Single-use negative pressure wound therapy for the treatment of chronic lower leg wounds
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Objective: Lower extremity ulcers are caused by multiple disease processes and contribute to a high level of patient morbidity and health-care spending in the US. Negative pressure wound therapy (NPWT) has been used extensively for wound bed preparation. Our aim is to assess the efficacy of an affordable, low-profile single-use NPWT (single-use NPWT) on chronic lower extremity wounds that would usually be deemed too small or superficial for traditional NPWT. Method: A prospective pilot study was undertaken in which chronic lower extremity wounds were treated with single-use NPWT. Study visits were biweekly for primary contact dressing change, with the negative pressure unit being changed weekly. Biweekly assessments were made of wound appearance, surface area, depth, exudate amount, peri-wound skin integrity, and signs of clinical infection. Digital photography was performed at each visit. Patients with venous leg ulcers (VLUs) were treated with a 3-layer wrap. Diabetic foot ulcers (DFUs) were treated with off-loading shoes. Results: The study recruited 12 patients. There were 13 wounds in total; two DFUs, two traumatic/postoperative/pressure ulcers, and nine VLUs. DFUs decreased in size on average 62%, VLUs by 32%, and traumatic/postoperative/pressure wounds by 74%. The wound appearance became more favourable and the wound depth decreased with the use of single-use NPWT. Conclusion: Single-use NPWT is a suitable therapy for chronic lower extremity wounds. Single-use NPWT led to a decrease in wound size and depth, an increased amount of granulation tissue, and a high level of patient satisfaction, with a low complication rate. Declaration of interest: This study was funded by Smith & Nephew, Hull, UK. JC Lantis is a paid consultant for KCI, Smith & Nephew, Healthpoint and Macrocure. C Gendics is a paid consultant for Macrocure and ManukaMed.Keywords:
Negative-pressure wound therapy
Granulation tissue
Wound care
Debridement (dental)
Diabetic ulcers
This study aims to conduct a literature review related to research results that discusses the effectiveness of NPWT on diabetic foot ulcers (DFU). The method used is a systematic review method from online databases such as Scopus, ClinicalKey, ClinicalKey Nursing, EBSCOhost, Proquest, ScienceDirect, Springer Link, Pubmed, and SAGE Journals using the keywords diabetes mellitus, negative pressure wound therapy, NPWT, and diabetic foot ulcer. The search uses the "AND" and "OR" logic booleans. The results of a systematic review study obtained six articles describing showing that NPWT can help speed up the healing process of DFU wounds. In conclusion, the use of Negative Pressure Wound Therapy (NPWT) in wound care is a relatively effective treatment method for diabetic foot wounds. Keywords: Diabetes Mellitus, Diabetic Foot Wounds, NPWT, Negative Pressure Wound Therapy
Negative-pressure wound therapy
Diabetic ulcers
Diabetic foot ulcer
Wound care
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Negative pressure wound therapy (NPWT) is commonly used in the continuous mode. Intermittent pressure therapy (IPT) results in faster wound healing, but it often causes pain. Variable pressure therapy (VPT) has therefore been introduced to provide a smooth transition between 2 different pressure environments, thereby maintaining the negative pressure environment throughout the therapy. The aim of the present study was to examine the effects of IPT and VPT on granulation tissue formation.A peripheral wound in a porcine model was treated for 72 hours with continuous NPWT (-80 mm Hg), IPT (0 to -80 mm Hg), or VPT (-10 to -80 mm Hg), using foam or gauze as wound filler. Wound contraction and force to remove the wound filler were measured. Biopsies from the wound bed were examined histologically for granulation tissue formation.Intermittent pressure therapy and VPT produced similar results. Wound contraction was more pronounced following IPT and VPT than continuous NPWT. Intermittent pressure therapy and VPT resulted in the formation of more granulation tissue than continuous NPWT. Leukocyte infiltration and tissue disorganization were more prominent after IPT and VPT than after continuous NPWT. Granulation tissue grew into foam but not into gauze, regardless of the mode of negative pressure application, and less force was needed to remove gauze than foam.Wound contraction and granulation tissue formation is more pronounced following IPT and VPT than continuous NPWT. Granulation tissue grows into foam but not into gauze. The choice of negative pressure mode and wound filler is crucial in clinical practice to optimize healing while minimizing pain.
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This case study examines the effectiveness of using negative pressure wound therapy (NPWT) in the management of a hard-to-heal (chronic) wound with exposed ankle bone to reduce associated wound exudate and promote production of granulation tissue. A 60-year-old male patient who was able to attend wound follow-up diligently twice weekly for eight weeks, and weekly thereafter, was selected from a private hospital to take part. During each dressing change, the wound was cleansed with superoxidised cleansing solution, and minimal sharp debridement was performed. In the authors' opinion, the NPWT device used in this study is light and convenient for use in the community or home care setting. The NPWT wound dressing was connected to the NPWT machine via a connecting tube and the device then switched on using the default setting of a negative pressure of 125mmHg. Following the application of the NPWT device, the exposed ankle bone was successfully covered with healthy granulation tissue and healed within 20 weeks with minimal exudate formation in the wound. In the authors' opinion, NPWT is able to promote progress to wound healing; to minimise unnecessary dressing changes and, based on feedback from the patient, is comfortable to wear and when in use.
Negative-pressure wound therapy
Granulation tissue
Wound care
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Wound dressing
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Vacuum-assisted closure (VAC) therapy, also referred to as vacuum-assisted closure negative pressure wound therapy (VAC NPWT), delivered to various dermal wounds is believed to influence the formation of granulation tissue via the mechanism of microdeformational signals. In recent years, numerous experimental investigations have been initiated to study the cause-effect relationships between the mechanical signals and the transduction pathways that result in improved granulation response. To accurately quantify the tissue microdeformations during therapy, a new three-dimensional finite element model has been developed and is described in this paper. This model is used to study the effect of dressing type and subatmospheric pressure level on the variations in the microdeformational strain fields in a model dermal wound bed. Three-dimensional geometric models representing typical control volumes of NPWT dressings were generated using micro-CT scanning of VAC GranuFoam, a reticulated open-cell polyurethane foam (ROCF), and a gauze dressing (constructed from USP Class VII gauze). Using a nonlinear hyperfoam constitutive model for the wound bed, simulated tissue microdeformations were generated using the foam and gauze dressing models at equivalent negative pressures. The model results showed that foam produces significantly greater strain than gauze in the tissue model at all pressures and in all metrics (p<0.0001 for all but epsilon(vol) at -50 mm Hg and -100 mm Hg where p<0.05). Specifically, it was demonstrated in this current work that the ROCF dressing produces higher levels of tissue microdeformation than gauze at all levels of subatmospheric pressure. This observation is consistent across all of the strain invariants assessed, i.e., epsilon(vol), epsilon(dist), the minimum and maximum principal strains, and the maximum shear strain. The distribution of the microdeformations and strain appears as a repeating mosaic beneath the foam dressing, whereas the gauze dressings appear to produce an irregular distribution of strains in the wound surface. Strain predictions from the developed computational model results agree well with those predicted from prior two-dimensional experimental and computational studies of foam-based NPWT (Saxena, V., et al., 2004, "Vacuum-assisted closure: Microdeformations of Wounds and Cell Proliferation," Plast. Reconstr. Surg., 114(5), pp. 1086-1096). In conjunction with experimental in vitro and in vivo studies, the developed model can now be extended into more detailed investigations into the mechanobiological underpinnings of VAC NPWT and can help to further develop and optimize this treatment modality for the treatment of challenging patient wounds.
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Diabetic foot (DF) is a common complication of diabetes and the first cause of hospital admission in diabetic patients.In recent years several guidelines have been proposed to reinforce the the management of DF with a notable increase in diabetes knowledge and an overall reduction of amputations.Significant improvements have been reached in the treatment of diabetic foot ulcers (DFUs) and nowadays clinicians have several advanced medications to apply for the best local therapy.Among these, negative pressure wound therapy (NPWT) is a useful adjunct in the management of chronic and complex wounds to promote healing and wound bed preparation for surgical procedures such as skin grafts and flap surgery.NPWT has shown remarkable results although its mechanisms of action are not completely understood.In this paper, we offer a complete overview of this medication and its implication in the clinical setting.We have examined literature related to NPWT concerning human, animal and in vitro studies, and we have summarized why, when and how we can use NPWT to treat DFUs.Further we have associated our clinical experience to scientific evidence in the field of diabetic foot to identify a defined strategy that could guide clinician in the use of NPWT approaching to DFUs.
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In Brief Negative pressure wound therapy (NPWT) is an option for management of complex wounds such as diabetic foot ulcers; therefore, the nursing literature from 2000 to 2010 was reviewed for studies comparing clinical outcomes for diabetic foot ulcers treated with NPWT and those treated with standard moist wound therapy (SMWT). PubMed and OVID databases were explored using the following search terms: vacuum-assisted closure, NPWT, diabetic wounds, and standard most wound therapy. Research studies to judge efficacy were limited to the results from studies of experimental studies with randomized clinical trials on patients with diabetic foot wounds as the inclusion criteria. Four studies were identified that met the established criteria. Despite variations in patient population, methodology, and additional outcome variables studied, NPWT systems were shown to be more effective than SMWT with regard to proportion of healed wounds and rate of wound closure. The CE test for this article is available online only at the journal website, jwocnonline.com, and the test can be taken online at NursingCenter.com/CE/JWOCN.
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Diabetic ulcers
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Negative-pressure wound therapy
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Granulation
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PURPOSE: To provide an overview of the literature related to the treatment of diabetic foot ulcers. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: Outline the management goals and assessment of diabetic foot ulcers. Describe the surgical treatment and wound care of diabetic foot ulcers.
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Foot (prosody)
Diabetic foot ulcer
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Introduction and objective: Diabetes is one of the most common metabolic diseases in the world. Diabetic foot ulcers, which are often the result of the disease, are undoubtedly a nursing challenge. Negative pressure wound therapy (NPWT) is a new therapeutic method supporting wound healing, which has been useful in patients with diabetic foot. The purpose of this study is to compare the effectiveness of negative pressure therapy in comparison to the standard method in the treatment of diabetic foot. Review methods: In February 2023, articles found in the Medline (Pubmed) and Google Scholar databases were selected by using the following keywords: negative pressure wound therapy; VAC therapy; traditional dressing; standard moist wound care; diabetic foot. Brief description of the state of knowledge: NPWT has been proven to be associated with reduced healing time and faster appearance of granulation tissue, which is a sign of wound healing. Patients using this method require fewer dressing changes and surgical cleanings. Negative pressure therapy reduces the time to rehospitalisation and the risk of amputation or resection of the diabetic foot. Summary: Negative pressure wound therapy is more effective in the treatment of diabetic foot ulcers than traditional therapy. Despite the costs associated with NPWT being higher, the method proves to be more profitable. It is important to remember about good therapy technique and proper selection of patients.
Negative-pressure wound therapy
Wound care
Granulation tissue
Debridement (dental)
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Diabetic foot ulcer
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당뇨병성 족부 궤양(diabetic foot ulcer, DFU)은 당뇨병에 동반되는 매우 심각한 합병증으로 당뇨병 환자의 사망률을 2배 이상 증가시키며 비외상성 하지 절단 원인의 절반 이상을 차지한다[1,2]. 뼈, 인대 등이 노출되는 DFU는 전신상태가 불량한 사람에서 주로 발생하며 하지 절단이 필요한 경우가 많다[2]. DFU는 병태생리적으로 신경병증, 하지 허혈, 감염, 변형의 여러 원인이 복합적으로 동반되고[2-4], 치료에 오랜 시간과 많은 비용이 소요되어 심각한 보건학적 및 경제적 문제를 야기한다. 만성적인 DFU를 효과적으로 치료하기 위한 다양한 치료법이 개발되어 왔으며 그 중 진공보조 봉합 (Vacuum-Assisted Closure, VAC)을 이용한 음압 창상 치료법(Negative-Pressure Wound Therapy, NPWT)은 매우 주목할 만한 방법이다[5]. 다기관 무작위 대조군 연구에서 VAC-NPWT가 심각한 DFU에서 고식적인 치료방법만큼 안전하면서, 상처 치유 속도를 개선시키고, 하지 절단율을 줄였다[6-8]. 컴퓨터 조절 진공 펌프와 드레싱용 스폰지, 부착성 드레싱 제재, 배기 튜브 등으로 구성된 상품화된 시스템(V.A.CRATS; KCI, San Antonio, Texas, U.S.A)이 있으나 높은 비용으로 국내에서는 난치성 만성 창상이나 욕창, 심각한 외상 후 창상 등에 제한적으로 사용되고 있다[9,10]. 최근 국내 논문에서 비용 문제를 해결하기 위해 컴퓨터-조절 진공 펌프 대신 벽흡인기(wall suction)를 이용한 변형된 방법으로 만성 창상을 치료한 결과를 보고하였다 [11-13]. 이에 저자들은 세 명의 심각한 DFU 환자에서 고가의 Abstract Original Articles & Case Reports
Negative-pressure wound therapy
Diabetic foot ulcer
Foot (prosody)
Wound care
Wound Closure
Foot pressure
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