Negative-Pressure Wound Therapy in Infants and Children: A Population-Based Study

Santosa, Katherine B.; Keller, Matthew; Olsen, Margaret A.; Keane, Alexandra M.; Sears, Erika D.; Snyder‐Warwick, Alison K.

doi:10.1016/j.jss.2018.10.043

Cited by 19 publications

(12 citation statements)

References 119 publications

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“…Since its introduction in 1997 ( 16 , 17 ), the vacuum technique has been subject to a large spectrum of applications in the adult population. However, it has not yet proven the same efficacy and safety in children ( 18 ). Nonetheless, the literature on the efficacy of vacuum therapy seems promising in terms of the treatment of complicated pediatric wounds as pressure ulcers, extremity wounds, surgical wound dehiscence, skin grafting, or complex abdominal defects ( 9 – 11 , 19 – 21 ) and also congenital abdominal wall defects ( 5 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Vacuum-assisted staged omphalocele reduction: A preliminary report

et al. 2022

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IntroductionOmphalocele represents a rare congenital abdominal wall defect. In giant omphalocele, due to the viscero-abdominal disproportion, gradual reintegration of eviscerated organs is often associated with medical challenges. We report our preliminary experience combining staged gravitational reduction with vacuum (VAC) therapy as a novel approach for treatment of giant omphalocele.Patients and methodsRetrospective chart review of six patients (five females) born between September 2018 and May 2022 who underwent staged reduction of giant omphalocele in conjunction with VAC therapy was conducted. Treatment was performed at two German third-level Pediatric Surgery Departments. Biometric and periprocedural data were assessed. Main outcome measure was the feasibility of VAC therapy for giant omphalocele. Data are reported as median and interquartile range (Q1–Q3).ResultsGestational age was 37 (37–38) weeks, and birth weight was 2700 (2500–3000) g. VAC dressing was changed every 3 (3–4) days until abdominal fascia closure at the age of 9 (3–13) days. Time to first/full oral feeds was 3 (1–5)/20 (12–24) days with a hospital stay of 22 (17–30) days. Follow-up was 8 (5–22) months and complications were of minor extent (none: n = 2; Clavien–Dindo I: n = 3; Clavien–Dindo II: n = 1), comprising a delayed neo-umbilical cord rest separation (n = 2) and/or concomitant neo-umbilical site infection (n = 2) with no repeat surgery.ConclusionIn neonates with giant omphalocele, VAC constitutes a promising and technically feasible enhancement of the staged gravitational reduction method. This study shows evidence that VAC may accelerate restoration of the abdominal wall integrity in giant omphalocele, thus minimizing associated comorbidities inherent to a prolonged hospitalization.

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Section: Discussionmentioning

confidence: 99%

Vacuum-assisted staged omphalocele reduction: A preliminary report

et al. 2022

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“…Pain represents a common concern surrounding the use of NPWT in children 44 . Encouragingly, the results showed that procedures involving NPWT were not perceived by clinicians, caregivers or children as significantly more painful than standard dressing changes.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children

Frear

Cuttle²,

McPhail

et al. 2020

British Journal of Surgery

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Background: The efficacy of negative pressure wound therapy (NPWT) in the acute management of burns remains unclear. The purpose of this trial was to compare standard Acticoat™ and Mepitel™ dressings with combined Acticoat™, Mepitel™ and continuous NPWT to determine the effect of adjunctive NPWT on re-epithelialization in paediatric burns. Methods: This two-arm, single-centre RCT recruited children with acute thermal burns covering less than 5 per cent of their total body surface area. The primary outcome was time to re-epithelialization. Blinded assessments were performed using photographs captured every 3-5 days until discharge. Secondary measures included pain, itch, grafting, perfusion and scar management referrals. Results: Some 114 patients were randomized. Median time to re-epithelialization was 8 (i.q.r. 7-11) days in the NPWT group and 10 (8-14) days in the control group. In a multivariable model, NPWT decreased the expected time to wound closure by 22 (95 per cent c.i. 7 to 34) per cent (P = 0⋅005). The risk of referral to scar management was reduced by 60 (18 to 81) per cent (P = 0⋅013). Four participants in the control group and one in the NPWT group underwent grafting. There were no statistically significant differences between groups in pain, itch or laser Doppler measures of perfusion. Adverse events were rare and minor, although NPWT carried a moderate treatment burden, with ten patients discontinuing early. Conclusion: Adjunctive NPWT hastened re-epithelialization in small-area burn injuries in children, but had a greater treatment burden than standard dressings alone. Registration number: ACTRN12618000256279 (http://ANZCTR.org.au).

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“…Negative pressure wound therapy is widely used for pediatric patients and has a low frequency of serious complications 2 . However, we found that the extensive VAC system from the abdominal to chest walls decreased the compliance of the chest wall.…”

Section: Discussionmentioning

confidence: 67%

“…By providing negative pressure to the wound tissue, NPWT improves blood flow, promotes granulation tissue, and decreases edema and bacterial counts 1 . Because NPWT has a low occurrence of serious complications, it is widely used in infants and can be effectively used in surgical and nonsurgical disciplines 2 . Indeed, when NPWT is used for the treatment of post‐sternotomy wounds, NPWT reduces the need for mechanical ventilation by closing the thoracic cavity 3–5 .…”

Section: Introductionmentioning

confidence: 99%