Effect Of Topical Negative Pressure Research Articles

D161. Effectiveness of Topical Negative Pressure Dressing on Patient Outcomes in Plastic and Reconstructive Surgery

D161. Effectiveness of Topical Negative Pressure Dressing on Patient Outcomes in Plastic and Reconstructive Surgery

Therapeutic Effect of Topical Negative Pressure Therapy/Vacuum-Associated Closure Therapy on Cephalic Facial Skin Abscess.

Objective: To evaluate the efficacy and safety of topical negative pressure therapy/vacuum-associated closure (TPN/VAC) in the treatment of cephalic facial skin abscess with infection. Methods: Forty-seven patients with cephalic facial skin abscesses were divided into two groups. The observation group was treated with negative pressure sealing drainage technique and primary wound suture. The control group was treated with abscess incision and drainage first; the second stage was wound suture after three to five days. The time and times of wound dressing, the pain score during wound dressing, the time of antibiotic use, and the recurrence rate were observed. Results: The wound healing time of the observation group was seven days, which was better than that of the control group for 10-12 days. The time of dressing change in the observation group was 14.9 ± 2.0 minutes (11-19 minutes), and the time of dressing change in the control group was 14.6 ± 2.6 minutes (10-20 minutes). There was no difference between the two groups (p > 0.05). The total number of dressing changes per patient in the observation group was three to five times, and the total number of dressing changes per patient in the observation group was five to eight times. There was a statistically significant difference between the two groups (p < 0.05). The pain score of the observation group was 3.2 ± 0.6 points (2-4 points), and the pain score of the control group was 5.1 ± 0.8 points (4-7 points). The difference between the two groups was statistically significant (p < 0.05). There was no recurrence in the observation group and two cases in the control group. Conclusion: Local negative pressure closed drainage technology can shorten the patient's healing course and reduce the duration of treatment, reduce the pain of dressing changes, improve prognosis, and have satisfactory therapeutic effect. It is a simple, effective, and safe technology, which is worthy of clinical application.

A novel method for flap delay vacuum assisted flap delay: an experimental study in rabbits

Flaps are the workhorse of plastic surgery practice. The delay procedures have been defined to prevent flap necrosis. The golden standard method of delay is a surgical delay. On the other hand, a major drawback of surgical delay is two sessions of surgery. Efforts have been made to omit one session and increase the patient safety and decrease the costs. The writer's aim was to evaluate the effects of topical negative pressure, applied prior to flap elevation, on flap survival, perfusion and compare the results with the surgical delay. In a rabbit random flap model, prior to elevation, the writers used a topical negative pressure system on the lateral thoracic region of, for induction of delay and compared the results with surgical delay and the control group. The total and necrotic flap areas, necrosis ratio, histomorphometric vascular density, immunohistochemical evaluation of neovascularization (CD31/CD34), Laser Doppler images and computerized tomography contrast uptake were used to compare the groups. In all of the parameters, the vacuum assisted flap delay was equivalent to surgical delay. Both were superior to non-delayed flaps. Control group had 65.56 ± 18.02% flap necrosis rate, while Surgical Delay group had 37.31 ± 30.74% and Vacuum Assisted Flap Delay group had 19.58 ± 27.35%. Vacuum Assisted Flap Delay did not require an extra operation for the delay procedure. The mechanism of action in the vacuum-assisted flap delay is unclear. The clinical significance should be studied further. However, vacuum assisted flap delay seems to be a promising method in the clinical setting.

Role of Negative Pressure Therapy in Healing of Diabetic Foot Ulcers

Thirty patients (17 female and 13 males) with chronic diabetic foot ulceration, age ranged from 50 to 65 years (53.4+ 4.1years), were selected from outpatient clinic of Benha teaching hospitals, Egypt from April 2013 to March 2014. Aim: Foot ulceration is one of the most common and severe complications of diabetes. The aim of the current was to clarify the effectiveness of topical negative pressure as a non invasive treatment approach for diabetic ulcers. Methods: Patients were divided into two equal groups; the first group was the control group and treated by traditional dressing while the second one was treated by negative pressure. The treatment course was extended up to six weeks; dressing was changed daily for the first group and day after day for the second group. Assessment was carried out before starting the course and after six weeks of treatment for both groups. The ulcer volume assessment was done by using a 10 cm syringe filled by terramycin ointment, and the wound surface area by using a graded plastic sheet. Student t-test was used to analyze the gained data of wound volume and surface area. Results: There was a significant improvement in the wound volume and surface area in the negative pressure group than that of the control group. Conclusion: It could be concluded that topical negative pressure is an effective non-invasive method in treating chronic diabetic foot ulceration.

Effectiveness of topical negative pressure/closed incision management in the prevention of post-surgical wound complications: a systematic review protocol

Review question/objective The aim of this review is to identify the effectiveness of topical negative pressure in the prevention of post-surgical wound complications. More specifically, the objective is to identify: The effectiveness of topical negative pressure in the prevention of post-surgical site infections, wound dehiscence, wound breakdown and/or wound complications in adults compared to other methods that assisting wound healing. Inclusion criteria Types of participants This review will consider studies that include male and female adults and children who have had TNP applied to their surgical wound following a surgical procedure in one these areas, but not confined to: trauma, cardiothoracic, orthopedic, general, vascular or obstetric surgery. Types of intervention This review will consider studies that evaluate the use of TNP directly over an incision, following any surgical procedure. Types of comparator The comparator will be the standard form of care used by the clinician in the absence of TNP (other dressings such as foams, silicone, gauze or hydrocolloids). Types of outcomes This review will consider studies that include, but are not restricted to the following outcome measures: Healing wound parameters, e.g. time, wound size, exudate levels Surgical site infections – superficial and deep Surgical wound dehiscence Wound pain Wound seroma Length of hospital stay

Clinical effectiveness of topical negative pressure for dermal substitutes in burns

Wound Repair and RegenerationVolume 20, Issue 6 p. 791-792 Editorial Clinical effectiveness of topical negative pressure for dermal substitutes in burns David G. Greenhalgh MD, David G. Greenhalgh MD Clinical Section Editor Wound Repair and RegenerationSearch for more papers by this author David G. Greenhalgh MD, David G. Greenhalgh MD Clinical Section Editor Wound Repair and RegenerationSearch for more papers by this author First published: 30 October 2012 https://doi.org/10.1111/j.1524-475X.2012.00855.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume20, Issue6November‐December 2012Pages 791-792 RelatedInformation

The effect of topical negative pressure on wound biofilms using an in vitro wound model

Chronic non-healing wounds affect a significant number of patients worldwide. Although the etiologies of these wounds are varied, bacterial infection has been suggested as a major factor responsible for the perpetual inflammation and tissue destruction observed in such wounds. Recent evidence has emerged suggesting that bacterial biofilms in particular may have a significant role in this process. At the same time, topical negative pressure dressing is gaining acceptance as a therapy which promotes healing in recalcitrant wounds. In this study an in vitro Pseudomonas aeruginosa biofilm model was developed to mimic potential surface wound biofilms. Topical negative pressure dressing was applied to the model and the effects of topical negative pressure dressing on the in vitro wound biofilms were examined using both quantitative microbiological counting technique and imaging studies. The results demonstrated a small but statistically significant reduction in biofilm bacteria at 2 weeks when exposed to topical negative pressure. When this was combined with silver impregnated foam, the reduction was far more significant and was observable within 24 hours. Microscopically, it was also noted that topical negative pressure compressed the biofilm architecture with a reduction in thickness and diffusion distance.

Effect of TNP on the microbiology of venous leg ulcers: a pilot study

To investigate the effect of topical negative pressure, delivered using Vacuum Assisted Closure (VAC, KCI), on the microbiology of chronic, non-infected venous leg ulcers (VLUs). Patients receiving compression therapy for a chronic VLU were recruited into this prospective pilot study. The ulcer was swabbed and VAC was applied at 125mmHg continuous sub-atmospheric pressure on day 1 for six days. Standard methods for bacteriological sampling and measuring the wound surface area were applied at baseline and at the VAC dressing changes on days 3 and 6. Log median colony forming units (CFUs) per cm2 were used for statistical analyses. The bacterial species were identified. Seven patients were recruited into and completed the study. The median log10 CFU/cm2 on days 1, 3 and 6 were 3.5, 4.7 and 5.1 respectively. There was a significant increase in bacterial colonisation between days 1 and 6 (p<0.02). No change was observed in the identified microbiological species during therapy with VAC. This pilot study suggests that VAC therapy increases absolute numbers of bacteria colonising non-infected leg ulcers. KCI supplied the VAC equipment and ARANZ the SilhouetteMobile, but both had no other influence on the study.

Topical negative pressure therapy of a sternotomy wound increases sternal fluid content but does not affect internal thoracic artery blood flow: Assessment using magnetic resonance imaging

Topical negative pressure therapy has excellent healing effects in poststernotomy mediastinitis. Topical negative pressure therapy reduces bacterial counts, increases wound edge microvascular blood flow and granulation tissue formation, and facilitates healing. No study has yet been performed to examine the effect of topical negative pressure on the blood and fluid content in the sternal bone marrow, which is a crucial component in osteitis. Eight pigs underwent median sternotomy, left internal thoracic artery harvesting, followed by topical negative pressure treatment. Magnetic resonance imaging was used to quantify both tissue fluid and/or blood content (T2-weighted short tau inversion recovery [T2-STIR]) and internal thoracic artery blood flow (flow quantification). Before application of topical negative pressure, the T2-STIR signal intensity ratio was lower for the left than for the right hemisternum (left, 1.3; right, 2.6), indicating lower levels of tissue fluid content on the left, devascularized side. On application of topical negative pressure, the T2-STIR signal intensity ratio increased immediately for both the sternal bone and the pectoral muscle (left hemisternum after 4 minutes of topical negative pressure: 2.3), leveled off after 4 minutes, and remained unchanged for the ensuing 40 minutes, suggesting movement of fluid and/or blood into the tissue of the wound edge. Topical negative pressure did not affect blood flow in the right internal thoracic artery. T2-STIR measurements show that topical negative pressure increases sternotomy wound edge tissue fluid and/or blood content. Topical negative pressure creates a pressure gradient that presumably draws fluid from the surrounding tissue to the sternal wound edge and into the vacuum source. This "endogenous drainage" may be one possible mechanism by which osteitis is resolved by topical negative pressure in poststernotomy mediastinitis.

The effectiveness of topical negative pressure in the treatment of pressure ulcers: a literature review

The objective of the study was to gain insight into the effectiveness of vacuum-assisted closure (VAC) therapy or, more particularly, topical negative pressure (TNP) in the treatment of pressure ulcers. We carried out a systematic search in Medline, Embase and Cinahl for Randomized Clinical Trials (RCTs) involving topical negative pressure in pressure ulcers over the period 1992–2007. Five RCTs were included. Two studies dealt exclusively with pressure ulcers. No significant differences in wound healing were found in these studies. Three other studies (mixed etiology of wounds) did show significant differences in wound healing, in the decrease of wound treatment time, and in the decrease in number of bacteria. The quality of these studies, both in terms of methodology and otherwise, did not always match with the scientific standard. Moreover, these studies lacked subgroup analyses. The analyzed studies described positive effects of TNP, although both the control treatment and the end points varied in these studies. On the basis of the systematic assessment of these five RCTs, the conclusion is that TNP has not proven to be more effective than various control interventions. The differences between and within the studies in terms of control interventions, the differences in randomization and a number of weaknesses in the analyses do not allow a good comparison. The main recommendations for follow-up studies include: randomization of patients rather than of wounds, a homogeneous patient population, the use of a single well-defined and procedurally documented control intervention, and prior calculation of the random sample size.

Myocardial topical negative pressure increases blood flow in hypothermic, ischemic myocardium

Objectives. Hypothermia protects the myocardium from oxidative injury during ischemic stress and reperfusion. We have previously shown that topical negative pressure (TNP) of −50 mmHg significantly increases microvascular blood flow in the underlying myocardium in normal, ischemic, and reperfused porcine myocardium. The present study was designed to elucidate the effect of TNP between −50 mmHg and −150 mmHg on microvascular blood flow in ischemic myocardium during hypothermia. Design. The microvascular blood flow in the myocardium was recorded, in seven pigs, using laser Doppler velocimetry. Analyses were performed in the epicardium and in the myocardium, after 40 minutes of occlusion of the LAD followed by cooling to 31°C. Results. A TNP of −50 mmHg applied to the epicardium, from 23.3±3.8 PU to 104.2±31.3 PU (*p<0.05), and in the myocardium, from 35.0±7.2 PU to 74.2±21.8 PU (*p<0.05). Conclusions. Only a TNP level of −50 mmHg significantly increased the microvascular blood flow in both the epicardium and in the myocardium during hypothermia.

A pilot study on the effect of topical negative pressure on quality of life

To discover the impact of topical negative pressure (TNP) on quality of life. An exploratory prospective cohort study was conducted on 26 patients undergoing TNP. The Cardiff Wound Impact Schedule (CWIS), a wound-specific tool, was used to investigate quality-of-life scores before therapy and four weeks after therapy or at wound closure. Wound dimensions were measured at both assessments, and the values for the CWIS domains (physical symptoms, social functioning, well-being and overall quality of life) were investigated using parametric and non-parametric tests. The mean duration of TNP therapy was 3.3 +/- 1.7 weeks. Topical negative pressure therapy helped to achieve complete wound closure in 14 patients (54%), and there was a mean reduction in wound surface area from 52.2 cm2 (range 4-150) to 26.8 cm2 (0-120). While there was no significant change in quality of life in patients whose wounds healed (1 +/- 11.9), the physical-functioning domain improved in obese patients (20 +/- 21, p < 0.05) and worsened in ambulatory patients (-3 +/- 13, p < 0.05). The portableTNP system had no significant impact on quality of life (-3 +/- 16), while the global quality-of-life score worsened with surgical intervention (-0.5 +/- 2, p < 0.05). Although TNP aids wound closure in patients with complex wounds, in selected cases their quality of life can worsen. This is the first exploratory cohort study of its kind, and has identified an urgent need to validate the use of patient-based outcome measures in TNP therapy. Such data can be useful in allocating resources and justifying funding in wound care.

Poststernotomy mediastinitis: comparison of two treatment modalities

Poststernotomy mediastinitis (PM) is a serious and potentially lethal condition with an overall incidence varying from 0.4-5%. There is little consensus on the ideal management of PM. The aim of this retrospective study was to investigate the effectiveness of topical negative pressure (TNP) therapy vs. traditional closed drainage techniques (CDT) as a treatment modality for PM. We reviewed the data of 10,467 patients who underwent median sternotomy between 1 January 1992 and 31 December 2003. During this period 63 patients were treated for PM. Twenty-nine of these patients were treated with TNP and 34 with conventional CDT. Primary points of interest were: treatment modalities, mortality, surgical site infection recurrence and, duration of therapy and hospital stay. In this series, the total incidence of poststernotomy mediastinitis was 0.6% with high morbidity rates. In the TNP group, lower rates of recurring infection, therapeutic failure and fewer defects at discharge were seen (P<0.05). In conclusion, the results of our series add further data to the knowledge that PM is an important cause of morbidity and mortality. TNP is a safe and adequate treatment modality for treating PM.

Topical negative pressure for treating chronic wounds.

Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure is used to promote healing of surgical wounds by using suction to drain excess fluid from wounds. To assess the effectiveness of topical negative pressure (TNP) in treating people with chronic wounds and to identify an optimum TNP regimen. The Cochrane Wounds Group Specialised Trials Register was searched until July 2000. Experts in the field and relevant companies were contacted to enquire about ongoing and recently completed relevant trials. In addition citations within obtained papers were scrutinised to identify additional studies. All randomised controlled trials which evaluated the effectiveness of TNP in treating chronic wounds were considered. Eligibility for inclusion, data extraction and details of trial quality was conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials fulfilled the selection criteria and they used different outcome measures. Two small trials with a total of 34 participants evaluated the effectiveness of TNP on chronic wound healing. Trial 1 considered patients with any type of chronic wound; Trial 2 considered patients with diabetic foot ulcers only. The trials compared TNP (as open cell foam dressing with continuous suction) for the first 48 hours with saline gauze dressings. Trial 1 reported a statistically significant reduction in wound volume at 6 weeks in favour of TNP. Trial 2 (continuous suction, followed by intermittent suction after 48 hours) reported a reduction in the number of days to healing and a reduction in wound surface area at 2 weeks in favour of TNP, - although no statistical analysis was reported. The two small trials provide weak evidence suggesting that TNP may be superior to saline gauze dressings in healing chronic human wounds. However, due to the small sample sizes and methodological limitations of these trials, the findings must be interpreted with extreme caution. The effect of TNP on cost, quality of life, pain and comfort was not reported. It was not possible to determine which was the optimum TNP regimen.