Topical Negative Pressure Wound Dressing and Its Applications in the Hand—A Review of the Literature

The use of topical negative pressure wound therapy (NPWT) has become increasingly popular in the management of complex wounds. There are many theories as to the mechanism of action of NPWT, but the essential components of the various systems remain consistent. There are many attractive potential properties of negative pressure dressings that lend themselves to the management of upper limb injuries. This article explores the technique of negative pressure wound dressing, the theories pertaining to mechanism of action, and the increasingly broad indications described for the use of NPWT in the hand. The literature pertaining to the efficacy of NPWT in general is also discussed.

Negative-pressure dressings in lower limb skin grafts: a randomised control trial of PICO versus standard dressings

Objective: Negative-pressure wound therapy (NPWT) can reduce the incidence of exudate and haematoma beneath a split-thickness skin graft (SSG) compared with traditional standard dressings. However, NPWT has not been universally adopted for lower limb SSGs despite evidence that its use is linked with improved graft take and a tendency towards early mobilisation. PICO (Smith and Nephew®), an ultra-lightweight NPWT device now available in Australia, can provide a smaller, more manageable NPWT dressing. The primary objective of this study was to compare lower limb graft take rate in PICO versus standard dressing groups, and a secondary objective was comparing quality of life (QOL) in these groups. Method: A prospective, randomised control trial was conducted of 71 lower limb wounds from 59 patients, with 36 wounds randomised to standard dressings and 35 to PICO dressings. Graft take was measured and expressed as a percentage of total wound area. Postoperative mobilisation day, patient comfort, complication frequencies, ease of dressing removal and QOL scores were also recorded. Results: The graft area percentage was not statistically significantly different between the PICO and standard dressing groups (p=0.054). All patients in the PICO group were mobilised by postoperative day one, but 8 per cent in the standard dressing group were still not mobilised by postoperative day five (PICO vs standard, p=0.003). There was no statistically significant difference in patient comfort, patient QOL or complication frequency in the PICO versus standard dressing group at any postoperative visit, but the PICO dressings were statistically significantly easier to remove (p=0.04). Conclusion: PICO dressings are not inferior or superior to standard dressings for lower limb SSGs.

Oncoplastic breast surgery: the role of negative pressure wound therapy

Wound-related problems following breast surgery are common. Delayed wound healing can lead to poor cosmesis and, among breast cancer patients, can result in delays in receiving adjuvant treatment. The aim of our review was to look at the literature in relation to the role of negative pressure wound therapy in oncoplastic breast surgery, as at the time of writing, there is no consensus on the use of prophylactic negative pressure dressings in closed wounds following breast surgery.

Surgical Management of a Large Chronic Prepatellar Bursitis: 2-Stage Technique

Treatment of a large chronic prepatellar bursitis can be difficult to manage surgically because of a high rate of local complications and a significant chance of recurrence. We present a 2-stage technique using negative pressure dressings which produced a good outcome with no recurrence at one year after surgery.

Negative Pressure Dressings over Free Muscle Flaps with Immediate Split-Thickness Skin Grafting: A 9-Year Experience

Background Negative pressure wound therapy has allowed for significant advances in the treatment of wounds. This occurs through a process of angiogenesis, microdeformation, macrodeformation, and decrease in exudate and bacterial load. It is routinely used as a bolster in the management of skin grafts. However, its role as a dressing over free muscle flaps has not gained widespread acceptance due to the fear of flap compromise. Methods A retrospective review of 97 patients over 9 years was performed. All patients underwent free muscle flap coverage of various wounds with immediate split-thickness skin grafting. A negative pressure dressing was applied, with windows made in the foam sponge to enable Doppler monitoring as well as visual inspection of the flap. Complications including flap failure, skin graft loss, hematoma, distal flap necrosis, negative pressure dressing failure, partial muscle necrosis, and mild flap congestion were assessed. Results Flap loss occurred at a rate of 8.2% (eight flaps). Four of these flaps were lost due to patient factors not attributable to the dressing. In the remaining four flaps (4.1% of the series), it is conceivable that the negative pressure dressing was a contributing factor. However, this failure rate is comparable to flap loss rates in studies where negative pressure dressings were not used. The rates of skin graft failure, hematoma, distal flap necrosis, inability to maintain seal, partial muscle necrosis, and mild flap congestion were also acceptable and similar to studies where negative pressure dressings were not used. Conclusion Negative pressure dressings over free muscle flaps with immediate split-thickness skin grafts are effective and safe to use while allowing for postoperative flap monitoring and skin graft protection.

Negative pressure dressings are no better than standard dressings for open fractures

The study Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: the WOLLF randomised clinical trial. Costa ML, Achten J, Bruce J, et al; UK WOLLF Collaboration Published on 9 October 2018 JAMA 2018;319:2280-8. This project was funded by the National Institute for Health Research Health Technology Assessment Programme (project number 10/57/20). To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000655/negative-pressure-dressings-are-no-better-than-standard-dressings-for-open-fractures