Application of the Single Use Negative Pressure Wound Therapy Device (PICO) on a Heterogeneous Group of Surgical and Traumatic Wounds

Abstract

Objectives: Traumatic wounds and surgery inherently have their complications. Localized infections, wound dehiscence, and excessive wound leakage can be devastating to the patient with a prolonged recovery, but it is also costly to the hospital with an increased length of stay, extra workload, and dressing changes. The single use PICO (Smith and Nephew Healthcare, Hull, United Kingdom) negative pressure wound therapy (NPWT) dressing has revolutionized our management of various acute, chronic, and high output wounds. It requires fewer dressing changes than conventional practice, is used in the outpatient setting, and is a necessary adjuvant therapy to hasten wound healing.

Aims: To observe the efficacy of the PICO vacuum-assisted healing within a cost improvement programme.

Settings: Plastic surgery department, Royal London Hospital.

Materials and methods: Twenty-one patients with a diversity of postoperative or posttraumatic wounds were considered suitable for PICO application and treated totally on an outpatient basis once the PICO dressing was applied. All wounds were then subjected to continued PICO dressings until healed.

Results: All patients tolerated the PICO well with no dressing failure or failure to comply. The number of dressings per patient ranged from 1 to 7. The cost per patient of treatment ranged from £120 to £1578. Estimated cost of all PICO dressing for 21 patients including plastic surgery dressing clinic appointments = £13,345. Median length of treatment to healing (days) = 16; standard deviation = 9.5. Eight patients would have had an inpatient bed stay with conventional therapy, total 24 bed days saved at Bartshealth @£325 per day.

Conclusions: The outpatient application of a disposable NPWT can benefit a wide range of clinical wounds that optimizes patient care, promotes rapid wound healing, and importantly helps manage costs.

Keywords: early patient discharge; negative pressure wound dressing; plastic surgery; single use device; wound management.

Figures

Figure 1

(a) Wound on first presentation in surgical outpatients department. Excessive amount of exudate from radiation damaged skin breakdown and fat necrosis. Bleeding from the nipple area as eschar debrided. (b) First application of the PICO with Allevyn foam to cover the nipple area. Dressing pad shows exudate leaking into the dressing after the first application. (c) Area after 7 PICO applications, June 2012.

Figure 2

(a) Wound prior to pectoralis major flap cover. (b) Postoperative stage following flap repair and skin graft coverage. Wound shows first stages of breakdown along proximal edges on July 14, 2012. (c) First application of PICO on July 18, 2012. Extra OpSite around the dressing edges to facilitate neck movement. PICO changed twice weekly for 2 weeks to monitor exudate management and observe wound coverage. (d) Wound on August 16, 2012. Decision made to discontinue PICO and manage conservatively and treat areas of over granulation with nitrate.

Figure 3

(a) Wound at initial debridement. (b) At the time of first SSG check and reapplication of PICO. (c) Healed fully by October 2012.

Figure 4

(a) Central wound dehiscence left flank. PICO applied on 13 July. (b) Wound nearly closed by August 7. No further PICO dressing from this time and fully healed by end August.

Figure 5

(a) Initial view of the left groin showing the site of SLNB and the difficulties in covering the wound area with adequate dressings. The dehiscence was not a concern but the copious amount of seroma leakage. (b) Dressing 1 week later with exudate manageable. PICO dressing had been changed at 3 days by general practitioner, then returning to PDC at RLH for weekly review. (c) SLNB site 5 weeks later. Seroma fluid now dissipated, small exit wound. Decision made to stop PICO and return to conventional dressings. Wound healed 2 weeks later.