Negative Pressure Wound Therapy in Pediatric Burn Patients: A Systematic Review.

Abstract

Significance: Negative pressure wound therapy (NPWT) requires the placement of a dressing over a wound, covered with an adhesive film, and applying to these dressing a negative pressure in a controlled fashion. This therapy is a powerful complement to surgical care of wounds. Data are however poor on its use in pediatric burns. Recent Advances: This systematic review, including a total of 466 patients, shows that NPWT as the initial treatment for burned children and after skin grafting has been shown to produce promising results. In the majority of studies, skin graft take rate is close to 100%. This therapy is particularly beneficial in the pediatric population because of less frequent dressing changes and early mobilization. NPWT devices accurately quantify burns water losses and allow tailoring liquid resuscitation. Critical Issues: NPWT is not in the subject of controlled clinical trials in pediatric; most publications are case reports or retrospective reviews. The sporadic complications include bleeding, local infections, and mechanical device issues. Future Directions: NPWT has been used in 2-month up to 18-year-old children with deep second- to third-degree burn of multiple etiologies, from a few days up to several months, on small to 40% total body surface area (%), and in difficult areas. Data gathered provide empirical guidelines on NPWT use in pediatric burns using continuous mode with a pressure of -50 to -75 mmHg for children younger than 2 years, and -75 to -125 mmHg in children over 2 years of age. Prospective randomized studies are needed to provide validated rules.