I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Using Low Pressure, NPWT for Wound Preparation & the Management of Split-Thickness Skin Grafts in 3 Patients with Complex Wound
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42 Abstract: The use of negative pressure wound therapy (NPWT) is well established in the management of hard-to-heal wounds. One institution, familiar with NPWT’s capabilities as well as its shortcomings (eg, pain at dressing changes and pain with the maximum recommended setting of 125 mm Hg), sought a viable alternative. A low pressure, negative pressure wound therapy (LP-NPWT) system, using subatmospheric pressure levels of 75 mm Hg and a low-adherence dressing, was evaluated to prepare the wound bed for split-thickness skin graft (STSG) on three patients. One patient was a healthy 23-year-old man with extensive trauma-related soft tissue wounds. The two women — 54 and 47 years old — had multiple comorbidities. One had a lower extremity fasciotomy wound and the other had a dehisced surgical wound with a history of irradiation. Wound area was reduced >60% in all three wounds in 3 to 6 weeks as new granulation tissue developed. The average pain reported was moderate (4 to 5 on a Visual Analogue Scale), ranging from 2 to 10 during dressing changes to 1 to 7 between dressing changes; pain levels reported tended to decrease as therapy progressed. Little or no trauma on dressing removal and no signs of infection were noted. In all cases, STSGs, followed by 4 days of LP-NPWT were applied and all wounds healed. The results from these three cases suggest that the LP-NPWT system is a useful healing adjunct for complex wound bed preparation and graft management. Clinical studies to quantify the effects of LP-NPWT technology and compare its safety and efficacy to other negative pressure systems are needed.
Key Words: case series, traumatic wounds, skin grafts, low-pressure negative pressure therapy
Ms. Nease is a physical therapist, Memorial Health University Medical Center, Savannah, GA. Please address correspondence to: Cheryl Nease, PT, Memorial Health University Medical Center, 4700 Waters Avenue, Savannah, GA 31403; email: cnease1987@aol.com.
The use of negative pressure wound therapy (NPWT) has been well established and documented in the successful management of hard-to-heal wounds. From as far back as 1947 when the use of suction drainage was recorded for clearing postoperative accumulation of blood, bile, or exudate, the use of NPWT has been a valuable addition to the clinician’s armamentarium of products and strategies.1
Understanding of clinical wound management and the mechanisms of NPWT action has expanded, as have NPWT system, dressing, and material technologies. A recent review2 of the published literature concluded that the benefits of NPWT may include reduction of wound volume/size, faster wound healing, enhancement of the rate of graft take, reduction of complications, and reduction of nursing time and costs.
The reported benefits of NPWT include the creation of a moist wound 
environment, physical stimulation of a biologic response, removal of exudate and reduction of edema, alteration of wound fluid composition, assistance in granulation tissue formation, and control of bacterial burden.2,3 One key element in the mechanism of action as described in the literature is “… the application of mechanical force [cellular strain] to wounds induces tissue deformation at the level of individual cells, leading to cell stretch, thereby providing a powerful mechanism for inducing cell proliferation and angiogenesis and hence promoting wound healing.”4
Memorial Health University Medical Center (MHUMC), the author’s institution, a 535-bed, level 1 trauma center and teaching hospital, lacks a standard protocol for the management of complex and/or large wounds.
References:
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3. Andros G, Armstrong DG, Attinger C, et al. Consensus statement on negative pressure wound therapy (V.A.C.® Therapy) for the management of diabetic foot wounds. WOUNDS. 2006;6 (suppl):1–32.
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8. Penny H. Treatment of a chronic (8 years), infected, full-thickness plantar ulcer utilizing a novel negative pressure wound therapy with Bio-Dome dressing technology. Poster presented at the American Professional Wound Care Association. Fort Worth, TX. March 6–9, 2008.
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