1
|
Allen D, Robinson T, Schmidt M, Kieswetter K. Preclinical assessment of novel longer-duration wear negative pressure wound therapy dressing in a porcine model. Wound Repair Regen 2023; 31:349-359. [PMID: 37074154 DOI: 10.1111/wrr.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
While reticulated open cell foam (ROCF) is a well-established dressing for negative pressure wound therapy (NPWT), there is the known potential for granulation tissue ingrowth if left in place for longer than 72 h. This may cause wound bed disruption, bleeding, and pain upon dressing removal. In addition, any retained foam fragments may elicit an adverse tissue reaction. A novel, easy to use dressing designed to utilise the advantages of ROCF while addressing its challenges has recently been created. This 7 day study investigated the utility of a novel NPWT dressing under longer-duration wear circumstances while assessing the prevalence of tissue ingrowth and ease of dressing removal in full-thickness excisional wounds utilising a porcine model. Histopathology and morphometry evaluations indicated thicker granulation tissue with, depending on the parameters assessed, either comparable or better tissue quality for wounds treated with the novel dressing. Greater re-epithelialization levels were also evident compared with ROCF. Three-dimensional imaging analysis indicated faster wound fill with a corresponding decrease in wound area with the novel dressing. Furthermore, tissue ingrowth was limited to only ROCF-treated wounds, which was not unexpected in this longer-duration wear study. The force required to remove the novel dressing was considerably lower compared with ROCF, correlating to the tissue ingrowth results. Results of this study illustrate that the novel dressing provided more favourable wound healing results compared with traditional ROCF. In addition, reduction in the risk of tissue ingrowth and low dressing peel force may allow it to be used as a longer-wear dressing.
Collapse
Affiliation(s)
- Diwi Allen
- Medical Solutions Division, 3M Company, San Antonio, Texas, USA
| | | | - Marisa Schmidt
- Medical Solutions Division, 3M Company, San Antonio, Texas, USA
| | | |
Collapse
|
2
|
Patton D, Avsar P, Wilson P, Mairghani M, O'Connor T, Nugent L, Moore Z. Treatment of diabetic foot ulcers: review of the literature with regard to the TIME clinical decision support tool. J Wound Care 2022; 31:771-779. [PMID: 36113541 DOI: 10.12968/jowc.2022.31.9.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this clinically orientated paper is to offer an overview of diabetic foot ulcer (DFU) dressings generally, and more specifically, their use in the treatment of DFUs. METHOD The TIME clinical decision support tool (CDST) has been used as a clinical tool that can help clinicians bring together the different aspects of dressings for DFU treatment into a holistic approach to patient care. RESULTS DFUs are often difficult to heal, are painful and impact negatively on the individual's quality of life. Most DFU dressings are designed to support the healing of hard-to-heal wounds and represent one part of the management of DFUs. Apart from providing a moist environment, absorbing increased exudate, enhancing granulation and assisting in autolysis, the dressings need to be cost-effective. Wound dressing selection is based on clinical knowledge that ensures the dressing is most appropriate for the individual and the wound, taking into account the comorbidities that the individual may have. CONCLUSION This paper has highlighted how the use of the TIME CDST model can enhance clinical care and is a further tool clinicians should consider when developing and executing DFU treatment plans. Future research needs to focus on large multicentre studies using robust methodologies, given the current gaps in the evidence, to determine the effectiveness of dressing products for DFUs.
Collapse
Affiliation(s)
- Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Associate Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.,Adjunct Professor, Griffith University, Australia
| | - Pinar Avsar
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Pauline Wilson
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Maisoon Mairghani
- Public Health and Epidemiology, RCSI University of Medicine and Health Sciences
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, Griffith University, Australia.,Honorary Professor, Lida Institute, Shanghai, China.,Professor, Fakeeh College of Health Sciences
| | - Linda Nugent
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Adjunct Assistant Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin.,Honorary Professor, Lida Institute, Shanghai, China.,Professor, Fakeeh College of Health Sciences.,Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Visiting Professor, University of Wales, Cardiff, UK
| |
Collapse
|
3
|
The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2022; 150:176e-188e. [PMID: 35583955 DOI: 10.1097/prs.0000000000009232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infected wounds extend healing time and are associated with higher treatment costs than noninfected wounds. Several observational studies indicate that negative-pressure wound therapy with instillation can effectively reduce bacterial bioburden and improve wound healing. Only a few randomized trials with small sample sizes have been published, and a meta-analysis directly comparing negative-pressure wound therapy with instillation to current standard care is lacking. It is therefore uncertain whether negative-pressure wound therapy with instillation actually improves wound healing. The authors performed a systematic review and hypothesized that negative-pressure wound therapy with instillation reduces wound closure time. METHODS The PubMed, Embase, and CENTRAL databases were searched up to December of 2020 for English studies that compare negative-pressure wound therapy with instillation-to either negative-pressure wound therapy without instillation or to other types of wound care-for the treatment of acute or chronically infected wounds. Time to wound closure was analyzed using a random effects meta-analysis in predefined subgroups according to study design and comparative wound care. RESULTS The authors identified 14 studies describing 1053 patients. Meta-analysis of three randomized trials shows no significant difference in time to wound closure between negative-pressure wound therapy with instillation and that without (mean difference, 0.48 day; 95 percent CI, -0.70 to 1.65; I ² = 0 percent). Data from eleven observational studies indicate that negative-pressure wound therapy with instillation reduces wound closure time (from 1.6 to 16.8 days; no pooled data). Because of imprecision and risk of bias, the available evidence provides only low-level certainty. CONCLUSIONS There is currently insufficient evidence to support or discard the use of negative-pressure wound therapy with instillation for infected wounds. More randomized trials are needed to determine whether a beneficial effect can be substantiated.
Collapse
|
4
|
Collier M, Di Santolo C, Leger P, Mastronicola D, Sánchez EN, De Bellis P. Addressing the challenges of open wounds with single-use NPWT. J Wound Care 2022; 31:S1-S28. [DOI: 10.12968/jowc.2022.31.sup2a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark Collier
- Nurse Consultant and Associate Lecturer, Tissue Viability (UK); Chair of the Leg Ulcer Forum (England and Wales); European Wound Management Association (EWMA) council member
| | - Cécile Di Santolo
- Home Care Doctor, L'Hospitalisation à Domicile de l'Agglomératon Nancéienne (HADAN), Vandœuvre-lès-Nancy, France
| | - Philippe Leger
- Angiologist, Wound Ulcer Centre, Clinique Pasteur, Toulouse, France
| | - Diego Mastronicola
- Dermatologist, Outpatient Wound Healing Centre, Local Health System, Frosinone, Italy
| | - Endika Nevado Sánchez
- Medical Doctor, Department of Plastic and Reconstructive Surgery, Burgos University Hospital, Burgos, Spain
| | - Paola De Bellis
- Clinical Nurse Specialist, Outpatient Wound Healing Centre, Local Health System, Frosinone, Italy
| |
Collapse
|
5
|
Paolini G, Sorotos M, Firmani G, Gravili G, Ceci D, Santanelli di Pompeo F. Low-vacuum negative pressure wound therapy protocol for complex wounds with exposed vessels. J Wound Care 2022; 31:78-85. [PMID: 35077217 DOI: 10.12968/jowc.2022.31.1.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. METHOD The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (-80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72-96 hours. RESULTS This protocol was followed in five male patients (aged 23-68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20-61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. CONCLUSION The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.
Collapse
Affiliation(s)
- Guido Paolini
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy.,Sant'Andrea Hospital in Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, PhD School of Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | - Guido Firmani
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
| | | | - Diego Ceci
- Sant'Andrea Hospital in Rome, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
| |
Collapse
|
6
|
Qiu X, Wu Y, Zhang D, Zhang H, Yu A, Li Z. Roles of Oxidative Stress and Raftlin in Wound Healing Under Negative-Pressure Wound Therapy. Clin Cosmet Investig Dermatol 2021; 14:1745-1753. [PMID: 34848985 PMCID: PMC8612843 DOI: 10.2147/ccid.s334248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022]
Abstract
Background Negative-pressure wound therapy (NPWT) is an effective way to promote wound healing. However, its mechanisms have not been investigated thoroughly. Growing evidence suggests that oxidative stress and Raftlin levels play important roles in wound healing. However, whether NPWT promotes wound healing through this mechanism remains unclear. Purpose Our study focuses on the different levels of oxidative stress and antioxidant response between wounds treated by NPWT and routine dressing change. The objective of this study was to measure the differences in Raftlin levels between the two groups, which is a new biomarker related to wound healing. Methods We divided 48 male Sprague-Dawley rats with identical full-thickness skin defects into two groups. At specific times (0, 3, 5, 7, 9, 11, and 13 days after surgery), wound tissue samples were obtained for immunohistochemistry and biochemical analysis. The expression of Raftlin and levels of oxidative stress, including malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) levels were measured by biochemical analysis. Wound-healing times were also compared. Results In the NPWT group, MDA levels were significantly decreased on days 3, 5, and 7. Furthermore, the expressions of SOD and CAT were significantly reduced on days 3 and 5. Our data also revealed that Raftlin was significantly upregulated across the whole period of wound healing. Moreover, wound healing in the NPWT group was significantly more rapid (16 days on average) than in the control group (24 days on average). On day 13 post surgery, the wound-healing percentage in the NPWT group was 91%, while that in the control group was 48%. Conclusion NPWT may promote wound healing by upregulating Raftlin and inhibiting oxidative stress levels.
Collapse
Affiliation(s)
- Xingan Qiu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Yifan Wu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Hao Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Zonghuan Li
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| |
Collapse
|
7
|
Yasheng T, Mijiti A, Yushan M, Liu Z, Liu Y, Yusufu A. Ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage in the treatment of 18 cases of chronic osteomyelitis. J Int Med Res 2021; 49:300060521999530. [PMID: 33784843 PMCID: PMC8020234 DOI: 10.1177/0300060521999530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Ozone is a colorless gas used as a disinfectant and to treat diseases by limiting the effects of bacteria, viruses, fungi, yeast, and protozoa. In this study, we investigated the clinical efficacy of ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage (VSD) in the treatment of chronic osteomyelitis. METHODS Eighteen patients (14 men and 4 women) with chronic osteomyelitis in the limbs (tibia: 13 cases; femur: 4 cases; humerus: 1 case) admitted to our hospital between April 2012 and October 2018 were selected. The patients were aged 9 to 52 years, with a mean age of 31 years. All patients underwent ozonated water lavage and physiological saline irrigation combined with VSD negative pressure closed drainage during hospitalization. The patients were followed up for 18 to 84 months, with a mean of 31 months. RESULTS Osteomyelitis recurred in only one case of nonunion. The length of hospitalization was 18 to 29 days, with a mean of 21 days. CONCLUSIONS A combination of ozonated water lavage, physiological saline irrigation, and VSD provided good clinical effects in the treatment of chronic osteomyelitis, and thus, is recommended for such treatment.
Collapse
Affiliation(s)
- Tayierjiang Yasheng
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Aini Mijiti
- Department of Orthopedics, Second People's Hospital of Kashgar Area, Kashgar, Xinjiang, PR China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| |
Collapse
|
8
|
Huang Y, Hu J, Mao B, Ni P, Shou Y, Hou L, Xie T. Perspectives on the Process of Negative Pressure Wound Therapy at Home in Patients With Chronic Wound: A Qualitative Descriptive Study. INT J LOW EXTR WOUND 2020; 21:384-396. [PMID: 32772902 DOI: 10.1177/1534734620946577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to explore the experience of negative pressure wound therapy (NPWT) at home among Chinese chronic wound patients. Qualitative descriptive study design was adopted, and qualitative data were collected through semistructured in-depth interviews. A purposive, sampling method was used. Informants were recruited from one single wound healing center of a teaching hospital and were interviewed following one course of NPWT at home. A thematic content analysis was undertaken in the framework of input-process-output theory to guide analysis. Of the 13 participants interviewed, 9 were female and 4 were male with an age ranging from 20 to 69 years. Two major categories with their corresponding codes were identified. The first, positive experience, had 6 codes: high-degree identity and feeling hope (input); easy operation and convenience (process); improvement of symptoms and effective treatment (output). The second category, negative experience, had 11 codes: high expenditure, defects of the NPWT device, health education deficiency, and lack of independence and rationales in making decision of NPWT (input); poor communication with wound professionals, unexpected circumstances, therapeutic side effects, and a change of self-image (process); impact on physical symptoms and daily life, impact on social activities, and impact on psychological well-being (output). Patients considered the NPWT at home as a promising regimen, but they also had a feeling of not being prepared and lack of health education to make medical decision independently. The participants' perceptions and experiences would provide valuable information to promote the intervention program of health education and advance service process optimization.
Collapse
Affiliation(s)
- Yao Huang
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of nursing
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, USA
| | - Beiqian Mao
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengwen Ni
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Shou
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Nursing department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Xie
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
9
|
Squitieri L, Tsangaris E, Klassen AF, van Haren ELWG, Poulsen L, Longmire NM, van Alphen TC, Hoogbergen MM, Sorensen JA, Cross K, Pusic AL. Patient-reported experience measures are essential to improving quality of care for chronic wounds: An international qualitative study. Int Wound J 2020; 17:1052-1061. [PMID: 32320141 PMCID: PMC7949344 DOI: 10.1111/iwj.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 02/03/2023] Open
Abstract
Traditional quality measures for chronic wounds have focused on objective outcomes that are challenging to risk adjust, lack patient input, and have limited ability to inform quality improvement interventions. Patient-reported experience measures (PREMs) provide information from the patient perspective regarding health care quality and have potential to improve patient-centredness, increase care efficiency, and generate actionable data for quality improvement. The purpose of this study was to understand patient experiences and health care processes that impact quality of care among patients with chronic wounds. Sixty patients at least 18 years of age with various wound aetiologies were recruited from Canada, Denmark, The Netherlands, and the United States as part of a larger phase 1 qualitative study to develop a patient-reported outcome measure for chronic wounds (WOUND-Q). All patients had a chronic wound for at least 3 months, were fluent in their native speaking language, and able to participate in a one-on-one semi-structured interview. Interviews were digitally recorded and transcribed verbatim. Interpretive description was used to identify recurrent themes relating to patient experience and quality of care. We identified five domains (care coordination, establishing/obtaining care, information delivery, patient-provider interaction, and treatment delivery) and 21 sub-domains (access to patient information, interdisciplinary communication, encounter efficiency, provider availability, specialist referral, staff professionalism, travel/convenience, modality, reciprocity, understandability/consistency, accountability, continuity, credentials, rapport, appropriateness, complication management, continuity, environment/setting, equipment and supply needs, expectation, and patient-centred) as potential opportunities to measure and improve quality of care in the chronic wound population. PREMs for chronic wounds represent an important opportunity to engage patients and longitudinally assess quality across clinical settings and providers. Future research should focus on developing PREMs to complement traditional objective and patient-reported outcome measures for chronic wounds.
Collapse
Affiliation(s)
- Lee Squitieri
- Robert Wood Johnson Clinical Scholars Program, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Health Services Research and DevelopmentU.S. Department of Veterans Affairs Greater Los Angeles Health SystemLos AngelesCaliforniaUSA
| | - Elena Tsangaris
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Harvard Medical SchoolBrigham and Women's HospitalBostonMassachusettsUSA
| | - Anne F. Klassen
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | | | - Lotte Poulsen
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
| | | | - Tert C. van Alphen
- Department of Plastic and Reconstructive SurgeryCatharina ZiekenhuisEindhovenThe Netherlands
| | - Maarten M. Hoogbergen
- Department of Plastic and Reconstructive SurgeryCatharina ZiekenhuisEindhovenThe Netherlands
| | - Jens Ahm Sorensen
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
| | - Karen Cross
- Division of Plastic and Reconstructive SurgerySt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Andrea L. Pusic
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Harvard Medical SchoolBrigham and Women's HospitalBostonMassachusettsUSA
| |
Collapse
|
10
|
McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention: A qualitative study. J Clin Nurs 2020; 29:2557-2571. [PMID: 32279371 DOI: 10.1111/jocn.15279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 01/18/2023]
Abstract
AIMS AND OBJECTIVES To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention. BACKGROUND Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as "healing by secondary intention." These wounds are often slow to heal, prone to infection and complex to manage. DESIGN A qualitative, descriptive approach, using semi-structured interviews. METHODS Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of "Framework" approach. Consolidated criteria for reporting qualitative research guided the study report. RESULTS Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. CONCLUSIONS Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. RELEVANCE FOR CLINICAL PRACTICE Clinical decision-making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments.
Collapse
Affiliation(s)
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Research and Innovation Division, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS Trust, Hull, UK
| |
Collapse
|
11
|
Combination of negative pressure wound therapy using vacuum-assisted closure and ozone water flushing for treatment of diabetic foot ulcers. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00769-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
12
|
Clark JM, Rychlik S, Harris J, Seikaly H, Biron VL, O'Connell DA. Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy. J Otolaryngol Head Neck Surg 2019; 48:21. [PMID: 31113481 PMCID: PMC6528371 DOI: 10.1186/s40463-019-0344-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD. Methods Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications. Results Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively (P = 0.016). Flexion at seven days was improved in NPD group (P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation. Conclusions In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.
Collapse
Affiliation(s)
- Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada
| | - Shannon Rychlik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada.,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 8440-112 St, 1E4 Walter Mackenzie Centre, Edmonton, Alberta, T6G 2B7, Canada. .,Alberta Head and Neck Centre for Oncology and Reconstruction, Edmonton, Alberta, Canada.
| |
Collapse
|
13
|
Tzeravini E, Tentolouris A, Tentolouris N, Jude EB. Advancements in improving health-related quality of life in patients living with diabetic foot ulcers. Expert Rev Endocrinol Metab 2018; 13:307-316. [PMID: 30381974 DOI: 10.1080/17446651.2018.1541403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) constitutes a burden to patients with diabetes deteriorating their quality of life. Health related quality of life (HRQoL) can now be quantified with the use of specific tools; some of them provide a holistic approach to patients' well-being, while others are disease specific or even region specific. Many of these tools are applicable to patients with DFU. This review will present current data about the impact different interventions in the management of DFU on quality of life related parameters. AREAS COVERED We performed a search of literature using keywords 'diabetes mellitus', 'diabetic foot ulcer', 'diabetic foot', 'health related quality of life', 'quality of life' and 'SF-36' to identify studies that contained data about the relationship between different interventions and quality of life of patients with diabetic foot ulcers. EXPERT COMMENTARY Available data are not sufficient to conclude on the impact of interventions aimed to heal DFU on HRQoL. There is need for more, better designed studies and meta-analysis to estimate the effect of treatments on HRQoL in patients with DFUs. The development of new, diabetic foot specific tools will help to improve our knowledge in this field.
Collapse
Affiliation(s)
- Evangelia Tzeravini
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Anastasios Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Nikolaos Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Edward B Jude
- b Department of Medicine, Diabetes Centre , Tameside Hospital NHS Foundation Trust , Ashton-under-Lyne , UK
- c Department of Medicine , Manchester University , Manchester , UK
- d Manchester Metropolitan University , Manchester , UK
| |
Collapse
|
14
|
Mattox EA. Reducing Risks Associated With Negative-Pressure Wound Therapy: Strategies for Clinical Practice. Crit Care Nurse 2018; 37:67-77. [PMID: 28966197 DOI: 10.4037/ccn2017308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Negative-pressure wound therapy represents a relatively new strategy for wound management. Significant, life-threatening complications (bleeding, infection, and retained dressing material) have been associated with negative-pressure wound therapy. As a result, the Food and Drug Administration published several warnings to negative-pressure wound therapy users and recommended that clinicians ordering, managing, and/or monitoring negative-pressure wound therapy be aware of the potential complications and be prepared to take prompt action to reduce patients' risk for harm. This article reviews and organizes published consensus, expert opinion, research, and manufacturer guidelines about patient safety during negative-pressure wound therapy relevant to nurses practicing in acute and critical care settings, including in advanced practice roles.
Collapse
Affiliation(s)
- Elizabeth Andersson Mattox
- Elizabeth Andersson Mattox is a nurse practitioner at the VA Puget Sound Health Care System in the pulmonary and critical care medicine section. She previously worked as the director of patient safety for a large, high-complexity health care system.
| |
Collapse
|
15
|
Affiliation(s)
- Amy Cray
- Staff Nurse, Dermatology, Nottingham NHS Treatment Centre
| |
Collapse
|
16
|
Borregaard B, Lerbæk B, Bak S, Ludvigsen MS. Deep sternal wound infection after cardiac surgery - A phenomenological-hermeneutic study of patients’ experiences with negative pressure wound therapy. ACTA ACUST UNITED AC 2016. [DOI: 10.18261/issn.1892-2686-2016-03-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Janssen A, Mommers E, Notter J, de Vries Reilingh T, Wegdam J. Negative pressure wound therapy versus standard wound care on quality of life: a systematic review. J Wound Care 2016; 25:154, 156-9. [DOI: 10.12968/jowc.2016.25.3.154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A.H.J. Janssen
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - E.H.H. Mommers
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - J. Notter
- Department of Community Health, Birmingham City University, Birmingham, UK
| | | | - J.A. Wegdam
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| |
Collapse
|
18
|
Itani HE. Reviewing the benefits and harm of NPWT in the management of closed surgical incisions. Br J Community Nurs 2016; Suppl Community Wound Care:S28, S30, S32-4. [PMID: 26052992 DOI: 10.12968/bjcn.2015.20.sup6.s28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of negative pressure wound therapy (NPWT) for the treatment of open traumatic, non-traumatic, chronic wounds and coverage over skin grafts has increased in popularity over the past decade. Although the exact mechanism of the action of NPWT on wound healing is still an active area of research, evidence propose it is achieved by removing oedema, increasing blood circulation, reducing bacterial bio-burden, providing a moist wound-healing environment, and increasing granulation tissue formation. In recent years, there has been an emerging body of literature describing a novel application of NPWT on closed surgical wounds, especially on closed orthopaedic incisional (COI) wounds. It has been suggested that applying NPWT to a COI may decrease the incidence of surgical wound-healing complications, such as hematoma, seroma, infection, or dehiscence, and hasten the healing of the incision. This review will evaluate the potential effect on the reduction of postoperative closed wound complications and examine the benefits and harm of NPWT in the management of COI.
Collapse
|
19
|
Li Z, Yu A. Complications of negative pressure wound therapy: a mini review. Wound Repair Regen 2015; 22:457-61. [PMID: 24852446 DOI: 10.1111/wrr.12190] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/22/2014] [Indexed: 11/29/2022]
Abstract
Negative pressure wound therapy, with its wide indications and narrow contraindications, has been widely used for various complicated wounds. Despite its excellent properties in promoting wound healing, there are sporadic but increasing reports on the complications. These complications included bleeding, infection, pain, rupture of the heart, and death in the short term. When used for the long term, the therapy may decrease life quality, increase anxiety, and lead to malnutrition. In this review, we briefly summarize the complications of negative pressure wound therapy.
Collapse
Affiliation(s)
- Zonghuan Li
- Department of Micro-Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | | |
Collapse
|
20
|
Marston WA, Armstrong DG, Reyzelman AM, Kirsner RS. A Multicenter Randomized Controlled Trial Comparing Treatment of Venous Leg Ulcers Using Mechanically Versus Electrically Powered Negative Pressure Wound Therapy. Adv Wound Care (New Rochelle) 2015; 4:75-82. [PMID: 25713749 DOI: 10.1089/wound.2014.0575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/01/2014] [Indexed: 11/12/2022] Open
Abstract
Objective: This study compares two different negative pressure wound therapy (NPWT) modalities in the treatment of venous leg ulcers (VLUs), the ultraportable mechanically powered (MP) Smart Negative Pressure (SNaP®) Wound Care System to the electrically powered (EP) Vacuum-Assisted Closure (V.A.C.®) System. Approach: Patients with VLUs from 13 centers participated in this prospective randomized controlled trial. Each subject was randomly assigned to treatment with either MP NPWT or EP NPWT and evaluated for 16 weeks or complete wound closure. Results: Forty patients (n=19 MP NPWT and n=21 EP NPWT) completed the study. Primary endpoint analysis of wound size reduction found wounds in the MP NPWT group had significantly greater wound size reduction than those in the EP NPWT group at 4, 8, 12, and 16 weeks (p-value=0.0039, 0.0086, 0.0002, and 0.0005, respectively). Kaplan-Meier analyses showed greater acceleration in complete wound closure in the MP NPWT group. At 30 days, 50% wound closure was achieved in 52.6% (10/19) of patients treated with MP NPWT and 23.8% (5/21) of patients treated with EP NPWT. At 90 days, complete wound closure was achieved in 57.9% (11/19) of patients treated with MP NPWT and 38.15% (8/21) of patients treated with EP NPWT. Innovation: These data support the use of MP-NPWT for the treatment of VLUs. Conclusions: In this group of venous ulcers, wounds treated with MP NPWT demonstrated greater improvement and a higher likelihood of complete wound closure than those treated with EP NPWT.
Collapse
Affiliation(s)
- William A Marston
- Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | - David G Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine , Tucson, Arizona
| | - Alexander M Reyzelman
- Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University , Oakland, California
| | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, Florida
| |
Collapse
|
21
|
Noncontact, low-frequency ultrasound therapy enhances neovascularization and wound healing in diabetic mice. Plast Reconstr Surg 2014; 134:402e-411e. [PMID: 25158717 DOI: 10.1097/prs.0000000000000467] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic wounds are a major source of morbidity for patients and represent a significant health burden. Implementing noninvasive techniques that accelerate healing of these wounds would provide great benefit. Ultrasound appears to be an effective modality for the treatment of chronic wounds in humans. MIST Therapy is a noncontact, low-frequency ultrasound treatment delivered through a saline mist. A variety of mechanisms have been proposed to explain the efficacy of ultrasound therapy, but the underlying molecular and cellular pathways impacted by this technique remain unclear. The in vivo effect of noncontact, low-frequency ultrasound was therefore examined in a humanized excisional wound model. METHODS The treatment group received noncontact, low-frequency ultrasound therapy three times per week, whereas the control group received a standard dressing change. Wounds were photographed at regular intervals to calculate healing kinetics. Wound tissue was harvested and processed for histology, quantitative polymerase chain reaction, and enzyme-linked immunosorbent assay. RESULTS The MIST group demonstrated significantly accelerated wound healing, with 17.3 days to wound closure compared with 24 days in the controls (p < 0.05). This improvement became evident by day 9, with healing evidenced by significantly decreased mean wound area relative to original size (68 percent versus 80 percent; p < 0.01). Expression of markers of neovascularization (stromal cell-derived factor 1, vascular endothelial growth factor, and CD31) was also increased in the wound beds of noncontact, low-frequency ultrasound-treated mice compared with controls. CONCLUSION Noncontact, low-frequency ultrasound treatment improves neovascularization and wound closure rates in excisional wounds for diabetic mice, likely because of the stimulated release of angiogenic factors.
Collapse
|
22
|
A case of continuous negative pressure wound therapy for abdominal infected lymphocele after kidney transplantation. Case Rep Transplant 2014; 2014:742161. [PMID: 25374744 PMCID: PMC4206933 DOI: 10.1155/2014/742161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy.
Collapse
|
23
|
The Patient's Conceptions of Wound Treatment with Negative Pressure Wound Therapy. Healthcare (Basel) 2014; 2:272-81. [PMID: 27429276 PMCID: PMC4934590 DOI: 10.3390/healthcare2030272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/10/2014] [Accepted: 07/02/2014] [Indexed: 11/24/2022] Open
Abstract
During the last two decades, additional methods have been developed in wound care where traditional treatments have been insufficient. Negative pressure wound therapy (NPWT) is one such method. This method has been described in multiple studies, but still, many pieces of the puzzle are missing to get a complete picture of NPWT’s impact on the patient’s health-related quality of life and how the patient experiences the treatment. The purpose of this study was to describe the patient’s conceptions of wound treatment with NPWT. The study was inspired by phenomenography, and eight interviews were conducted with patients treated with NPWT. The results of the study were grouped into two main categories: stress and adaptation. Three descriptive categories were presented under stress: personal environment, competence of the nursing staff and organization and continuity of the dressing changes. Two descriptive categories were presented under adaptation: knowledge and creativity and confidence with the healthcare. Patients were affected by the treatment, and at times, the stress meant that they had difficulty coping. The most common source of stress observed in this study was the care environment, particularly the organization of the dressing changes and deficiencies in the healthcare personnel’s competence.
Collapse
|
24
|
Ren H, Li Y. Severe complications after negative pressure wound therapy in burned wounds: two case reports. Ther Clin Risk Manag 2014; 10:513-6. [PMID: 25061310 PMCID: PMC4085333 DOI: 10.2147/tcrm.s66117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We present two typical cases of severe complications (sepsis and hemorrhage) after negative pressure wound therapy (NPWT) in burned patients. Necrotic tissues in some deep burn wounds are difficult to judge correctly and remove thoroughly. An electrically burned blood vessel looks “intact” but can easily break. Necrotic tissue or injured blood vessels when using NPWT are dangerous, both for causing sepsis and hemorrhage. This is the first article that reports the severe complications of NPWT in burned patients. It is imperative to heed indications and avoid contraindications. Proper preparation of wound beds, close observation, and sufficient irrigation are also crucial to avoid these severe complications, and there is an urgent need to substitute the central vacuum system with the low-pressure system.
Collapse
Affiliation(s)
- Haitao Ren
- Department of Burns and Wound Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yuan Li
- Department of Ultrasound, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| |
Collapse
|
25
|
Upton D, Andrews A. Negative pressure wound therapy: improving the patient experience Part 3 of 3. J Wound Care 2013; 22:671-2,674,676-8 passim. [DOI: 10.12968/jowc.2013.22.12.671] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- D. Upton
- Institute of Health and Society, University of Worcester, UK
| | - A. Andrews
- Institute of Health and Society, University of Worcester, UK
| |
Collapse
|
26
|
Upton D, Andrews A. Negative pressure wound therapy: improving the patient experience Part 2 of 3. J Wound Care 2013; 22:582, 584-91. [PMID: 24225598 DOI: 10.12968/jowc.2013.22.11.582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the clear benefits of negative pressure wound therapy (NPWT) as a treatment for wounds, it is essential that greater focus is given to the patient experience of this treatment. In particular, it is important that any unpleasant consequences, such as pain, stress, and skin trauma are minimised, so as to promote quality of life and healing. This article presents part two of three studies which aim to explore ways in which the patient experience of NPWT can be improved. In this study, the views of wound care clinicians (n=12) were investigated in greater depth through semi-structured interviews. Findings indicate a pressing need to minimise pain, particularly through ongoing assessment and collaboration with patients, and also through the use of appropriate dressings, films and other products that promote patient comfort. Additionally, it is evident that greater education is needed for both nurses and patients about NPWT, in order to promote high-quality care and patient wellbeing.
Collapse
Affiliation(s)
- D Upton
- Professor of Health Psychology, Institute of Health and Society, University of Worcester, UK
| | | |
Collapse
|
27
|
Upton D, Andrews A. Negative pressure wound therapy: improving the patient experience Part 1 of 3. J Wound Care 2013; 22:552-7. [DOI: 10.12968/jowc.2013.22.10.552] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D. Upton
- Institute of Health and Society, University of Worcester, UK
| | - A. Andrews
- Institute of Health and Society, University of Worcester, UK
| |
Collapse
|