Abstract and Introduction
Background: Complex wounds are associated with a challenging healing process, prolonged hospitalization, increased treatment cost, and workforce loss. In this case series, negative pressure wound therapy (NPWT) with and without instillation and dwell time (NPWTi-d), closed incision negative pressure therapy (ciNPT), and open abdomen negative pressure therapy (OA-NPT) use in the management of complex wounds were examined.
Methods: Fifty-nine patients (mean age, 55.0 ± 14.8 years) across secondary and tertiary care centers in Turkey were treated. Patients were examined, and a NPWT system was selected based on wound care needs. Dressing changes occurred every 2 to 7 days, depending on therapy type. Wound closure occurred through surgical closure or secondary intention.
Results: Patient wound types consisted of acute wounds (n = 10), chronic wounds (n = 34), postoperative wound dehiscence (n = 9), and tumor resection/flap necrosis (n = 6). Thirty-six patients (61.0%) received NPWT, 16 (27.1%) received NPWTi-d, 5 (8.5%) received ciNPT, and 2 (3.4%) received OA-NPT. Average treatment duration was 19.7 ± 13.7 days. Surgical closure occurred in 45 patients, and secondary closure was observed in 13 patients; the remaining patient showed wound improvement. Wound healing complications were observed in 2 patients (scar formation and partial flap necrosis).
Conclusions: Our findings indicate an association of negative pressure therapy with favorable wound healing outcome in complex wounds. Negative pressure therapy seems to be a useful treatment option to bridge wound care between initial debridement and final reconstruction.
Negative pressure wound therapy (NPWT) is based on the topical application of subatmospheric pressure through a vacuum source onto the wound bed filled with a porous dressing, creating a negative pressure environment in the wound.[1,2] NPWT has become widely used in the management of complex wounds of various etiologies, such as open abdominal wounds, nonhealing wounds, and chronic wounds along with an expansion of clinical use over the last decade.[1–6]
NPWT has been available since the early 1990s and has evolved to include a range of devices, allowing the clinician to tailor NPWT to the wound. NPWT in open abdomen management (OA-NPT) and NPWT with instillation and dwell time (NPWTi-d) were introduced in the 2000s, offering a noted improvement in wound management options compared with standard wound care dressings.[6–9] At the beginning of 2010, an NPWT system designed specifically for the application of negative pressure therapy on clean, closed incisions (closed incision negative pressure therapy [ciNPT]) became available.[2,10,11]
The efficacy of NPWT in wound management is associated with the generation of subatmospheric pressure in a closed system that results in increased exudate removal, reduction of edema, and promotion of granulation tissue formation.[1,2,12] NPWTi-d cleanses the wound through the instillation of topical wound solutions and prepares the wound for closure. ciNPT helps to hold incision edges together, acts as a barrier to external contamination, and removes fluid and infectious materials. While OA-NPT provides separation between the abdominal wall and viscera, it also protects the abdominal contents, draws the wound edges together, provides a barrier against the external environment, and removes fluid from the paracolic gutters.
The utility of negative pressure therapy in the management of complex wounds is considered critical given that these wounds are likely to have a delayed or complicated healing process and prolonged hospitalization, leading to increased treatment costs and considerable workforce loss. In this case series, we aimed to provide data on the utility of NPWT, NPWTi-d, ciNPT, and OA-NPT in the management of complex wounds based on the clinical experience of physicians from several disciplines at both secondary and tertiary care centers across Turkey.
ePlasty. 2022;22(e60) © 2022 HMP Communications, LLC