The use of negative pressure wound therapy (NPWT), as an adjunct for primary wound healing, in deep partial-thickness paediatric foot burns: A case report (original) (raw)
Trials, 2019
Background: Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone. Methods/design: A total of 104 children will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present to the participating children's hospital within 7 days of their injury with a thermal burn covering <5% of their total body surface area. Facial and trivial burns will be excluded. Following a randomised controlled parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™. The intervention arm will be treated with silverimpregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants' dressings will be changed every 3 to 5 days until their wounds are fully re-epithelialised. Time to re-epithelialisation will be studied as the primary outcome. Secondary outcomes will include pain, pruritus, wound progression, health-care-resource use (and costs), ease of management, treatment satisfaction and adverse events. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. Discussion: The study will be the first randomised controlled trial to explore the clinical effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management.
International Journal of Surgery Case Reports
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Negative Pressure Wound Therapy (NPWT) to Treat Complex Defect of the Leg after Electrical Burn
Chirurgia (Bucharest, Romania : 1990)
Negative pressure wound therapy is a non-invasive treatment that uses under atmospheric pressure to increase blood supply to the wound, stimulating the formation of granulation tissue, angiogenesis, proliferation of fibroblasts and endothelial cells. Negative pressure therapy has also the ability to decrease the bacterial load, reduce swelling and decrease exudate while maintaining a moist environment that facilitates healing. Our patient, a 17 year old male, suffered major third and fourth-degree high voltage electrical burns on 60% of the body surface, in November 2011. After the excision of the necrotic tissue (muscles and tendons), the lower extremity of the right leg- the tibial bone, the fibula, external and internal malleoli became exposed circularly. The soft-tissue defect was partially covered by using an internal twin muscle flap and free split skin. Then, a cross leg flap technique has been used, partially covering the defect with a contralateral thigh flap. Surface swab ...
Children
Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patien...
Negative Pressure Wound Therapy
Archives of Surgery, 2008
To systematically examine the clinical effectiveness and safety of negative pressure wound therapy (NPWT) compared with conventional wound therapy. MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched. Manufacturers were contacted, and trial registries were screened. Randomized controlled trials (RCTs) and non-RCTs comparing NPWT and conventional therapy for acute or chronic wounds were included in this review. The main outcomes of interest were wound-healing variables. After screening 255 full-text articles, 17 studies remained. In addition, 19 unpublished trials were found, of which 5 had been prematurely terminated. Two reviewers independently extracted data and assessed methodologic quality in a standardized manner. Seven RCTs (n = 324) and 10 non-RCTs (n = 278) met the inclusion criteria. The overall methodologic quality of the trials was poor. Significant differences in favor of NPWT for time to wound closure or incidence of wound closure were shown in 2 of 5 RCTs and 2 of 4 non-RCTs. A meta-analysis of changes in wound size that included 4 RCTs and 2 non-RCTs favored NPWT (standardized mean difference: RCTs, -0.57; non-RCTs, -1.30). Although there is some indication that NPWT may improve wound healing, the body of evidence available is insufficient to clearly prove an additional clinical benefit of NPWT. The large number of prematurely terminated and unpublished trials is reason for concern.
Negative pressure wound therapy: past, present and future
International Wound Journal, 2013
From antiquity to today, tissue repair and wound healing have played a central role in health. Over the past generation, negative pressure wound therapy (NPWT) has shown itself to be a valuable adjunct in wound healing, with effects that are superior to many traditional wound treatment modalities. Applications of NPWT are widespread, with use seen in management of severe soft tissue loss, prevention of surgical site infections, treatment of diabetic foot ulcers, and improving skin graft survival. This article reviews the biology, mechanics, and therapeutic effects of NPWT, while also discussing social and economic aspects of use. Finally, various possible adjustments and modifications to NPWT are addressed, all of which contribute to the continual evolution of NPWT at the frontier of modern wound healing and surgery.
Negative Pressure Wound Therapy: The Experience of Our Surgery Department
Journal of Surgery Research and Practice, 2021
Introduction: The negative pressure wound therapy NPWT is a simple technique using negative pressure which aims to heal different types of wounds in different kinds of surgeries.The purpose of our study is to evaluate the results of this therapy on patients who have had delayed wound healing in cardiac, vascular or thoracic surgery.
Negative pressure wound therapy for traumatic wounds
Cochrane Database of Systematic Reviews, 2017
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of NPWT for managing traumatic wounds in any care setting.
Negative-Pressure Wound Therapy in Foot and Ankle Surgery
Foot & Ankle International, 2019
Negative Pressure Wound Therapy (NPWT) is frequently utilized to manage complex wounds, however its mechanisms of healing remain poorly understood. Changes in growth factor expression, micro- and macro-deformation, blood flow, exudate removal, and bacterial concentration within the wound bed are thought to play a role. NPWT is gaining widespread usage in foot and ankle surgery, including the management of traumatic wounds; diabetic and neuropathic ulcers; wounds left open after debridement for infection or dehiscence; high-risk, closed incisions; tissue grafts and free flaps. This article reviews the rationale for NPWT, its proposed mechanisms of action, and the evidence regarding its clinical applications within the field of foot and ankle surgery. Level of Evidence: Level V, expert opinion.
Negative pressure wound therapy: eleven-year experience at a tertiary care hospital
International Journal of Research in Medical Sciences, 2017
Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used...
World journal of plastic surgery, 2016
Thermal injury is associated with several biochemical and histopathological alteration in tissue. Analysis of these objective parameters in research and clinical field are common to determine healing rate of burn wound. Negative pressure wound therapy has been achieved wide success in treating chronic wounds. This study determines superficial burn wound healing with intermittent negative pressure wound therapy under limited access and conventional dressings. A total 50 patients were randomised into two equal groups: limited access and conventional dressing groups. Selective biochemical parameters such as hydroxyproline, hexosamine, total protein, and antioxidants, malondialdhyde (MDA), wound surface pH, matrix metalloproteinase-2 (MMP-2), and nitric oxide (NO) were measured in the granulation tissue. Histopathologically, necrotic tissue, amount of inflammatory infiltrate, angiogenesis and extracellular matrix deposition (ECM) were studied to determine wound healing under intermitten...
EWMA Document: Negative Pressure Wound Therapy
Journal of Wound Care, 2017
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4–6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12–14 The ongoing controversy regarding high-level evidence in wound care in general is w...
Uses of Negative-Pressure Wound Therapy in Orthopedic Trauma
Recent clinical techniques, results, and research in wounds, 2018
Negative pressure wound therapy (NPWT) is ideal for soft tissue defects that can heal through secondary intention or require skin grafting. NPWT prevents desiccation, reduces edema, limits hematoma, and facilitates wound drainage. NPWT is an effective way to downscale the complexity of soft tissue reconstruction. NPWT can decreases the risk of wound complication when applied to high-risk incisions after fracture surgery.
Clinical recommendations and practical guide for negative pressure wound therapy with instillation
International Wound Journal, 2015
Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well-established advanced therapy that has been successful in adjunctive management of acute and chronic wounds. In recent years, the introduction of topical wound solution delivery in combination with NPWT has provided further benefits to wound healing. A commercially available system now offers automated, volumetric control of instilled topical wound solutions with a dwell time in combination with NPWT (NPWTi-d; V.A.C. VeraFlo™ Therapy, KCI, an Acelity company, San Antonio, TX). This NPWTi-d system differs from other instillation systems in that a timed, predetermined volume of topical wound solution is intermittently delivered (versus continuously fed) and allowed to dwell in the wound bed (without NPWT), for a user-selected period of time before NPWT is resumed. This added accuracy and process simplification of solution delivery in tandem with NPWT have prompted use of NPWTi-d as first-line therapy in a wider subset of complex wounds. However, considerably more research is required to validate efficacy of NPWTi-d in various wound types. The purpose of this review is to provide a relevant overview of wound healing, describe current literature supporting the adjunctive use of NPWTi-d, propose a clinical approach for appropriate application of NPWTi-d and conclude with case studies demonstrating successful use of NPWTi-d. Based on this review, we conclude that either a large case series examining effects of NPWTi-d on different wound types or possibly a large prospective registry evaluating NPWTi-d with real-world topical wound solutions versus immediate debridement and closure would be valuable to the medical community in evaluating the efficacy of this promising therapy. The copyright line for this article was changed on 3 June 2015 after original online publication. Key Messages • effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan • negative pressure wound therapy (NPWT) is a wellestablished advanced therapy that has been successful in the adjunctive management of acute and chronic wounds
Injury, 2011
Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
OUTCOMES OF MODIFIED NEGATIVE PRESSURE WOUND THERAPY
Background: Negative Pressure Wound Therapy (NPWT) or Vacuum Assisted Closure (VAC) is a method used to cover large wounds, decubitus ulcers and open fractures which cannot be closed either primarily or secondarily and which often requires skin graft or flaps or complex reconstructive procedure to cover the wound. Methods: We applied our modification of NPWT in 128 patients on large wounds, neglected wounds, large decubitus ulcers, fasciotomies and open fractures. Compared to the patented VAC system, our modification included presterilized foam, Saran® wrap or Glad® wrap, infant feeding tube or a nasogastric tube and bed side suction machine. Results: Majority of our cases were from open fractures. There were 98 cases of large soft tissue wounds, 3 cases of fasciotomies for compartment syndrome, 7 cases of peri-operative trauma infections, 16 cases of diabetic wounds and 4 decubitus ulcers. In our study, the average number of modified NPWT changes is 3 to 4, average number of days between modified NPWT changes is 3 to 5 days, and length of time modified NPWT applied before closure is 14 to 21 days. Most frequent mode of coverage is Split Thickness Skin Graft obviating the need of more complex flaps and microvascular reconstructive procedures. Conclusion: Our modifications are not inferior to the patented VAC but works just as well. The costs of our modifications are much less than the patented VAC, which is economical for our setting.
Injury, 2020
Introduction: Extensive lower limb traumatic injuries are particularly challenging when they associate skin and soft tissue defects, moreover when the patient is a child. In view of more frequent recommendations and reports of negative pressure wound therapy (NPWT) use for severe trauma and extensive soft tissue defects of the lower extremity, we aimed at reviewing the indications and outcomes of this technique in our pediatric plastic surgery department. Method: We performed a retrospective study for the period 2016-2019, in order to identify patients having suffered injuries of the ankle and foot, for who NPWT was used in the therapeutic protocol. Results: For the study period we identified a total of 9 children with ankle and foot injuries who had NPWT in their therapeutic protocol. The average age was 10 years (range 3 years 5 months to 14 years 4 months) and 8 of them were pedestrians, victims of traffic accidents. Five patients presented with associated injuries and fractures in other anatomic locations. NPWT was started 1-3 days after admission and it was used in average for 21.77 days, with good results in all cases. For 8 patients NPWT was sufficient to contract the wound and cover exposed bone and tendons before closing with split thickness skin graft (STSG). One patient needed also a free muscular flap transfer before grafting. All patients achieved complete healing and started physical therapy before discharging. Conclusion: NPWT has proven to be an easy to use, safe and effective therapeutic tool for pediatric patients, with considerable improvement for healing in case of traumatic injuries of foot and ankle, presenting extensive skin and soft tissue defects and bone exposure in children. NPWT is also suitable for children since its use implies less frequent dressing changes, and decreases the level of pain and anxiety, and spares donor areas needed for more complicated procedures and, by creating an optimal grafting bed, it ensures good outcomes, in the short term and long term as well.
Negative Pressure Wound Therapy(NPWT) has remained one of the popular methods of managing complex wounds across surgical branches, including orthopaedics. Creating a sub atmospheric pressure on wound bed helps in granulation tissue formation. Many commercial forms of NPWT are being used worldwide. Unfortunately, these commercial devices comes with huge monetary burden to patient. In order to make this sub atmospheric therapy available to unaffordable patients many modifications have been made. This present study evaluates the efficacy of NPWT given by using locally available materialsat hospital and cost effectiveness of the treatment along with a review of literature. Methods and materials: The study included 32 wounds in 32 patients who were treated at our institution. After debriding wounds, negative pressure was applied using pre sterilised polyurethane foam, suction catheter, suction apparatus and transparent adhesive sealing material(Tegaderm,Ioban.3M). Intermittent negative pressure of-50 to-125mmHg was applied. Dressing was changed every 48hrs. Results: Average size of wounds at the beginning of NPWT was 102.9 sq.cm and at the end of therapy wound size reduced by ̴ 30% in surface area. An average of 5.2 dressings were required to achieve desired result. Mean duration of NPWT was 12 days. 23 of 32 wounds were covered by split skin graft once healthy granulation bed was prepared, 8 wounds healed by secondary intension. Average cost per dressing was 300INR. No NPWT associated complications were found. All wounds healed without any wound breakdown. Conclusion: By using principles of NPWT, effective use of locally available resources can be utilized to provide sub atmospheric pressure to achieve similar results as of commercial NPWT but with significant cost reduction. Further long term controlled studies are needed in this aspect which would help in providing affordable wound management.