Abstract
NPWT is increasingly used in patients with diabetic foot. The protocol for performing NPWT is subject to debate. Main concerns regard the type of suction to use (continuous, intermittent, or variable), the wound-packing material, or the exact pressure to apply. Typically, an optimum pressure range of –80 to –125 mmHg is indicated. Following bone resection in diabetic foot patients, the surgical wound is left open, which often entails bleeding from the resection site. In these cases, the start of NPWT was typically delayed by 24–48 hours – during that time a pressure dressing was applied – and NPWT was only started once bleeding had ceased. In order to initiate NPWT as soon as possible, we decided to start it at a higher negative pressure than usual, i.e. –180 mmHg, expecting that this would stop the bleeding. Only then would we reduce the negative pressure. This paper presents the course of NPWT with high negative pressure values after an amputation in 2 diabetic foot patients. In both cases, our assumptions were confirmed. The patients did not bleed, the drained volume did not exceed 30 ml (which seems clinically insignificant) in the first 40 minutes of treatment. Later, with negative pressure at –120 mmHg, no bleeding into the dressing was observed. Following the treatment (which lasted for 9 days), the wounds granulated normally, with no signs of inflammation. Applying VAC dressing using high negative pressure values to bleeding wounds immediately after surgery may stop the bleeding, enabling immediate initiation of NPWT.
Highlights
Following bone resection in diabetic foot patients, the surgical wound is left open, which often entails bleeding from the resection site
In order to initiate N EGATIVE pressure wound therapy (NPWT) as soon as possible, we decided to start it at a higher negative pressure than usual, i.e. –180 mmHg, expecting that this would stop the bleeding
This paper presents the course of NPWT with high negative pressure values after an amputation in 2 diabetic foot patients
Summary
N EGATIVE pressure wound therapy (NPWT) is increasingly used in patients with diabetic foot, both in treating wounds caused by ulceration, and in healing surgical wounds following bone resection. NPWT assists in wound healing in a number of ways: it drains exudate, contracts the wound edges, alters blood flow in the wound edges, stimulates angiogenesis, reduces tissue edema, stimulates the formation of granulation tissue, creates a moist environment, and stimulates the wound bed.[1,2,3] Multiple studies indicate that NPWT is superior to other wound dressing methods. This work did not receive any financial support. Author affiliations: Department of General, Minimally Invasive and Trauma Surgery, Franciszek Raszeja City Hospital in Poznan, ul. Mickiewicza 2, 60-834 Poznan, Poland , (JB, PP, AK, AR, SS)
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