247. Management of grade IV pressure ulcer with a novel negative pressure device in traumatic paraplegia subjects

BACKGROUND CONTEXT Pressure ulcers (PUs) are wounds initiated by pressure on the skin that blocks circulation, causing the skin and underlying tissues to die. PUs are a major health problem for bedridden patients or persons with reduced mobility; individuals with spinal cord injury (SCI) are especially more prone to developing pressure ulcers. Chronic wounds such as PUs are difficult to treat with available standard medical therapy and represent a burden on health care professionals and drain on resources and developing more effective treatments is therefore a necessity. Recent interest in the treatment of chronic wounds has shifted from a primary focus on the selection of topical dressings augmented by pharmaceutical agents to a focus on therapies designed to enhance various aspects of the wound healing cascade. Negative pressure wound therapy includes mechanical, vacuum-assisted methods that exert negative pressure of 60 to 125 mm Hg on the wound bed. Commercially available devices are typically rented and require costly consumables. This study focuses on a novel, bellows-powered negative pressure device (NPD) that is easy to apply and does not require electricity. PURPOSE The purpose of this study was to find the efficacy of negative pressure wound therapy by a novel negative pressure device for the treatment of PUs. STUDY DESIGN/SETTING This study was done at the Spinal Cord Injury Unit, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, India. PATIENT SAMPLE Thirty-four spinal cord injury (SCI) cases resulting paraplegia with PUs of grade 4 were recruited in the study. All cases were equally divided in two treatment groups: 17 cases managed by negative pressure wound therapy by a novel NPD and & 17 were received wet to moist gauze dressing as standard wound care. OUTCOME MEASURES Reduction of length, width and depth of PUs, reduction of exudate and formation of healthy granulation tissue. METHODS Application of the novel NPD and all subsequent dressing-related procedures occurred at the patient's bedside. The perforated end of the drainage tube was placed on the wound surface, and its other end was extended approximately 10 cm away from the wound margin and connected to the bellows. Sterilized foam was trimmed according to the size and geometry of the wound and placed on top as a cover. The transparent film dressing was used to cover the wound and the border of adjoining healthy skin in order to achieve an airtight seal. The bellows of the NPD was charged to attain appropriate cyclical/ intermittent negative pressure. Patients and caregivers were taught how to charge the NPD and advised to charge it after every 5 to 6 hours. Standard wound care was done by wet to moist dressing with normal saline. RESULTS Wound healing outcome measures were compared at 3, 6 and 9 weeks. There were no significant changes in the length and width of PUs between the groups until week 3. Significantly reduced length and width of NPD treated PUs were found at week 6 (p=0.04) which further reduced at week 9 (p=0.001) as compared to standard wound care group cases. Similarly, significant reduction in the depth of PUs was found in the NPD treated group at week 9 (P CONCLUSIONS Negative pressure wound therapy may be the future of wound healing. Our novel negative pressure device is safe, easy to apply and efficacious in treating the pressure ulcer. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.