Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing

Abstract

Role of negative pressure dressing and moist wound healing are well established in the treatment of both acute and chronic wounds with certain advantages and disadvantages in both the techniques. Both these techniques prevents wound colonization, but the negative pressure dressing method has proved to have a greater potency to remove secretions, prevent wound invasion and eradication established infection. In both these techniques there is no accessibility to wound environment. Limited access dressing (LAD) is a moist wound dressing with negative pressure. It provides limited access to the wound through two small ports for both dressers and pathogens. The LAD design has notable advantages like wound isolation that reduces chance of wound colonization and safe disposal of infected materials (important factor to reduce hospital-acquired infections), while avoiding some major disadvantages such as opacity of dressing materials, inaccessible offensive smelling wound environment, and relatively high treatment costs. In LAD a definite intermittent negative pressure regimen is followed. The intermittent negative pressure (cycle of 30 minutes suction and 3½ hours rest) is effective. Overall, the LAD is a safe and effective alternative to conventional dressing methods. LAD is an excellent research tool for wound healing as frequent/continuous record of wound healing is possible without disturbing the wound healing process. LAD is an effective dressing for limb salvage in cases of acute and chronic complex wounds. Leech effect prevents wound related systematic response syndrome and sepsis. Suction-assisted dressing (SAD) is a combination of semiocclusive dressing with negative pressure. It works by removal of fluids by intermittent (like LAD) negative pressure and preventing bacterial invasion. SAD is especially advantageous where soakage is less, there is no dead tissue covering the wound (e.g., following skin grafting), superficial skin wounds (e.g., donor area) and also where LAD is technically difficult to apply over circumferential trunk and neck dressings under anesthesia.

Diabetic Foot Salvage by Limited Access Dressing (LAD)

“…For applying LAD over extremity wounds [10][11][12] (Figure 1), either ethylene oxide presterilized customized polythene bag are used or based on the shape, size and site of the wound customized polythene bag is sealed using semi automatic plastic sealing machine and sterilized by immersion in 2.45% w/v glutaraldehyde solution for 20 minutes. Two thick nasogastric tubes (extra holes are made if required) after placed in between the bag and wound are brought out through the polythene cover at the predetermined site.…”

“…The efficacy of LAD in eradication of resistant bacterial infections [10], was studied (2010; unpublished) on 60 patients with one or more wounds. Out of 60 patients, in 57 (95%) patients bacterial growth was detected, treatment with LAD for 10 days resulted in no growth in 34/57 (59.6%) patients, and reduction in the number of organisms in 19/57 (33.33%) patients.…”

“…In a preliminary study [10] (August 2005, September 2007 at Burns ward Kasturba Medical College, Manipal) to prove leech effect two identical groups of 54 thermal burns (less than 48 hrs duration) patients were made: Control group and LAD treated group each comprising of 27 extremities burn matching in age, sex and TBSA burn. There was no statistically significant difference in occurrence of SIRS on Day 1 (control group 26 vs LAD group 23; p value 0.742), but on Day 5 the difference in occurrence of both SIRS (control group 18 vs LAD group 23, p value 0.029) and occurrence of organ Dysfunction (control group 12 vs. LAD group 4; p value 0.017) was significant.…”

“…LAD has been designed to reduce the pain and discomfort of conventional dressings, to reduce the frequency of dressing, to reduce the chances of wound infection and to improve the results obtained by negative pressure dressing [10][11][12].…”

“…Since LAD combines principles of both moist wound dressing and negative pressure dressing with some extra advantages over both these methods, it offer a consistent and better chance of limb salvage. Negative pressure of LAD along with placement of drains in infectesfascial planes of foot (concept of target tissue [10]) and leg helps to stop the spread of infection along fascial/ peritendinous planes.…”