Uso da terapia por pressão subatmosférica em feridas traumáticas agudas

Dimas André Milcheski,Hugo Alberto Nakamoto,Bernardo Nogueira Batista,Diego Daniel Pereira,Marcus Castro Ferreira,Paulo Tuma Jr

doi:10.1590/s0100-69912013000500008

Dimas André Milcheski, Hugo Alberto Nakamoto + Show 4 more

Open Access

https://doi.org/10.1590/s0100-69912013000500008

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Abstract

To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs. One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT). Of the 178 patients who underwent SPT, 129 (72.5%) were male and 49 (27.5%) were aged between 18 and 40 years. Degloving injuries to the limbs were the most common type of traumatic wounds, being responsible for the hospitalization of 83 (46.6%) patients. Mean hospital stay was 17.5 days. A total of 509 procedures were performed (average 2.9 per patient). SPT was used in 287 procedures, 209 (72.8%) on traumatic wounds and 78 (27.2%) of skin grafts. The number of exchanges of the SPT apparel per patient was 1.6 and the mean time of use, 8.5 days. SPT significantly reduced morbidity and healing time of injuries when compared with previously performed dressing treatments. The subatmospheric pressure therapy is a useful method in treating acute traumatic wounds, acting as a bridge between the emergency treatment and the final coverage of the skin lesions, being better when compared with more traditional methods of plastic surgery.

Highlights

In polytrauma patients, the treatment of complex wounds to the limbs, defined as acute and extensive loss of cutaneous coverage, associated or not with fractures, should constitute a significant part of care 1
When analyzing the time elapsed between trauma and care by the Plastic Surgery team, we found that 128 (71.9%) patients were seen in less than 24 hours of evolution, and in 29 (16.3%) patients care occurred between 24 hours and seven days of evolution
The treatment of acute traumatic wounds to soft tissues is a relevant theme in discussions about the initial care to polytraumatized patients

Summary

Introduction

The treatment of complex wounds to the limbs, defined as acute and extensive loss of cutaneous coverage, associated or not with fractures, should constitute a significant part of care 1. More extensive and deep lesions of the soft tissue form a particular group, with direct implications in the patient’s systemic status - whether by bleeding, hydroelectrolytic imbalance or local infection. There may be need for specific treatments in the affected site, such as skin grafting, local flaps or microsurgical flaps, which require specialized care by the plastic surgeon. The first studies on the negative pressure therapy, a new option for the treatment of wounds, were published In the 80s and 90s 2-4. Since 2001, the Department of Plastic Surgery of HC-FMUSP has employed this method, more appropriately called subatmospheric pressure therapy (SPT)

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