Does Wound VAC Temporization Offer Patient-Reported Outcomes Similar to Single-Stage Excision Reconstruction After Myxofibrosarcoma Resection?

BACKGROUND

Vacuum-assisted closure (VAC) temporization is a promising technique to achieve local control in aggressive soft tissue sarcomas. Despite its previously reported efficacy, adoption of VAC temporization remains limited, primarily due to the scarce literature on patient-reported outcomes (PROs) supporting its efficacy. This study compared the postoperative PROs after VAC temporization or single-stage (SS) excision and reconstruction for patients undergoing surgical resection for myxofibrosarcoma management.

METHODS

A retrospective analysis of myxofibrosarcoma patients who underwent surgical resections at our institution from 2016 to 2022 was performed. Postoperative PROs collected prospectively for those treated with VAC temporization or SS excision/reconstruction were compared using a visual analog scale (VAS) for pain and three Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires: Global Health Short-Form Mental (SF Mental), Global Health Short-Form Physical (SF Physical), and Physical Function Short-Form 10a (SF 10a). Absolute and differential (postoperative minus preoperative) scores at the 1-month, 3-month, 6-month, 1-year, and 2-year time points were compared.

RESULTS

The analysis included 79 patients (47 treated with VAC temporization and 32 treated with SS excision/reconstruction). All outcomes were similar between the groups except for physical function 1 year after surgery, in which the differential PROMIS SF 10a scores were higher in the SS group (p = 0.001). All the remaining absolute and differential PROMIS and VAS pain scores were similar between the groups at all time points. Postoperative complications did not differ between the groups.

CONCLUSION

The PROs for physical and mental health, physical function, and pain were similar between the myxofibrosarcoma patients who had VAC temporization and those who had SS excision/reconstruction after surgical resection.

Nurses' Readiness to Undertake Controlled Negative Pressure Therapy in the Treatment of Chronic Wounds-Research Report

Local wound treatment with negative pressure wound therapy (NPWT) shortens the healing process but requires the supervision of trained medical personnel for administering the therapeutic procedures. Professional supervision and control of the effectiveness of NPWT, as well as education conducted by nurses, are of particular importance for therapeutic and caring processes, both in hospital and at home. The aim of the study was the assessment of the perception of NPWT by certified nurses in the topical treatment of chronic wounds. The study was conducted using the method of estimation and a diagnostic survey with the proprietary NPWT perception questionnaire: 495 subjects were enrolled in the study and 401 respondents aged 25-67 years qualified for statistical analysis. Despite their experience and competence, the respondents critically assessed their knowledge, pointing to an average subjective level of knowledge related to wound treatment and a low level of knowledge related to NPWT. Most of the respondents had no experience of independent treatment using this method. The data obtained from the questionnaire clearly indicate theoretical preparation and high motivation to undertake activities related to the implementation of NPWT in their own practice. Low readiness values suggested that the subjects did not have the resources or the ability to implement the method. The perception of NPWT in the surveyed group of nurses was determined by numerous factors, including self-assessment of their own knowledge, motivation and readiness to use NPWT. A high level of NPWT perception was noted, despite low motivation related to the availability and knowledge of the method. Theoretical knowledge is insufficient to implement innovative methods in local wound treatment. Practical skills and motivation are indispensable elements that should be met during the training and education of nurses in the field of wound care.

Consensus on the health education of home-based negative pressure wound therapy for patients with chronic wounds: a modified Delphi study

Background

The study aimed to develop consensus on the components of health education of home-based negative pressure wound therapy (NPWT) for patients with chronic wounds.

Methods

A Delphi method was used to achieve consensus on the components of health education and 75% agreement and coefficient of variation (CV) <0.25 were used as cutoff. Sixteen experts were recruited purposefully to finish this study.

Results

Two rounds of consultation were implemented. Consensus was achieved on 36 of the 42 statements. The final agreed list of statements represented three domains: health education before carrying out home-based NPWT, health education for the treatment day of NPWT at hospital and health education for NPWT at home.

Conclusions

This study was the first attempt to develop consensus on the comprehensive components of health education of home-based NPWT for patients with chronic wounds. According to the established framework and components of health education, wound professionals can safely and effectively implement health education of home-based NPWT for patients with chronic wounds and improve their self-care ability and treatment experience at home.

Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients

BACKGROUND

Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of our study was to leverage a population-level analysis to advance our current knowledge about outpatient NPWT use in pediatric patients.

MATERIALS AND METHODS

We analyzed the Truven Health Analytics MarketScan Commercial Claims Database from 2006 to 2014 to identify children treated with NPWT. We compared patient characteristics, indications, complications before and after NPWT, health care utilization within 30 d of NPWT initiation, and health care cost profile of patients treated with NPWT primarily as outpatients versus inpatients. Outpatient NPWT was defined as patients with ≤50% of NPWT coded during an inpatient hospitalization, whereas inpatient NPWT was defined as patients with >50% of NPWT.

RESULTS

We identified 3184 patients (1621 inpatients and 1563 outpatients) aged 0-17 y, who were treated with NPWT from 2006 to 2014. Outpatient NPWT was implemented across multiple ages, comorbidities, and indications, with a low complication rate (2.4%). After controlling for hematologic comorbidity and indications, outpatient NPWT was associated with lower risk of complications (odds ratio: 0.57, 95% confidence interval 0.38-0.86) and lower median total costs ($5602.03) compared with inpatient ($15,233.21) therapy.

CONCLUSIONS

Outpatient NPWT management in pediatric patients was associated with low complication rates. Additional studies are necessary to determine the most overall cost-effective treatment setting for NPWT in the pediatric population.

Reducing Risks Associated With Negative-Pressure Wound Therapy: Strategies for Clinical Practice

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.