Clinical Experience With the Use of Negative Pressure Wound Therapy Combined With a Silver-impregnated Dressing in Mixed Wounds

A Retrospective Study of 50 Cases

Peter Bukovcan, MD, PhD; Jan Koller, MD, PhD; Marianna Hajská, MD, PhD; Peter Záhorec, MD, PhD

Disclosures

Wounds. 2016;28(8):255-263. 

In This Article

Abstract and Introduction

Abstract

Introduction. Although negative pressure wound therapy (NPWT) has been used for more than 20 years, as far as the authors are aware, there is little research aimed at the evaluation of the combination of NPWT with a silver-impregnated dressing.

Objective. The aim of this study was to examine the effect, efficacy, and safety of NPWT in conjunction with a silver-impregnated dressing.

Materials and Methods. The authors used a retrospective study of 54 acute and chronic wounds treated in 50 patients over a 2-year period. Demographic data, wound characterizations, wound cultures before and after NPWT, the duration of NPWT and number of sponge changes for each patient, the types of surgical procedures used for wound closure following NPWT, and the healing time and length of hospital stays were recorded.

Results. In 26 wounds, deep structures (ie, bones and tendons) were exposed. The mean NPWT duration was 9.2 days. Mean healing time was 16 days. There was a statistically significant decrease in the pathogenic microbial strains after NPWT treatment combined with the silver-impregnated dressing (paired t test; P = 0.0038). The shift from complicated to easier surgical wound-closure procedures was observed.

Discussion. According to all results obtained, described, and discussed, the authors consider the use of a nonadherent silver-impregnated dressing in conjunction with NPWT to be beneficial and efficacious. No adverse events or reactions related to the silver-impregnated contact layer used during NPWT have been observed in the patients, which confirmed the safety of this method.

Introduction

The management of wounds with problematic healing (eg, massive infection or extensive tissue loss with/without exposure of deep structures such as muscles, tendons, or bones), where conservative and conventional surgical treatment methods are insufficiently effective, attracts considerable attention of many clinicians. Advanced wound care treatment methods are necessary to achieve healing of these problematic wounds. Negative pressure wound therapy (NPWT), introduced by Morykwas,[1] offers treatment options for the management of problematic wounds. This nonpharmacological treatment method utilizes physical principles (subatmospheric pressure) for wound environment manipulation to enhance natural wound healing processes, leading to accelerated wound healing. To date, NPWT has proven its versatility in the management of both acute and chronic wounds in a wide range of indications: open fractures;[2] extensive tissue loss, severe wound infections, destructive burn injuries,[3] and frostbite; enhancement of skin graft and skin substitute take;[4,5] salvage of compromised flaps;[6] wounds with massive edema and/or venostasis; trophic ulcers (ie, venostatic, arterial, neuropathic, diabetic,[7] and postirradiation); pressure ulcers;[8] and sternal or abdominal dehiscences.[9,10] Nevertheless, it must be emphasized that NPWT cannot replace surgical debridement, which should always be performed before applying topical negative pressure. However, the indication and contraindication criteria for NPWT usage should be considered and strictly followed as with any other treatment method. In NPWT, several mechanisms act in concert and exert beneficial effects: stimulation of blood flow, angiogenesis, and granulation formation; derivation of soluble wound healing inhibitor substances from the wound area; mechanical forces pulling the wound edges together; reduction of tissue edema; and reduction of bacterial contamination. The latter is considered to be one of the key factors in wound healing. To stimulate wound healing, according to the literature,[11,12] the authors attempted to enhance this antibacterial effect by using a silver-impregnated dressing in conjunction with NPWT. To prove the antimicrobial activity and clinical effectiveness of this combination are not the same, different types of wounds were included, which also gives more insight into the management of problematic wounds. The authors describe their experience with NPWT combined with a silver-impregnated dressing for the treatment of 54 wounds in 50 patients over a 2-year period.

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