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Abstract

Introduction: Negative Pressure Wound Therapy (NPWT) has become an effective treatment option for pressure ulcers. However, there is scarce evidence about cause for the variety of wound healing rate despite the optimal use of NPWT for pressure ulcers. Methods: We performed negative pressure wound therapy (NPWT) for the following type of pressure ulcers (PrUs) associated with severely septic patients from 2012 to 2013: 1) grade IV PrUs; and 2) PrUs with area >15 cm2 (approximately equal to 0.5% of body surface area). Post-hoc analysis was subsequently performed. After initially screening 16 patients with PrUs, 14 patients comprising 18 PrUs were finally enrolled. The PrUs were treated using a combination of early surgical debridement and NPWT. The outcome measures were the rate of granulation tissue formation and the reduction rate of wound area. Results: Among 16 patients, 35.7% had bacteremia. Mean (± standard deviation) initial PrU area was 60.8 ± 11.3 cm2, and 50% of the PrUs were surrounded by flushed skin. NPWT was used to treat 83% of the PrUs. The median time to complete granulation tissue formation without necrotic tissue in the wound bed was 26.5 days (interquartile range, 19–29 days). The rate of granulation tissue formation was associated with detection of bacteremia on arrival at the hospital (p=0.030). The reduction rate of wound area was associated with redness of the skin surrounding PrUs on arrival (p=0.071). Conclusions: These results suggest that bacteremia was associated with delayed granulation tissue formation, and skin redness was associated with slowed reductions in wound area. Therefore, early surgical debridement and NPWT should represent an effective procedure for counteracting such delays in wound healing.