Use of controlled negative pressure in management of phlegmon caused by fulminant complication of pressure wound

Abstract

Rationale:Effective wound healing depends on the adequate choice of the wound cleansing method, to enable rapid removal of necrotic tissue. Negative pressure wound therapy (NPWT) is an effective non-invasive technique for management of wounds of varied aetiology, including deep tissue injuries caused by pressure.Patient concerns:This article discusses a case of an 82-year-old female receiving hospice care at home owing to progressing untreated thoracic spinal stenosis, bedridden for 4 years, incapable of self-care.Diagnoses:Three fulminant pressure wounds, 50 cm2 each, with signs of undermining, Stage II/IV according to National Pressure Ulcer Advisory Panel, were identified in the area of the sacrum and the right and left trochanter. Despite measures used to prevent pressure sores, and nutritional supplementation, two months later a fourth pressure ulcer involving subcutaneous tissue was identified in the area of the right sciatic tuber, accompanied with signs of systemic inflammatory response, as well as massive phlegmon and lesion in the ischial bone.Interventions:As previously applied treatments (surgical necrectomy, biological therapy - Lucilia Sericata maggots, autolysis, pharmacological therapy) proved ineffective, NPWT was experimentally administered to evacuate exudate and to cleanse the wound.Outcomes:Application of negative pressure during a 42-day therapy allowed significantly faster cleansing of the wound. The pressure wounds was significantly reduced in size, and necrotic tissue was removed from the sciatic tuber, which ultimately was covered with granulation tissue.Lessons:Controlled negative pressure can successfully be used in the process of cleansing an infected pressure wound to safely remove exudate and to minimise local inflammation. Administration of controlled negative pressure is an effective and safe method in the process of cleansing an infected pressure wound.

Effects of vacuum sealing drainage to improve the therapeutic effect in patients with orthopedic trauma and to reduce post‑operative infection and lower‑limb deep venous thrombosis

“…This contributes to the dilation of the capillaries and accelerates and promotes the growth of granulation tissue (14). Negative pressure helps in controlling local edema, removing inflammatory mediators, reconstructing blood vessels, forming granulation and reducing the biological load of the wound (15). According to relevant studies (16,17), VSD has achieved good results in the treatment of scald wounds and avulsion injuries of limb skin and soft tissues.…”

Management of a heel wound as part of the holistic care of patients at the end of their lives – a literature review and own professional experience

“…System oceny NERDS Rycina 2. Zaopatrzenie ran u pacjenta u kresu życia [23,63] therapeutic index for local infektions), które opiera się na stanie klinicznym rany, co może ograniczyć zbyt wczesne wdrażanie leczenia przeciwdrobnoustrojowego. Prosta ocena zakłada wykorzystanie sześciu zmiennych charakterystycznych dla infekcji ranywzrost temperatury, ból, zaczerwienienie, obrzęk, wysięk, zatrzymanie procesu gojenia [61].…”

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“…13,15,42,45,48 In some cases, wound dressings with negative pressure may be adequate and facilitate the drainage process. 35,48,50 Pruritus frequently occurs due to irritating skin processes due to contact with substances and stimulation by pruritogens (histamine, serotonin, cytokines, and opioids). Options for the treatment of this symptom are the regular use of humectants and lubricants on the skin, in addition to topical steroid, menthol cream and Transcutaneous Electrical Nerve Stimulation (TENS).…”

“…27,37,42 Negative pressure therapy is indicated as useful in most cases, except for if in cases of neoplasms it is still contraindicated. 35,48,50 The occurrence of bleeding in the wound is often related to the presence of fragile capillaries. Thus, a simple cleaning or removal of cover adhered to the wound bed can cause bleeding.…”