Combination of negative pressure wound therapy and acoustic pressure wound therapy for treatment of infected surgical wounds: a case series

The optimal wound therapy for healing infected wounds post surgery or surgical debridement has not been established. Negative pressure wound therapy and acoustic pressure wound therapy are advanced wound-healing modalities that apply forms of mechanical pressure to wound tissue in an effort to promote healing by stimulating cellular proliferation. Using a combination of negative pressure wound therapy and acoustic pressure wound therapy was evaluated in a series of six patients with large, infected surgical wounds presenting with moderate to large amounts of serosanguineous drainage. After concurrent treatment with both modalities (range: 4 to 12 weeks), wound volume was reduced by 99% to 100% in all wounds except one wound for which depth at end of treatment was not measurable due to hypergranulation. Similarly, wound surface area was reduced by 82% to 100%, with the exception of the hypergranular wound, which decreased in size by 60%. Serosanguineous wound drainage was reduced in four wounds and remained unchanged in two wounds.     

Negative pressure wound therapy for massive subcutaneous emphysema: a systematic review and case series

BackgroundMassive subcutaneous emphysema can cause considerable morbidity with respiratory distress. To resolve this emphysema in short-term, negative pressure wound therapy could be applied as added treatment modality. However, its use is sparsely reported, and a variety of techniques are being described. This study provides a systematic review of the available literature on the effectiveness of negative pressure wound therapy as treatment for massive subcutaneous emphysema. In addition, our institutional experience is reported through a case-series.MethodsThe PubMed, Embase and Cochrane Library were systematically searched for publications on the use of negative pressure wound therapy for subcutaneous emphysema following thoracic surgery, trauma or spontaneous pneumothorax. Moreover, patients treated at our institution between 2019 and 2021 were retrospectively identified and analyzed.ResultsThe systematic review provided 10 articles presenting 23 cases. Studies demonstrated considerable heterogeneity regarding the location of incision, creation of prepectoral pocket, and surgical safety margin. Also closed incision negative pressure wound therapy and PICO^© device were discussed. Despite the apparent heterogeneity, all techniques provided favorable outcomes. No complications, reinterventions or recurrences were documented. Furthermore, retrospective data of 11 patients treated at our clinic demonstrated an immediate response to negative pressure wound therapy and a full remission of the subcutaneous emphysema at the end of negative pressure wound therapy. No recurrence requiring intervention or complications were observed.ConclusionsThe findings of this study suggest that negative pressure wound therapy, despite the varying techniques employed, is associated with an immediate regression of subcutaneous emphysema and full remission at the end of therapy. Given the relatively low sample size, no technique of choice could be identified. However, in general, negative pressure wound therapy appears to provide fast regression of subcutaneous emphysema and release of symptoms in all cases.     

Negative pressure wound therapy: Evidence-based treatment for complex diabetic foot wounds

Negative pressure therapy is a novel technology used for the promotion of wound healing and has emerged as the standard care in the management of problem wounds. Negative pressure wound therapy has been met with rapid clinical success and widespread acceptance. The literature is replete with case series, small trials, and noncomparative studies; however, there are few prospective, randomized, human trials examining this technology and its ability to promote healing. We review and evaluate the current literature on negative pressure therapy and its efficacy in the healing of complex diabetic wounds.     

Using negative pressure wound therapy following surgery for complex pilonidal disease: a case series

Complex pilonidal disease, an uncommon manifestation of an anorectal condition, is characterized by chronic or recurrent abscesses with extensive, branching sinus tracts. Definitive treatment requires wide excision of all involved tissue followed by secondary intention healing or reconstructive surgery. All treatment options have unique advantages and disadvantages. Following recent reports that negative pressure wound therapy after surgery for complex pilonidal disease may be a useful alternative to moist saline dressing treatments, five patients (three men and two women, median age 21 years [range: 16 to 63 years]) with complex pilonidal disease (symptom duration range 6 months to 30 years) were treated on an outpatient basis. Following wide excision under general anesthesia, a portable negative pressure wound therapy device was applied. Mean wound defect size after excision was 11 cm x 4 cm x 5 cm, or 205 cm(3) (range 90 cm(3) to 410 cm(3)). Negative pressure wound therapy was used for an average of 6 weeks (range 4 to 9 weeks) and mean time to complete epithelialization was 12 weeks (range 9 to 22 weeks), including use of moist saline dressings post negative pressure wound therapy. Treatment was discontinued in one patient due to skin irritation. No other complications were observed. Long-term follow-up is required to assess the risk of recurrent pilonidal disease or wound failure following negative pressure wound therapy. Additional studies of negative pressure wound therapy in the management of pilonidal disease are warranted.     

Acoustic pressure wound therapy to facilitate granulation tissue in sacral pressure ulcers in patients with compromised mobility: a case series

Electrical stimulation and other modalities are recommended for treatment of pressure ulcers in spinal cord injury patients but their use may be limited by clinical contraindications such as necrosis and infection. Acoustic pressure wound therapy can be used to address infection and has no known contraindications related to wound status. A retrospective nonconsecutive study was conducted involving five inpatients with sacral pressure ulcers and compromised mobility (spinal cord injury, ventilator/mobility dependency, or persistent vegetative state) treated with acoustic pressure wound therapy three times per week, 4 to 6 minutes per session, for 5 weeks to 5.5 months. Acoustic pressure wound therapy was administered until necrotic tissue was removed, granulation was complete, drainage resolved to moderate levels, and wound size was compatible with indications for high-voltage electrical stimulation. Within 1 to 4 weeks of starting acoustic pressure wound therapy, four out of five wounds with substantial yellow slough or eschar demonstrated 100% granulation tissue and wound area and volume decreased 71% to 97% and 75% to 99%, respectively. Subsequent treatments included electrical stimulation alone (three patients) or in conjunction with negative pressure wound therapy (one patient), and silver foam (one patient). Acoustic pressure wound therapy was found to be an effective option in preparing wounds for subsequent therapy.     

Negative pressure wound therapy and skin grafting for necrotizing fasciitis in a patient with rheumatoid arthritis treated with abatacept: A case report

Herein, we present a case of necrotizing fasciitis (NF) in a patient with rheumatoid arthritis (RA) treated with abatacept. Cultures of the patient’s leg effusion revealed group A Streptococcus. Treatment included antibiological drugs, repeat debridement, negative pressure wound therapy (NPWT), and skin grafting. This case highlights the need for suspicion of severe bacterial infection for early diagnosis and effective treatment. NF with RA can be treated effectively with repeat debridement and NPWT.     

Negative pressure wound therapy: "a rose by any other name"

Negative pressure wound therapy is one of the dominant adjunctive wound care modalities used in North America. One company has a proprietary hold on the market for this type of wound therapy and recent wound care literature has focused on the company's products rather than on the concept itself. Currently utilized standards for negative pressure wound therapy are based on a few relatively recent publications originating after 1997. However, a review of the English and Russian literature that predates this work reveals discrepancies regarding optimal duration of treatment, intensity of negative pressure, mode of application, timing of application, and intervals between treatments. A careful review of research that has rarely been cited in recent wound care literature elucidates the inconsistencies between currently held dogma and less well known negative pressure research. In order to achieve optimal outcomes of care, current practices must be re-evaluated and researched using well-established guidelines for determining treatment safety and effectiveness.     

Negative pressure wound therapy achieved by vacuum-assisted closure: Evaluating the assumptions

Wounds and the accompanying loss of skin integrity often place a patient at increased risk for disability or death. Billions of dollars are spent each year to treat wounds and the effectiveness of these different treatments is highly variable. Following a 1997 publication describing a new treatment therapy that involved creating negative pressure over the wound, many publications have described the purported mechanism of action by which negative pressure may help wounds heal. Although this therapy appears effective, it remains unknown whether it is more effective than other wound closure techniques. In addition, although many uncontrolled, non-randomized studies describing the effectiveness of this therapy have been published, few prospective randomized trials have been conducted. Small sample sizes, variable outcome measures across studies, and significant methodological problems in the available randomized control trials further limit the conclusions that can be drawn regarding the relative effectiveness of vacuum-assisted wound closure. Analysis of these data provides weak evidence to suggest that negative pressure therapy is superior to saline gauze dressings in healing chronic wounds. Randomized controlled trials comparing healing, costs of care, patient pain, and quality-of-life outcomes of this treatment to non-gauze type dressings and other treatment modalities are needed.     

Negative pressure wound therapy in the adjunctive management of necrotizing fascitis: examining clinical outcomes

Prompt diagnosis and treatment of necrotizing fascitis reduces the morbidity and mortality rates of this devastating disease. To examine the clinical outcomes of using negative pressure wound therapy in the adjunctive management of wounds secondary to necrotizing fascitis, a retrospective review of medical records was conducted. Participants included 11 consecutive patients (16 wounds) with a diagnosis of necrotizing fascitis admitted to a teaching hospital between 2000 and 2005 and treated on an inpatient basis with negative pressure wound therapy. The patients included seven men, four women (average age 54 years; range 18 to 82 years). Variables abstracted from the medical records and consultation notes included: demographic information, tissue and blood bacteriological data, wound history, wound healing outcomes, duration of negative pressure wound therapy, length of hospital stay, and mortality and morbidity information. Variables were entered into an electronic database and analyzed. Operative tissue biopsies were obtained and all participants received serial surgical debridements as well as infection, nutrition, and hemodynamic support. Negative pressure wound therapy was applied to the wound(s) at 125 mm Hg continuous negative pressure until reconstructive closure could be performed. Most wounds (10) were on lower extremities, seven patients presented with sepsis, and beta-hemolytic Streptococcus was identified in nine wounds. Mean number of negative pressure wound therapy treatment days was 25 (range: 7 to 74), mean length of stay was 67 days (range: 21 to 186). All wounds were successfully closed--73% received split-thickness skin grafts, 27% required flaps, 100% limb salvage was achieved, and all patients survived. No negative pressure wound therapy or dressing-associated complications were observed. Negative pressure wound therapy was found to be a viable adjunctive treatment in the management of wounds associated with necrotizing fascitis.     

Acoustic pressure wound therapy in the treatment of a vasculopathy-associated digital ulcer: a case study

Digital vasculopathy and subsequent digital ulceration are common and painful complications of limited cutaneous systemic sclerosis. Although the use of hydrocolloid occlusive dressings has been found to reduce pain, frequently required surgical or chemical debridement can be intensely painful in such ulcers. Acoustic pressure wound therapy is a noncontact, low-frequency ultrasound therapy used for painless debridement in a variety of acute and chronic wounds. It was administered to treat an intensely painful, methicillin-resistant Staphylococcus aureus-infected finger ulcer resulting from peripheral, bilateral vasculopathy in a 68-year-old man with a history of three prior fingertip amputations secondary to limited cutaneous systemic sclerosis-associated digital vasculopathy. At treatment initiation, 90% of the 11 cm2 wound was covered with firmly adherent fibrin slough. Acoustic pressure wound therapy was performed three times weekly for 5 minutes per treatment and the wound was covered with a hydrocolloid occlusive dressings. Pain scores decreased from 10 (visual analog scale, 0 = none, 10 = extreme) at the beginning of treatment to 0 at the week 8 assessment and his analgesics were discontinued. After 10 weeks (31 acoustic pressure wound therapy treatments), the wound was completely closed.     

Differentiated local therapy of chronic wounds with modern wound dressings

Differentiated local therapy of chronic wounds with modern wound dressings. The therapy of chronic wounds comprises besides treating the underlying disease, for instance compression therapy and phlebosurgery with venous ulcus cruris modern differentiated local therapy. Conventional wound therapy comprises primarily of colour solutions, various ointments, local antimicrobial agents, and sterile pressure bandages. Although it has been proven that conventional methods impede wound healing compared with modern wound dressings they are still widely used. In comparison the principle of moist wound healing is the basis of modern differentiated wound therapy. Therefore a vast number of modern wound dressings has been established in the last years. As not every wound dressing is suitable for every type of wound the knowledge of available modern wound dressings is essential in order to choose the wound dressing which is most suitable for the individual case. In the exudation/cleaning phase polyurethane foams, alginates and dressings containing activated charcoal are indicated. They can also be used in the granulation phase. The granulation phase is main indication for hydrokolloids and hydrogels. They are also used beside non-adhesive dressings and alginates in the epithelialisation phase. Besides the above synthetic wound dressings cytokines and biological skin equivalents are increasingly used in modern wound therapy. Biological skin equivalents comprise of epidermis equivalents, dermis substitutes and combined epidermis-dermis equivalents which are being developed at present. These will possibly be more effective on wound closure. Phase adapted use of modern wound dressings enables acute and chronic wounds to heal quickly and without complications. Present clinical studies are evaluating the importance of cytokines and new vital skin substitutes, which might offer interesting possibilities for further improvement in wound treatment.     

Developing evidence-based algorithms for negative pressure wound therapy in adults with acute and chronic wounds: literature and expert-based face validation results

Negative pressure wound therapy (NPWT) is used extensively in the management of acute and chronic wounds, but concerns persist about its efficacy, effectiveness, and safety. Available guidelines and algorithms are wound type-specific, not evidence-based, and many lack clearly described relative and absolute contraindications and stop criteria. The purpose of this research was to: (1) develop evidence-based algorithms for the safe use of NPWT in adults with acute and chronic wounds by nonwound expert clinicians, and (2) obtain face validity for the algorithms. Using NPWT meta-analyses and systematic reviews (n = 10), NPWT guidelines of care (n = 12), general evidence-based guidelines of wound care (n = 11), and a framework for transitioning between moisture-retentive and NPWT care (n = 1), a set of three algorithms was developed. Literature-based validity for each of the 39 discreet algorithm steps/decision points was obtained by reviewing best available evidence from systematic literature reviews (n = 331 publications) and abstraction of all NPWT-relevant publications (n = 182) using the patient-oriented Strength of Recommendation (SORT) taxonomy. Of the 182 NPWT studies abstracted, 25 met criteria for level 1 and 2 evidence but only one general assessment step had both level 1 evidence and an "A" strength of recommendation. Next, an Institutional Review Board-approved, cross-sectional mixed methods survey design face validation pilot study was conducted to solicit comments on, and rate the validity of, the 51 discreet algorithm-related statements, including the 39 decisions/steps. Twelve (12) of the 15 invited interdisciplinary wound experts agreed to participate. The overall algorithm content validity index (CVI) was high (0.96 out of 1). Helpful design suggestions to ensure safe use were made, and participants suggested an examination of commonly used wound definitions in follow-up studies. Results of the literature-based face validation confirm that the evidence base for using NPWT remains limited, especially for chronic wounds, and that safety guidance may be affected by the fact that evidence-based ratings cannot accurately reflect relative or absolute product contraindications because they simply are not included in clinical studies. These findings, the positive expert panel comments, and the high CVI confirm the need for an algorithm with explicit NPWT start-and-stop criteria and suggest that follow-up content and construct validation of these algorithms is warranted.     

Negative pressure therapy: theory and practice

Negative pressure (wound) therapy, synonymous with topical negative pressure or vacuum therapy mainly cited as branded VAC? (vacuum-assisted closure) therapy, is a mode of therapy used to encourage wound healing. It is used both as primary treatment of chronic and complex wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. The device has come into wide and successful use, although the physiological basis of its effect is not yet fully understood, and with a delay, increasingly evidence-based data become available. A meta-analysis was made of peer-reviewed publications (PubMed-Medline) chosen on the basis of inclusion of the terms randomized clinical trial, vacuum-assisted closure, and topical negative pressure. Scientific data were evaluated from experimental animal studies, randomized clinical trials, observations of clinical applications, and case reports on all known effects of VAC therapy. Systematic analysis of the data shows efficacy concerning induction of wound healing mechanisms, especially in the early stage. Increased perfusion can be considered proven. Data analysis shows positive efficacy for treatment of infection. Although this therapy appears effective and its superiority to conventional techniques has been demonstrated, there are still some critical votes concerning efficacy. Because its mechanisms of action remain unclear, and because there is still some gap between evidence-based data and the excellent clinical results, further prospective, randomized, blinded studies are needed. Even so, we conclude that vacuum therapy, used when indicated and especially by experienced surgeons, is an excellent tool to support wound healing.     

Acupuncture combined with auricular point sticking therapy for post stroke depression:a randomized controlled trial

正Objective To observe the clinical effects of acupuncture combined with auricular point sticking based on the western medication for post stroke depression(PSD).Methods Sixty patients with PSD were randomly assigned into an acupuncture plus auricular application group(a combination group)and a medication group,30 cases in each one.20 mg paroxetine hydrochloride was prescribed orally in the medication group,once a day for continuous     

Topical negative pressure therapy in wounds after cardiothoracic surgery: successful experience supported by literature

BACKGROUND: Patients undergoing cardiothoracic surgery are at substantial risk of developing surgical site infections (SSI). SSI is not only associated with an increased morbidity but also with high mortality. Topical negative pressure therapy (TNP) is a promising method for treating surgical site defects (SSD). In recent years, we have gained a wide experience with TNP in a great variety of SSD. METHODS: We completed a prospective follow-up report of all patients treated with TNP after cardiothoracic surgery at the Academic Medical Centre Amsterdam, a university hospital. A review of the current evidence for TNP in cardiothoracic surgery is presented. RESULTS: Between August 2000 and March 2005, TNP was used in 105 patients in 113 SSD. As we gained more experience, we saw a decline in hospital stay ( P < 0.0001) and duration of TNP therapy. Surgical closure was performed in 62 % of patients using simple surgical (reconstructive) techniques. Therapy-related complications were rare (n = 1). CONCLUSION: Based on clinical findings and supported by the research presented, the treatment modality of choice for SSD after cardiothoracic surgery is TNP.