Indigenously Prepared Intermittent Negative Pressure Wound Dressing: Effective and Economic in Indian Scenario

Abstract

Introduction: Intermittent negative pressure wound treatment (INPWT) is a proven way to accelerate wound healing by increasing blood flow, promoting angiogenesis and suction removal of matrix metalloproteinases. The purpose of the study was to evaluate the use of INPWT in pressure sores. In our study, we have used very low-cost locally available material for INPWT in place of commercially available costly vacuum-assisted closure (VAC) machine and dressing. Materials and Methods: This was a prospective study conducted in the department of plastic and reconstruction surgery and physical medicine and rehabilitation at a tertiary level facility. Eighty patients of spinal cord injury with 70% of ASIA Grade A and B with pressure ulcer most commonly at sacral and ischial regions with National Pressure Ulcer Advisory Panel Grade 3 and Grade 4 pressure sore were treated. Patients enrolled included 57 males and 23 females. The study employed locally manufactured low-cost materials such as foam, Ioban tape, Room Vac drain and suction machine (easily and locally available at any primary, secondary as well as tertiary healthcare centre) for INPWT in patients with pressure sores. Dressing was changed every 4th day till desired granulation tissue was formed. Results: Out of patients who were treated with INPWT, 30% achieved direct closure, 49% required split skin grafting and 21% required reconstruction by local flaps. Commercial available VAC machines available in the market cost around 300,000–500,000 INR, and the cost of single dressing is around 7000–15,000 INR. This may not be economically feasible, especially in patients having large wounds which require multiple applications of these dressings with our indigenous dressing; there is a 95%–98% decrease in pricing of dressing. Conclusion: The study concluded that low-cost indigenously prepared INPWT dressing produced effective results at minimum cost that were at par with commercially available costly VAC dressing. This low-cost indigenously prepared INPWT can be groundbreaking in treatment of patients with pressure ulcer in developing country like India in both rural and urban settings.