BackgroundDiabetic wounds with additional comorbidities are costly, time intensive, and difficult to heal. Often, multiple modalities may be necessary to achieve wound resolution, relying on the synergistic advantage of each therapy to affect wound healing. The selectivity of Clostridium collagenase is physiologically effective at degrading non-viable collagen fibers while preserving living collagen tissue. Additionally, negative pressure wound therapy (NPWT) has long been used to aid wound healing while concurrently depreciating biological wound burden time.MethodsSix patients were selected from those appearing to our university based limb salvage service. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base, in which NPWT was indicated, without exclusion criteria. Patients enrolled were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded.ResultsTandem application of these therapies appeared to expedite wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Unfortunately, not all patients were able to reach full healing; with two patients experiencing ulcer recurrence, likely a result of their significant comorbid nature.ConclusionIn our experience, we have noticed a specific subgroup of patients who benefit greatly when collagenase enzymatic debridement therapy is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds to the next step in healing despite the current paucity in literature discussing this specific pairing.
The use of antibiotic-impregnated chitosan sponges appears a safe and effective mechanism of local delivery of antimicrobials in wounds. Future studies and clinical trials are ongoing to confirm these results and to guide clinical applications.
From antiquity to today, tissue repair and wound healing have played a central role in health. Over the past generation, negative pressure wound therapy (NPWT) has shown itself to be a valuable adjunct in wound healing, with effects that are superior to many traditional wound treatment modalities. Applications of NPWT are widespread, with use seen in management of severe soft tissue loss, prevention of surgical site infections, treatment of diabetic foot ulcers, and improving skin graft survival. This article reviews the biology, mechanics, and therapeutic effects of NPWT, while also discussing social and economic aspects of use. Finally, various possible adjustments and modifications to NPWT are addressed, all of which contribute to the continual evolution of NPWT at the frontier of modern wound healing and surgery.
How to cite this article
Hatch DC, Sauciuc V, Wagler EC, Schenavar B, Armstrong D. Negative Pressure Wound Therapy: Past, Present, and Future. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):80-87.
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