The Efficiency and Results Of Negative Pressure Wound Therapy Method In The Treatment Of SlowHealing Lower Extremity Wounds

Abstract

Aim: The chronic infected wounds are commonly encountered in the orthopedic practice and occur due to several etiological factors. They are responsible for serious morbidity and mortality. Regardless of the etiology, the underlying factors at these wounds are healing problems and predisposition to infection due to microvascular insufficiency. There are several methods for the treatment of these wounds. One of them is vacuum assisted closure systems (VAC) or negative pressure wound therapy (NPWT). The aim of present study is to evaluate the NPWT methods’ efficacy in the treatment of chronic lower extremity wounds with insufficient microvascular blood supply.Material-method: The data and results of a case series of five patients with several etiologies who had been treated by NPWT are analyzed and the results are evaluated retrospectively in this study.Findings and results: Five patients with chronic wound in their lower extremities due to microvascular circulation insufficiency were treated with NPWT for a period ranging from 11 to 51 days (average 31 days). The chronicity time was average 53,3 days in patients. NPWT was applied in -75 mmHg with -150 mmHg pressures. According to findings of this study, the NPWT was found influent as a method for the treatment of chronic wounds with insufficient blood circulation in lower extremities.

Keywords

• Chronic wounds, vacuum assisted closure, infection, diabetes, Buerger disease, negative pressure wound therapy.

Zor İyileşen Alt Ekstremite Yaralarının Tedavisinde Negatif Basınçlı Yara Tedavi Yönteminin Etkinliği ve Sonuçları

Öz

Özet:

Amaç:

Alt ekstremitelerin kronik enfekte yaraları, ortopedi pratiğinde sıkça karşılaşılan ve birden fazla etyolojiye bağlı oluşan, ciddi morbidite ve mortalite nedenleridir. Etyolojisi ne olursa olsun fizyopatolojisinde mikrovasküler yetmezliğe bağlı iyileşme zorluğu ve enfeksiyona yatkınlık vardır. Tedavisinde bir çok yardımcı yöntem kullanılmaktadır. Bunlardan biri de vakum yardımlı yara kapama (VAC) yada negatif basınçlı yara tedavi (NBYT) yöntemidir. Bu çalışma ile zor iyileşen yaraların tedavisinde NBYT yönteminin erkinliği araştırılması amaçlandı.

Gereç-yöntem:

Kliniğimizde çeşitli etyolojik faktörelere bağlı kronik yaraları olan ve tedavisinde negatif basınçlı yara tedavi sistemleri kullanılan 5 hastalık bir olgu serisinin verileri analiz edilerek, tedavi sonuçları geriye dönük olarak değerlendirilmiştir.

Bulgular ve sonuç:

Alt ekstremitelerinde kronik yarası bulunan ve yara kronisite süresi 53,3 gün olan beş hasta ortalama 31 (11-51) gün süre ile tedavi edildi. Hastalara -75 ile -150 mmHg basınç ile NBYT uygulandı. Çalışmanın sonuçlarına göre NBYT, dolaşım bozukluğu nedeni ile ortaya çıkan alt ekstremite yaralarının tedavisinde başarılı bir yöntem olarak bulundu.

Anahtar Kelimeler

• Kronik yara,vakum yardımlı kapama,enfeksiyon,diyabet,Buerger hastalığı,negatif basınçlı yara tedavisi.

References

1. Armstrong DG, Lavery LA, Boulton AJ: Negative pressure wound therapy via vacuum-assisted closure following partial foot amputation: what is the role of wound chronicity? Int Wound J 2007, 4:79-86.
2. Mendonca DA: Negative pressure wound therapy: an important adjunct to wound care. South Med J 2006, 99:562-563.
3. Ennker IC, Malkoc A, Pietrowski D, Vogt PM, Ennker J, Albert A: The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis--a single center experience with 54 patients. J Cardiothorac Surg 2009, 4:5.
4. Chadwick P: The use of negative pressure wound therapy in the diabetic foot. Br J Nurs 2009, 18:S12, S14, S16, passim.
5. Ferreira MC, Carvalho VF, Kamamoto F, Tuma P, Jr., Paggiaro AO: Negative pressure therapy (vacuum) for wound bed preparation among diabetic patients: case series. Sao Paulo Med J 2009, 127:166-170.
6. Gupta S, Baharestani M, Baranoski S, de Leon J, Engel SJ, Mendez-Eastman S, Niezgoda JA, Pompeo MQ: Guidelines for managing pressure ulcers with negative pressure wound therapy. Adv Skin Wound Care 2004, 17 Suppl 2:1
7. Gupta S, Cho T: A literature review of negative pressure wound therapy. Ostomy Wound Manage 2004, 50:2S-4S.
8. Hemkens LG, Waltering A: Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial: response to Blume et al. Diabetes Care 2008, 31:e76; author reply e77.

9. Jerome D: Advances in negative pressure wound therapy: the VAC instill. J Wound Ostomy Continence Nurs 2007, 34:191-194.
10. Miller MS, Whinney R, McDaniel C: Treating a nonhealing wound with negative pressure wound therapy. Adv Skin Wound Care 2006, 19:202, 204-205.
11. Mokhtari A, Gustafsson R, Sjogren J, Nilsson J, Lindstedt S, Malmsjo M, Ingemansson R: Haemodynamic effects of -75 mmHg negative pressure therapy in a porcine sternotomy wound model. Int Wound J 2009, 6:48-54.
12. Preston G: An overview of topical negative pressure therapy in wound care. Nurs Stand 2008, 23:62-64, 66, 68.
13. Sandison S: Negative pressure wound therapy promoted healing of diabetic foot ulcers more than advanced moist wound therapy. Evid Based Nurs 2008, 11:116.
14. Schlatterer D, Webb LX: Orthopedic indications for negative pressure wound therapy. Ostomy Wound Manage 2005, 51:27S-28S.
15. Sepulveda G, Espindola M, Maureira M, Sepulveda E, Ignacio Fernandez J, Oliva C, Sanhueza A, Vial M, Manterola C: [Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial]. Cir Esp 2009, 86:171-177.
16. Steenvoorde P, de Roo RA, Oskam J, Neijenhuis P: Negative pressure wound therapy to treat peri-prosthetic methicillin-resistant Staphylococcus aureus infection after incisional herniorrhaphy. A case study and literature review. Ostomy Wound Manage 2006, 52:52-54.
17. Thompson G: An overview of negative pressure wound therapy (NPWT). Br J Community Nurs 2008, 13:S23-24, S26, S28-30.
18. Ubbink DT, Vermeulen H, Legemate DA: Comment on: “Negative pressure wound therapy: a systematic review of effectiveness and safety”, P. Vikatmaa, V. Juutilainen, P. Kuukasjarvi, A. Malmivaara, Eur J Vasc Endovasc Surg 2008;36(4):438-48.
19. Eur J Vasc Endovasc Surg 2009, 37:740-741; author reply 741-742.
20. Vikatmaa P, Juutilainen V, Kuukasjarvi P, Malmivaara A: Negative pressure wound therapy: a systematic review on effectiveness and safety. Eur J Vasc Endovasc Surg 2008, 36:438-448.
21. Wu SC, Armstrong DG: Clinical outcome of diabetic foot ulcers treated with negative pressure wound therapy and the transition from acute care to home care. Int Wound J 2008, 5 Suppl 2:10-16.
22. Yazışma Adresi / Correspondence: Hayati AYGÜN Kafkas Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Departmanı, 36100 Kars Türkiye e-posta: [e-mail]