Evaluation of the combination of a biofilm-disrupting agent and negative pressure wound therapy: a case series

2021 ◽  
Vol 30 (1) ◽  
pp. 9-14
Author(s):  
Thomas E Serena ◽  
Omar Jalodi ◽  
Laura Serena ◽  
Keyur Patel ◽  
Matthew Mynti
Keyword(s):  
Negative Pressure ◽  
Protease Activity ◽  
Negative Pressure Wound Therapy ◽  
Pressure Ulcers ◽  
Wound Care ◽  
Case Series ◽  
Treatment Resistant ◽  
Wound Therapy ◽  
Wound Fluid ◽  
Hospitalised Patients

Objective: Approximately three million people in the US have hard-to-heal pressure ulcers (PUs), including 10% of hospitalised patients. Healing depends on ulcer stage and patient comorbidities. Despite advances in nutrition and wound care, PUs can take months or years to reach complete closure. To date, clinical studies have focused on single modality therapy. However, there is no one therapy that can address all of the deficits in these complex, hard-to-heal wounds. A commonly used treatment for PUs, negative pressure wound therapy (NPWT), has demonstrated improved healing in Stage 3 and 4 PUs. NPWT entails applying suction to a porous sponge fitted into the wound cavity and sealed with an occlusive dressing. Negative pressure facilitates wound healing by removing wound fluid containing harmful proteases, stimulating the formation of granulation tissue and promoting wound contracture. However, it does not affect biofilm formation. We hypothesised that adding an antibiofilm agent might increase the effectiveness of NPWT in recalcitrant PUs. Method: A prospective case series was conducted in outpatient wound care centres and a skilled nursing facility to examine the combination of a biofilm-disrupting antimicrobial agent (Blast-X, Next Science, US) in combination with NPWT (VAC, 3M, US) in healing and reducing bacterial burden in treatment-resistant pressure ulcers. Patients consented to application of the antibiofilm agent and NPWT three times per week for four weeks. The wounds were measured, imaged for bacteria and tested for host and bacterial protease activity weekly. Results: Of the 10 patients, four dropped out of the study before the end of the four weeks. Of the remaining six, four patients experienced a reduction in wound surface area and volume, reduced protease activity and lower bacterial levels. Conclusion: The results of this study showed that multimodal therapy, including NPWT and biofilm disruption, may restart the healing of stagnant treatment-resistant PUs.

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.

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.

Poor Nutrition Is a Relative Contraindication to Negative Pressure Wound Therapy for Pressure Ulcers

2010 ◽  
Vol 23 (11) ◽  
pp. 508-516 ◽  
Author(s):  
Chester H. Ho ◽  
Heather L. Powell ◽  
Joseph F. Collins ◽  
William A. Bauman ◽  
Ann M. Spungen
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Pressure Ulcers ◽  
Wound Therapy ◽  
Relative Contraindication ◽  
Poor Nutrition

Negative pressure wound therapy for patients with hard-to-heal wounds: a systematic review

2020 ◽  
Vol 29 (4) ◽  
pp. 206-212
Author(s):  
Alexandra HJ Janssen ◽  
Johannes A Wegdam ◽  
Tammo S de Vries Reilingh ◽  
Anne M Eskes ◽  
Hester Vermeulen
Keyword(s):  
Content Analysis ◽  
Negative Pressure ◽  
Methodological Quality ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Qualitative Studies ◽  
Self Control ◽  
Wound Therapy ◽  
Electric Device

Objective: Despite the lack of evidence, negative pressure wound therapy (NPWT) is commonly used in patients with hard-to-heal wounds. In our medical centre, one third of patients with abdominal wounds infected postoperatively end this therapy prematurely due to negative experiences and prefer standard wound care. This study was designed to explore the effects of NPWT on quality of life (QoL). Method: A search from 2000 to 2019 in eight databases was performed to identify qualitative studies of patients treated with NPWT. Studies were selected by two independent reviewers, who appraised the methodological quality, extracted and structured the data and performed content analysis. Results: A total of five qualitative studies with good methodological quality, incorporating 51 individual patients, were included. After content analysis, four major themes emerged: reduced freedom of movement caused by an electric device; decreased self-esteem; increased social and professional dependency; and gaining self-control. Conclusion: NPWT has major effects on the physical, psychological and social domains of QoL. Knowledge of these effects may lead to improved treatment decisions for patients with hard-to-heal wounds regarding use of NPWT or standard wound care.

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