Sound Evidence - May 2008 - (Page 2) Figure 1a. Patient 2’s wound on August 28, 2007. Figure 1b. Patient 2’s wound on October 1, 2007. APWT comes from case series reports and small randomized trials.1,3 Negative pressure wound therapy is specifically associated with reduced drainage from wounds with large amounts of exudate but is not considered a debridement modality.4 Conversely, APWT is not known for reducing drainage per se but is indicated for cleansing and maintenance debridement by removing yellow slough, fibrin, tissue exudates, and bacteria. Using a combination of NPWT and APWT in a series of infected wounds post surgery or surgical debridement was evaluated at a 60-bed, acute rehabilitation hospital. Case Series Six patients with large, infected wounds of surgical origin with serosanguineous exudate were treated with a combination of NPWT (V.A.C.®, Kinetic Concepts Inc., San Antonio, Tex) and APWT (MIST Therapy® System, Celleration, Inc. Eden Prairie, Minn). A summary of patient and wound characteristics, medical histories, and wound treatments is provided in Table 1. Infections were confirmed by swab culture. Six wounds were in need of therapy to remove devitalized tissue and microbial infection, as well as promote granulation tissue formation and, ultimately, wound closure. After unsuccessful attempts at debridement using wet-to-dry dressings daily over a period of 1 to 3 weeks, a combined approach using NPWT and APWT was pursued. Before initiating NPWT and APWT, the wounds had been present and nonhealing for anywhere from 11 days to 8.5 weeks. In accordance with the manufacturer’s clinical guidelines, NPWT dressings were applied with continuous pressure at 125 mm Hg and dressings were Figure 2. Patient 2’s wound on November 30, 2007. changed three times per week. Acoustic pressure wound therapy was administered three times per week at the same visits as the NPWT dressing changes; APWT treatment duration (minutes per session) was based on wound area per the manufacturer’s recommended treatment algorithm (ie, longer times for larger wounds). No other wound care modalities were administered during the study period. As shown in Table 1, NPWT and APWT were administered concurrently over treatment periods ranging from 4 to 12 weeks; all but one patient received 8.5 weeks of treatment or less. Treatment involved between 4 and 20 minutes per session, with the majority needing 9 minutes or more. Patients received a total of 14 to 26 APWT treatments each. Also shown in Table 1, wound volume was reduced by 99% to 100% in all wounds, except for Patient 5 in whom May 2008 Vol. 54 Issue 5 51
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