Mieczyslawa Franczyk

Vacuum assisted closure for the treatment of sternal wounds: the bridge between débridement and definitive closure.

&NA; A method to refine the treatment of sternal wounds using Vacuum Assisted Closure (V.A.C.) therapy as the bridge between débridement and delayed definitive closure is described. A retrospective review of 35 consecutive patients with sternal wound complications over a 2‐year period (March of 1999 to March of 2001) was performed. The treatment of sternal wounds with traditional twice‐a‐day dressing changes was compared with the treatment with the wound V.A.C. device. An analysis of the number of days between initial débridement and closure, number of dressing changes, number and types of flaps needed for reconstruction, and complications was performed. Eighteen patients were treated with traditional twice‐a‐day dressing changes and 17 patients were treated with V.A.C. therapy alone. The two groups were similar regarding age, sex, type of cardiac procedure, and type of sternal wound. The V.A.C. therapy group had a trend toward a shorter interval between débridement and closure, with a mean of 6.2 days, whereas the dressing change group had mean of 8.5 days. The V.A.C. therapy group had a significantly lower number of dressing changes, with a mean of three, whereas the twice‐a‐day dressing change group had a mean of 17 (p < 0.05). Reconstruction required an average of 1.5 soft‐tissue flaps per patient treated with traditional dressing changes versus 0.9 soft‐tissue flaps per patient for those treated with V.A.C. therapy (p < 0.05). Before closure, there was one death among patients undergoing dressing changes and three in the V.A.C. therapy group, all of which were unrelated to the management of the sternal wound. Patients with sternal wounds who have benefited from V.A.C. therapy alone have a significant decrease in the number of dressing changes and number of soft‐tissue flaps needed for closure. Finally, the V.A.C. therapy group had a trend toward a decreased number of days between débridement and closure. (Plast. Reconstr. Surg. 111: 92, 2003.)

A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device

ObjectiveTwo methods of subatmospheric pressure wound therapy—wall suction applied to a sealed gauze dressing (GSUC) and the vacuum-assisted closure device (VAC)—were compared in hospitalized patients at University of Chicago Medical Center. Summary of Background DataVAC therapy is widely used, but can be expensive and difficult to apply; it also fails in some patients. MethodsA randomized prospective study of 87 patients (N = 45 in the GSUC arm and N = 42 in the VAC arm) was undertaken between October 2006 and May 2008. The study comprised patients with acute wounds resulting from trauma, dehiscence, or surgery. ResultsDemographics and wound characteristics were similar in both groups. There were significant reductions in wound surface area and volume in each group. In the GSUC group, the reductions in wound surface area and volume were 4.5%/day and 8.4%/day, respectively (P < 0.001 for both), and in the VAC group, this was 4.9%/day and 9.8%/day, respectively (P < 0.001 for both). The reductions in wound surface area and volume were similar in both groups (P = 0.60 and 0.19, respectively, for the group-by-time interaction). The estimated difference (VAC − GSUC) was 0.4% (95% confidence interval: −1.0, 1.7) for wound surface area and 1.4% (95% confidence interval: −0.7, 3.5) for volume. The mean cost per day for GSUC therapy was

The impact of topical lidocaine on pain level assessment during and after vacuum-assisted closure dressing changes: A double-blind, prospective, randomized study

4.22 versus

Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: vacuum-assisted closure and gauze suction.

96.51 for VAC therapy (P < 0.01) and the average time required for a GSUC dressing change was 19 minutes versus 31 minutes for a VAC dressing change (P < 0.01). The sum of pain intensity differences was 0.50 in the GSUC group compared with 1.73 for the VAC group (P = 0.02). ConclusionsGSUC is noninferior to VAC with respect to changes in wound volume and surface area in an acute care setting. In addition, GSUC dressings were easier to apply, less expensive, and less painful.

Cost-effective Alternative for Negative-pressure Wound Therapy

Background: Vacuum-assisted closure dressing changes are frequently painful. The authors hypothesized that administering topical lidocaine into the vacuum-assisted closure sponge would decrease pain during dressing changes. Methods: A double-blind, randomized, prospective study was performed on patients (n = 70) undergoing vacuum-assisted closure dressing changes at a single institution between October of 2003 and June of 2005. Patients were randomized to receive either 0.2% lidocaine or 0.9% saline administered through the vacuum-assisted closure tubing into the foam dressing 30 minutes before changing the dressing. All patients received morphine sulfate ad libitum. Pain scores were assessed according to a 0 to 10 numeric pain scale. Results: Wound characteristics and patient demographics were similar for both groups. Patients receiving lidocaine reported less pain than control patients during the dressing change (4.3 versus 6.3; p = 0.005) and immediately after (2.4 versus 4.7; p < 0.001) the dressing change. Thirty minutes after the dressing change, pain scores were similar in both groups. Thirty minutes after the dressing change, more patients in the lidocaine group requested small doses of narcotics (>3 mg morphine equivalent) than in the control group. Conclusions: During the initial vacuum-assisted closure dressing change, 0.2% lidocaine administered through the suction tubing led to a reduction in pain reported by the patients in the authors’ study. The duration of lidocaine administered in this fashion may be fairly short, because more patients in this group began to request small doses of opiates 30 minutes after the dressing change. Thus, lidocaine may improve patient comfort during vacuum-assisted closure therapy.

Evolving techniques for negative pressure wound therapy and the value of grass roots comparative effectiveness research.

Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors’ institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. The authors report a randomized controlled trial comparing the efficacy of the GSUC vs the VAC in securing STSG. A prospective, randomized, controlled trial was conducted in 157 wounds in 104 patients requiring STSG from August 2009 to July 2012. All wounds were randomized to VAC or GSUC treatment and assessed for skin graft adherence/take. At postoperative day 4 or 5, NPWT was discontinued, and the size of the graft and any nonadherent areas were measured and recorded. Concomitant comorbidities, wound location, etiology, study failures, and reoperative rates were also reviewed. In all, 77 and 80 wounds were randomized to the GSUC and VAC study arms. Patient demographics were similar between both groups in terms of age, sex, comorbidities, etiology, and wound location. In all, 64 of 80 wounds in the GSUC group and 60 of 77 wounds in the VAC group had full take of the skin graft by postoperative day 4 or 5 (P = .80). The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.

Low-pressure negative-pressure wound therapy using the Pleur-evac system in hemodynamically unstable patients.

Background: Current predominantly used equipments for negative-pressure wound therapy (NPWT) are expensive. In current healthcare climate continually emphasizing cost containment, importance in developing more cost-effective alternatives cannot be understated. Previously, therapeutically equivalent methods of providing NPWT was demonstrated using just low-cost, universally available supplies, coined Gauze-SUCtion (GSUC). Here, we examine long-term potential financial savings of utilizing GSUC over commercialized products. Methods: A retrospective cost analysis was performed at the University of Chicago Medical Center between 1999 and 2014. All NPWT was provided via either GSUC or commercialized vacuum-assisted closure (VAC, KCI) device. Sum of all material component costs were reviewed to determine theoretical average daily cost. For the VAC group, recorded institutional spend to KCI was also reviewed to determine actual daily cost. In the GSUC group, this figure was extrapolated using similar ratios. Labor costs for each method were determined using analysis from prior study. Patient demographics, etiology, wound location, and treatment length were also reviewed. Results: Total of 35,871 days of NPWT was provided during the 15-year span. Theoretical average cost of VAC was

Abstract P87: Subatmospheric Pressure Wound Therapy (SAWT)

94.01/d versus

Early Mobilization of Patients After Split-Thickness Skin Grafting to the Lower Extremities With the Use of Subatmospheric Pressure Wound Therapy: A Feasibility Study

3.61/d for GSUC, whereas actual average was

A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device: a supplementary subgroup analysis of infected wounds.

111.18/d versus