Limited Access Dressing

Pramod Kumar, MS, MCh, DNB

Disclosures

Wounds. 2008;20(2):49-59. 

In This Article

Abstract and Introduction

The Limited Access Dressing (LAD) combines the principles of moist wound healing and topical negative pressure dressing along with a provision of an additional port (12-14 FR size tube) for instilling antimicrobial solution/gas of choice (to make wound environment aerobic/anaerobic) without any need to change the dressing. The efficacy of the dressing technique was proven by a study of 39 cases, including 12 cases with exposed bone and tendon (July 2004 to March 2005) where wounds were prepared by LAD II and split-thickness skin grafting with LAD II. Efficacy of LAD was assessed by observing the time to development of healthy granulation tissue and by the quantity of graft take under LAD by day 10. For the wounds studied, an average of 1.51 LAD (range 1-3) was required to develop granulation tissue fit for skin grafting. The average number of days required to prepare the wound under LAD was 17.05 days. An average of 1.03 LAD was required for covering the wound with skin graft (range 1 to 2; median 1) and overall graft take under LAD was 99.87%. In 24 of 39 wounds, an average of 33.83 days of treatment with conventional dressing (range 7 to 120 days; median 22.5 days) could not achieve healthy granulation. When these wounds were switched to LAD, wound preparation took an average of 13.2 days (range 3 to 32 days; median 12 days). It was concluded that LAD is a safe and effective alternative to conventional dressing methods.

After 1960, apart from conventional closed dressing techniques, moist wound dressings and negative pressure dressings are the most commonly discussed in the literature.

The author designed the Limited Access Dressing (LAD) in an attempt to combine the advantages of both moist wound healing and negative pressure dressings.The design has notable advantages, while avoiding some major disadvantages such as an inaccessible, offensive smelling wound environment, and relatively high treatment costs.

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