Negative pressure therapy (vacuum) for wound bed preparation among diabetic patients: case series

Abstract

CONTEXT: Complications from diabetes mellitus affecting the lower limbs occur in 40 to 70% of such patients. Neuropathy is the main cause of ulceration and may be associated with vascular impairment. The wound evolves with necrosis and infection, and if not properly treated, amputation may be the end result. Surgical treatment is preferred in complex wounds without spontaneous healing. After debridement of the necrotic tissue, the wound bed needs to be prepared to receive a transplant of either a graft or a flap. Dressings can be used to prepare the wound bed, but this usually leads to longer duration of hospitalization. Negative pressure using a vacuum system has been proposed for speeding up the treatment. This paper had the objective of analyzing the effects of this therapy on wound bed preparation among diabetic patients.CASE SERIES: Eighty-four diabetic patients with wounds in their lower limbs were studied. A commercially available vacuum system was used for all patients after adequate debridement of necrotic tissues. For 65 patients, skin grafts completed the treatment and for the other 19, skin flaps were used.Wound bed preparation was achieved over an average time of 7.51 days for 65 patients and 10 days for 12 patients, and in only one case was not achieved.CONCLUSIONS: This experience suggests that negative pressure therapy may have an important role in wound bed preparation and as part of the treatment for wounds in the lower limbs of diabetic patients. RESUMOCONTEXTO: Complicações do diabetes mellitus que afetam os membros inferiores ocorrem em 40 a 70% dos pacientes. A neuropatia é a principal causa de ulceração e pode estar associada com problemas vasculares. A ferida evolui com necrose e infecção, e se não for corretamente tratada poderá terminar em amputação. O tratamento cirúrgico é preferido em feridas complexas, quando não há cicatrização espontânea. Após desbridamento cirúrgico do tecido necrótico do leito da ferida este precisa ser preparado para receber um transplante, seja um enxerto ou um retalho. Curativos podem ser usados para o preparo do leito da ferida, mas frequentemente levam a um longo tempo de hospitalização. A pressão negativa usada através de um sistema vácuo foi proposta para acelerar o tempo de tratamento. O presente trabalho teve como finalidade analisar os efeitos desta terapia no preparo do leito de feridas em pacientes diabéticos. SÉRIE DE CASOS:Oitenta e quatro pacientes diabéticos com feridas em membros inferiores foram estudados. Um sistema vácuo de uso comercial foi utilizado em todos os pacientes após adequado desbridamento de tecidos necróticos. Em 65 pacientes enxertos de pele completaram o tratamento e em outros 19 retalhos cutâneos. O preparo do leito da ferida foi conseguido, em média, em 7,51 dias em 65 pacientes, em 10 dias para 12 pacientes e em somente um caso não foi efetivo. CONCLUSÃO:A experiência sugere que a terapia por pressão negativa possa ter um papel importante no preparo do leito e como parte do tratamento de feridas nos membros inferiore...

Role of customised negative-pressure wound therapy in the integration of split-thickness skin grafts: A randomised control study

“…Other causes of wounds reported in literature for which NPWT has been used for the integration of STSG include diabetic wounds,[13] hidradenitis cystica and amputation stump wounds,[5] wounds following excision of irradiated extremity sarcomas,[14] necrotising fasciitis and associated pubic bone osteomyelitis,[15] Fournier's gangrene,[16] chronic leg ulcers,[17] over punch grafts after excision of melanoma feet[18] and over radial forearm free flap donor sites. [19] NPWT has also been used for securing skin grafts to microvascular free flaps[20] and for the vulvovaginal reconstruction with skin grafts.…”

Complex Wounds in Patients Receiving Hemodialysis

“…The commonest skin disorders are xerosis and pruritus 8,9) . Recent epidemiological studies have demonstrated that the prevalence of pruritus among patients who are adequately dialyzed remains high, ranging between 42 and 75% [10][11][12] . Uremic pruritus is very frustrating for patients since no effective treatment for relief of the itching has been demonstrated.…”

Effects of negative-pressure wound therapy combinedwith microplasma on treating wounds of ulcer and the expression of heat shock protein 90

“…In clinics, the incidence rate of diabetic foot ulcer, deep burn, bedsore, severe varicosity, obliterans of lower extremities, ulcers caused by severe trauma and others, especially chronic refractory skin ulcer has increased significantly which greatly influence the patients survival rate (1). After debridement, medical dressing for periodic dressing change is a common treatment, but the effective rate is only 40–60%, and the infection rate still reaches 10–30% (2).…”