Role Of Negative Pressure Wound Therapy Research Articles

Evaluation of the Use of Negative Pressure Wound Therapy for Securing Split-Thickness Skin Grafts for Coverage of Chronic Wounds

Abstract Background Split-thickness skin grafting (STSG) is a versatile reconstructive option that has passed the test of time. However, many factors can cause poor graft take. Negative pressure wound therapy (NPWT) has transformed the management of complicated wounds and has been used as a means for securing split-thickness skin grafts (STSG). The role of NPWT in the fixation of grafts was compared to conventional Tie over bolster dressing. Aim of the Work To assess whether NPWT would result in a better graft take especially in wounds with large surface area. Patients and Methods This is a parallel group randomized control study. conducted from November 2021 to June 2022 in the Plastic, burns, and maxillofacial Surgery Department, Ain Shams University Hospitals. Block randomization of 52 patients into one of the two groups (NPWT vs. non-NPWT; 26 patients each) was done. Graft take/loss and length of hospital stay post-grafting were assessed. Results Mean graft take in the NPWT group was quantitatively and qualitatively better than that in the non-NPWT group. None of the patients in the NPWT group required a second coverage procedure. No major complication was encountered with the use of NPWT. Conclusion Compared with conventional tie over bolster dressing, NPWT is a simple, yet powerful and effective alternative in the integration of STSG. It significantly increases the rate of graft take especially in large wounds, while reducing rates of complications and hence re-operation.

Updated Scenario on Negative Pressure Wound Therapy.

Negative pressure wound therapy (NPWT) is a widely used and effective treatment for managing complex wounds. This document discusses how NPWT can be used in wound care in an updated way. The updated scenario on NPWT provides a concise overview of the current state of NPWT and its implications in clinical practice. It highlights recent developments in NPWT, as well as the advancements in this field. As part of NPWT, vacuum-assisted closure is used and negative pressure is applied to the wound bed. It discusses the key components and mechanisms. In addition to improving wound healing, NPWT also reduces infection rates and improves patient comfort, among other benefits. In addition, this document discusses the specific indications and contraindications of NPWT, as well as the types of wounds that can be treated with NPWT, including diabetic foot ulcers, pressure ulcers, and traumatic wounds. The document emphasizes the importance of choosing patients appropriately and assessing wounds to ensure optimal outcomes. In addition, it provides evidence-based guidelines and clinical recommendations on NPWT. In addition to reviewing the latest research findings supporting NPWT in a variety of clinical settings, it also discusses randomized controlled trials and systematic reviews. In addition, it discusses the potential complications and challenges associated with NPWT, including pain, bleeding, and device malfunction. The purpose of this document is to shed light on the role of NPWT in wound care management by providing an updated scenario. NPWT can be incorporated into clinical practice by healthcare professionals if they understand its principles, benefits, indications, and limitations. Healthcare providers can optimize patient outcomes and improve wound healing in diverse patient populations by staying abreast of the latest advancements in NPWT.

Effect of negative pressure wound therapy on wound thermometry in diabetic foot ulcers.

Negative pressure wound therapy (NPWT) is the treatment of choice for diabetic foot ulcers (DFUs), and the role of NPWT in the management of DFU is limited. The aim of the study was to compare the effects of NPWT versus conventional dressing (CD) on wound healing in DFU. A total of 55 patients were included and divided into two groups: 23 patients were treated with NPWT and 32 patients with CD. The NPWT dressings were changed every 7 days, while the CDs were changed daily. Wound culture sensitivity, wound size, granulation tissue, and pain evaluation (assessed by Visual Analog Scale) were all measured at the start and 3 weeks or until the ulcer was healed. The wound margin temperature was measured at four random sites for thermometric evaluation, and normal limb temperature was also measured for comparison. Patients' satisfaction and treatment costs were also compared. On days 14 and 21, the wound size was reduced significantly in the NPWT group (P < 0.001 and P < 0.001, respectively). The percentage reduction in wound size from baseline to days 7, 14, and 21 was significantly higher in the NPWT group (P = 0.013, P = 0.001, and P = 0.029, respectively). On days 7, 14, and 21, the granulation tissue score was significantly higher in the NPWT group (P = 0.001, P = 0.001, and P < 0.001, respectively). On days 14 and 21, the mean VAS score was significantly low in the NPWT group (P < 0.001 and P < 0.001, respectively). The majority of wounds in the NPWT group were sterile on day 21 compared to those in the CD group (P = 0.008). The majority of patients in the NPWT group had excellent patient satisfaction (P < 0.001). The average material cost was significantly higher in the NPWT group (P = 0.001). The mean wound temperature of the affected limb was significantly higher compared to that of the unaffected limb (P < 0.001). In terms of early formation of granulation tissue, faster wound size reduction, less discomfort, and patient satisfaction, the study indicated that NPWT appeared to be superior. An initial rise in temperature in a DFU may indicate the presence of a pre-ulcerative lesion.

The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal.

Introduction Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI. Methods A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale. Results After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens. Conclusion This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed.

The role of negative-pressure wound therapy in the management of axillary hidradenitis suppurativa.

The role of negative-pressure wound therapy in the management of axillary hidradenitis suppurativa.

The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience.

Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according to the PRISMA guidelines) on the use of NPWT in the treatment of PG, and we report our personal experience with two patients treated with this device. The result of the review showed that articles on the topic are, in their entirety, of low levels of evidence, such as case series, case reports, and reviews. Improvement in wound healing with the use of NPWT was observed in 85.1% of the patients studied. Besides, a significant association between improvement in wound healing with NPWT and immunosuppressive therapy was observed. Regarding the cases reported here, both showed good outcomes with the use of NPWT and skin graft during the treatment of PG injuries. Due to the rarity of PG, there is a scarcity of studies with robust evidence for standardization and comparison between treatments, which consequently makes it difficult to select therapeutic options. However, based on this systematic review and reported cases, we consider NPWT a safe option for adjuvant treatment of wounds caused by PG if combined with systemic immunosuppression, which plays a key role in greater chances of successful treatment. This approach should be recommended, whenever possible, associated with skin grafting to accelerate wound closure. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: a systematic review and personal experience.

The Role of Negative Pressure Wound Therapy with Instillation and Dwell Time in the Preparation of Wound Bed

Introduction Although the negative pressure wound therapy (NPWT) is a time tested method of wound preparation, the role of NPWT with instillation and dwell time (NPWTi-d) in decreasing the downtime of wound preparation needs to be evaluated. Objective The objective of this study is assess the role of NPWTi-d in wound bed preparation. Materials and Methods This study was conducted in a tertiary care center, after getting informed consent and ethical clearance. NPWTi-d was done on a 36-years-old female with no known co-morbidities admitted with infected raw area over the right below knee amputation stump and exposed bone who was not responding well to conventional wound dressing. NPWT was applied with the help of sterile polyurethane sponge and two tubes. The antimicrobial solution used was ionic silver solution, just enough to wet the sponge completely and up to the point when the transparent occlusive covering begins to lift. Negative pressure was applied at 125 mmHg. The wound was bathed with ionic silver solution and it was allowed to stay in the wound for 10-minutes, after every 2-hours of negative pressure application. This was continued for 1-week. The dressing was opened at the end of 1-week, wound irrigated with normal saline, exudate swabs for culture taken and debrided, following which fresh NPWTi-d was applied. This was repeated for the next 3-weeks. Result By the end of third week, the wound became clean, fully covered with healthy granulation and the wound bed was ready to undergo the definitive wound cover procedure.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

The role of negative pressure wound therapy in the treatment of pilonidal disease

Pilonidal disease is a particularly difficult disorder to treat. Guidelines and recommendations for the treatment of pilonidal disease neglects the use of negative pressure wound therapy (NPWT), but studies strongly support the role of NPWT in prevention of surgical site infection in high-risk groups.&#x0D; During a webinar on the pilonidal disease, we asked 51 participants to complete a questionnaire about the treatment of pilonidal disease. They answered questions about the way they treat their patients with pilonidal disease, and about using NPWT.&#x0D; The study showed that relatively large number of surgeons use NPWT to treat patients with pilonidal disease, the majority of them are satisfied at maintaining the tightness and effectiveness of a vacuum dressing and would use the single-use NPWT systems, if they was more available. It seems that the NPWT in the pilonidal disease is increasingly used and this method is gaining more and more popularity.

The Role of Negative-Pressure Wound Therapy in Lower-Limb Reconstruction.

Negative-pressure wound therapy (NPWT) has gained increasing popularity among clinicians since its introduction in 1997 as a potential aid to wound healing. Multiple benefits of NPWT have since been proven in studies, including increase in granulation tissue formation, decrease in bacterial load, and the improved survival of flaps. With our increasing use and greater understanding of the tissue and cellular changes that occur in a wound treated with NPWT, our lower-limb reconstructive practice has also evolved. Although controversial, the definite timing for lower-limb reconstruction has stretched from 72 hours to longer than 2 weeks as NPWT contains the wound within a sterile, closed system. It has also shown to decrease the rate of infection in open tibia fractures. Previously, a large number of critical defects of the lower limb would require free tissue transfer for definitive reconstruction. NPWT has reduced this rate by more than 50% and has allowed for less complicated resurfacing procedures to be performed instead.

Role of Negative Pressure Therapy as Damage Control in Soft Tissue Reconstruction for Open Tibial Fractures.

The concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed. A negative-pressure dressing can be easily and rapidly applied to obtain a temporary closure between surgical stages. While negative pressure wound therapy (NPWT) has clear indications in the management of chronic wounds, its applications in the acute setting in victims of polytrauma are uneven. We conducted a review of the current clinical literature to evaluate the role of NPWT in this field, which points out that the negative pressure, applied immediately after the first debridement, seems to be an optimal bridge to the final reconstruction up to 7 days.

The Role of Negative-Pressure Wound Therapy in Latissimus Dorsi Flap Donor Site Seroma Prevention: A Cohort Study.

BackgroundDonor site seroma is the most common complication after latissimus dorsi (LD) flap harvest. This study aimed to evaluate the efficacy of negative-pressure wound therapy (NPWT) in preventing donor site seroma formation after the harvest of an LD flap for breast reconstruction. MethodsIn this prospective matched-pair study, 40 patients in whom an LD flap was harvested for breast reconstruction were enrolled. NPWT was used in 20 patients, and in a control group composed of another 20 patients, the conventional donor site dressing technique was used. Information was collected regarding postoperative complications, the incidence of seroma, total drainage volume, the number of percutaneous seroma aspirations, and the volume aspirated. ResultsIn the NPWT group, the incidence of seroma formation after drain removal was significantly lower than in the control group (15% vs. 70%; odds ratio=0.07; relative risk, 0.24). Both the mean percutaneous aspirated volume (P=0.004) and the number of percutaneous aspirations (P=0.001) were also significantly lower in the NPWT group. There were no significant differences in the total drainage volume or the duration of wound drainage between the NPWT dressing group and the control group (P>0.05). ConclusionsThis study showed that NPWT is a promising tool for reducing the incidence of seroma formation after removing the drain at the donor site after LD flap harvesting. It is a simple and safe technique.

Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments.

Negative-pressure wound therapy (NPWT) plays an important role in the treatment of complex wounds. Its effect on limb salvage in the management of the diabetic foot is well described in the literature. However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers. Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.

Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of diffi cult wounds, including post-sternotomy mediastinitis. Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A) and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B) between January 2006 and January 2010. Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was signifi cantly shorter in group A (mean, 13.5 ± 3.2 days) compared to 18 days (mean, 21.2 ± 16.4 days) in group B (p< 0.001). Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24%) patients in group B suffered recurrences. Hospital stay was signifi cantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days) (p= 0.001). Conclusion: A signifi cantly shorter healing time was confi rmed with vacuum assisted closure. Hospital stay remained signifi cantly shorter in group A (35 vs. 46 days).

Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma: the role of negative-pressure wound therapy

Lower limb reconstruction with pedicled or free flaps can be commonly compromised by venous insufficiency. This complication often leads to partial/complete flap necrosis and increases the risk of superinfection. Negative-pressure wound therapy (NPWT) is known to increase local blood flow, decrease edema, promote tissue granulation, and reduce the likelihood of soft tissue infection. This study aims to evaluate the effectiveness of NPWT in the treatment of congested pedicled and free flaps of the lower limb after reconstructions in lower limb traumas. A retrospective analysis was performed on four congested (pedicled and free) flaps on the lower limbs. NPWT was applied in all cases after partial flap debridement. NPWT was able to improve and resolve tissue edema and venous insufficiency, avoid further flap necrosis, and promote granulation. On NPWT removal, a split-thickness skin graft was applied on the wound, achieving complete and uneventful healing. NPWT is a useful instrument in managing flaps affected by venous insufficiency in lower limb reconstruction, although larger studies are necessary to better define the effectiveness and indications of NPWT in this setting.

Role of Negative Pressure Wound Therapy in Treating Peripheral Vascular Graft Infections

Wound complications involving large subcutaneous vessels can cause significant challenges for surgeons. Negative pressure wound therapy (NPWT) has been increasingly used for treating complex wounds in vascular surgery, including groin infections, either as a bridge to surgical closure or as a primary wound treatment modality. Although a growing body of evidence exists for managing various problematic wounds, such as diabetic foot ulcers and open abdominal wounds, the role of NPWT in wounds involving large blood vessels or wounds complicating infected vascular grafts has not been well defined. A multidisciplinary advisory panel reviewed the literature relevant to wounds related to vascular surgical procedures and complications, focusing on large subcutaneous or infected vascular conduits. The results supported by the literature and the clinical practice of the consensus panel suggested that NPWT can be a useful adjunct to the management of vascular groin infections and dehiscences but must be used with caution.