Application of the Single Use Negative Pressure Wound Therapy Device (PICO) on a Heterogeneous Group of Surgical and Traumatic Wounds

Caroline Payne, BSc (Hons), MSc, FRCS (Eng), FRCS (Plast); Daren Edwards, RGN, MBE

Disclosures

ePlasty. 2014;14 

In This Article

Abstract and Introduction

Abstract

Objectives. Traumatic wounds and surgery inherently have their complications. Localized infections, wound dehiscence, and excessive wound leakage can be devastating to the patient with a prolonged recovery, but it is also costly to the hospital with an increased length of stay, extra workload, and dressing changes. The single use PICO (Smith and Nephew Healthcare, Hull, United Kingdom) negative pressure wound therapy (NPWT) dressing has revolutionized our management of various acute, chronic, and high output wounds. It requires fewer dressing changes than conventional practice, is used in the outpatient setting, and is a necessary adjuvant therapy to hasten wound healing.

Aims. To observe the efficacy of the PICO vacuum-assisted healing within a cost improvement programme.

Settings.  Plastic surgery department, Royal London Hospital.

Materials and Methods.  Twenty-one patients with a diversity of postoperative or posttraumatic wounds were considered suitable for PICO application and treated totally on an outpatient basis once the PICO dressing was applied. All wounds were then subjected to continued PICO dressings until healed.

Results.  All patients tolerated the PICO well with no dressing failure or failure to comply. The number of dressings per patient ranged from 1 to 7. The cost per patient of treatment ranged from £120 to £1578. Estimated cost of all PICO dressing for 21 patients including plastic surgery dressing clinic appointments = £13,345. Median length of treatment to healing (days) = 16; standard deviation = 9.5. Eight patients would have had an inpatient bed stay with conventional therapy, total 24 bed days saved at Bartshealth @£325 per day.

Conclusions. The outpatient application of a disposable NPWT can benefit a wide range of clinical wounds that optimizes patient care, promotes rapid wound healing, and importantly helps manage costs.

Introduction

The intrinsic nature of surgery in all specialties means that there can be adverse events associated with the operation. These events vary to those associated specifically to the type of surgery performed, to the universal problematic complications of wound dehiscence and localized infection. Surgical site infection (SSI) is costly not only in fiscal terms to the admitting hospital but primarily to the patient in regard to physical and psychological well being, extended length of stay, and repeated, usually painful, dressing changes to the area. Surgical site infections account for 15.7% of hospital-acquired infections in hospital inpatients (Health Protection Agency, SSI prevalence data for 2011),[1] and at least 5% of patients undergoing a surgical procedure develop a SSI.[2] In 2008, this alone increased the costs of individual patient care by £814 to £6626 depending on the type of surgery and the severity of the infection (overall cost to the NHS exceeds £90 m), a major part of this cost is the extra inpatient bed stay. This has led to an integrated management approach and specific care pathways, which is now at the forefront of hospital prevention plans and includes assessment of wound dressings.

The application of negative pressure wound therapy (NPWT) to an operative site is now a commonplace. Negative pressure wound therapy was popularized after reports by Morykwas et al[3] and their research on wounds treated by topical negative pressure in animal and clinical studies.[4] The standard porous polyurethane foam system was commercialized by KCI (Kinetic Concepts Incorporation, San Antonio, Texas) into the VAC system. Negative pressure wound therapy is a generic technology with wide range of devices available in the commercial market that provide variable topical negative pressure, wound contact layer, and portability. Negative pressure wound therapy has several modes of action on wound beds including angiogenesis, stimulation of growth of granulation tissue,[5] evacuation of wound exudate, decreased bacterial bioburden,[6] and wound contraction.[7] There is a strength of evidence of its clinical efficacy with more than 1000 reviewed publications, so it has become widely used in the management of a variety of surgical beds either to prepare it for further a procedure[8,9] or to promote the healing of a definitive procedure.[10,11] It is frequently used in circumstances where it is desired to expedite the normal healing process after uncomplicated surgery or after trauma.[12–14]

In many circumstances, this group of patients can be managed on the short stay admission wards to then enable most of their postoperative recovery in their own home. Advances in surgical technique have helped achieve these goals in the form of minimally invasive procedures, robotics, and better application of local anesthetics to block the operative site foregoing the need for recovery from a general anesthetic.[15] The confounding factor is that although the surgery can be done as a day case, the length of stay can be prolonged due to application of a nonportable NPWT device.

To compliment this holistic patient episode in the short stay surgical unit, there is the necessity to develop reliable and advanced wound dressings that promote healing, are comfortable to the patient, require minimal changes, and can be totally performed as an outpatient. The use of NPWT in the community is expanding with the advent of smaller, more portable devices. In Bart's Health NHS Trust, we have found obstacles to the use of community NPWT in the past. There has been a combination of reasons for this, including lack of funding and health care professionals' unfamiliarity with the usage of NPWT devices. The benefits of portable NPWT devices can be clearly seen. In particular, the PICO system retains the benefits of many ambulatory systems with the addition of its own specific advantages.

We have found that the PICO system achieves all designated treatment goals and have reviewed patients in our department to assess the overall advantages of the PICO system and the fiscal burden.

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