A review of topical negative pressure therapy in wound healing: sufficient evidence?

Mouës, Chantal M.; Heule, Freerk; Hovius, Steven E.R.

doi:10.1016/j.amjsurg.2010.04.029

Cited by 166 publications

(147 citation statements)

References 68 publications

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“…Contradictory data exist on the increase of local tissue perfusion [84,84]. An advantage in edema reduction rests on weak evidence [85]. There are contradictory indications with overall weak evidence for selective drainage of destructive proteases with the relative predominance of healing-promoting cytokines in the wound bed [85,86].…”

Section: Moisture Balancementioning

confidence: 99%

“…An advantage in edema reduction rests on weak evidence [85]. There are contradictory indications with overall weak evidence for selective drainage of destructive proteases with the relative predominance of healing-promoting cytokines in the wound bed [85,86]. Independent of the involved mechanisms of action, however, the success in healing of negative-pressure therapy must be evaluated.…”

Section: Moisture Balancementioning

confidence: 99%

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Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

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SummaryThe number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis.Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.

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Section: Moisture Balancementioning

confidence: 99%

Section: Moisture Balancementioning

confidence: 99%

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

View full text Add to dashboard Cite

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“…22 Bacterial clearance was similar in both the groups, a tad better in conventional group (VAC : 80%, conventional : 83.3%) which is similar to certain studies but, in few other studies reduction in bacterial load was reported this can be due to improvement in circulation and oxygenation to compromised or damage tissue, which enhances the resistance to infection. 5,8,9,13,17,19,22 Increase in local tissue oxygen levels reduce or eliminate the growth of anaerobic organisms, which have been correlated to decreased healing rates. Also increased flux makes greater amounts of oxygen available to neutrophils for oxidative bursts that kill bacteria.…”

Section: Bacterial Clearancementioning

confidence: 99%

“…5 In various studies they found either decrease in bacterial load or no change but whatever was the bacterial load it did not have any significant impact on outcome. 8,13,14,17 Due to less wound fluid and better circulation greater amounts of oxygen is made available for the bacteria killing oxidative bursts. Concentration of immune cells is better in VAC because of foam.…”

Section: Bacterial Clearancementioning

confidence: 99%

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A randomized controlled trial comparing low cost vacuum assisted dressings and conventional dressing methods in the management of diabetic foot ulcers

et al. 2017

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INTRODUCTIONIndia, is ranked first in the list of the ten nations most affected with diabetes, foot ulceration is the most common complication, affecting approximately 15% of diabetic patients during their lifetime. This can be attributed to several social and cultural practices such as barefoot walking, inadequate facilities for diabetes care and education, and poor socioeconomic conditions. 1 Diabetic foot ulceration followed by amputation contributes dramatically not only to the morbidity among persons with diabetes but is also associated with severe clinical depression. 2 ABSTRACTBackground: Diabetic foot ulcers are chronic wounds which are difficult to heal, due to ischemia and intrinsic defects in angiogenesis and impaired immunity against infection. VAC therapy influences positive mechanical forces on the growth of tissues, especially in stimulating cell migration and mitosis, optimizes blood flow, decreases local tissue edema from the wound bed and provides an occlusive environment for wound healing under moist, clean and sterile conditions. Aims and objective was to compare the effectiveness of low cost hospital made VAC dressing with conventional dressings in healing of diabetic foot ulcers. Methods: This study was a prospective, randomized controlled trial and included 60 patients with diabetic foot ulcers admitted over 3 months. Patients were randomly allocated to two groups: odd numbered patients to VAC therapy and the even numbered patients to conventional dressings. Wound swab was taken before the start of the study. The data was analyzed and presented in percentages or proportions using Chi-square test and Student-t-test wherever applicable. Results: In this study it was found that in the VAC dressing group 76.7% of the ulcers had red granulation tissue at the end of therapy compared to 46.7% in conventional group. The mean wound bed preparation time was found to be 15.60 days in the conventional dressing group and 8.50 days in the VAC therapy group. In the VAC group 72.73% ulcers had no bacteria at the end of therapy. Conclusion: In this study, it was found that Vacuum Assisted Closure therapy was more effective than conventional dressings in the wound bed preparation of diabetic foot ulcers.

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Negative Pressure Wound Therapy in Head and Neck Surgery

Asher

White

Golden

et al. 2014

JAMA Facial Plast Surg

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IMPORTANCE Negative pressure wound therapy has been shown to accelerate healing. There is a paucity of literature reporting its use as a tool to promote wound healing in head and neck reconstruction. OBJECTIVE To review 1 institution's experience with negative pressure dressings to further describe the indications, safety, and efficacy of this technique in the head and neck. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at a tertiary care academic hospital. One hundred fifteen patients had negative pressure dressings applied between April 2005 and December 2011. Data were gathered, including indications, details of negative pressure dressing use, adverse events, wound healing results, potential risk factors for compromised wound healing (defined as previous radiation therapy, hypothyroidism, or diabetes mellitus), and wound characteristics (complex wounds included those with salivary contamination, bone exposure, great vessel exposure, in the field of previous microvascular free tissue transfer, or in the case of peristomal application in laryngectomy). EXPOSURE Negative pressure wound therapy utilized after head and neck reconstruction. MAIN OUTCOMES AND MEASURES Indications for therapy, length and number of dressing applications, identification of wound healing risk factors, classification of wound complexity, wound healing results, and adverse events related to the use of the device. RESULTS Negative pressure wound therapy was used primarily for wounds of the neck (94 of 115 patients [81.7%]) in addition to other head and neck locations (14 of 115 patients [12.2%]), and free tissue transfer donor sites (7 of 115 patients [6.1%]). The mean (SD) wound size was 5.6 (5.0) cm. The mean number of negative pressure dressing applications was 1.7 (1.2), with an application length of 3.7 (1.4) days. Potential risk factors for compromised wound healing were present in 82 of 115 patients (71.3%). Ninety-one of 115 patients (79.1%) had complex wounds. Negative pressure dressings were used in wounds with salivary contamination (n = 64), bone exposure (n = 40), great vessel exposure (n = 25), previous free tissue transfer (n = 55), and peristomal application after laryngectomy (n = 32). Adverse events occurred in 4 of 115 patients (3.5%). CONCLUSIONS AND RELEVANCE Negative pressure wound therapy in head and neck surgery is safe and has potential to be a useful tool for complex wounds in patients with a compromised ability to heal. LEVEL OF EVIDENCE 4

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A review of topical negative pressure therapy in wound healing: sufficient evidence?

Cited by 166 publications

References 68 publications

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

A randomized controlled trial comparing low cost vacuum assisted dressings and conventional dressing methods in the management of diabetic foot ulcers

Negative Pressure Wound Therapy in Head and Neck Surgery

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