient's best interest. The use of the vacuum pack, in conjunction with vacuum-assisted wound management and new biological prostheses now offer patients with an open abdomen a better and simpler alternative to the giant "planned ventral hernia". With very few exceptions in the most critically ill patients, the survivors of damage control surgery or infected pancreatic necrosis should not be sent home with a huge defect only to undergo a complex reconstruction a year later. Simpler and better alternatives exist. The new concepts and technologies presented in this review, when widely adopted, will rapidly translate into safer and better management of the patient with an open abdomen.

Closed incision management with negative pressure wound therapy

Post-sternotomy mediastinitis is the most severe surgical site infection after sternotomy with an incidence between 1-4% related to the patient co-morbidity. This complication will increase morbidity and mortality and may also have an economic impact. There are guidelines to prevent surgical site infections; however, age and co-morbidities increase and therefore it is important to develop new tools to improve wound healing. This manuscript will give an overview of a new concept using negative pressure wound therapy over a closed incision (so-called, closed incision management) after surgery and will include the principles of negative pressure wound therapy and the positively applied mechanical forces as a permutation of Wolff's law. The use and indication of this therapy is supported by experimental studies divided into physiological and biomechanical property studies. Finally, an overview of clinical studies is given based on the evidence rating scale for therapeutic studies.

Vacuum Assisted Closure Therapy versus Standard Wound Therapy for Open Musculoskeletal Injuries

Background. This study was performed to evaluate the results of vacuum assisted wound therapy in patients with open musculoskeletal injuries. Study Design and Setting. Prospective, randomized, and interventional at tertiary care hospital, from 2011 to 2012. Materials and Methods. 30 patients of open musculoskeletal injuries underwent randomized trial of vacuum assisted closure therapy versus standard wound therapy around the upper limb and lower limb. Mean patient age was 39 ± 18 years (range, 18 to 76 years). Necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. Data Management and Statistical Analysis. The results obtained were subjected to statistical analysis. Results. The size of soft tissue defects reduced more than 5 mm to 25 mm after VAC (mean decrease of 26.66%), whereas in standard wound therapy, reduction in wound size was less than 5 mm. A free flap was needed to cover exposed bone and tendon in one case in standard wound therapy group. No major complication occurred that was directly attributable to treatment. Conclusion. Vacuum assisted wound therapy was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the upper limb and lower limb, thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.

The use of vacuum-assisted wound closure therapy in thoracic operations

BACKGROUND

Conventional treatment of complex, nonresolving empyemas after an episode of pneumonia or a chest operation often requires an open-window thoracostomy. This necessitates frequent, often painful dressing changes and is associated with prolonged hospitalization. The wound is often malodorous, causing significant social distress to patients and unquestionably affects their quality of life. We assessed the value of using vacuum-assisted closure (VAC) therapy in managing patients with a persistent infected pleural space.

METHODS

The study included 10 patients. All patients signed an informed consent and were debriefed before the procedure. An empyema developed in 1 patient after an episode of pneumonia. The other 9 had recently undergone a thoracic surgical procedure. All patients underwent initial open drainage of the pleural cavity and debridement. A VAC therapy system was then inserted intraoperatively or on the first postoperative day. The patients were discharged home with a portable VAC therapy system in situ. Subsequent dressing changes were managed by tissue-viability nurses in the community, without the need for further anesthesia or analgesia. Over a period of time, the cavity was sterilized and eventually obliterated spontaneously.

RESULTS

All patients were mobilized early and fast-tracked through the hospital. This prevented the need for daily dressing changes; hence, minimizing the disruption of normal activities and reducing the need for nursing care. Overall, the length of hospitalization was shorter, and the VAC therapy facilitated closure of the infected wound cavity. The use of the VAC therapy system negated the need for a second surgical procedure to close the wound cavity. None of the patients reported pain, odor, or inconvenience associated with the VAC therapy system.

CONCLUSIONS

Our observations suggest that the use of VAC therapy to treat such patients is safe, facilitates early discharge and recovery, and offers a "civilized," cost-effective treatment in a community setting.

A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series

Over the last decade Vacuum Assisted Closure((R)) (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.((R)) Therapy and V.A.C. Instill((R)) with either GranuFoam() or GranuFoam Silver() Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.((R)) Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.((R)) Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.((R)) Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.

Management of enterocutaneous fistulas

Management of enterocutaneous fistulas (ECFs) involves (1) recognition and stabilization, (2) anatomic definition and decision, and (3) definitive operation. Phase 1 encompasses correction of fluid and electrolyte imbalance, skin protection, and nutritional support. Abdominal imaging defines the anatomy of the fistula in phase 2. ECFs that do not heal spontaneously require segmental resection of the bowel segment communicating with the fistula and restoration of intestinal continuity in phase 3. The enteroatmospheric fistula (EAF) is a malevolent condition requiring prolonged wound care and nutritional support. Complex abdominal wall reconstruction immediately following fistula resection is necessary for all EAFs.

Comparison of vacuum-assisted closure device and conservative treatment for fasciotomy wound healing in ischaemia-reperfusion syndrome: preliminary results

Ischaemia-reperfusion syndrome (IRS) is a condition that may require early fasciotomy. In the past, fasciotomies ultimately required prolonged hospitalisation. Vacuum-assisted closure (VAC) therapy system is an innovative method which promotes wound healing by reducing wound oedema, increasing microcirculation, and stimulation of granulation tissue. The aim of this retrospective study was to compare the VAC treatment with the conservative treatment of the fasciotomy wound until definitive surgical closure. The researchers retrospectively identified 15 patients, 3 females and 12 males, with a mean age of 69 years, who underwent a fasciotomy between January 2003 and December 2009 at the University Hospital of Geneva. All of the fasciotomies performed on the patients were on account of IRS. Seven patients were subjected to wound treatment using the VAC-system device and eight patients underwent treatment through the usual conservative method. The data were analysed by comparing the operative wound size, length of time for wound closure and duration of hospital stay in both groups. The number of days after fasciotomy until surgical wound closure in the VAC-system group (n = 7) ranged from 8 to 13 days with a mean of 11 days. The wound size at the day of closure was decreased in length by a mean of 58% (range 29-67%) and in diameter by a mean of 56% (range 33-75%). The duration of hospital stay for this group ranged from 12 to 18 days with a mean of 14 days. No signs of infections were observed and no re-operation was required after first closure. In the conservative group (n = 8), the time to wound closure ranged between 12 and 20 days with a mean of 15 days. The wound size was decreased in length by a mean of 40% (range 32-53%) and in diameter by a mean 46% (range 30-70%). The mean duration of hospital stay was 18·5 days. Three of the patients in the conservative treatment group manifested wound infection during the course of the treatment. VAC device could be a new standard for treatment of fasciotomy wound. VAC therapy is a recent innovation and becoming more and more a necessary complementary therapy to hasten wound healing. In our preliminary study, the VAC-system device showed significantly reduction of the wound size, decreased tissue oedema, duration of hospital days and improvement of granulation tissue.

Clinical outcome of diabetic foot ulcers treated with negative pressure wound therapy and the transition from acute care to home care

Diabetic foot ulcers affect millions of people in the United States of America and impose tremendous medical, psychosocial and financial loss or burden. Negative pressure wound therapy (NPWT) is generally well tolerated and appears to stimulate a robust granulation tissue response compared with other wound healing modalities. This device may be a cost-effective adjunctive wound healing therapy. This literature review will focus on the clinical outcome of diabetic foot ulcers treated with NPWT, its implication in the transition from acute care to home care, factors that might influence clinical outcomes in home care as well as quality-of-life aspects in these patients. Patient care for diabetic foot ulceration is complex and necessitates multiprofessional collaboration to provide comprehensive wound care. It is clear that when we strive for limb preservation in this most high-risk population, it is important to have an available versatile, efficacious wound healing modality. There is a need for an easy transition from acute care to home care. Resources need to be combined in a collaborative and synergistic fashion to allow patient to perform many daily living activities while receiving the potential benefits of an advanced wound healing modality.

Use of porcine dermal collagen graft and topical negative pressure on infected open abdominal wounds

This article reports on two cases in which porcine dermal collagen grafts were used successfully alongside topical negative pressure therapy in order to close open abdominal wounds in which severe infection was present.

Transverse Rectus Abdominis Myocutaneous Flap Wound-Healing Complications in Breast Reconstruction: Assisted Closure Using Foam Suction Dressing

Transverse rectus abdominis myocutaneous (TRAM) flap necrosis is a difficult reconstructive problem which historically has entailed protracted management with poor aesthetic outcome. The use of a foam suction dressing achieves effective delayed primary closure of the flap wound with an acceptable aesthetic result. The results of using a vacuum-assisted closure (VAC) system were examined in three patients. The VAC system was found to be safe and effective in facilitating the closure of large and complex wounds without skin grafting. This option should thus be given serious consideration in some difficult wound healing situations.

Use of topical negative pressure with a lipidocolloid dressing: results of a clinical evaluation

OBJECTIVE

To evaluate the protection and acceptability of Urgotul wound dressing in the local management of acute or chronic wounds receiving topical negative pressure (TNP) therapy.

METHOD

This was a prospective multicentre non-comparative open-label trial. At each dressing change the investigating physician clinically evaluated and photographed the wound. Planimetric measurement was undertaken and wound depth was assessed at the start and end of the treatment. Follow-up was undertaken until deemed clinically unnecessary by the investigator.

RESULTS

Sixty-six patients were included (42 acute wounds and 24 chronic wounds) and followed up for an average of 17 days. Dressing changes were deemed entirely painless in 52% of cases (compared with 18% at baseline) and pain between two consecutive dressing changes was absent in 66% of cases (34% at baseline). Removal of the TNP-interface dressing combination was considered'very easy' or 'easy' in 94% of cases and adherence to the wound was recorded as 'absent' in 88%. On average, the dressings were changed every 3.8 +/- 1.1 days (all wounds were considered), and wound area and depth were reduced by 19% and 54% respectively by the end of the follow-up period.

CONCLUSION

Use of the interface dressing in combination with TNP substantially reduced the pain caused by dressing changes. It therefore makes more acceptable the use of this technique, which aims to optimise the management of wounds that are sometimes considered to be in a therapeutic impasse.

Management of Intractable Sternal Wound Infections with Topical Negative Pressure Dressing

BACKGROUND

Sternal osteomyelitis after cardiac surgery is a life-threatening complication. The potential spread of infection into the mediastinum, involving the prosthetic valve, grafts, and suture lines, makes this an extremely serious complication confronting both cardiac and plastic surgeons.

AIM

Topical negative pressure (TNP) dressing has been proven to be effective for wound healing. We want to take advantages of this equipment to improve the results of intractable sternal wound infection. The results are discussed.

METHODS

From December 1996 to July 2002, 25 patients with sternal wound infections were treated at Kaohsiung Medical University Hospital. Nine patients suffering intractable sternal osteomyelitis were managed with debridement and TNP dressings. These patients received 1-3 debridements (an average of 2.2 debridements), and the average TNP dressing treatment period was 20.2 days (ranging from 3 to 43 days). After management, the infections were controlled and healthy vascularized wounds were achieved. Then, flap reconstruction could be performed for complete wound closure. Seven of the nine patients survived, and there was no recurrence of sternal osteomyelitis during follow-up period (ranging from 5 to 70 months).

CONCLUSION

The advantages of applying TNP dressings in cases of intractable sternal wound infections include (1) protecting the underlying mediasternal structure from infection, (2) permitting delayed sternal closure to avoid cardiac compression induced compromised cardiopulmonary function, (3) possibility of repeated wound inspection and bedside debridement, (4) cost-effectiveness of wound care, and (5) providing an option to promote sternal wound secondary healing for patients in poor physical condition.

Guidelines for managing pressure ulcers with negative pressure wound therapy

Pressure ulcers are a serious health issue, leading to clinical, financial, and emotional challenges. Numerous treatment modalities are available to promote wound healing, yet clinicians may be unsure how to incorporate these treatment options into an overall plan of care for the patient with a pressure ulcer. A consensus panel of experienced wound care clinicians convened in July 2004 to review the mechanisms of action and research basis for one such treatment modality: negative pressure wound therapy. After answering key questions about this modality, they developed an algorithm to assist the clinician in making decisions about using negative pressure wound therapy appropriately in patients with Stage III and Stage IV pressure ulcers.

Is Vacuum Assisted Closure a valid technique for debriding chronic leg ulcers?

OBJECTIVE

Between May 2001 and October 2002 a prospective controlled open non-comparative study was performed to assess the effectiveness of topical negative pressure in the fibrinous debridement of chronic leg ulcers.

METHOD

Fifteen leg ulcers that had not responded to several other treatment modalities were treated with the Vacuum Assisted Closure system (KCI) for six days.

RESULTS

The median percentage reduction in fibrinous tissue was 28% on day three and 40% on day six. Between days one and three the percentage change was > or = 50% in four patients and > or = 25% in six patients. Between days three and six percentages of fibrin in the wound were lower in all patients, except for two who had higher percentages and two who had the same percentage.

CONCLUSION

VAC therapy was rapidly efficacious, promoting angiogenesis and the formation of healthy tissue.

Topical negative pressure therapy: mechanisms and indications

Topical negative pressure (TNP) therapy has emerged as a high-technology, microprocessor-controlled physical wound-healing modality. Complex effects at the wound-dressing interface following application of a controlled vacuum force have been documented. These include changes on a microscopic, molecular level and on a macroscopic, tissue level: interstitial fluid flow and exudate management, oedema reduction, effects on wound perfusion, protease profiles, growth factor and cytokine expression and cellular activity, all leading to enhanced granulation tissue formation and improved wound-healing parameters. Primary indications for clinical use have been documented and include traumatic wounds, open abdominal wounds, infected sternotomy wounds, wound bed preparation, complex diabetic wounds and skin-graft fixation. Whilst this therapy now forms an essential part of the wound healing armamentarium, extensive clinical trials are recommended to confirm efficacy and delineate its optimum use.

Use of a Vacuum-Assisted Device to Facilitate Abdominal Closure

The inability for abdominal closure in critically ill surgical patients provides a complex problem. Often, these patients are left with a large ventral hernia, which requires readmission for abdominal wall repair. We are reporting on the use of a vacuum-assisted device (VAD) to facilitate abdominal wall closure. Fifteen patients were enrolled for placement of a VAD. Selection was based on the diagnosis of abdominal compartment syndrome, the inability for abdominal closure at the initial operation, or the inability to close the abdomen upon re-exploration. Ten (67%) patients were successfully closed within 11 days using the VAD. Predictors of successful closure were the duration of VAD placement (<12 days, P < 0.001), the total amount of VAD output (<3 L, P < 0.04), the patient's cumulative fluid balance within the first 2 weeks (<2 L, P < 0.002), or the presence of a systemic infection at the time of attempted closure (P < 0.001). After 6 months, there have been no complications in patients successfully closed with this device. There have been a few recent reports describing VAD abdominal closures. While not successful for every case, the majority of our patients were able to have their abdominal wall closed primarily. We plan to use this technique to help shorten hospital stay and prevent readmission for hernia repair.

Adverse alteration of wound flora with topical negative-pressure therapy: a case report

Topical negative pressure (TNP) has achieved widespread use in the treatment of problematic wounds. We report the case of a patient treated with TNP for groin-wound dehiscence following inguinal block dissection. During treatment, clinical signs of sepsis developed, in association with a progressively worsening anaerobic wound infection. This infection settled with antibiotic therapy and cessation of TNP treatment. We postulate that the air-free environment created by TNP potentiated the growth of the anaerobic bacteria, resulting in significant sepsis, and therefore recommend close surveillance of bacterial flora while using this therapy, particularly in susceptible patients.

Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens

BACKGROUND

Damage control and decompressive laparotomies salvage severely injured patients who would have previously died. Unfortunately, many of these patients develop open abdomens. A variety of management strategies exist. The end result in many cases, however, is a large ventral hernia that requires a complex repair 6 to 12 months after discharge. We instituted vacuum-assisted wound closure (VAWC) to achieve early fascial closure and eliminate the need for delayed procedures.

METHODS

For 12 months ending June 2000, 14 of 698 trauma intensive care unit admissions developed open abdomens and were managed with VAWC dressing. This was changed every 48 hours in the operating room with serial fascial approximation until complete closure.

RESULTS

Fascial closure was achieved in 13 patients (92%) in 9.9 +/- 1.9 days, and 2.8 +/- 0.6 VAWC dressing changes were performed. There were 2 wound infections, no eviscerations, and no enteric fistulas.

CONCLUSIONS

Use of VAWC can safely achieve early fascial closure in more than 90% of trauma patients with open abdomens.

Abdominoplasty wound-healing complications: assisted closure using foam suction dressing

Abdominoplasty dehiscence, with or without skin necrosis, is a difficult reconstructive problem, which historically entailed protracted management with poor aesthetic outcome. The use of a foam suction dressing in combination with rapid serial wound closure achieves effective delayed primary closure of the abdominoplasty wound with an acceptable aesthetic result. This approach allows effective wound control and functioning, as a mechanical closure device enables rapid closure by serially reducing the foam dressing size with wound closure laterally. This technique has been used in four cases; successful closure was achieved within 8 days, resulting in a stable linear abdominoplasty scar in each case.

Topical negative pressure therapy in wound care

A review of the development and use of sub-atmospheric pressures in the management of patients with different types of wound