Managing Wound Dehiscence With Mechanical Negative Pressure Wound Therapy: A Case Report

2021 ◽  
Vol 33 (12) ◽  
pp. E75-E78
Author(s):  
Robert Klein
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Single Case ◽  
Wound Dehiscence ◽  
Metatarsal Head ◽  
Outpatient Setting ◽  
Wound Therapy ◽  
Surgical Wounds

Mechanical negative pressure wound therapy (mNPWT) is commonly used in the management of a variety of wounds, including diabetic foot ulcerations, surgical wounds, venous ulcerations, and wound dehiscence. This mechanically powered, disposable modality can be used to manage wounds in the outpatient setting and has been shown to be an effective wound care option when transitioning patients from the inpatient to outpatient setting and continuing NPWT for wound care. Mechanical NPWT helps promote wound healing by decreasing edema and via removal of tissue debris and exudate. Traditional NPWT is bulky, is often noisy, and requires a power source. A mechanically powered, disposable, easily applied, off-the-shelf mNPWT device is available for patients with small- to medium-sized wounds with mild to moderate exudate. The disposable mNPWT device provides −125 mm Hg pressure, is silent and small, can be worn under clothes, and allows the patient to be fully ambulatory, thus, more mobile. The mNPWT device tubing can be cut to fit to enable safer ambulation than the powered system and to enable the patient to work and enjoy social activities without a medical device showing. This single case study of a patient with chronic diabetic foot ulcerations of the medial first metatarsal head and dorsal proximal interphalangeal joints of the second and third toes of the left foot, which had not been successfully treated with conservative care and had been present for more than 1 year.

scholarly journals Closed Incisional Negative Pressure Wound Therapy at Flap Suture Line: An Innovative Approach for Improving Outcomes in Suboptimal Wound Conditions

2020 ◽  
Vol 53 (01) ◽  
pp. 090-096
Author(s):  
Ravikiran Naalla ◽  
Smriti Bhushan ◽  
Minhaj Ul Abedin ◽  
Ashish Dhanraj Bichpuriya ◽  
Maneesh Singhal
Keyword(s):  
Dead Space ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Wound Dehiscence ◽  
Suture Line ◽  
Wound Therapy ◽  
Flap Coverage ◽  
The Mean ◽  
Complex Wounds

Abstract Background Persistent dead space following flap cover is a frequently encountered challenge following the reconstruction of complex wounds. It may lead to a hematoma, seroma, wound infection, and wound dehiscence. Wound dehiscence could be a devastating complication. Closed incisional negative pressure wound therapy (ciNPWT) over the surgical incisions was found to reduce surgical site infection (SSI) and wound dehiscence. We applied this principle at the closed flap suture line and through this article, we share the indications, technique, and outcomes. Methods A retrospective analysis (January 2018–June 2019), in which selected high-risk patients who underwent ciNPWT at the flap suture following complex reconstruction (pedicled or free flap) were included in the study. The indications include deep incisional/organ SSI after debridement and flap coverage, persistent dead space following flap coverage, chronic osteomyelitis. Patients were analyzed in the follow-up period in terms of complications, wound healing. Results Nine patients underwent ciNPWT over the flap suture line. The mean age was 32.2 years (range: 10–48 years). The mean duration of the NPWT application was 7.3 days (range: 3–21 days). Three of the nine patients had flap-related minor complications. One patient had marginal flap necrosis and required skin grafting, one patient had minor wound dehiscence (1 cm) which required secondary skin suturing and one patient had chronic discharging sinus related to osteomyelitis of ischium, which subsequently healed with antibiotics and local wound care. None of the patients had NPWT-related complications. Conclusion Closed incisional NPWT decreases the untoward effects of dead space following the reconstruction of complex wounds. The incidence of SSI and wound gaping can be reduced.

Evaluation of Wound Care and Health-Care Use Costs in Patients with Diabetic Foot Ulcers Treated with Negative Pressure Wound Therapy versus Advanced Moist Wound Therapy

2014 ◽  
Vol 104 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Vickie R. Driver ◽  
Peter A. Blume
Keyword(s):  
Health Care ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Patient Records ◽  
Median Cost ◽  
Wound Therapy ◽  
The Mean

Background We conducted a post-hoc retrospective analysis of patients enrolled in a randomized controlled trial to evaluate overall costs of negative pressure wound therapy (NPWT; V.A.C. Therapy; KCI USA, Inc, San Antonio, Texas) versus advanced moist wound therapy (AMWT) in treating grade 2 and 3 diabetic foot wounds during a 12-week therapy course. Methods Data from two study arms (NPWT [n = 169] or AMWT [n = 166]) originating from Protocol VAC2001-08 were collected from patient records and used as the basis of the calculations performed in our cost analysis. Results A total of 324 patient records (NPWT = 162; AMWT = 162) were analyzed. There was a median wound area reduction of 85.0% from baseline in patients treated with NPWT compared to a 61.8% reduction in those treated with AMWT. The total cost for all patients, regardless of closure, was $1,941,472.07 in the NPWT group compared to $2,196,315.86 in the AMWT group. In patients who achieved complete wound closure, the mean cost per patient in the NPWT group was $10,172 compared to $9,505 in the AMWT group; the median cost per 1 cm2 of closure was $1,227 with NPWT and $1,695 with AMWT. In patients who did not achieve complete wound closure, the mean total wound care cost per patient in the NPWT group was $13,262, compared to $15,069 in the AMWT group. The median cost to close 1 cm2 in wounds that didn't heal using NPWT was $1,633, compared to $2,927 with AMWT. Conclusions Our results show greater cost effectiveness with NPWT versus AMWT in recalcitrant wounds that didn't close during a 12-week period, due to lower expenditures on procedures and use of health-care resources.

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.

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.

Autologous fat grafting combined with negative pressure wound therapy in severe diabetic foot ulcer: a case study

2021 ◽  
Vol 30 (Sup4) ◽  
pp. S38-S40
Author(s):  
Zheng Biyao ◽  
Xu Gang ◽  
Jiang Hai ◽  
Duan Chenwang ◽  
Liu Xuan
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Foot Ulcer ◽  
Fat Grafting ◽  
Autologous Fat Grafting ◽  
Wound Therapy ◽  
Autologous Fat ◽  
Split Thickness Skin Grafting

Objective: Hard-to-heal wounds are a surgical challenge, and diabetic foot ulcers (DFUs) are one of the most common and severe varieties. Previous studies have shown that autologous fat grafting (AFG) and negative pressure wound therapy (NPWT) have the potential to promote wound healing. This case study describes how these two methods together helped in the healing of a serious DFU. Case history: A 65-year-old female patient had a severe DFU on her right foot, with a 30-year history of disease and renal failure. By the time symptoms were evident, regular dressing changes and antibiotic treatment were inadequate. She received surgical debridement, AFG and NPWT. Finally, as the granulation tissue covered the full wound bed, the wound was closed by split-thickness skin grafting. One month later, the DFU was fully healed with no recurrences. Conclusion: The application of AFG or components of adipose tissue to treat hard-to-heal wounds has been researched at both the molecular level and in clinic. In this case, we have proved the curative effect of jointly using AFG and NPWT.

Sign in / Sign up

Export Citation Format

Share Document