Case Report: Using Dual Therapies? Negative Pressure Wound Therapy and Modified Silicone Gel Liner? to Treat a Limb Postamputation and Dehiscence
Abstract: Orthopedic trauma wounds with extensive soft tissue damage can be costly and time consuming to heal. This case report illustrates a positive outcome using negative pressure wound therapy in tandem with a silicone gel liner to treat a nonhealing, dehisced incision following a below-the-knee amputation. The primary goal of using the 2 therapies together was to close the wound while actively reshaping and shrinking the residual limb for a prosthesis. The simultaneous use of these therapies resulted in quicker limb maturation and a reduction in the time for prosthetic fitting compared to the previous standard of care at the authors? institution.
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Negative Pressure Wound Therapy in Post-Cesarean Superficial Wound Disruption: A Report of 3 Cases
Abstract: Wound disruption after cesarean section is a common complication that may cause additional stress postpartum. The treatment options are secondary closure with the risk of reinfection or healing by secondary intention. In some cases, negative pressure wound therapy can be a useful alternative. Three cases of superficial wound disruption after cesarean section performed for failure to progress are presented. Successful closure with negative pressure wound therapy was achieved after conventional surgical treatment options were exhausted or unacceptable to the patients. Negative pressure wound therapy is a safe, feasible, and well-tolerated treatment option.
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Combination of Subatmospheric Pressure Dressing and Gravity Feed Antibiotic Instillation in the Treatment of Post-Surgical Diabetic Foot Wounds: A Case Series?Part 2.
Case study 1: diabetic foot ulcer with osteitis of the fifth metatarsal head. Negative pressure wound therapy with instillation was utilized in conjunction with intravenous antibiotics from the fourth through sixth inpatient day. Case study 2: diabetic foot ulcer with osteomyelitis.
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Commentary: New Microvascular Blood Flow Research Challenges Practice Protocols in Negative Pressure Wound Therapy
Abstract: Negative pressure wound therapy (NPWT) is a topical treatment used to promote healing in acute and chronic wounds by applying negative pressure to the wound bed. The most widely used NPWT product in the United States and Canada is Vacuum-Assisted Closure® (V.A.C.® Therapy?, KCI Inc., San Antonio, Tex). This article briefly reviews the literature on V.A.C. pressure levels, discusses the conventional pressure settings that are commonly used with the V.A.C., and explores new literature that challenges commonly recommended pressure settings associated with use of the V.A.C.
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A Comparative Histological Study of Skin Graft Take with Tie-Over Bolster Dressing Versus Negative Pressure Wound Therapy in a Pig Model: A Preliminary Study [Brief Communication]
Abstract: Negative pressure wound therapy (NPWT) (Vacuum-Assisted Closure®, V.A.C.®, Kinetic Concepts Inc., San Antonio, Texas) has been shown to accelerate wound healing in animal and clinical studies. This is due to removal of interstitial fluids, which increases oxygen and nutrient delivery to tissues, increased vascularity and granulation tissue, decreased bacterial colonization, and removal of inhibitory factors from chronic wound edema. A histological study was recommended in the original article to give scientific answers regarding the positive effect of NPWT on the healing process of the skin graft. In this study, two meshed split-thickness skin grafts were performed in a mirror image on the back of a pig. On one side a conventional bolster dressing was applied, and on the other side the NPWT system was used. Three days later, both dressings were removed and core biopsies were obtained from each side on postoperative Days 3, 5, 7, 9, and 11. The NPWT side showed less wound edema, faster narrowing of the separation plane between the graft and the recipient wound bed, and earlier termination of the acute inflammatory reaction.
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Reducing Bacterial Bioburden in Infected Wounds with Vacuum Assisted Closure and a New Silver Dressing?A Pilot Study
Abstract: The use of silver is increasing rapidly in the management of infected wounds and wounds at risk for infection. This 5-patient case series reviews the results of a pilot study designed to determine efficacy and safety of negative pressure wound therapy (NPWT; V.A.C.® Therapy?, KCI, San Antonio, Tex) with the new silver foam dressing (V.A.C.® GranuFoam® Silver? Dressing, KCI). Data on wound progression and the primary endpoints?time to clear infection, time to wound closure, and time to discharge from hospital?are detailed in this manuscript. For the 5 patients treated with NPWT and the silver foam dressing, the mean time for treatment was 13.00 ± 3.39 days and the mean time to patient discharge was 16.00 ± 6.63 days. Wounds were clear of clinical signs of infection in 7.00 ± 1.58 days and closed in 19.20 ± 8.76 days.
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Negative Pressure Dressings: An Alternative to Free Tissue Transfers?
Abstract: Free tissue transfer is a well established tool for the reconstruction of large, complicated wounds of the extremities. However, when free flap reconstruction is contraindicated or in cases where it has failed, the management of this type of wound presents a formidable task. Although negative pressure wound therapy (NPWT) plays an increasing role in the treatment of complex open wounds, there are only a few reports of successful management of wounds with areas of exposed tendon or bone. The authors present their experience with the use of NPWT in the treatment of open wounds of the extremities with relatively large areas of exposed bone.
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Combination of Subatmospheric Pressure Dressing and Gravity Feed Antibiotic Instillation in the Treatment of Post-Surgical Diabetic Foot Wounds: A Case Series?Part 1
Abstract: A new negative pressure wound therapy (NPWT) device with solution instillation capability (V.A.C.® Instill?, KCI, San Antonio, Tex) will be discussed. Historical delivery methods for local antibiotic levels directly to the post-surgical field are antibiotic-laced beads, Kritter-type instillation catheters, and closed suction irrigation. These devices will be reviewed and contrasted with both traditional NPWT as well as the new NPWT with instillation. The authors present 5 diabetic foot surgical case studies highlighting the use of NPWT with instillation followed by a discussion of the reduced length of stay demonstrated in the case studies. The basis of both moist wound healing and wound irrigation will be discussed. The pros and cons of various topical solution choices will be reviewed. The authors will also present a list of scenarios in which the new NPWT with instillation option should be considered.
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Bolster Versus Negative Pressure Wound Therapy for Securing Split-Thickness Skin Grafts in Trauma Patients
Abstract: Purpose: The purpose of this retrospective chart review was to compare the effectiveness of negative pressure wound therapy (NPWT) (Vacuum-Assisted Therapy®, V.A.C.®, Kinetic Concepts, Inc., San Antonio, Texas) to traditional cotton bolster dressings in split-thickness skin graft (STSG) survival in trauma patients. Methods: The authors conducted a retrospective chart review of 40 patients admitted to a level I trauma center over a two-year period and treated with split-thickness skin grafting, with in-hospital graft survival as the main endpoint. Results: Forty patients underwent STSG placement over 46 wounds. Indications included soft tissue loss (graft n=34) and fasciotomy site (n=12). The grafts were secured using either NPWT (n=21) or a traditional cotton bolster (n=25). Zero grafts failed in the NPWT group, while one graft failure occurred in the bolster group on a sizeable soft tissue loss injury to the torso/extremity (300cm2 graft). There were no significant differences in graft failure, mean graft size, total length of patient hospital stay, or length of time the dressings were left in place between the NPWT and bolster groups. Treatment costs were considerably larger in the NPWT group. The average cost per patient in the NPWT and cotton bolster groups were approximately $1,000 and $18.50, respectively. Conclusion: The in-hospital results achieved with NPWT compare well to the traditional cotton bolsters, with NPWT being a viable option for securing STSG and ensuring graft survival. However, the routine use of NPWT may not be cost effective. A prospective, randomized trial examining grafts with higher associated failure rates using these two modalities would help answer questions about NPWT?s use in this patient population.
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Composition of Wound Fluid from Pressure Ulcers Treated with Negative Pressure Wound Therapy Using V.A.C.® Therapy in Home Health or Extended Care Patients: A Pilot Study
Abstract: The purpose of this pilot study was to characterize changes in concentrations of tumor necrosis factor (TNF)-a, interleukin (IL)-1b, matrix metalloproteinase (MMP)-3, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 in wound fluid collected from pressure ulcers in adults treated with negative pressure wound therapy (NPWT; V.A.C.® Therapy, KCI, San Antonio, Tex). Wound fluids were collected from 8 patients with Stage III or IV pressure ulcers in home care and extended care settings. Concentrations of analytes were measured immediately prior to initiation of NPWT (Day 0) and at Days 1, 3, and 7 continuous NPWT. There were statistically significant (P < 0.05) decreases from baseline in the levels of MMP-3 (Day 0 > [Day 1 ~ Day 3 ~ Day 7]), MMP-9 (Day 0 > [Day 1 ~ Day 3]), and MMP-3:TIMP-1 ratios (Day 0 > [Day 1 ~ Day 3 ~ Day 7]). No other significant differences were detected. Previous studies have shown a consistent decrease in protease levels to have prognostic value for healing. Thus, the change in composition of fluids from pressure ulcers treated with NPWT may be beneficial to wound healing.
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