Wound-Healing Following Negative-Pressure Wound Therapy with Use of a Locally Developed AquaVac System as Compared with the Vacuum-Assisted Closure (VAC) System

BACKGROUND

Negative-pressure wound therapy (NPWT) gained widespread clinical use after its introduction in the 1990s because of its many beneficial effects on the wound environment. However, high treatment costs have limited its use in third-world countries. The present study compares a low-cost, locally developed NPWT system with a commercially available system in terms of efficacy, reliability, ease of application, and safety.

METHODS

This prospective, randomized controlled trial involved 36 patients who were managed with NPWT with either a low-cost, locally developed system (AquaVac) or a commercially available Vacuum-Assisted Closure Advanced Therapy System (VAC ATS; KCI). The low-cost NPWT system described consists of a converted aquarium pump as a reusable vacuum source and a dressing system that can be found in the hospital supply room: food plastic wrap as an occlusive drape, surgical gauze as wound filler, nasogastric tubes as tubing, and used intravenous (IV) bottles as effluent canisters. The purpose of the study was to compare the 2 systems in terms of (1) time to apply the dressing, (2) exudate levels, (3) amount of granulation tissue, (4) wound size reduction, (5) average cost of treatment, (6) visual analog scale (VAS) pain scores, and (7) complications.

RESULTS

The experimental low-cost system had a small but statistically insignificant advantage over the commercially available system in terms of application time, pain during dressing changes, and wound contraction percentage. The 2 systems were comparable in terms of the amount of exudate, granulation tissue coverage, and VAS scores during the course of treatment. No wound or periwound complications were observed. The systems were significantly different in terms of cost, with the AquaVac system being 7 times less expensive than the VAC ATS system ($63.75 compared with $491.38 USD).

CONCLUSIONS

The low-cost AquaVac system was shown to be comparable with the commercial VAC ATS system, suggesting that it is an effective and safe alternative method for NPWT in resource-challenged settings.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cost Effectiveness of a Platelet-rich Plasma Preparation Technique for Clinical Use

INTRODUCTION

Despite limited clinical evidence, platelet-rich plasma (PRP) is currently used for the treatment of various soft tissue injuries, but optimal use of PRP has yet to be determined. In many instances, PRP is prepared using commercial devices that lack standardized preparation techniques and consistent quality of the PRP produced.

OBJECTIVE

The aim of this study is to explore a simple, easy, economical method of PRP preparation that is practical for clinical use.

MATERIALS AND METHODS

This cross-sectional study was conducted at the Sports Medicine Clinic at the University of Malaya Medical Centre, Malaysia. Participants were healthy postgraduate students and staff at the Sports Medicine Department. The PRP was prepared using a single centrifugation technique. Leukocyte and platelet levels were compared with that of a whole blood baseline and a commercial preparation kit.

RESULTS

The PRP produced using this technique contained significantly higher mean platelet (1725.0 vs. 273.9 x 109/L) and leukocyte (33.6 vs. 7.7 x 109/L) levels compared with whole blood. There was no significant difference in the mean platelet and leukocyte levels between the PRP produced in this study and by a commercial PRP system.

CONCLUSIONS

A single-centrifugation protocol using readily available materials in a typical clinical setting could produce PRP of comparable quality to those of a commercial PRP production system.

A comparison of Gaelic football injuries in males and females in primary care

The Ladies Gaelic Football Association has a playing population of 150,000 of which 33% are adults. A number of studies have been published on rates of injury among male athletes but none on female athletes in Gaelic football. A retrospective review of insurance claims, submitted under the Gaelic Athletic Association Player Insurance Injury Scheme. 405 injuries were recorded, 248 [107 (70%) male, 141 (58%) female] to the lower limb, 91 [33 (21%) male, 58 (23%) female] to the upper limb. The majority of lower limb injuries [56 (52%) male, 56 (40%) female] were to muscle. Almost a third of upper limb injuries were fractures [10 (30.3%) male, 33 (57%) female]. injuries/1000 hours playing was 8.25 for men and 2.4 for women. The injury rate in ladies Gaelic football was found to be significantly lower than in men's Gaelic football. Lower limb injuries accounted for the majority of injuries in both sports.

A pediatric acute wound service: a novel approach in wound management

INTRODUCTION

In 2001, in response to an overwhelming increase in patient visits for various pediatric abscesses, burns, and other wounds, an ambulatory burn and procedural sedation program (Pediatric Acute Wound Service, or PAWS) was developed to minimize operating room utilization. The purpose of this study is to report our initial 7-year experience with the PAWS program.

METHODS

The hospital records of all children managed through PAWS from 2001 to 2007 were reviewed. Outcomes measured include patient demographics, number and location of visits per patient, procedure information, cause of wounds, and reimbursement. chi(2) test and linear regression were performed using GraphPad Prism (GraphPad Software Inc, San Diego, CA).

RESULTS

Overall, 7620 children (age 0-18 years) received wound care through PAWS from 2001 to 2007. There were no differences in patient age, race, and sex during this time period. Between 2001 and 2007, the percentage of patients seen as outpatients increased from 51% to 68% (P < .05), and the average number of visits per patient decreased from 3.9 to 2.4 (P = .05). In, 2007, 46% of the children required only 1 visit. In 2007, 74% of the visits were for management of wound and soft tissue infections, compared with only 9% in 2001 (P < .05). The contribution margin of a PAWS visit and total contribution margin in 2007 were $1052 and $4.0 million, respectively.

CONCLUSION

The creation of PAWS has allowed for the transition in management of most pediatric skin and soft tissue wounds and infections to an independent ambulatory setting, alleviating the need for operating room resources, while functioning at a profitable cost margin for the hospital.

Reconstruction of limited soft-tissue defect with open tibial fracture in the distal third of the leg: a cost and outcome study

This study was conducted to analyze the cost and outcome of free-tissue transfers versus local muscle flaps for reconstruction of limited soft-tissue defects associated with tibial fractures in the distal third of the leg. Twelve adult patients underwent either free (n = 6) or local muscle (n = 6) flap reconstruction were retrospectively reviewed. Total operative time for local muscle flap reconstruction was 215 +/- 47 minutes compared with 450 +/- 90 minutes (P < 0.0002) for free-muscle transfer. Median length of hospital stay after reconstruction was 7 days for local muscle flap compared with 9 days for free-muscle transfer. Total cost of the local muscle flap procedure was US dollars 11,729 +/- US dollars 4460 compared with US dollars 19,989 +/- US dollars 3295 (P < 0.0004) for free-flap reconstruction. Five of 6 patients in each group had excellent soft-tissue contours. Fracture healing was evident in all patients of each group. Thus, a local muscle flap for reconstruction of a limited distal tibial wound appears to be more cost-effective than free-tissue transfer because of equivocal outcomes achieved but at approximately half of the cost.

Continuous versus interrupted suturing of traumatic lacerations: a time, cost, and complication rate comparison

BACKGROUND

The most frequently used techniques in the repair of traumatic lacerations are interrupted and continuous suturing.

METHODS

We performed a prospective study of interrupted and continuous suturing techniques evaluating suturing rates, suture economy, and complication rates in the repair of 101 traumatic lacerations.

RESULTS

Continuous closure was accomplished at a statistically faster rate (mean, 0.276 cm/min) than interrupted closure (mean, 0.175 cm/min; p = 0.004). Less suture material was used in the continuous closures (0.321 suture packets/cm) than in interrupted closures (0.508 suture packets/cm; p = 0.03). No statistically significant difference existed in the complication rate between the two closure methods (continuous, 1 of 44; interrupted, 1 of 57; p = 0.59).

CONCLUSION

Although suturing technique should be selected primarily on the basis of wound characteristics and surgeon preference, continuous suturing warrants consideration for the closure of traumatic lacerations because of its time/material economy and the lack increased complication rates.

The effectiveness of an early active intervention program for workers with soft-tissue injuries. The Early Claimant Cohort Study

STUDY DESIGN

A prospective cohort of approximately 1600 injured workers off work because of soft-tissue musculoskeletal problems was followed for 1 year through a series of structured telephone interviews.

OBJECTIVE

To determine the effectiveness of a Workers' Compensation Board-sponsored early, active, exercise and education program based in the community in comparison to "usual" care.

SUMMARY OF BACKGROUND DATA

The program established in 1990 was available in more than 100 clinics. Results from an earlier pilot study indicated lower overall claims costs for workers attending the program compared with non-attenders.

METHODS

Subjects were recruited at the time of Workers' Compensation Board claim registration. Routinely collected data and self-reported responses to demographic, quality-of-life, functional status, pain, recovery expectations, and workplace response to injury questions were used to determine selection factors for community clinic attendance. Economic and non-economic outcomes were compared for clinic attenders and non-attenders.

RESULTS

For the 885 male and female new back problem cases in the study, overall clinic attenders were not systematically different from non-attenders at baseline. Analysis of duration of benefits showed no significant difference between attenders and non-attenders, although health care costs for clinic attenders were significantly higher. Functional status, health-related quality-of-life, and pain measures all improved significantly throughout time for both groups, bit there were no statistically significant differences in rate of improvement.

CONCLUSION

There was no advantage from the program compared with usual care on the outcomes measured-a finding consistent with recent studies that examined the longer-term effectiveness of other interventions in the first few weeks of back pain symptoms.