Extensively described in the 1990s, negative pressure wound therapy (NPWT) promotes the wound healing process and is an effective way to manage all types of acute and chronic wounds, including those considered refractory to other therapeutic procedures.1,2 This nonpharmacological therapy has emerged as a cutting-edge technology because it may provide an alternative solution for health care professionals involved in wound care management and as such may represent one of the most successful treatment modalities for wound healing.3
Despite positive clinical outcomes, reviews of the literature4,5 regarding patients’ experiences show varying side effects of this procedure such as pain, stress, and anxiety. Qualitative research6 shows patients receiving NPWT felt stress relative to the care environment and the dressing change process; specifically, foam dressing change often required prescription of oral analgesics. In a more recent study7 that described the effect of NPWT-related pain on the daily life activities on patients following abdominal surgery, pain was mostly reported during foam dressing changes and wrap removal; in addition, that impairment caused some patients to discontinue treatment. This commonly reported pain during NPWT foam removal is probably due to the ingrowth of granulation tissue in the micropores present on the foam.8
Authors recommend a range of strategies to reduce pain at removal of the foam, including the use of analgesics or local anesthetics 30 to 60 minutes before, impregnating the foam with saline solution before removal, switching the pump off 1 hour before dressing removal, and gradually reducing the negative pressure.9,10 Pain on removal also may be avoided or reduced by using a nonadherent dressing beneath the foam dressing.
UrgoTul (URGO Medical, Fort Worth, TX) is a nonadhesive, nonocclusive contact layer made of nonwoven polyester mesh impregnated with hydrocolloid particles dispersed in a petroleum jelly matrix. Numerous prospective clinical trials11 have demonstrated the benefits of this dressing in the local treatment of acute and chronic wounds. In France, caregivers familiar with the NPWT procedure often introduce an UrgoTul contact layer between the NPWT foam and the wound bed. Its small mesh size prevents granulation tissue from migrating into the foam, reducing the risk of damaging granulation buds at removal. This procedure allows a painless or less painful removal of the foam dressing and results in improved patient acceptability of the NPWT procedure. This dressing is widely recognized to induce a painless dressing removal, as reported in clinical pediatric trials12 and in the management of congenital epidermolysis bullosa skin lesions,13 and its use is supported by a large survey13 (N = >5000) on the incidence of pain in patients presenting with acute and chronic wounds.
The aim of this clinical study was to evaluate the benefits of the UrgoTul contact layer with regard to patient pain experiences when used in combination with NPWT foam in the local treatment of acute and chronic wounds.