Less Frequent Dressing Changes With Negative Pressure Wound Therapy Reduces Injured Children’s Pain and Fear
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Abstract: Negative pressure wound therapy (NPWT) has become an accepted method to assist in optimizing the management of wounds. It can decrease the frequency of dressing changes, which reduces pain and fear in pediatric patients. An 8-year-girl with lower extremity avulsion injuries underwent debridement and received NPWT for 17 days. The dressing foam was changed only twice during NPWT. Secondary skin grafting was performed 24 days later, and the wound was resurfaced 35 days after injury. Negative pressure wound therapy reduces the frequency of required dressing changes, even while the wound releases massive exudate, which reduces pain and brings comfort to injured children.
Negative pressure wound therapy (NPWT) for open injury has recently gained popularity among various surgical specialties.1–3 This system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of NPWT to promote microcirculation and granulation tissue proliferation has been verified. Thus, it has allowed uncomplicated wounds to heal quickly.4 While NPWT has been shown to be useful in a variety of situations, one unique potential benefit in children is that it promotes the removal of excessive discharge through a suction tube, which keeps the wound surface clean and consequently decreases the requirement of dressing changes.
The authors present a case of a child with a severe leg degloving injury who underwent successful NPWT with reduced pain.
An 8-year-old girl sustained a detrition injury to the right leg after she was run over by a truck. The patient had extensive soft tissue injury to the entire right foot, except the heel, and sustained a laceration to the right leg. All of the toes had been amputated, and the extensor tendons and metacarpal bones were exposed (Figure 1A, B). She underwent immediate debridement under general anesthesia. The degloved skin of sole and dorsal pedis was removed and then returned to the wound as a free skin graft after cleansing. The lower leg wound had no skin defect; however, the muscles were damaged severely. Thus, the wound of the lower leg was left open and covered with an artificial dermis (Teruderermis®, Orimpas-Terumo Co., Ltd., Tokyo, Japan) instead of direct closure, in order to prevent compartment syndrome. Negative pressure wound therapy was applied as the postsurgical wound dressing for 17 days instead of the usual ointment-impregnated gauze. Polyurethane foam and a drainage tube were adapted to fit the wound and were sealed with a transparent film. The tube was connected to a vacuum source, which was used to generate subatmospheric pressure (125 mmHg) in the local wound environment (Figure 2). Significant wound discharge was noted over the first 10 days and was drained through the suction tube. Consequently, the foam dressing was changed only twice during NPWT treatment. The wounds of the instep and heel were favorably covered with grafted skin 2 weeks later without infection, and the lower leg wound showed favorable granulation tissue growth (Figure 3). Secondary split-thickness skin grafting for the remaining raw surface was performed 24 days after injury.