A novel treatment approach for traumatic scalp defects with exposed calvaria denuded of pericranium by combined application of low-temperature plasma and negative pressure wound therapy: A case series.

Since its introduction 20 years ago for the treatment of chronic wounds, negative pressure wound therapy use has expanded to a variety of other wound types. Various mechanisms of action for its efficacy in wound healing have been postulated, but no unifying theory exists. Proposed mechanisms include induction of perfusion changes, microdeformation, macrodeformation, exudate control and decreasing the bacterial load in the wound. We surmise that these different mechanisms have varying levels of dominance in each wound type. Specifically, negative pressure wound therapy is beneficial to acute open wounds because it induces perfusion changes and formation of granulation tissue. Post-surgical incisional wounds are positively affected by perfusion changes and exudate control. In the context of chronic wounds, negative pressure wound therapy removes harmful and corrosive substances within the wounds to affect healing. When skin grafts and dermal substitutes are used to close a wound, negative pressure wound therapy is effective in promoting granulation tissue formation, controlling exudate and decreasing the bacterial load in the wound. In this review, we elucidate some of the mechanisms behind the positive wound healing effects of negative pressure wound therapy, providing possible explanations for these effects in different wound types.

Incidence of surgical site infections at skin graft recipient sites with negative pressure wound therapy: A meta-analysis.

There is moderate-certainty evidence for no clear difference between NPWT and standard care on the proportion of wounds healed at six weeks for open fracture wounds. There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds. Moderate-certainty evidence means that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. It is uncertain whether there is a difference in risk of wound infection, adverse events, time to closure or coverage surgery, pain or health-related quality of life between NPWT and standard care for any type of open traumatic wound.

Indications for the use of negative pressure wound therapy (NPWT) are broadening with a range of systems now available on the market, including those designed for use on clean, closed incisions and skin grafts. Reviews have concluded that the evidence for the effectiveness of NPWT remains uncertain, however, it is a rapidly evolving therapy. Consequently, an updated systematic review of the evidence for the effects of NPWT on postoperative wounds expected to heal by primary intention is required. To assess the effects of NPWT on surgical wounds (primary closure, skin grafting or flap closure) that are expected to heal by primary intention. We searched the following electronic databases to identify reports of relevant randomised clinical trials:the Cochrane Wounds Group Specialised Register (searched 28 January 2014); the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, issue 12); Database of Abstracts of Reviews of Effects (2013, issue 12); Ovid MEDLINE (2011 to January 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 24 January 2014); Ovid EMBASE (2011 to January 2014 Week 44); and EBSCO CINAHL (2011 to January 2014). We conducted a separate search to identify economic evaluations. We included trials if they allocated patients to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with a different type of NPWT. We assessed trials for their appropriateness for inclusion and for their quality. This was done by three review authors working independently, using pre-determined inclusion and quality criteria. In this first update, we included an additional four trials, taking the total number of trials included to nine (785 participants). Three trials involved skin grafts, four included orthopaedic patients and two included general surgery and trauma surgery patients; all the included trials had unclear or high risk of bias for one or more of the quality indicators we assessed. Seven trials compared NPWT with a standard dressing (two of these were 'home-made' NPWT devices), one trial compared one 'home-made' NPWT with a commercially available device. In trials where the individual was the unit of randomisation, there were no differences in the incidence of surgical site infections (SSI); wound dehiscence, re-operation (in incisional wounds); seroma/haematoma; or failed skin grafts. Lower re-operation rates were observed among skin graft patients in the 'home-made' NPWT group (7/65; 10.8%) compared to the standard dressing group (17/66; 25.8%) (risk ratio (RR) 0.42; 95% CI 0.19 to 0.92). The mean cost to supply equipment for VAC® therapy was USD 96.51/day compared to USD 4.22/day for one of the 'home-made' devices (P value 0.01); labour costs for dressing changes were similar for both treatments. Pain intensity score was also reported to be lower in the 'home-made' group when compared with the VAC® group (P value 0.02). One of the trials in orthopaedic patients was stopped early because of a high incidence of fracture blisters in the NPWT group (15/24; 62.5%) compared with the standard dressing group (3/36; 8.3%) (RR 7.50; 95% CI 2.43 to 23.14). Evidence for the effects of negative pressure wound therapy (NPWT) for reducing SSI and wound dehiscence remains unclear, as does the effect of NPWT on time to complete healing. Rates of graft loss may be lower when NPWT is used, but hospital-designed and built products are as effective in this area as commercial applications. There are clear cost benefits when non-commercial systems are used to create the negative pressure required for wound therapy, with no evidence of a negative effect on clinical outcome. In one study, pain levels were also rated lower when a 'home-made' system was compared with a commercial counterpart. The high incidence of blisters occurring when NPWT is used following orthopaedic surgery suggests that the therapy should be limited until safety in this population is established. Given the cost and widespread use of NPWT, there is an urgent need for suitably powered, high-quality trials to evaluate the effects of the newer NPWT products that are designed for use on clean, closed surgical incisions. Such trials should focus initially on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.

A Commentary on “Prophylactic negative pressure wound therapy for closed laparotomy incision after ventral hernia repair: A systematic review and meta-analysis” (Int J Surg 2022; 97:106216)

Background: Managing complex soft tissue defects remains a major challenge in orthopedic trauma and reconstructive surgery. Negative Pressure Wound Therapy (NPWT), or Vacuum-Assisted Closure (VAC), has significantly improved wound care by reducing edema, stimulating granulation tissue, and controlling infection. However, conventional NPWT systems have limitations in large tissue defects or when external fixation is required. The CNP Easy-dress system, a controlled 3D negative pressure dressing, was developed to overcome these shortcomings. Thi study evaluates the clinical efficacy, safety, and applicability of the CNP 3D Easy-dress system in managing complex soft tissue defects. Methods: This case series includes four patients with extensive soft tissue defects, three of whom required external fixation. All patients were treated with NPWT using the CNP 3D Easy-dress system at the Center for Orthopedic Trauma and Plastic Surgery, Hue Central Hospital, starting from September 2024. Results: All patients showed rapid improvement of soft tissue and robust granulation tissue formation after an average of 2–4 dressing changes. Subsequent wound coverage was successfully achieved with skin grafts or free flaps, with no complications such as infection or flap failure. Conclusion: The application of the CNP 3D Easy-dress system enhances the effectiveness of NPWT in the management of complex soft tissue defects, particularly in cases requiring external fixation. This method shortens treatment duration, minimizes complications, and improves postoperative functional recovery.

Negative pressure wound therapy (NPWT) has been commonly used over the years for a wide range of chronic/refractory lesions. Alternatively, autologous micrografting technology is recently becoming a powerful modality for initiating wound healing. The case presented is of a patient with a lower leg ulcer that had responded poorly to NPWT alone for three weeks. Consequently, the patient was put on a combination therapy of NPWT and micrografting. After injection of a dermal tissue micrografts suspension into the entire wound bed, NPWT was performed successively for two weeks, resulting in fresh granulation tissue formation. Thereafter, the autologous skin graft was taken well. This case study indicates that for a chronic/refractory ulcer patient with poor NPWT outcome, combination therapy using micrografting treatment and NPWT could rapidly initiate and enhance granulation tissue formation, creating a favorable bedding for subsequent skin grafting.

Wound management is a major concern in open fracture cases. Negative Pressure Wound Therapy (NPWT) is an advanced method for managing open wounds. It is a topical treatment using sub-atmospheric pressure to increase blood flow, remove bacteria and increase growth of granulation tissue in the wound. The study was performed to evaluate the results of NPWT in patients with open fracture in lower extremity. Using Aquarium pump as an NPWT device, 16 patients were prospectly treated for open fractures in their inferior extremity. Mean patients' age range was 21 to 60 yrs. The patients under study either had suffered from trauma, fall or had post operative wound infection. Many of them had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3rd or 4th day and treatments were continued for 07 to 28 days. Exposed tendons and bones were successfully covered with healthy granulation tissue in all cases, depth of the wounds reduced as well as surface areas. In 12 cases coverage of granulation tissue were achieved and further managed by skin grafting, 4 cases with wound infections were closed with secondary suture. No significant complications were noted regarding the treatment. NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in lower extremity and thus to shorten healing time and minimize secondary soft tissue defect coverage procedures. DOI: http://dx.doi.org/10.3329/fmcj.v7i2.13500 Faridpur Med. Coll. J. 2012;7(2):63-66

Reconstruction of complex injuries of the extremities with full-thickness wounds is a challenging but important task. If primary closure is not feasible, more complex procedures are required, such as split-thickness skin graft or flap surgery. Recently, several studies have shown good results when combined with negative pressure wound therapy (NPWT) and artificial dermal replacement therapy after extensive surgical debridement and NPWT administration for severe complex wounds accompanied by tendon or bone exposure. However, flap surgery remains the only treatment for wounds in which the hardware is exposed after fracture fixation. Therefore, in this study, we attempted to prove the usefulness of the combined treatment using artificial dermal substitutes (MatriDerm) and NPWT by focusing on hardware-exposed wounds, which have not been studied before. From 2019 to 2021, we treated with our wound management procedure 14 patients with hardware-exposing wounds after internal fixation using plates, out of 48 patients with full-thickness posttraumatic skin defect. Before skin grafting, after surgical debridement and thorough washouts, MatriDerm was placed and NPWT was applied over it. This staged approach aimed at conditioning even the most complex wounds so that closure with MatriDerm-augmented skin grafting would become possible in a one-step approach. We stratified the duration of treatment and number of replacements in NPWT according to the type of injury. Cases with open fractures required significantly longer NPWT than those with closed fractures (P = 0.01); however, there was no significant difference between the Gustilo-Anderson classification within open fractures (P > 0.05). Patients with open fractures underwent a mean of 6.6 changes while those with closed fractures underwent 2.5 (P = 0.002) until the final wound closure with MatriDerm-augmented skin grafting was performed. There was no significant difference in the treatment period based on the location and size of the wound, and there was no significant difference in the number of NPWT replacements. Skin grafting was successful in all 14 patients. This study revealed that NPWT and artificial dermis-augmented skin grafting after combined treatment with NPWT and artificial dermis were sufficiently useful for hardware-exposed wounds, where flap surgery has been considered the only treatment to date.

Aim: The aim of the study was to study how negative pressure wound therapy (NPWT) aids in wound healing, limb salvage, and reduces the need for flap surgeries in foot and ankle crush injuries. Methods: A retrospective study conducted from January 2018 to January 2023, involving 108 patients with foot and ankle injuries requiring debridement and NPWT. Wound healing, granulation tissue formation, wound shrinkage, number of NPWT applications, swab culture, and flap surgeries post-NPWT therapy were assessed. Results: Among the 108 cases (94 males and 14 females), 82 had bony injuries, 26 had soft tissue injuries, and 32 had comorbidities. After debridement and NPWT (100–150 mm Hg), the average number of NPWT sessions per patient was 1.7, with an average wound shrinkage of 1.8 cm 2 /day. Of the 108 patients, 24 were culture positive; 77 (73%) required only skin grafts, while 31 (27%) needed flap surgeries. Nine of ten limbs were salvaged in wounds with MESS score >7. Postoperative complications occurred in seven patients, five of whom had comorbidities. Conclusion: NPWT therapy significantly improves wound healing by promoting granulation tissue formation, reducing edema, and enhancing graft uptake. It decreases the need for flap surgeries, especially cross-legged flaps, and reduces complication rates. NPWT is superior to traditional methods for complex foot and ankle wounds.

According to previous research, adjunctive negative pressure wound therapy (NPWT) can help manage infected wounds when applied along with appropriate debridement and antibiotic therapy as deemed clinically relevant. NPWT not only removes fluid, and reduces oedema, but also promotes perfusion around the wounds. In addition, NPWT may lead to improved graft fixation when used as a bolster, especially in patients who are less compliant or have poor graft fixation that result from using traditional methods. NPWT is a good choice to bolster skin grafts in young, active and less-compliant patients. We propose an enhanced segmental compartment-covered technique, which uses NPWT adjunctively as first-line wound treatment to help manage postoperative infection. Moreover, NPWT promotes granulation tissue formation to prepare the wound bed for subsequent skin graft and may be used as a bolster over the graft, which helps to attain skin graft viability.

Background The value of negative-pressure wound therapy as a bridge to definitive closure of traumatic extremity wounds has been established in adults. Negative-pressure wound therapy has been used to assist granulation tissue formation and promote closure of wounds. In this study, we evaluated our experience with negative-pressure wound therapy for pediatric extremity wounds requiring delayed closure. Patients and methods A prospective study was conducted on 20 pediatric patients presenting with extremity injuries involving soft-tissue defects not suitable for immediate primary closure. Initial evaluation of the traumatized patient, wound irrigation, debridement, and antibiotic therapy were carried out and a plan for each case was outlined. Negative-pressure wound therapy was established using the vacuum-assisted closure system and dressings were changed every 3 days before definitive closure either by skin graft, Integra dermal matrix followed by skin graft, or local flaps. Results Granulation tissue was noted in all wounds by day 3. The mean duration of vacuum therapy was 12±3.3 days in patients whose wounds were closed by local flap advancement (n=4), 9±3.6 days in patients whose wounds were closed by skin grafts (n=8), and 6±4.8 days in patients whose wounds were closed by Integra dermal matrix (n=8). There was no incidence of skin graft or Integra losses. All local flaps healed complet ely. The mean follow-up period was 18±6.8 months, during which no complications were noted. Conclusion As a relatively atraumatic wound care technique with little complications, negative-pressure wound therapy provides a highly effective option as a bridge for soft-tissue management of extremity trauma in pediatric patients.

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Wound healing in diabetic foot ulcers (DFU) poses challenges, requiring extensive debridement and amputations. Negative pressure wound therapy (NPWT) can be utilized for DFUs with large soft tissue defects to promote granulation tissue growth. The optimal timeframe for successful NPWT lacks extensive studies. Advanced wound scanning with a three-dimensional (3D) camera can enhance DFU area and volume calculations. This study aimed to investigate the efficacy of 3D wound assessment in predicting granulation tissue filling velocity following NPWT in DFUs. Methods: After receiving IRB approval from the single Korean center, a retrospective case series study was performed for 101 DFUs (Wagner classification 3 and 4) undergoing NPWT from September 2018 to June 2019. Demographic data, vascular patency, and wound characteristics were recorded. Wound was irrigated before NPWT. An infra-red 3D camera (inSight ®, eKare, Fairfax, VA, USA) was used to capture digital photographs. Wound area and volume were measured. Measurements were taken weekly from before treatment to one month after using inSight ® cloud software. The risk factors of diabetic foot ulcers related to wound healing were evaluated. Results: NPWT resulted in significant area improvements for open diabetic foot ulcers (p = 0.001). Postoperative 1-week area change velocity was 1.35 cm2/day, peaking at 2 weeks (1.84 cm2/day). Volume also showed significant improvement over time (p = 0.001), with a 1-week peak velocity of 1.20 cm3/day. All peak area and volume changes occurred within two weeks after NPWT application. Midfoot and hindfoot exhibited higher velocity of volume than forefoot (p = 0.001). Postoperative volume change was the fastest with a patent peroneal artery. Conclusion: 3D wound assessment for velocity of granulation tissue filled in an open DFU after NPWT could be effective to predict outcomes. Most wound healing following NPWT in DFUs was completed within two weeks. Application of NPWT for an additional two weeks did not significantly impact the completion of wound healing even though midfoot and hindfoot exhibited higher velocity of volume than forefoot.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P53. Management of pressure injury with a novel negative pressure device (NPD) in people with spinal cord injury (SCI)

The epidemiology, management and impact of surgical wounds healing by secondary intention: a research programme including the SWHSI feasibility RCT