Negative Pressure Wound Therapy

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Negative Pressure Wound Therapy

Postby patoco » Sun Mar 04, 2007 10:10 pm

Negative Pressure Wound Therapy

This is a hot topic in wound care and has been the subject of several recent clinical studies, so we should know about it.

Negative pressure wound therapy (NPWT) is a topical treatment intended to promote healing in acute and chronic wounds. It involves the application of negative pressure (suction) to the wound bed.

I'll include more info as it becomes available. Here are some abstracts.

Pat

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Lymphorrhea responds to negative pressure wound therapy.

J Vasc Surg. 2007 Mar

Abai B, Zickler RW, Pappas PJ, Lal BK, Padberg FT Jr.
Section of Vascular Surgery, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, and Veterans Affairs New Jersey Health Care System, Newark and East Orange, NJ.

Lymphoceles and lymph fistulas are common complications of femoral exposure for vascular procedures. Three patients who required readmission after their vascular interventions were treated with negative pressure wound therapy. Once adequate control of the drainage was obtained, the patients were discharged home with a portable suction unit. The mean time to stop lymph leak was 14 days, and the mean length of hospital stay was 7.3 days. This method of management offers early control of fluid drainage, rapid control of the wound, earlier closure, and the potential for reduced length of stay. Patient acceptance and convenience may be enhanced by outpatient management and return to work in appropriately motivated individuals.

PMID: 17321350 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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

J Wound Care. 2007 Feb

Mendonca DA, Drew PJ, Harding KG, Price PE.
Department of Plastic and Reconstructive Surgery, Selly Oak Hospital, Birmingham, UK.

OBJECTIVE: To discover the impact of topical negative pressure (TNP) on quality of life.

METHOD: 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.

RESULTS: 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).

CONCLUSION: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.

PMID: 17319616 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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Negative pressure wound therapy achieved by vacuum-assisted closure: Evaluating the assumptions.

Ostomy Wound Manage. 2007 Jan

Morris GS, Brueilly KE, Hanzelka H.
Anderson Cancer Center, Houston, TX 77030-4009, USA. gsmorris@mdanderson.org

Wounds and the accompanying loss of skin integrity often place a patient at increased risk for disability or death. Billions of dollars are spent each year to treat wounds and the effectiveness of these different treatments is highly variable. Following a 1997 publication describing a new treatment therapy that involved creating negative pressure over the wound, many publications have described the purported mechanism of action by which negative pressure may help wounds heal. Although this therapy appears effective, it remains unknown whether it is more effective than other wound closure techniques. In addition, although many uncontrolled, non-randomized studies describing the effectiveness of this therapy have been published, few prospective randomized trials have been conducted. Small sample sizes, variable outcome measures across studies, and significant methodological problems in the available randomized control trials further limit the conclusions that can be drawn regarding the relative effectiveness of vacuum-assisted wound closure. Analysis of these data provides weak evidence to suggest that negative pressure therapy is superior to saline gauze dressings in healing chronic wounds. Randomized controlled trials comparing healing, costs of care, patient pain, and quality-of-life outcomes of this treatment to non-gauze type dressings and other treatment modalities are needed.

PMID: 17264356 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings.

J Vasc Surg. 2006 Nov

Vuerstaek JD, Vainas T, Wuite J, Nelemans P, Neumann MH, Veraart JC.
Department of Dermatology, University Hospital Maastricht, Maastricht, The Netherlands. info@DermaClinic.be

BACKGROUND: Current treatment modalities for chronic leg ulcers are time consuming, expensive, and only moderately successful. Recent data suggest that creating a subatmospheric pressure by vacuum-assisted closure (V.A.C., KCI Concepts, San Antonio, Texas) therapy supports the wound healing process.

METHODS: The efficacy of vacuum-assisted closure in the treatment of chronic leg ulcers was prospectively studied in a randomized controlled trial in which 60 hospitalized patients with chronic leg ulcers were randomly assigned to either treatment by V.A.C. or therapy with conventional wound care techniques. The primary outcome measure was the time to complete healing (days). Statistical analysis was performed on the intention-to-treat basis.

RESULTS: The median time to complete healing was 29 days (95% confidence interval [CI], 25.5 to 32.5) in the V.A.C. group compared with 45 days (95% CI) in the control group (P = .0001). Further, wound bed preparation during V.A.C. therapy was also significantly shorter at 7 days (95% CI 5.7 to 8.3) than during conventional wound care at 17 days (95% CI, 10 to 24, P = .005). The costs of conventional wound care were higher than those of V.A.C. Both groups showed a significant increase in quality of life at the end of therapy and a significant decrease in pain scores at the end of follow-up.

CONCLUSIONS: V.A.C. therapy should be considered as the treatment of choice for chronic leg ulcers owing to its significant advantages in the time to complete healing and wound bed preparation time compared with conventional wound care. Particularly during the preparation stage, V.A.C. therapy appears to be superior to conventional wound care techniques.

PMID: 17000077 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=17000077

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Negative-pressure wound therapy: a snapshot of the evidence.

Int Wound J. 2006 Dec

Mendonca DA, Papini R, Price PE.
Regional West Midlands Burns Centre, Burns and Plastic Surgery Department, Selly Oak Hospital, Birmingham, UK. derickmen@yahoo.com

Topical negative pressure (TNP) is a mode of therapy used to encourage wound healing. It can be used as a primary treatment for chronic/complex wounds or as an adjunct to surgery. Based on the evidence to date, the clinical effectiveness of negative-pressure therapy is still unclear. Although case reports and retrospective studies have demonstrated enhanced wound healing in acute/traumatic wounds, chronic wounds, infected wounds, wounds secondary to diabetes mellitus, sternal wounds and lower limb wounds, there are very few randomised controlled trials, with unclear results. The evidence is lacking for the use of TNP therapy for other indications to enhance wound healing such as patients with decubitus ulcers, diabetes and peripheral vascular disease and to improve skin graft take. There have been, as yet, no quality-of-life studies available for negative-pressure therapy. Despite this, the usage of TNP has increased. This review provides an overview of clinical studies using TNP and proposes avenues for further research to elucidate the exact mechanism of TNP, in addition to large randomised controlled clinical trials of patients undergoing this therapy.

PMID: 17199762 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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Negative pressure wound therapy: evidence-based treatment for complex diabetic foot wounds.

Curr Diab Rep. 2006 Dec

Suess JJ, Kim PJ, Steinberg JS.
Negative pressure therapy is a novel technology used for the promotion of wound healing and has emerged as the standard care in the management of problem wounds. Negative pressure wound therapy has been met with rapid clinical success and widespread acceptance. The literature is replete with case series, small trials, and noncomparative studies; however, there are few prospective, randomized, human trials examining this technology and its ability to promote healing. We review and evaluate the current literature on negative pressure therapy and its efficacy in the healing of complex diabetic wounds.

PMID: 17118227 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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There are other articles available at:

Wounds - A compendium of Clinical Research and Pratice

http://www.woundsresearch.com/Negative- ... nd-therapy

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Consensus Statement on Negative Pressure Wound Therapy

http://www.woundsresearch.com/docs/071406_wnds_kci.pdf

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Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com
patoco
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Re: Negative Pressure Wound Therapy

Postby patoco » Sun Jul 05, 2009 9:08 am

Intermittent Negative Pressure Wound Therapy and Lower Negative Pressures - Exploring the Disparity between Science and Current Practice: A Review of the Literature.

Ostomy Wound Manage. 2009 Jun

Ahearn C.
Director of Clinical Services, Prospera(R), Fort Worth, Texas; Email: cahearn@prospera-npwt.com.

Negative pressure wound therapy (NPWT) is used to treat a wide and growing range of problematic acute and chronic wounds. Continuous therapy delivered at -125 mm Hg has been routinely recommended, despite consistent research findings suggesting potential advantages to the use of lower pressures and intermittent therapy. To enhance understanding and document the disparity between the body of NPWT science and current practice with respect to negative pressure levels and modes of therapy, a search of the English-language literature from June 1989 through May 2009 was conducted. Thirty-six publications found to contain directly relevant information (in vitro, in vivo, and clinical data) were examined. While lower negative pressures and intermittent therapy were associated in earlier studies with improved microvascular blood flow in porcine wound models and with reduced pain in patients, early system shortcomings discourage adoption of intermittent therapy. Subsequent preclinical studies confirmed the beneficial effects of intermittent therapy compared to continuous therapy on blood flow and granulation tissue formation and lower pressures (-75 mm Hg or -100 mm Hg) compared to higher pressure (-125 mm Hg) on soft tissue blood flow. Considering the available preclinical evidence, reported patient pain, and common use of high-pressure continuous NPWT in clinical practice, high-quality randomized controlled clinical trials must be conducted to help clinicians optimize care.

PubMed

http://www.ncbi.nlm.nih.gov/pubmed/1956 ... Sum|PubMed
patoco
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Posts: 2175
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