Management of large chronic venous leg ulcers with negative pressure wound therapy

Abstract

Abstract-Introduction: Venous leg ulcers (VLU) occur in 1% of the adult population and are associated with chronic disability, diminished quality of life and high health-care costs. Treatment is often slow, difficult and recurrence is high because of inappropriate conditions of the wound bed.Patients and Methods: This study involves 14 patients with chronic venous ulcers larger than 100 cm 2 treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalized tissues and partial stripping of an insufficient great saphenous vein in the first operation. After adequate haemostasis, NPWT kit was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Dressing impregnated with neutral triglycerides and silver ions was used as a first layer and the black polyurethane NPWT foam was applied over it. The pain assessment was performed for 7 patients using 10 cm visual analog scale (VAS).Results: The mean number of NPWT dressing changes prior to grafting was 5.8. The mean number of NPWT foam changes was 2.8 after skin grafting. We accomplished complete healing of 92% of applied skin grafts surface. One patient had recurrence of venous ulcers in the follow-up period. Moreover, one patient required regrafting.Conclusions: The application of NPWT provides quick wound-bed preparation and high graft take in venous ulcer treatment.

Successful treatment of postoperative, radiation-associated wound dehiscence around tracheostomy with negative pressure wound therapy.

“…It creates a moist environment, improves fluid removal, reduces tissue edema, contracts the wound, mechanically stimulates the wound bed, induces cell proliferation, alters blood flow in the wound edges, stimulates neo-angiogenesis and the formation of granulation tissue. 7,8 The use of negative pressure wound therapy in neck region can be difficult to manage for a variety of reasons. First, many patients with complicated wounds in this region have a tracheostomy nearby, therefore, it is hard to achieve an adequate air tight seal over and around the airway.…”