Retained wound vacuum foam in non-healing wounds: a real possibility

Mazoch, Mathew J.; Montgomery, Corey

doi:10.12968/jowc.2015.24.sup6.s18

Cited by 11 publications

(15 citation statements)

References 8 publications

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“…In fact, tNPWT actively prevented reepithelialization, inducing substantial wound edge epidermal hyperproliferation. tNPWTtreated wounds also displayed extensive filler material trapped in the granulation tissue (observed in earlier studies; in pigs 24,25 and in patients [26][27][28] ), which may contribute to heightened local tissue inflammation. 29 NPWT-associated healing has previously been linked to dampened proinflammatory cytokines, TNFa and IL-1b, compared to non-NPWT treatment.…”

Section: Discussionmentioning

confidence: 58%

Pre-Clinical Assessment of Single-Use Negative Pressure Wound Therapy During In Vivo Porcine Wound Healing

Brownhill

Huddleston

Bell³

et al. 2021

Advances in Wound Care

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Traditional negative pressure wound therapy (tNPWT) systems can be large and cumbersome, limiting patient mobility and adversely affecting quality of life. PICOÔ, a no canister single-use system, offers a lightweight, portable alternative to tNPWT, with improved clinical performance. The aim of this study was to determine the potential mechanism(s) of action of single-use NPWT (sNPWT) versus tNPWT. Approach: sNPWT and tNPWT were applied to an in vivo porcine excisional wound model, following product use guidelines. Macroscopic, histological, and biochemical analyses were performed at defined healing time points to assess multiple aspects of the healing response. Results: Wounds treated with single-use negative pressure displayed greater wound closure and increased reepithelialization versus those treated with traditional negative pressure. The resulting granulation tissue was more advanced with fewer neutrophils, reduced inflammatory markers, more mature collagen, and no wound filler-associated foreign body reactions. Of note, single-use negative pressure therapy failed to induce wound edge epithelial hyperproliferation, while traditional negative pressure therapy compromised periwound skin, which remained inflamed with high transepidermal water loss; features not observed following single-use treatment. Innovation: Single-use negative pressure was identified to improve multiple aspects of healing versus traditional negative pressure treatment. Conclusion: This study provides important new insight into the differing mode of action of single-use versus traditional negative pressure and may go some way to explaining the improved clinical outcomes observed with single-use negative pressure therapy.

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Section: Discussionmentioning

confidence: 58%

Pre-Clinical Assessment of Single-Use Negative Pressure Wound Therapy During In Vivo Porcine Wound Healing

Brownhill

Huddleston

Bell³

et al. 2021

Advances in Wound Care

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“…However, these reports have largely focused on the effects of sustained compression and damage at the wound bed: foam filler interface. Retention of wound filler can also increase inflammatory cell influx and promote foreign body reactions 12,34,35 . Our data now suggest the importance of considering wound‐edge epidermal‐derived inflammatory mediators.…”

Section: Discussionmentioning

confidence: 67%

Cellular benefits of single‐use negative pressure wound therapy demonstrated in a novel ex vivo human skin wound model

Wilkinson

Longhorne

Roberts

et al. 2020

Wound Repair Regeneration

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Negative pressure wound therapy is a widely used treatment for chronic, nonhealing wounds. Surprisingly, few studies have systematically evaluated the cellular and molecular effects of negative pressure treatment on human skin. In addition, no study to date has directly compared recently available single‐use negative pressure modalities to traditional negative pressure devices in a controlled setting. Here we developed a novel large‐scale ex vivo human skin culture system to effectively evaluate the efficacy of two different negative pressure wound therapy modalities. Single‐use and traditional negative pressure devices were applied to human ex vivo wounded skin sheets cultured over a period of 48 hours. Cellular tissue response to therapy was evaluated via a combination of histological analysis and transcriptional profiling, in samples collected from the wound edge, skin adjacent to the wound, and an extended skin region. Single‐use negative pressure wound therapy caused less damage to wound edge tissue than traditional application, demonstrated by improved skin barrier, reduced dermal‐epidermal junction disruption and a dampened damage response. Transcriptional profiling confirmed significantly less activation of multiple pro‐inflammatory markers in wound edge skin treated with single‐use vs traditional negative pressure therapy. These findings may help to explain the greater efficacy of sNPWT in the clinic, while offering a noninvasive system to develop improved NPWT‐based therapies.

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“…The accidental retainment of NPWT foams in acute, chronic, or infected wounds might further complicate the clinical course. [27][28][29][30][31][32][33][34][35] Over the past two decades, various commercially available NPWT systems have been introduced into clinical practice, which has made familiarity with all systems difficult (Table 1). The different systems in combination with the several surgical indications used, the lack of standardized documentation of the number and localization of inserted foams, and unplanned or emergency surgeries with different surgical teams, might act as predisposing factors for the emergence of this rare complication.…”

Section: Clinical Relevancementioning

confidence: 99%

“…A literature search up to June 2019 in PubMed revealed nine studies reporting on foam retainment after NPWT (Table 2). [27][28][29][30][31][32][33][34][35] All studies had an evidence level of IV. All publications, except for one, were case reports.…”

Section: Retained Foams In Npwt-literature Overviewmentioning

confidence: 99%

“…Most identified studies are case reports with no exact statements about the incidence of this complication within a large collective. [27][28][31][32][33][34][35] Only two studies provide some information about this topic. Caniano et al described the presence of retained VAC foams in 2 out of 21 patients (9.5%) suffering from pilonidal disease.…”

Section: Retained Foams In Npwt-literature Overviewmentioning

confidence: 99%

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Retained Negative Pressure Wound Therapy Foams as a Cause of Infection Persistence

Anagnostakos

Thiery

Sahan

2021

Advances in Wound Care

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Significance: Negative pressure wound therapy (NPWT) has become a valuable adjunct in the treatment of acute and chronic wounds in several surgical disciplines. Retained foams are among its side effects, and they pose a rare but devastating complication at the site of this therapy, which might be associated with wound-healing complications, infection persistence, repeated surgical revisions, and prolonged antibiotic courses. Recent Advances: In the past 15 years, an increasing number of studies have identified this potential problem. Although the exact incidence remains unknown, initial studies have indicated rates of up to 10% in large collectives being treated by NPWT. Critical Issues: The lack of radiopaque markers does not allow for the visual control of retained foams using plain radiographs. Further imaging methods (e.g., CT and MRI) also do not help in adequate differential diagnosis. The lack of routine documentation of the number, type, and localization of the inserted foam(s) and unplanned surgery with a different surgical team pose risk factors for foam retainment. Future Directions: Introducing new documentation records for wounds treated with NPWT is recommended. At foam removal, all dressing materials should be examined for integrity. The development of foams with radiopaque markers by the industry, such as those routinely used in surgical gauze swabs, might also be a useful step to minimize the risk of foam retainment within wounds.

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Retained wound vacuum foam in non-healing wounds: a real possibility

Cited by 11 publications

References 8 publications

Pre-Clinical Assessment of Single-Use Negative Pressure Wound Therapy During In Vivo Porcine Wound Healing

Pre-Clinical Assessment of Single-Use Negative Pressure Wound Therapy During In Vivo Porcine Wound Healing

Cellular benefits of single‐use negative pressure wound therapy demonstrated in a novel ex vivo human skin wound model

Retained Negative Pressure Wound Therapy Foams as a Cause of Infection Persistence

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