Benefits of negative pressure wound therapy with instillation in the treatment of hard-to-heal wounds: a case series

2020 ◽  
Vol 29 (4) ◽  
pp. 248-253 ◽  
Author(s):  
Valérie Latouche ◽  
Hervé Devillers
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Dwell Time ◽  
Negative Pressure Wound Therapy ◽  
Early Stage ◽  
Case Series ◽  
Wound Therapy ◽  
Impaired Wound Healing ◽  
The Mean ◽  
Mean Cost

Objective: Impaired wound healing can lead to hard-to-heal wounds, which impact on patients, clinicians and healthcare systems. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) was developed to manage wounds through early-stage cleansing. This study describes the use of NPWTi-d to help manage hard-to-heal wounds in patients with risk factors for impaired wound healing. Method: In this case series, patients were treated between October 2015 and March 2018 at a community hospital in western France. Normal saline solution was instilled into wounds with a dwell time of 10 minutes, followed by the application of negative pressure at −75 mmHg to −125 mmHg for 2–3 hours. If needed, patients were given appropriate oral or intravenous antibiotic treatment in conjunction with NPWTi-d and subsequent wound therapies. Results: A total of 15 patients participated in the study. Mean age was 81±13 years, and 12 (80%) patients were malnourished with blood albumin levels of 30.1±5.7g/l, and 12 (80%) patients were given antibiotic therapy. The mean duration of NPWTi-d was 19.4±20.8 days, with a mean number of dressing changes of 6.6±6.8; the duration of NPWTi-d and the number of dressing changes for pressure ulcers was three times that of the other wound types. The mean cost of NPWTi-d in this study was €1643.40±€1709.13. Overall, NPWTi-d provided early-stage wound cleansing and helped achieve adequate granulation tissue formation and progression to the next phase of wound healing. Conclusion: In these cases, NPWTi-d was a beneficial and effective method of treating hard-to-heal wounds that were resistant to traditional treatments, yielding favourable clinical outcomes.

Novel home use of mechanical negative pressure wound therapy in diabetic foot ulcers

2021 ◽  
Vol 30 (12) ◽  
pp. 1006-1010
Author(s):  
Xuxin Lim ◽  
Li Zhang ◽  
Qiantai Hong ◽  
Enming Yong ◽  
Shufen Neo ◽  
...  
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Length Of Hospital Stay ◽  
Wound Therapy ◽  
Primary Wound Closure ◽  
Mean Cost

Objective: Mechanical negative pressure wound therapy is an ultraportable, light weight and disposable single-use device that has been shown to promote wound healing. This study evaluated home use of a mechanically powered negative pressure wound therapy (NPWT) in diabetic foot wounds. Methods: Patients underwent revascularisation and/or debridement or amputation before starting mechanical NPWT. Wound outcomes and images of the wounds were recorded at each follow-up visit by the wound nurse. Patients were followed up until wound closure or end of therapy. Results: A total of 12 patients (each with one wound) were included in the study. Of the 12 wounds, 33.3% (n=4) of wounds achieved primary wound closure while the remaining 66.6% (n=8) of wounds demonstrated a mean wound size reduction of 37.5±0.13%. Of the closed wounds, mean time to healing was 4.75±2.50 weeks. There was 100% limb salvage with no further debridement or amputations, and no 30-day unplanned readmissions. Mean length of hospital stay before starting home NPWT was 9.75±6.31 days. Mean number of NPWT changes was 8.33±2.67 sessions, while mean duration of therapy was 4.0±1.54 weeks. Mean cost of home NWPT therapy was US$1904±731 per patient. Conclusion: The home use of mechanically powered NPWT in diabetic foot wounds demonstrated excellent wound healing rates and 100% limb salvage, with no complications.

scholarly journals A Role for Postoperative Negative Pressure Wound Therapy in Multitissue Hand Injuries

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hyung Sup Shim ◽  
Ji Seon Choi ◽  
Sang Wha Kim
Keyword(s):  
Wound Healing ◽  
Reconstructive Surgery ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Injury Severity ◽  
Hand Injury ◽  
Wound Therapy ◽  
The Mean ◽  
Group 2 ◽  
Functional Position

In this study, we compared outcomes in patients with acute hand injury, who were managed with or without negative pressure wound therapy (NPWT) after reconstructive surgery. All of the patients who sustained acute and multitissue injuries of the hand were identified. After reconstructive surgery, a conventional dressing was applied in Group 1 and NPWT was applied in Group 2. The dressing and NPWT were changed every 3 days. The mean age and Hand Injury Severity Scoring System score of both groups were not significantly different. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were evaluated 1 month after all the sutures were removed and 1 year postoperatively, which were both significantly lower in Group 2. Applying NPWT to the hand promoted wound healing by reducing edema, stabilizing the wound, and providing immobilization in a functional position. Early wound healing and decreased complications enabled early rehabilitation, which led to successful functional recovery, both objectively and subjectively.

scholarly journals A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

2020 ◽  
Author(s):  
Nadia Sim ◽  
Shaun Lee ◽  
Hao Yun Yap ◽  
Qian Ying Tan ◽  
Jerilyn Tan ◽  
...  
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Wound Therapy ◽  
Flap Technique ◽  
The Mean ◽  
Mean Time ◽  
Ray Amputation

Abstract Background: Wound healing post ray amputation for toe gangrene is commonly complicated by adjacent digital loss after applying Topical Negative Pressure Wound Therapy (TNPWT). This is either due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This ultimately results in exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) with eventual gangrene and a larger wound bed, thus mandating further ray amputation and subsequently enlarge the wound bed. We describe the use of the TOPHAT filleted toe flap technique – a combination of a filleted toe flap to protect the adjacent MTPJ capsule and a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The fillet flap protects the adjacent joint capsule and reduce the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. Methods: We conducted a prospective review of patients with toe gangrene requiring ray amputations who underwent the TOPHAT filleted toe flap technique in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialisation. Results: 9 patients underwent treatment with the TOPHAT filleted toe flap technique between 2019 and 2020. 2 patients had minimal tip necrosis of the flap which required minor debridement. All except 2 patients whom declined further treatment, progressed to definitive skin coverage with skin grafting. One patient had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting was 49.5 days post-operatively and the mean time to final wound epithelialisation was 107.5 days post-operatively. Patients were all satisfied with the outcomes and were able to return to pre-morbid function. Conclusions: The TOPHAT filleted toe flap technique has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease.

225 Clinical application and efficacy of Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d): A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Mantelakis
Keyword(s):  
Clinical Application ◽  
Negative Pressure ◽  
Dwell Time ◽  
Negative Pressure Wound Therapy ◽  
Meta Analysis ◽  
Complete Healing ◽  
Current Data ◽  
Wound Therapy ◽  
The Mean ◽  
Mean Time

Abstract Background This study evaluates the current clinical evidence of Negative Pressure Wound Therapy with Instillation and dwell time (NPWTi-d) to establish its clinical application and efficacy. Method MEDLINE, EMBASE, and CENTRAL databases were searched from 1946 to July 2019 for studies reporting clinical outcomes on wounds treated with NPWTi-d. The primary outcome was proportion of wounds with complete healing. The secondary outcomes were mean time for healing, NPWTi-d settings, cost, length of stay and adverse events. Results Thirteen articles were included with a total of 624 wounds in 542 patients involving wounds of various aetiology. The pooled proportion of wound that achieved complete healing was 93.65% (95%CI: 84.02-99.04). Normal saline was the most commonly used instillation solution with the mean dwell time of 14.23 minutes (95%CI: 10.88-17.59) and instillation cycle every 4.17 ± 2.32 hourly. The mean therapy duration was 10.69 days (95%CI: 10.46-10.91) with daily cost of $194.80. The mean hospital stay was 18.1 days (95%CI: 17.20-19.00). There were no severe adverse effects reported. Discussion NPWTi-d is an adjuntive therapy to aid complete healing of the vast majority of wounds. However, the current data is limited by the lack of level 1 evidence.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

The effects and use of negative pressure wound therapy – a set of case reports

2020 ◽  
Vol 99 (4) ◽  
pp. 183-188
Keyword(s):  
Wound Healing ◽  
High Risk ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Wide Spectrum ◽  
Case Reports ◽  
Modern Medicine ◽  
Wound Therapy ◽  
Basic Set

Modern medicine offers a wide spectrum of wound healing resources for acute or chronic wounds. Negative pressure wound therapy (NPWT) is a very effective method, allowing complicated defects and wounds to heal. The basic set is usually provided with various special accessories to facilitate the use and support safe application of NPWT to high-risk tissue. Selected case reports are presented herein to document the special use and combinations of materials in negative pressure wound therapy.

The role of angiopoetic factors in wound healing among patients with diabetes treated with negative-pressure wound therapy

Leczenie Ran ◽  
2015 ◽  
Vol 11 (4) ◽  
pp. 171-178
Author(s):  
Beata Mrozikiewicz-Rakowska ◽  
Joanna Kania ◽  
Ewelina Bucior ◽  
Adriana Nowak ◽  
Tomasz Grzela ◽  
...  
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Patients With Diabetes

659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Soft Tissue ◽  
Cell Suspension ◽  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Case Series ◽  
Dermal Substitute ◽  
Wound Therapy ◽  
Skin Cell ◽  
Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

scholarly journals MnSOD is implicated in accelerated wound healing upon Negative Pressure Wound Therapy (NPWT): A case in point for MnSOD mimetics as adjuvants for wound management

Redox Biology ◽  
2019 ◽  
Vol 20 ◽  
pp. 307-320 ◽  
Author(s):  
Gregory Lucien Bellot ◽  
Xiaoke Dong ◽  
Amitabha Lahiri ◽  
Sandeep Jacob Sebastin ◽  
Ines Batinic-Haberle ◽  
...  
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Management ◽  
Wound Therapy
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