Nurses' wound care competency in a sample of hospitals in Northern Vietnam

BACKGROUND

This study aimed to investigate the current situation regarding wound care by nurses in eight hospitals in the north of Vietnam, in order to plan the training for nurses to enable them to achieve the National Basic Competency Standards for Nurses.

METHODS

A cross-sectional descriptive prospective study was conducted from June 2020 to October 2020, with nurses in eight hospitals in four provinces of Northern Vietnam - Hanoi, Quang Ninh, Thai Nguyen and Bac Ninh. Data were collected based on a checklist of direct observation of nurses who provide wound care. The two main indicators were the knowledge score and the practical capacity/competence of the nurses in wound care.

RESULTS

A total of 518 nurses participated in the study, the mean age was 32.25±7.31; with 438 (84.6%) being female. Clinical experience of less than 10 years was reported by 63.6%; college education level (diploma) was reported by 58.1%, university level by 28.2%; and post-university level by 4%. The highest mean scores for knowledge were found in the categories of health education for patients, followed by care of clean wounds, communication skills and team work, management and professional development and pressure ulcer wound care. Under the practice domain the highest mean scores were ability to plan wound care, followed by self-evaluation, identification of wound types and implementation of wound care plans.

CONCLUSIONS AND RECOMMENDATIONS

The results showed that when judged against the competency standards, nurses' level of wound care competency needs to be improved. Also that there is a distinct theory-practice gap, which must be addressed. It is recommended that hospitals should conduct training for all nurses using the basic competency standards for Vietnamese nurses to improve the quality of care.

Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis

BACKGROUND

Negative Pressure Wound Therapy (NPWT) is considered an effective treatment in facilitating the healing of chronic wounds. However, its effect remains inconsistent, which allows for further investigation.

OBJECTIVE

This study aimed to assess the effectiveness of the NPWT program in improving the management of chronic wound healing.

DESIGN

Systematic review and meta-analysis was used.

DATA SOURCES

The search strategy ranged from 2016 to 2021 in PubMed, CINAHL, ProQuest, and ScienceDirect.

REVIEW METHODS

Risk of bias was done based on the Risk of Bias 2.0 guideline using RevMan 5.4.1, and meta-analysis was done using Jeffreys's Amazing Statistics Program (JASP) software version 0.16.3. Critical appraisal of the included articles was done according to Joanna Briggs Institute's (JBI) appraisal checklist.

RESULTS

A total of 15 articles were included, with 3,599 patients with chronic wounds. There was no publication bias in this study seen from the results of the Egger's test value of 0.447 (p >0.05), symmetrical funnel plot, and fail-safe N of 137. However, heterogeneity among studies was present, with I2 value of 66.7%, Q = 41.663 (p <0.001); thus, Random Effect (RE) model was used. The RE model showed a significant positive effect of the NPWT on chronic wound healing, with z = 3.014, p = 0.003, 95% CI 0.085 to 0.400. The observed effects include decreased rate of surgical site infection, controlled inflammation, edema, and exudate, as well as increased tissue with varying forest plot size, as demonstrated by the small effect size (ES = 0.24, 95% CI -0.26 to 0.79, p <0.05).

CONCLUSION

The analysis results show that the standard low pressure of 80-125 mmHg could improve microcirculation and accelerate the healing process of chronic wounds. Therefore, applying the NPWT program could be an alternative to nursing interventions. However, it should be carried out by competent wound nurses who carry out procedure steps, implement general patient care, and give tips on overcoming device problems and evaluation.

PROSPERO REGISTRATION NUMBER

CRD42022348457.

Ambulatory negative pressure wound therapy of subcutaneous abdominal wounds after surgery: results of the SAWHI randomized clinical trial

BACKGROUND

The SAWHI study showed that negative pressure wound therapy (NPWT) reduced treatment time by 7.8 days and had a 20.2% higher wound closure rate, but required a 2.1-day longer hospital stay than conventional wound treatment (CWT). The majority of study participants began treatment in the hospital and were discharged within 42 days.

METHODS

As an add-on to a multicenter randomized clinical trial, selected aspects of hospital discharge, outpatient treatment continuation, and subsequent wound closure outcomes are compared between the treatment arms in patients with subcutaneous abdominal wound healing impairment after surgery without fascia dehiscence in the per protocol population.

RESULTS

Within 42 days, wound closure rates were higher for outpatients in the NPWT arm than for outpatients in the CWT arm (27 of 55 [49.1%]) for both outpatient continuation of NPWT (8 of 26 [30.8%]) and outpatient CWT after NPWT was finished (27 of 121 [22.3%]). Time to wound closure was shorter for outpatients in the NPWT arm (outpatient transfer with: NPWT Mean ± standard error 28.8 ± 8.0 days; CWT 28.9 ± 9.5 days) than in the conventional treatment arm (30.4 ± 8.0 days). Nevertheless, within 30 study sites with patient enrollment, outpatient NPWT was performed in only 20 study sites for 65 of 157 study participants in the treatment arm.

CONCLUSIONS

Outpatient NPWT of postsurgical abdominal wounds with healing impairment is feasible and successful and should be encouraged whenever possible. Study site specific avoidance of outpatient NPWT emerges as an additional reason for the prolonged hospitalization time. Trial Registration ClinicalTrials.gov Identifier NCT01528033. Date of registration: February 7, 2012, retrospectively registered.

Negative Pressure Wound Therapy in Spinal Surgery

Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in cardiac, plastic, and general surgery, followed by a discussion of the emerging evidence base for NPWT in spinal surgery. We also discuss the different applications of NPWT for open wounds and closed incisions, and the promise of newer closed-incision NPWT (ciNPWT) devices. There is nominal but promising prospective evidence on NPWT's efficacy in select at-risk populations for post-operative wound complications after spinal surgery. As there is currently a paucity of robust clinical evidence on its efficacy, rigorous randomized prospective clinical trials are needed.

NPWT resource use compared with standard moist wound care in diabetic foot wounds: DiaFu randomized clinical trial results

Background

Diabetic foot ulcers not only have a negative impact on patient mortality, morbidity and quality of life, but also require high resource utilization to achieve complete wound healing. The aim of this evaluation was to compare resource utilization of negative pressure wound therapy (NPWT) and standard moist wound care (SMWC) for diabetic foot wounds after amputation, surgical debridement or wound cleansing.

Methods

The multicenter clinical DiaFu study enrolled 368 adults with diabetic foot ulcers between December 23, 2011 and October 21, 2014. Patients were randomly assigned to NPWT and SMWC. Evaluation of direct resource use comprised inpatient and outpatient treatment time, and personnel and material for wound treatment within 16 weeks. This resource use analysis was primarily based on the per protocol population (NPWT 44; SMWC 110).

Results

Treatment duration was 16 days shorter with NPWT (mean (SD) 82.8 (31.6), SMWC 98.8 (24.6); U test, p = 0.001) with 14.9 days shorter outpatient treatment (mean (SD) NPWT 68.3 (31.1), SMWC 83.2 (29.7)). The number of dressing changes per study participant was lower with NPWT (mean (SD) 35.1 (18.6), SMWC (42.9 (21.4); U test, p = 0.067). Time per dressing change was significantly lower with SMWC (mean (SD) 19.7 (12.8), NPWT (16.5 (8.2) minutes; U test, p < < 0.0001). Time for surgical debridements per study participant was 23.3 minutes shorter with NPWT (mean (SD) 20.5 (20.5), SMWC (43.8 (46.7); U test, p = 0.395).

Conclusions

Resource use was lower for NPWT, which may be an efficient treatment alternative to SMWC for diabetic foot wounds, to be demonstrated in subsequent cost analyses.

Trial registration

clinicaltrials.govNCT01480362 on November 28, 2011

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-022-00569-w.

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

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.

NPWT Resource Use Compared With Conventional Wound Treatment in Subcutaneous Abdominal Wounds With Healing Impairment After Surgery: SAWHI Randomized Clinical Trial Results

OBJECTIVE

To compare resource utilization of NPWT and CWT for SAWHI after surgery.

SUMMARY OF BACKGROUND DATA

NPWT is widely used in the management of complex wounds but high-level evidence of its resource use remains sparse.

METHODS

The multicenter, multinational, randomized clinical SAWHI study enrolled a total of 539 consecutive, compliant adult patients with SAWHI after surgery without fascial dehiscence between August 2, 2011, and January 31, 2018. Patients were randomly assigned to NPWT and CWT stratified by study site and wound size using a centralized web-based tool. Evaluation of direct resource use comprised inpatient and outpatient time, personnel and material for wound treatment, and associated wound-related procedures. The resource use analysis was primarily based on the per protocol population (NPWT 157; CWT 174).

RESULTS

Although treatment length within 42 days was significantly shorter in the NPWT arm {Mean [Standard deviation (SD)] NPWT 22.8 (13.4); CWT 30.6 (13.3); P < 0.001 U-test}, hospitalization time was shorter with CWT [Mean (SD) NPWT 13.9 (11.1); CWT 11.8 (10.8); P = 0.047 U-test]. Significantly more study participants were outpatient with CWT [N=167 (96.0%)] than with NPWT [N = 140 (89.2%) (P = 0.017)]. Time for dressing changes per study participant [Mean (SD) (min) NPWT N = 133, 196 (221.1); CWT N = 152, 278 (208.2); P < .001 U-test] and for wound-related procedures [Mean (SD) (min) NPWT 167 (195); CWT 266 (313); P < 0.001 U-test] was significantly lower with NPWT.

CONCLUSIONS

NPWT reduces resource use and maybe an efficient treatment alternative to CWT for SAWHI after surgery.

Patient and clinician experiences and opinions of the use of a novel home use medical device in the treatment of peripheral vascular disease - a qualitative study

BACKGROUND

Peripheral vascular diseases have a significant impact on functional quality of life. Previous research has demonstrated the complex, limiting and costly economic implications of these conditions such as lower limb ulceration chronicity and ischaemic amputation. These complex, limb and life threatening conditions demand the development of novel interventions with objective research as part of that development. Hence, a novel intermittent negative pressure medical device in the form of a wearable boot (FlowOx™) was developed. As part of the development process, this study aimed to explore patient and clinician opinions of the boot.

METHODS

A qualitative approach was used to collect patient and clinician experiences in Norway. An advisory group informed the semi-structured questions used in seven patient interviews and one clinician focus group (n = 5). The data were recorded digitally and transcribed verbatim. Patient and clinician data were analysed as distinct groups using a thematic process.

RESULTS

Data analysis resulted in five themes from the patients which gave insight into; the impact of the disease process; practicalities of using the boot, positive experiences of use; perceived outcomes; reflecting on use. Six themes were created from the clinicians. These gave insight into; ideal outcomes and how to measure them; ways to potentially use the boot; using research in healthcare; positives of the device; observed effects and next steps; potential improvements to the device.

CONCLUSION

This study provides insight into the experiences and opinions of FlowOx™. Patients and clinicians were positive about the device due to its ease of use. Those patients with peripheral arterial disease experienced significantly more benefit, especially for ischaemic ulceration than those with a chronic venous condition. Clinicians placed value on the patient reported outcomes in the treatment decision-making process. This preliminary study into experiences of FlowOx™ use provides valuable feedback that will inform design modification and ongoing research into implementation points and prospective user groups. FlowOx™ demonstrates potential as a conservative therapy offering users a convenient, home use, self-care management solution for improving symptomatic peripheral arterial disease and quality of life.

Delayed primary closure (DPC) of the skin and subcutaneous tissues following complex, contaminated abdominal wall reconstruction (AWR): a propensity-matched study

BACKGROUND

Wound complications following abdominal wall reconstruction (AWR) in a contaminated setting are common and significantly increase the risk of hernia recurrence. The purpose of this study was to examine the effect of short-term negative pressure wound therapy (NPWT) followed by operative delayed primary closure (DPC) of the skin and subcutaneous tissue after AWR in a contaminated setting.

METHODS

A prospective institutional hernia database was queried for patients who underwent NPWT-assisted DPC after contaminated AWR between 2008 and 2020. Primary outcomes included wound complication rate and reopening of the incision. A non-DPC group was created using propensity-matching. Standard descriptive statistics were used, and a univariate analysis was performed between the DPC and non-DPC groups.

RESULTS

In total, 110 patients underwent DPC following AWR. The hernias were on average large (188 ± 133.6 cm²), often recurrent (81.5%), and 60.5% required a components separation. All patients had CDC Class 3 (14.5%) or 4 (85.5%) wounds and biologic mesh placed. Using CeDAR, the wound complication rate was estimated to be 66.3%. Postoperatively, 26.4% patients developed a wound complication, but only 5.5% patients required reopening of the wound. The rate of recurrence was 5.5% with mean follow-up of 22.6 ± 27.1 months. After propensity-matching, there were 73 patients each in the DPC and non-DPC groups. DPC patients had fewer overall wound complications (23.0% vs 43.9%, p = 0.02). While 4.1% of the DPC group required reopening of the incision, 20.5% of patients in the non-DPC required reopening of the incision (p = 0.005) with an average time to healing of 150 days. Hernia recurrence remained low overall (2.7% vs 5.4%, p = 0.17).

CONCLUSIONS

DPC can be performed with a high rate of success in complex, contaminated AWR patients by reducing the rate of wound complications and avoiding prolonged healing times. In patients undergoing AWR in a contaminated setting, a NPWT-assisted DPC should be considered.

Negative Pressure Wound Therapy vs Conventional Wound Treatment in Subcutaneous Abdominal Wound Healing Impairment: The SAWHI Randomized Clinical Trial

Question

Is negative pressure wound therapy (NPWT) an effective and safe treatment option for subcutaneous abdominal wound healing impairment (SAWHI) after surgery?

Findings

In the randomized clinical SAWHI study that included 507 adults, wounds were closed significantly faster and more often in the NPWT arm (36.1 days for 92 of 256 study participants) than with conventional wound treatment (39.1 days for 54 of 251 participants). The number of participants with wound-related adverse events was higher in the NPWT arm (48 of 234) than in the conventional wound treatment arm (27 of 201).

Meaning

For SAWHI after surgery, NPWT is an effective treatment alternative to conventional wound treatment but causes more wound-related adverse events.

Importance

Negative pressure wound therapy (NPWT) is an established treatment option, but there is no evidence of benefit for subcutaneous abdominal wound healing impairment (SAWHI).

Objective

To evaluate the effectiveness and safety of NPWT for SAWHI after surgery in clinical practice.

Design, Setting, and Participants

The multicenter, multinational, observer-blinded, randomized clinical SAWHI study enrolled patients between August 2, 2011, and January 31, 2018. The last follow-up date was June 11, 2018. The trial included 34 abdominal surgical departments of hospitals in Germany, Belgium, and the Netherlands, and 539 consecutive, compliant adult patients with SAWHI after surgery without fascia dehiscence were randomly assigned to the treatment arms in a 1:1 ratio stratified by study site and wound size using a centralized web-based tool. A total of 507 study participants (NPWT, 256; CWT, 251) were assessed for the primary end point in the modified intention-to-treat (ITT) population.

Interventions

Negative pressure wound therapy and conventional wound treatment (CWT).

Main Outcomes and Measures

The primary outcome was time until wound closure (delayed primary closure or by secondary intention) within 42 days. Safety analysis comprised the adverse events (AEs). Secondary outcomes included wound closure rate, quality of life (SF-36), pain, and patient satisfaction.

Results

Of the 507 study participants included in the modified ITT population, 287 were men (56.6%) (NPWT, 155 [60.5%] and CWT, 132 [52.6%]) and 220 were women (43.4%) (NPWT, 101 [39.5%] and CWT 119 [47.4%]). The median (IQR) age of the participants was 66 (18) years in the NPWT arm and 66 (20) years in the CWT arm. Mean time to wound closure was significantly shorter in the NPWT arm (36.1 days) than in the CWT arm (39.1 days) (difference, 3.0 days; 95% CI 1.6-4.4; P < .001). Wound closure rate within 42 days was significantly higher with NPWT (35.9%) than with CWT (21.5%) (difference, 14.4%; 95% CI, 6.6%-22.2%; P < .001). In the therapy-compliant population, excluding study participants with unauthorized treatment changes (NPWT, 22; CWT, 50), the risk for wound-related AEs was higher in the NPWT arm (risk ratio, 1.51; 95% CI, 0.99-2.35).

Conclusions and Relevance

Negative pressure wound therapy is an effective treatment option for SAWHI after surgery; however, it causes more wound-related AEs.

Trial Registration

ClinicalTrials.gov Identifier: NCT01528033

Negative-pressure wound therapy for III/IV pressure injuries: A meta-analysis

This meta-analysis was conducted to identify the potential benefits and the efficacy of negative-pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32-1.70). There were significant differences in wound healing time (WMD = -16.47 days, 95% [CI (-22.36, - 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = -2.39, 95% CI [-3.47, -1.30], P ≤ .001); (SMD = -2.55, 95% CI [-4.07, -1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = -3.61, 95% [CI (-4.57, - 2.66) times, P ≤ .001]). Our meta-analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high-quality multicenter RCTs.

Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention.

METHODS

We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm).

RESULTS

We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD - 4.78, 95% CI - 7.79 to - 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events.

CONCLUSIONS

In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.

Negative Pressure Wound Therapy Assisted Closure: An Effective Mode of Management for Infected and Contaminated Wound With Non-Union Fracture Femur

High-energy open fractures are often associated with significant soft tissue damage and can have contamination. Infection of a fracture can be the most detrimental factor for fracture union. Control of infection and soft tissue coverage over exposed bone plays a vital role in its overall outcome. Negative pressure wound therapy (NPWT) assisted closure has depicted encouraging results for helping control of infection and wound closure. NPWT assisted closure promotes reduction of bacterial load in the wound, facilitates removal of secretion from the wound, promotes the formation of granulation tissue, and decreases wound size. We present a case of open fracture femur with severe infection and exposed bone. Along with infection and comminution of fracture, there was collection of necrotic tissue at the fracture site. Infection settled with debridement of wound and application of NPWT. With the application of NPWT, there was formation of granulation tissue and a decrease in wound size. The wound healed completely following application of secondary sutures. Any form of plastic procedures, such as muscle pedicle graft and split-thickness skin grafting, was not required for wound closure. NPWT-assisted closure is a promising mode of wound management in grossly infected wounds and obviates the need for further plastic procedures. The effect can be extrapolated to all open wounds with infection but must follow a thorough debridement and lavage.

Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention: A qualitative study

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.

Negative pressure wound therapy for patients with hard-to-heal wounds: a systematic review

OBJECTIVE

Despite the lack of evidence, negative pressure wound therapy (NPWT) is commonly used in patients with hard-to-heal wounds. In our medical centre, one third of patients with abdominal wounds infected postoperatively end this therapy prematurely due to negative experiences and prefer standard wound care. This study was designed to explore the effects of NPWT on quality of life (QoL).

METHOD

A search from 2000 to 2019 in eight databases was performed to identify qualitative studies of patients treated with NPWT. Studies were selected by two independent reviewers, who appraised the methodological quality, extracted and structured the data and performed content analysis.

RESULTS

A total of five qualitative studies with good methodological quality, incorporating 51 individual patients, were included. After content analysis, four major themes emerged: reduced freedom of movement caused by an electric device; decreased self-esteem; increased social and professional dependency; and gaining self-control.

CONCLUSION

NPWT has major effects on the physical, psychological and social domains of QoL. Knowledge of these effects may lead to improved treatment decisions for patients with hard-to-heal wounds regarding use of NPWT or standard wound care.

Vacuum-assisted closure (VAC®) systems and microbiological isolation of infected wounds

Background

Negative pressure wound therapy is now largely used to treat infected wounds. The prevention and reduction of healthcare-associated infections is a high priority for any Department of Health and great efforts are spent to improve infection control systems. It is assumed that vacuum-assisted closure (VAC®) dressings should be watertight and that all the secretions are gathered in a single container but there is no consistent data on air leakage and possible dispersion of bacteria from the machine.

Methods

We have conducted a prospective experimental study on 10 patients with diagnosis of wound infection to verify whether the filtration process is microbiologically efficient. We compared the bacteria population present in the wound to the one present in the air discharged by the VAC® machine.

Results

This study shows that the contamination of the VAC® machine is considerably lower than the environment or wound contamination.

Conclusions

Negative pressure wound therapy system does not represent a risk factor for healthcare-associated infections.

Mini-thoracostomy with vacuum-assisted closure: a minimally invasive alternative to open-window thoracostomy

Thoracostomy is a common treatment option for patients with stage III pleural empyema who do not tolerate pulmonary decortication. However, thoracostomy is considered mutilating because it involves a thoracic stoma, the closure of which can take years or require further surgery. A new, minimally invasive technique that uses the vacuum-assisted closure has been proposed as an alternative to thoracostomy. This study aims to analyze the safety and effectiveness of mini-thoracostomy with vacuum-assisted closure in an initial sample of patients.

Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis

BACKGROUND

Though several systematic reviews concerned have been published, controversy still exists. The current systematic review was designed to clarify the detailed advantages and disadvantages of the negative pressure wound therapy (NPWT) in treatment of open fractures in comparison with the conventional wound dressings.

METHODS

A systematic search was performed in Pubmed, Cochrane Library, Embase, and Google Scholar for the published relevant clinical studies. Unpublished studies were searched in Clinicaltrials, ICTRP and ISRCTN. The outcome measures included presence of infection, wound healing process, length of the patient hospital stay, flap issues, frequency of amputation, and patient life quality.

RESULTS

In the 8 randomized controlled trials (RCTs) (421 patients) and the 6 retrospective cohort studies (488 patients), NPWT resulted in a significantly lower infection rate, significantly shorter wound coverage time, wound healing time and hospital stay length, and the lower amputation rate. However, no statistically significant difference was found in the need for flap surgery, the proportion of free flaps, the flap failure rate or the fracture non-union rate. Only 1 RCT was reported to have a higher physical component score of short form 36 in the infected patients.

CONCLUSION

NPWT can significantly reduce the risk of infection in treatment of open fractures and accelerate their wound healing process. Some but not much evidence suggests that NPWT may possibly help reduce the severity of the limb injury and therefore provide a chance for the limb to avoid amputation. Use of NPWT in the flap area is probably safe, but should be carried out with caution. The advantage of NPWT over the conventional wound dressings still requires to be confirmed in the other aspects.

Open-to-Air Is a Viable Option for Initial Wound Care in Necrotizing Soft Tissue Infection that Allows Early Detection of Recurrence without Need for Painful Dressing Changes or Return to Operating Room

BACKGROUND

The standard treatment of necrotizing soft tissue infection (NSTI) includes extensive surgical debridement. Care of these debridements is challenging because of the size of the wound and associated pain. A potential solution is to leave the wounds open-to-air in the period after the initial debridement, allowing for regular inspection at bedside while reducing pain associated with frequent dressing changes. We evaluated the feasibility of this approach from a pain control standpoint.

PATIENTS AND METHODS

An audit of wound care modalities used on adult patients with NSTI admitted to a regional burn center between January 2009 and May 2014 was performed. Patients with at least one operation were included. Those opting for palliative care were excluded. Wound care was divided into four categories: open-to-air (OTA), negative-pressure wound therapy (NPWT), packing, and ointment. Wound care, pain score, pain medication use, and number of operations were collected for the first seven days after initial debridement. Pain management was assessed by pain scores. Analgesic use was measured and compared using conversion to morphine milligram equivalents (MME).

RESULTS

Ninety-six patients were included; 67% were men with average age of 50 years, resulting in a total of 672 days of wound care evaluated: 69 days of OTA, 127 days of NPWT, 200 days of packing, and 126 days of ointment (150 days were undocumented). Average daily pain score from all wound care modalities was 2.00. Negative pressure wound therapy had the highest reported daily pain score (2.18, p = 0.034), whereas OTA had the lowest pain score (1.63, p < 0.05). Mortality was lower in the OTA cohort but was not statistically significant; there were no other differences in long-term outcome.

CONCLUSION

Leaving wounds OTA is a safe and viable option in the immediate post-debridement period of NSTI to reduce pain, while permitting frequent re-evaluation for quick recognition of disease progression and repeat operative debridement if necessary.