Retrospective clinical evaluation of gauze-based negative pressure wound therapy

Abstract

Negative pressure wound therapy (NPWT) is an established modality in the treatment of challenging wounds. However, most existing clinical evidence is derived from the use of open-cell polyurethane foam at -125 mmHg. Alternative negative pressure systems are becoming available, which use gauze at a pressure of -80 mmHg. This study describes clinical results from a retrospective non comparative analysis of 30 patients treated with Chariker-Jeter gauze-based negative pressure systems (V1STA, Versatile-1 and EZ-Care; Smith & Nephew, Inc.) in a long-term care setting. The mean age of the patients was 72 years. The wounds consisted of chronic (n = 11), surgical dehiscence (n = 11) and surgical incision (n = 8). Wound volume and area were recorded at commencement and at the cessation of therapy. Discontinuation of therapy was instigated upon closure through secondary intention or when size and exudate were sufficiently reduced that the wounds could be managed by conventional wound dressing (median 41 days). An overall median reduction in wound volume of 88.0% (P < 0.001) and a 68.0% reduction in area (P < 0.001) compared with baseline were observed over the course of NPWT. The overall rate of volume reduction (15.1% per week) compares favourably with published data from foam-based systems.

Figures

Figure 1

Percentage reduction in wound dimensions divide by indication. The percentage reduction in volume (A), area (B) and depth (C) were calculated and box plots generated. Within each box, the horizontal line is the median and the cross indicates the mean. The box indicates the interquartile range, and the cut‐off lines above and below extend 1·5 times the interquartile range from the 25th or 75th percentile rolled back to where there are data. Those patients who lie outside this distance are represented by a square (outliers).

Figure 2

Kaplan–Meier plot showing the probability of achieving adequate progression over time in different indications. The Kaplan–Meier estimator was used to determine the median days to adequate wound progression over all indications and separately for chronic, surgical dehiscence and surgical incision indications.

Figure 3

Pressure ulcer in a 66‐year‐old female. This wound was treated with NPWT at −80 mmHg for a duration of 45 days, resulting in a 92% reduction in wound area (3·3 × 3·0–1·0 × 0·8 cm) and corresponding decrease in volume (depth 0·3 to 0 cm). The wound prior to initiation of therapy is shown in (A) and after discontinuation of therapy in (B). Therapy was discontinued because of its adequate progression and ability to manage by other means.

Figure 4

Dehiscence of surgical incision site in a 75‐year‐old female. This wound arose from a previously treated open reduction internal fixation in the arm and subsequent removal of hardware because of infection. The dehisced wound underwent several debridement episodes prior to treatment with NPWT at −80 mmHg for a duration of 15 days, resulting in a 89% reduction in wound area and corresponding decrease in volume.