Negative pressure wound therapy for treating pressure ulcers

Dumville, Jo C; Webster, Joan; Evans, Debra; Land, Lucy

doi:10.1002/14651858.cd011334.pub2

Cited by 38 publications

(23 citation statements)

References 39 publications

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“…There is good evidence for compression in treating the most common chronic wound type, venous leg ulcers but this again is not always used and, where it is used, is often applied with ineffective pressure [49,50,67]. In contrast, negative pressure wound therapy, a dressing with suction, is regularly deployed (and considered to be effective) even though there is no good quality evidence to support it in chronic wounds [68][69][70]. The development and use of bioengineered artificial skin in treating acute and chronic wounds has advanced from a scientific concept to a series of commercially available products over the last 30 years.…”

Section: Materials Relationships and Marketingmentioning

confidence: 99%

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Madden

Stark

2019

Journal of Tissue Viability

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Contemporary wound care in the UK has developed into two distinct complex wound care management spheres. The acute wound characterised by the contemporary, aggressive management of major trauma, and chronic wound care where there is widespread use of the term 'advanced' although, arguably its methods remain largely traditional [1]. Chronic wound care in the UK has now few connections with the more specialised systems that have developed for less prevalent burns and also for dermatological conditions [2,3]. Most management of people with complex wounds in the UK occurs in the community rather than in hospital with referral to a disparate range of health professionals including tissue viability nurses, vascular surgeons, podiatrists, physiotherapists, dermatologists, and occupational therapists. The bulk of the work is subsumed in community nursing.The historical literature on wound care has tended to concentrate on hospital-based, acute clinical activity, even though wound care decision-making, prevention and treatment are often the preserve of nursing and of patients themselves in the domestic rather than, or in addition to, the clinical sphere. While there has been much research examining the historical context of acute surgical wounds and injuries sustained on the battlefield [4], or 'wounding' as a predominantly socio-cultural process before the modern period [5], the case of chronic wounds has yet to be investigated.In 1962 George Winter published his observation that wounds in young pigs healed more quickly if covered rather than being left open to the air [6]. This has been widely seen as the starting point for 'advanced wound care' because it established the idea that a wound dressing could influence outcomes. It was followed by the introduction of occlusive and semi-occlusive dressings and various branded products such as Opsite from the 1980s. Wound care is now a multi-billion pound industry, yet there is a lack of recognition that products themselves are only a part of the story. As in other areas of healthcare, such as minimally-invasive surgery [7] and joint replacement [8], the development of innovation in this field can be seen as a multifaceted, uneven and contested process, not the simple invention and introduction of 'advanced' products and services.Drawing on historical, sociological and health sciences research and recordings of a series of Arts and Humanities Research Council (AHRC) funded cross disciplinary workshops connecting academics from a wide range of disciplines with service users, professionals and carers [9], this paper explores advanced wound care in the UK as a specific exemplar with wider resonance for understanding the particular climates in which clinical judgement and innovation adoption take place. It argues that with the historical shift from dry to moist wound healing came a narrow product focus in wound care which is intimately connected with the history of the professional development of AbstractGeorge Winter's 1962 paper in Nature reported his observation that wounds in ...

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Section: Materials Relationships and Marketingmentioning

confidence: 99%

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Madden

Stark

2019

Journal of Tissue Viability

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“…In contrast to the conclusion of the Cochrane meta-analysis, we would focus future trials on stage IV pressure ulcers at sacrum or ischium as 50% of all cases hospitalised in Germany are treated with NPWT. This is surprising as there is currently no rigorous randomised controlled trial (RCT) evidence available regarding the effects of NPWT compared with alternatives for the treatment of pressure ulcers (16).…”

Section: Icd-codementioning

confidence: 99%

Ten‐year analyses of the German DRG data about negative pressure wound therapy

Beckerath

Zapenko

Dissemond

et al. 2016

International Wound Journal

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Exact data regarding the clinical role of negative pressure wound therapy (NPWT) for wound care in a specific country are not available. Thus, we analysed the use of NPWT in hospitalised patients in Germany. Detailed lists of all hospitalised cases treated with NPWT in Germany for each of the years from 2005 to 2014 were obtained from the Federal Statistical Office, as well as lists of the 15 most frequent principal and additional diagnoses documented with NPWT in 2014. Within the 10-year time period of the study, the number of cases treated with NPWT increased by 349%, from 37 053 in 2005 to 129 269 in 2014. The rate of all hospitalised cases treated with NPWT increased form 0·22% to 0·66% in Germany. In 2014, wounds affecting skin and subcutaneous tissue (5-916.a0) are the most frequent documented indication for NPWT followed by deep wounds involving bones and joints at the limbs (5-916.a1). Open abdomens (5-916.a3) count for higher numbers than deep wounds of the thorax, mediastinum and sternum (5-916.a2). Fifty percent of all cases hospitalised for stage IV pressure ulcers at sacrum or ischium and around one third (32.2%) of cases with pyothorax received NPWT. Every fourth to fifth case hospitalised for disruption of surgical wounds or infections following a procedure (24·1%), as well as for infections and inflammations because of internal joint prosthesis or because of an internal fixation device was treated with NPWT (22·9%). In cases with diabetic foot syndrome, it is still every tenth case (10·1%). This analysis shows a substantial increase in the use of NPWT in the last decade for hospitalised patients. NPWT has a fixed role in the treatment of stage IV pressure ulcers at sacrum or ischium, pyothorax, infection and inflammation because of internal joint prosthesis or an internal fixation device and diabetic foot syndrome.

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“…Several clinical trials have reported improved outcomes with TNP, but most studies have been assessed as methodologically flawed and currently there is still uncertainty about its effectiveness. [16][17][18] In some cases, fluid collection devices such as ostomy bags could be used, especially if there is an underlying fistula feeding the wound.…”

Section: Wound Exudatementioning

confidence: 99%

<p>Assessment of acceptability and ease of use of gelling fiber dressings in the management of heavily exuding wounds</p>

Naik¹,

Harding²

2019

CWCMR

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Optimal exudate management plays an important role in wound healing. Choosing the right methods for this purpose is the key in achieving successful outcomes in the management of chronic wounds. Gelling fiber dressings are a class of dressing that forms a gel when they come into contact with wound exudate. This property allows them to effectively lock in excess fluid and at the same time provides enough moisture for healing to progress. Alginate and chitosan are naturally occurring gelling agents used in dressings, whereas carboxymethyl-cellulose, also called carmellose, is synthetically produced. This article reviews the use of these gelling fiber dressings in chronic wounds with a particular focus on their ability to manage wound exudate effectively.

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Negative pressure wound therapy for treating pressure ulcers

Abstract: There is currently no rigorous RCT evidence available regarding the effects of NPWT compared with alternatives for the treatment of pressure ulcers. High uncertainty remains about the potential benefits or harms, or both, of using this treatment for pressure ulcer management.

Cited by 38 publications

References 39 publications

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Ten‐year analyses of the German DRG data about negative pressure wound therapy

<p>Assessment of acceptability and ease of use of gelling fiber dressings in the management of heavily exuding wounds</p>

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