Topical Negative Pressure Dressings Research Articles

DIFFERENT APPROACHES IN THE MANAGEMENT OF DIABETIC FOOT ULCERS – EXPERIENCE AT A TERTIARY CARE HOSPITAL

Aims and Objectives: To compare the outcomes of the usage of the negative pressure wound therapy (NPWT) using vacuum assisted wound closure/ Collagen granules/ Offloading techniques with the conventional moist gauze dressing in the treatment of diabetic foot ulcers (DFU). Methods: Prospective, interventional study. Study conducted at B.L.D.E (DU)’s Shri B.M.Patil Medical College Hospital and Research Center, Vijayapur over a period of 5 years. The demographic characteristics, type of foot lesions and treatment with different modalities of dressings and outcome were studied. 50 cases in each group – NPWT/Collagen granules dressing/ offloading techniques and conventional moist gauze dressings were allocated alternatively. Results: 200 patients were included in the study, saw the gradual increase in the granulation tissue development, but the results were better in other groups than the conventional group and the collagen dressing group had more granulation tissue from week 1. There was early recovery among the other groups when compared to the conventional methods. The mean recovery were least in the collagen dressing group. 90% had good outcome in the negative dressing group. The outcome was 92% among the off loading group and 96% good outcome among the collagen group. But the conventional group had only 64% good outcome. And the difference was statistically significant. Conclusion: The comparison of different methods to treat the diabetic foot ulcer showed that collagen method of dressing to be superior to others followed by offloading and then by topical negative pressure dressing. The conventional method had less favorable and slow outcome.

1278 The Impact of Private Sector Cosmetic Surgery Complications on an NHS Plastic Surgery Service During the COVID-19 Second Wave: A Case Series

IntroductionCOVID-19 has demanded a dramatic reorganisation of plastic surgery services. Operating within the NHS has largely been scaled back to emergency and cancer work, with elective services either on hold or transferred to independent hospitals. During this time, with NHS resources critically stretched, a number of patients presented with serious complications of private sector aesthetic surgery, which required emergency NHS treatment. This series characterises the nature and outcome of these cases.MethodA retrospective audit of patients referred to a UK Plastic Surgery Unit with complications arising from private aesthetic surgery performed during the Second Wave of Covid-19 in 2020.ResultsEight patients presented. Two had surgery in the UK, five in Turkey and one in Lithuania. The primary procedures were abdominoplasty (n = 6), liposuction (n = 5). Presenting complications were Infection (n = 5) and wound dehiscence (n = 5). Two patients presented in septic shock and one developed necrotising panniculitis. One patient suffered perioperative death due to myocardial infarction. Mean hospital stay was 10 days (range 1-31) and median number of NHS surgical procedures was 2.5 (range 0-8). Three patients required removal of breast implants; four required topical negative pressure dressings and three underwent skin grafting. Up to 7 outpatient appointments were required per patient. All survivors have unsatisfactory aesthetic outcomes.ConclusionsThis case series raises important questions about the safety of major aesthetic surgery and “cosmetic tourism” during periods when the NHS’ ability to deal with severe complications may be severely limited.

Effect of Wound Closure Technique in Proximal Femoral Fractures: A Prospective Cohort Study.

To compare the effect of different wound closure techniques on wound drainage, postoperative length of stay, and complications in patients with proximal femoral fractures, including femoral neck fractures (31A fractures) and peritrochanteric fractures (31B fractures). Prospective cohort study. Footscray Hospital, Western Health, Victoria, Australia; an acute teaching hospital. All inpatients receiving surgery for proximal femoral fractures at our facility between May 2016 and August 2017. A total of 486 consecutive patients who presented during the study period were included in the study. Three cohorts of consecutive patients were assigned to use either skin staples, monofilament absorbable subcuticular sutures (Monocryl), or, sutures with the addition of 2-octylcyanoacrylate (OCA) (Monocryl and Dermabond), respectively, for skin closure according to when the patients entered the study. The primary outcome of interest was prolonged wound drainage measured using a standardized technique after postoperative day 3. Secondary outcomes included inpatient length of stay and overall complications. We found a statistically significant increase in prolonged wound drainage in the staples cohort compared with the subcuticular sutures cohort and the sutures and OCA cohort (21.1% vs. 8.5% vs. 4.4%, P < 0.001). Inpatient length of stay was also significantly increased in the staples cohort (5.83 days vs. 4.78 days vs. 5.5 days, P = 0.005). There were no statistically significant differences between the 3 cohorts when comparing incidence of any medical complications, withholding of thromboprophylactic agents, or usage of topical negative pressure dressings. In patients with proximal femoral fractures, closure with staples has the highest rate of prolonged wound drainage and length of stay. Subcuticular sutures in combination with OCA result in the lowest incidence of prolonged wound drainage. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Negative pressure temporary abdominal closure without continuous suction: a solution for damage control surgery in austere and far-forward settings

The use of topical negative pressure dressings in temporary abdominal closure has been readily adopted worldwide; however, a method of continuous suction is typically required to provide a seal. We...

To compare the efficacy of topical negative pressure dressing with that of conventional moist wound dressings, in healing of wounds

Background: Wounds and their management are fundamental to the practice of surgery. In the past 15 years there have been significant advances in complex acute and chronic wound management. One of the most significant discoveries was the improvement in wounds with negative pressure–assisted wound closure. The aim and objective of the study was efficacy of topical negative pressure dressing with that of a control group using conventional moist wound dressings, in healing of wounds, were assessed with quality of wound healing.Methods: This prospective randomized controlled study 50 patients with acute and traumatic wounds, sub-acute wounds, chronic open wounds, of which 25 patients underwent topical negative pressure dressing. The remaining 25 patients underwent conventional moist wound dressings. The results were compared after second week. Wounds were assessed depending on wound size and percentage of reduction of wound size, wound bed score and increase in wound bed score, percentage of granulation tissue cover, graft take up as the percentage of ulcer surface area.Results: Our present study shows significant reduction in wound size, in the study group 19.52 cm2 as compare to control group, (6.64 cm2) found to be statistically significant (p &lt;0.001). There is significant increase in wound bed score in the study group (mean difference was 9.60±2.16) where as in the control group there was not much increase in wound bed score (mean difference was 5.12±1.99) (p-valve 0.00001) which is statistically significant. The % of granulation tissue formation in the study group was 81.0±8.29 and in the control group was 53.60±19.23.Conclusions: Topical negative pressure dressing was better than conventional wound dressings in quality of wound healing.

Comparative analysis of the efficacy of topical negative pressure dressing with conventional wound dressing in wound healing

Background: Wounds and their management are fundamental to the practice of surgery. In the past 15 years there have been significant advances in complex acute and chronic wound management. One of the one of the most significant discoveries was the improvement in wounds with negative pressure–assisted wound closure. In this study, the efficacy of topical negative pressure dressing with that of a control group using conventional moist wound dressings, in healing of wounds, was assessed with quality of wound healing. Methods: This is a prospective randomized observational study, 50 patients visiting medical college hospital with acute and traumatic wounds, sub-acute wounds, chronic open wounds, of which 25 patients underwent topical negative pressure dressing. The remaining 25 patients underwent conventional moist wound dressings. Wounds were assessed depending on wound size and percentage of reduction of wound size, wound bed score, percentage of granulation tissue cover, graft take up as the percentage of ulcer surface area. Statistical analysis was done using unpaired students T test and paired T test. A p-value <0.05 was taken as significant. Results: Our study shows statistically significant reduction in wound size, in the study group 19.52 square centimetres (cm 2 ) as compare to control group i.e. 6.64 cm 2 (p<0.001). There is significant increase in wound bed score in the study group (mean difference was 9.60±2.16) where as in the control group there was not much increase in wound bed score (mean difference was 5.12±1.99) (p valve 0.00001). The percentage of granulation tissue formation in the study group was 81.0±8.29 and in the control group was 53.60±19.23 (p value=0.00001). The percentage of graft take up in the study group was 83.42±4.43 and in the control group was 63.18±11.24 (p value=0.00001). The mean hospital stay and cost of hospital stay is also reduced in topical negative pressure dressing group when compared to conventional wound dressings group. Conclusions: It is concluded that topical negative pressure dressing is better the conventional wound dressings in wound healing.

The increased killing of biofilms in vitro by combining topical silver dressings with topical negative pressure in chronic wounds

Chronic wounds remain a significant medical and financial burden in hospitals of today. A major factor in the transition from an acute to a chronic wound is its bacterial bioburden. Developments in molecular techniques have shown that chronic wounds remain colonised by many species of bacteria and that the bacteria within these chronic wounds exist in two forms. Treatments of chronic wounds have maintained a challenging field and significant ongoing research is being conducted. With the development of an in vitro wound model, we applied topical negative pressure (TNP) dressings to a spectrum of common bacterial biofilms found in chronic wounds and studied the synergistic efficacy between the application of TNP and silver-impregnated foam against these biofilms. This synergistic response was seen within the laboratory strains of staphylococcal biofilms over a 3-day treatment period but lost following the 5 days of treatment. However, combining topical pressure dressings and silver foam lead to a synergistic inactivation in Pseudomonas species over both 3-day and 5-day treatments.

Medical lessons learnt from the US and Canadian experience of treating combat casualties from Afghanistan and Iraq

The Winston Churchill Memorial Trust, established in 1965, funds Travelling Fellowships and both authors visited hospitals in Germany, Canada and the USA regarded as centres of excellence with expertise in...

Topical negative pressure for the treatment of neonatal post-sternotomy wound dehiscence

The use of topical negative pressure (TNP) dressings for sternal wound dehiscence or mediastinitis in the neonatal population is rare. The majority of case reports have focused on wound healing as an endpoint and have not discussed the physiological advantage that TNP dressings may impart with regard to sternal stabilisation, improved respiratory function and early weaning from mechanical ventilation. We present a case of the use of TNP in neonatal post-sternotomy wound dehiscence and mediastinitis, from a UK perspective, with an emphasis on wound healing and physiological optimisation. As well as an improvement in sternal wound healing due to the local effects of the TNP system, serial arterial blood gas analysis revealed a significant improvement in systemic physiological parameters, including a reduction in pCO(2) in the period (days 20-31) after application of TNP (p<0.0001) compared to the period before where simple occlusive dressings were applied. Hydrogen ion concentration also significantly reduced in this period (p=0.0058). The use of the TNP system in association with systemic antibiotics successfully treated the mediastinitis. A sealed, controlled wound environment also allowed ease of nursing and an expedited return to care by the parents. We would recommend the consideration of TNP dressings in similar cases of neonatal and paediatric sternal wound dehiscence. Not only do we observe the local effects of improved wound healing, the systemic effects of improved lung function are also valuable in the early management of such complex cases.

Improving vacuum-assisted closure of widely open abdomens with improvised elastic sutures

Widely dehisced abdominal wounds present as challenging surgical cases often incurring multiple complications such as bowel desiccation, perforation, and enterocutaneous fistula [1], equating a mortality of 25% [2]. With the extensive usage of topical negative pressure dressings, these complications have reduced. However these abdomens are now presenting as open wounds with incarcerated edges, necessitating skin grafting on bowel. We present an effective approach to the closure of open abdomens using a combination of topical negative pressure and elastic sutures improvised from silicone tubing. The elastic sutures stretch the skin and prevent wound edges from bedding down prematurely, thereby allowing primary closure.

Topical negative pressure therapy: Does it accelerate neovascularisation within the dermal regeneration template, Integra? A prospective histological in vivo study

Background The use of topical negative pressure (TNP) dressings with dermal regeneration template (DRT), Integra, has improved outcomes and simplified aftercare. Previous clinical studies have suggested accelerated vascularisation; with a reduction in the duration of the 1st stage after the application of Integra, from 2 to 4 weeks to as little as 4 days, but with no histological evidence. However, histological studies, without TNP, have shown that vascularisation occurs between the second and the fourth week. This study set out to examine histologically the rate of DRT neovascularisation when combined with TNP. Methods Eight patients with nine reconstruction sites were enlisted. Unmeshed Integra and fibrin sealant to promote adherence were used. TNP was applied for the duration between the 1st and the 2nd stages. Patients underwent serial biopsies on days 7, 14, 21 and 28 post-application. The biopsies were stained with H&E and endothelial markers CD31 and CD34. Template vascularisation was assessed as a percentage of the template depth in which patent, canalised vascular channels could be demonstrated. Results The median percentage of the template depth which demonstrated canalised channels was 0%, 20%, 61% and 80% for days, 7, 14, 21 and 28, respectively. Conclusion The application of TNP dressings to dermal templates can reduce shearing forces, restrict seroma and haematoma formation, simplify wound care and improve patient tolerance. However, this study could not demonstrate that TNP accelerates neovascularisation as verified by the presence of histologically patent vascular channels.

Management of Chronic Seroma following Latissimus Dorsi Breast Reconstruction: A New Technique

Sir: The latissimus dorsi flap is a reliable method of reconstructing any part of the body.1 Breast reconstruction using the latissimus dorsi flap is popular because it is reliable, not technically demanding, and cosmetically acceptable.2 Despite its popularity, it is associated with a complication rate of approximately 25 percent.3 The most common complication is the development of donor-site seroma that occurs in 21 to 79 percent of cases.4 Several different techniques have been documented in the management of seroma with variable results, including pressure dressings, repeated aspirations, long-term drains, talc poudrage, benign neglect, fibrin sealant, quilting sutures, and triamcinolone injections.1,4 Occasionally, seromas can become refractory to different treatments. In this article, we describe a patient with chronic donor-site seroma managed successfully by simple modification of the foam used in topical negative pressure dressings [vacuum-assisted closure (V.A.C.; Kinetic Concepts, Inc., San Antonio, Texas)]. A 65-year-old woman was referred with a chronic donor-site seroma and clinically symptomatic infection 3 years following primary breast reconstruction using a latissimus dorsi flap with axillary node clearance for breast carcinoma. During these 3 years, she had recurrent seromas that required aspirations. These became infected and resulted in recurrent episodes of donor-site infection. On examination, she was found to have a seroma that was treated initially with ultrasound-guided drainage and steroid injection. This recurred quickly and required further aspiration. Because of its refractory nature, the decision was made to treat the seroma and its capsule surgically by excision and application of vacuum-assisted closure. Intraoperatively, she was found to have a large capsule, which was excised completely (Fig. 1, left). The wound was left open as an ellipse. A microporous polyvinyl alcohol foam (V.A.C. Vers-Foam) was used in the cavity because of its high tensile strength. Four digitations were created in the foam as in Figure 1, right. These were then branched into the different corners of the cavity and the vacuum-assisted closure dressing was applied (Fig. 2, left). This process helped to promote granulation from all directions of the cavity and eliminate the possibility of forming loculations inside the cavity. The patient had dressing changes every 5 days. Before dressing changes, 30 ml of 0.25% bupivacaine was injected into the cavity through the vacuum-assisted closure tubing and left for 30 minutes to anesthetize the sensitive granulation tissue when the sponge was removed. Similar digitations with shorter limb length were created in the subsequent dressing changes. The wound healed well and she has remained without recurrence of seroma for 1 year (Fig. 2, right).Fig. 1.: (Left) The seroma capsule completely excised. (Right) The digitations created on the foam.Fig. 2.: (Left) The vacuum-assisted closure dressing in place with the normal vacuum-assisted closure foam on top of the polyvinyl alcohol foam inside the cavity. (Right) The completely healed wound.Donor-site seroma is the commonest complication following latissimus dorsi breast reconstruction. Although small seromas resolve spontaneously, a collection greater than 100 ml is associated with complications such as wound dehiscence, implant exposure, and infection, and is best treated by drainage.5 Occasionally, seromas are refractory, requiring further treatment in the form of steroid injections. In our case, the patient had a refractory seroma that was treated successfully by designing the foam to digitate into all corners of the cavity and applying topical negative-pressure dressing. Jagajeevan Jagadeesan, M.R.C.S. Marcus Bisson, F.R.C.S.(Plast.) Anthony Graeme Bowman Perks, F.R.C.S., F.R.C.S.(Plast.), F.R.A.C.S.(Plast.) Department of Plastic and Reconstructive Surgery; Nottingham City Hospital; Nottingham, United Kingdom

PR16 A PROSPECTIVE BLINDED RANDOMIZED CONTROLLED TRIAL OF COMMERCIAL VACUUM DRESSINGS VERSUS NON‐MECHANICAL TOPICAL NEGATIVE PRESSURE DRESSING FOR DAY SURGERY LOWER LEG SPLIT THICKNESS SKIN GRAFTS

Purpose: To show that ambulatory non‐mechanical negative pressure dressing results in equivalent graft take and survival compared with commercially available mechanical vacuum dressings.Methodology: Twenty‐four patients, both males and female, between 18 and 95 years of age in the Australian population requiring skin grafting of the lower limb from July 2008 were randomized consecutively into commercial vacuum assisted ambulatory dressing group, KCI Freedom VAC, [VAC] and non‐mechanical topical negative pressure dressing group using 14 gauge drain [Belovac]. Patients were discharged on the same day of surgery and reviewed at 5 or 6 days post‐operatively. Both groups were treated equally in all other facets of care. The dressings remained intact until outpatient review. A photo of the graft was taken upon removal of the dressing. Graft take/survival was measured from these photographs by an experienced plastic surgeon blinded to treatment group.Results: Graft take was found to be equivalent in both groups. All twelve patients in the VAC group were judged to have &gt;95% graft take at five/six days post‐op. In the Belovac group all twelve were judged to have &gt;95% graft take at 5/6 days. The cost for VAC group was $AUD413.50/478.50 [5/6 days] compared to $AUD55.93 for the Belovac dressing group.Conclusion: We conclude that non‐mechanical topical negative pressure dressings are equally effective as commercially available VAC dressings in for the treatment of lower limb skin grafts. We recommend that non‐mechanical topical negative pressure dressing is an acceptable, cheap and safe alternative to commercially available dressings for day surgery patient.

A comparative study of the efficacy of topical negative pressure moist dressings and conventional moist dressings in chronic wounds

ABSTRACT Aim: To assess the efficacy of topical negative pressure moist wound dressing as compared to conventional moist wound dressings in improving the healing process in chronic wounds and to prove that negative pressure dressings can be used as a much better treatment option in the management of chronic wounds. Materials and Methods: This is a prospective comparative study of data from 112 patients with chronic wounds, of which 56 patients underwent topical negative pressure dressings (17 diabetic, 10 pressure sores, nine ischemic, two varicose, 10 post-infective raw areas and eight traumatic - six had bone exposed, two orthopaedic prosthesis exposed). The remaining 56 patients underwent conventional moist dressings (20 diabetic, two ischemic, 15 pressure sores, three varicose, eight post-infective raw areas and eight traumatic - five had bone exposed, three orthopaedic prosthesis exposed). The results were compared after 10 days. The variables compared were, rate of granulation tissue formation as a percentage of ulcer area covered, skin graft take up as the percentage of ulcer surface area and duration of hospital stay. The variables were compared using Unpaired Student′s t test. A " P" value &lt; 0.05 was considered significant. Results: Out of 56 patients who underwent topical negative pressure dressings, six (10.71%) were failures, due to failure in maintaining topical negative pressure due to defective sealing technique; these were included into the study group. After 10 days, the mean rate of granulation tissue formation was 71.43% of ulcer surface area. All these 56 cases underwent split-thickness skin grafting. The mean graft take-up was 79.29%. The mean hospital stay was 32.64 days. In the remaining 56 patients, the mean rate of granulation tissue formation was 52.85% of ulcer surface area. The mean graft take-up was only 60.45% of the total ulcer surface area. The mean hospital stay was 60.45 days. Conclusion: To conclude, topical negative pressure dressings help in faster healing of chronic wounds and better graft take-up and reduce hospital stay of these patients.

A comparative study of the efficacy of topical negative pressure moist dressings and conventional moist dressings in chronic wounds

Aim: To assess the efficacy of topical negative pressure moist wound dressing as compared to conventional moist wound dressings in improving the healing process in chronic wounds and to prove that negative pressure dressings can be used as a much better treatment option in the management of chronic wounds. Materials and Methods: This is a prospective comparative study of data from 112 patients with chronic wounds, of which 56 patients underwent topical negative pressure dressings (17 diabetic, 10 pressure sores, nine ischemic, two varicose, 10 post-infective raw areas and eight traumatic - six had bone exposed, two orthopaedic prosthesis exposed). The remaining 56 patients underwent conventional moist dressings (20 diabetic, two ischemic, 15 pressure sores, three varicose, eight post-infective raw areas and eight traumatic - five had bone exposed, three orthopaedic prosthesis exposed). The results were compared after 10 days. The variables compared were, rate of granulation tissue formation as a percentage of ulcer area covered, skin graft take up as the percentage of ulcer surface area and duration of hospital stay. The variables were compared using Unpaired Student's t test. A P value <0.05 was considered significant. Results: Out of 56 patients who underwent topical negative pressure dressings, six (10.71%) were failures, due to failure in maintaining topical negative pressure due to defective sealing technique; these were included into the study group. After 10 days, the mean rate of granulation tissue formation was 71.43% of ulcer surface area. All these 56 cases underwent split-thickness skin grafting. The mean graft take-up was 79.29%. The mean hospital stay was 32.64 days. In the remaining 56 patients, the mean rate of granulation tissue formation was 52.85% of ulcer surface area. The mean graft take-up was only 60.45% of the total ulcer surface area. The mean hospital stay was 60.45 days. Conclusion: To conclude, topical negative pressure dressings help in faster healing of chronic wounds and better graft take-up and reduce hospital stay of these patients.

Interface Dressings Influence the Delivery of Topical Negative-Pressure Therapy

Topical negative-pressure therapy is a widely used wound management system that generates a negative pressure at the wound surface through a foam pad, which aids in wound stimulation through mechanical forces on the wound bed. System guidelines state that the foam dressing should be placed in direct apposition with the wound surface; however, an interface dressing is often inserted at this point to promote comfort at dressing changes. Topical negative-pressure dressings were applied to 40 healthy volunteers. Pressures at the skin surface under the dressing were recorded and compared with those measured by a topical negative-pressure machine using the Therapeutic Regulated Accurate Care pad system. These were repeated, inserting different types of interface dressings: petroleum jelly (Vaseline)-impregnated gauze, nonadherent silicone dressing, and mylar polyester film dressing. Pressures recorded at the skin interface with no interface dressing were close to those set on the topical negative-pressure machine (mean pressure change, -5.11 +/- 0.55 mmHg). Interposition of dressings at the skin/foam interface affected pressure transmission through the foam, and some caused significant decreases in pressures recorded at the skin surface (e.g., Vaseline-impregnated gauze: mean pressure change, -11.76 mmHg; maximum pressure change, -41 mmHg). The loss in negative pressure means that pressures designated by the machine cannot be relied on as a measure of wound pressure when certain dressings are used at the interface. This could be important in determining the outcome of some wounds under topical negative-pressure therapy treatment.