scholarly journals Experimental study of negative pressure wound therapy combined with platelet-rich fibrin for bone-exposed wounds

2021 ◽  
Author(s):  
Hong Zhang ◽  
Songyu Wang ◽  
Chen Lei ◽  
Guanmin Li ◽  
Biao Wang
Keyword(s):  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Contraction Rate ◽  
Sprague Dawley ◽  
Wound Therapy ◽  
Closure Rate ◽  
Platelet Rich Fibrin ◽  
Accelerate Wound Healing ◽  
Sprague Dawley Rats

Aim: To evaluate the efficacy of negative pressure wound therapy (NPWT) combined with platelet-rich fibrin (PRF) in treating bone-exposed wounds and explore its possible mechanism. Materials & methods: A bone-exposed wound was created in a total of 32 healthy Sprague-Dawley rats, which were treated with either control, NPWT group, PRF group or both (N + P group). The bone-exposed area, skin contraction rate and granulation coverage and the level of growth factors in granulation tissue were determined on days 4, 7 and 10. Results: The N + P group showed significantly higher wound closure rate than that achieved with others respectively. Four factors were significantly higher in N + P group than in the other three groups. Conclusion: Combination of NPWT and PRF can repair bone-exposed wounds effectively and accelerate wound healing.

scholarly journals Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e026345 ◽  
Author(s):  
Dörthe Seidel ◽  
Martin Storck ◽  
Holger Lawall ◽  
Gernold Wozniak ◽  
Peter Mauckner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Secondary Outcome ◽  
National Study ◽  
Wound Therapy ◽  
Closure Rate

ObjectivesThe aim of the DiaFu study was to evaluate effectiveness and safety of negative pressure wound therapy (NPWT) in patients with diabetic foot wounds in clinical practice.DesignIn this controlled clinical superiority trial with blinded outcome assessment patients were randomised in a 1:1 ratio stratified by study site and ulcer severity grade using a web-based-tool.SettingThis German national study was conducted in 40 surgical and internal medicine inpatient and outpatient facilities specialised in diabetes foot care.Participants368 patients were randomised and 345 participants were included in the modified intention-to-treat (ITT) population. Adult patients suffering from a diabetic foot ulcer at least for 4 weeks and without contraindication for NPWT were allowed to be included.InterventionsNPWT was compared with standard moist wound care (SMWC) according to local standards and guidelines.Primary and secondary outcome measuresPrimary outcome was wound closure within 16 weeks. Secondary outcomes were wound-related and treatment-related adverse events (AEs), amputations, time until optimal wound bed preparation, wound size and wound tissue composition, pain and quality of life (QoL) within 16 weeks, and recurrences and wound closure within 6 months.ResultsIn the ITT population, neither the wound closure rate (difference: n=4 (2.5% (95% CI−4.7% – 9.7%); p=0.53)) nor the time to wound closure (p=0.244) was significantly different between the treatment arms. 191 participants (NPWT 127; SMWC 64) had missing endpoint documentations, premature therapy ends or unauthorised treatment changes. 96 participants in the NPWT arm and 72 participants in the SMWC arm had at least one AE (p=0.007), but only 16 AEs were related to NPWT.ConclusionsNPWT was not superior to SMWC in diabetic foot wounds in German clinical practice. Overall, wound closure rate was low. Documentation deficits and deviations from treatment guidelines negatively impacted the outcome wound closure.Trial registration numbersNCT01480362and DRKS00003347.

scholarly journals Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

2021 ◽  
Author(s):  
Johanna C. Wagner ◽  
Anja Wetz ◽  
Armin Wiegering ◽  
Johan F. Lock ◽  
Stefan Löb ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Wound Complications ◽  
Skin Closure ◽  
Wound Treatment ◽  
Open Wound ◽  
Wound Therapy ◽  
Significant Difference ◽  
Open Wound Treatment

Abstract Purpose Traditionally, previous wound infection was considered a contraindication to secondary skin closure; however, several case reports describe successful secondary wound closure of wounds “preconditioned” with negative pressure wound therapy (NPWT). Although this has been increasingly applied in daily practice, a systematic analysis of its feasibility has not been published thus far. The aim of this study was to evaluate secondary skin closure in previously infected abdominal wounds following treatment with NPWT. Methods Single-center retrospective analysis of patients with infected abdominal wounds treated with NPWT followed by either secondary skin closure referenced to a group receiving open wound therapy. Endpoints were wound closure rate, wound complications (such as recurrent infection or hernia), and perioperative data (such as duration of NPWT or hospitalization parameters). Results One hundred ninety-eight patients during 2013–2016 received a secondary skin closure after NPWT and were analyzed and referenced to 67 patients in the same period with open wound treatment after NPWT. No significant difference in BMI, chronic immunosuppressive medication, or tobacco use was found between both groups. The mean duration of hospital stay was 30 days with a comparable duration in both patient groups (29 versus 33 days, p = 0.35). Interestingly, only 7.7% of patients after secondary skin closure developed recurrent surgical site infection and in over 80% of patients were discharged with closed wounds requiring only minimal outpatient wound care. Conclusion Surgical skin closure following NPWT of infected abdominal wounds is a good and safe alternative to open wound treatment. It prevents lengthy outpatient wound therapy and is expected to result in a higher quality of life for patients and reduce health care costs.

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.

653 Capillary Suction Device-a Novel Approach to Negative Pressure Wound Therapy

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S172-S173
Author(s):  
George F Babcock ◽  
Ranjit Chatterjee ◽  
Tara Riddle
Keyword(s):  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Donor Site ◽  
Large Cell ◽  
Wound Therapy ◽  
Capillary Suction ◽  
Fluid Uptake ◽  
Study Results ◽  
Negative Pressures

Abstract Introduction Negative Pressure Wound Therapy (NPWT) is a well-established procedure used for non-healing wounds including burn wounds. In NPWT, a special sealed dressing of large cell foam (>400 µm) or gauze is connected to a pump. The sealed dressing acts as a conduit to pressure transfer and aids in the passive flow of fluid. Most commonly, negative pressures between -10 and -125 millimeters of mercury (mm Hg) are used. The mechanism of healing is unknown but maybe due to removal of the exudate and bacteria, and the stimulation of tissue repair through micro deformation. Reticulated foams with micron-size open cells (100 to 5µm) exerts capillary suction between 10 and 60 mm of Hg with a multilayered foam dressing. The negative pressures produced are within the range of suction by mechanical pumps. Therefore, the long-term goal our research is to examine effectiveness of Capillary Suction Devices (CSD) as a topical device in both preventing and healing complicated wounds, burn and donor site wounds. Our hypothesis is that CSD is an effective, safe and lower cost alternative to vacuum-assisted NPWT. Methods Yorkshire pigs received 4 surgical posterior excision wounds, measuring 2 in. by 2 in. The wounds were covered with a NPWT dressing (110 mm Hg negative pressure by a pump), CSD with capillary suctions of 30 mm Hg (CSD-30) and 60+ mm Hg (CSD-60), and a conventional gauze dressing. The wounds were measured on 2 day and then every 4 to 5 days until wounds closed. We also measured and compared the total fluids collected with each dressing. Results By post-wound day 20, the wounds treated with CSD-60 and NPWT were 100% closed while the wounds treated with CSD-30 and gauze were 65 and 45%, respectively. This indicated comparable wound closure efficacies for CSD-60 and NPWT. The CSD-30 product was superior to gauze, but less efficacious than the tested NPWT protocol. The average total fluid uptake measured in grams dry weight were similar for CSD-60 and NPWT, 36 and 38g., respectively while the values were 24g for CSD-30 and 12g for gauze. However, the maximum fluid uptake observed at day 2 indicated that CSD-60 and CSD 30, 24 and 14g respectively, were superior to NPWT and gauze 12 and 7g respectively. Conclusions This data indicates comparable wound closure efficacies for CSD-60 capillary suction and NPWT. The CSD product with 30 mmHg suction was superior to gauze, but less efficacious than NPWT or CSD-60 protocol. The study results provide impetus for further research on the use of high suction CSD for replacement of pump mediated NPWT and the moderate suction CSD for preventing progression of high-risk wounds to an ulcerous stage. Applicability of Research to Practice This small study suggests that CSD maybe alternative in to NPWT. CSD provides a significant cost and weight advantage to the patient, as well is allowing for increased mobility.

scholarly journals Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

2016 ◽  
Vol 106 (2) ◽  
pp. 145-151 ◽  
Author(s):  
M. Kääriäinen ◽  
M. Kuuskeri ◽  
M. Helminen ◽  
H. Kuokkanen
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Component Separation ◽  
Separation Technique ◽  
Fascial Closure ◽  
Study Patient ◽  
Wound Therapy ◽  
Closure Rate ◽  
Component Separation Technique

Background and Aims: The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Material and Methods: Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Results and Conclusion: Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.

scholarly journals Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yaojun Wu ◽  
Liang Chen ◽  
Shaokun Wu ◽  
Liying Yu ◽  
Mimi Chen ◽  
...  
Keyword(s):  
Median Time ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Defect Size ◽  
Wound Therapy ◽  
Skin Stretching ◽  
Safe Approach ◽  
Large Skin

AbstractThe management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

scholarly journals A A simple and low-cost technique of creating a Negative Pressure Wound Therapy (NPWT) machine on the example of a severe phlegmon of lower limb in lower socio-economic area.

2018 ◽  
Vol 5 (1) ◽  
pp. 12-14
Author(s):  
Marcin Kiszka ◽  
Filip Kazubski ◽  
Magdalena Maj ◽  
Tomasz Banasiewicz
Keyword(s):  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Low Cost ◽  
Hiv Positive ◽  
Wound Therapy ◽  
Economic Area ◽  
Stay Time ◽  
Post Traumatic ◽  
The Cost

The Negative Pressure Wound Therapy (NPWT) is an approved method of healing lower extremity ulcers of various origin, accelerating the wound closure process, thus decreasing the hospital-stay time and lowering the cost of the treatment. Although it is scarcely needed in developing countries such as Kenya, there is a lack of official supplier of the NPWT equipment. We present an improvised method of constructing a reliable and effective NPWT dressing form widely available tools in a case of treating a post-traumatic phlegmon in a HIV-positive patient.

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 Evaluation of Systemic Effects of Negative Pressure Wound Therapy in Open Wound Treatment in Dogs

VCOT Open ◽  
2019 ◽  
Vol 02 (02) ◽  
pp. e1-e8
Author(s):  
Rebecca Albert ◽  
Sven Reese ◽  
Mirja C. Nolff ◽  
Andrea Meyer-Lindenberg
Keyword(s):  
Negative Pressure ◽  
Total Protein ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Systemic Effects ◽  
Wound Treatment ◽  
Characteristic Analysis ◽  
Open Wound ◽  
Wound Therapy ◽  
Open Wound Treatment

Objectives The aim of this study was to evaluate the systemic effect of negative pressure wound therapy (NPWT) on the treatment of complicated wounds in dogs. Materials and Methods Dogs undergoing open wound treatment were randomly assigned to one of two groups: NPWT (n = 11) or polyurethane foam dressing (n = 11). Rectal temperature, heart rate as well as haematocrit, thrombocytes, leucocyte count, band neutrophils, C-reactive protein (CrP), total protein and albumin were recorded daily from the beginning of therapy (day 0) until day 5, as well as on day 10. The effect of treatment on systemic parameters was evaluated as well as the prognostic power of the individual parameters with regard to successful wound closure. Results A more profound systemic decrease was found in total protein under NPWT. This difference was non-significant. Patients with non-successful closure displayed a non-significant trend towards lower initial leukocyte and thrombocyte counts and significantly higher CrP values on days 4, 5 and 10 (p < 0.05) compared with successfully treated patients. Receiver operating characteristic analysis revealed an optimal cutoff value of 70.2 mg/L at day 4 (sensitivity 80; specificity of 85.7). Conclusion There might be an increased loss of protein in NPWT-treated patients, which does not affect albumin levels, otherwise no systemic effects were detected compared with the control treatment. The parameter with the best sensitivity and specificity to detect serious complications (no wound closure achieved) was CrP at day 4.

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