Coverage of Exposed Bones and Joints in Critically Ill Patients: Lower Extremity Salvage with Topical Negative Pressure Therapy

Abstract

The patients described in this study were severely compromised by systemic and vascular disorders, so extremity amputation had been considered owing to the overall condition and the exposure of tendons and bones. Since it was possible to salvage the affected limbs with this straightforward and simple procedure, this type of treatment should be considered as a last attempt to prevent amputation.

Evidence-based recommendations for the use of negative pressure wound therapy in chronic wounds: Steps towards an international consensus

“…observed in wounds treated with NPWT as opposed to conventional therapy. The rate of granulation tissue formation has been reported to be slower than would be expected for acute, non-ischaemic wounds at six to 14 days, it therefore may not be appropriate to assess the wound for progression towards healing any sooner than one week of therapy [66]. Dressing changes should however be carried out every two to three days as a minimum to ensure that there is no deterioration of the wound.…”

“…Clare et al [43] (L3) reported that six of eight wounds with severe PVD healed completely following NPWT. Horch et al [66] (L3) reported a series of 21 patients with CLI all of whom successfully received a STSG following NPWT. Vuerstaek et al [68] (L1) reported a RCT of a mixed group of lower limb ulcers, over half of which had an arterial component to them (with ABI values as low as 0.6).…”

“…NPWT may also be of benefit following surgical closure, in bolstering a STSG to the prepared ischaemic wound surface to encourage good graft take [66,69,70]. Repeat graft procedures may be necessary [66], indicating that to achieve stable closure in these challenging wounds, a degree of perseverance is expected.…”

“…Repeat graft procedures may be necessary [66], indicating that to achieve stable closure in these challenging wounds, a degree of perseverance is expected.…”

“…Several L3 studies [43,66,67] report healing outcomes in patients with chronic lower limb ischaemia in the absence of successful revascularization. Clare et al [43] (L3) reported that six of eight wounds with severe PVD healed completely following NPWT.…”