SoundEvidence - August 2008 - (Page 52) TABLE 1 TREATMENT CHARACTERISTICS AND OUTCOMES AFTER ADJUVANT USE OF ACOUSTIC PRESSURE WOUND THERAPY FOR SACRAL PRESSURE ULCERS IN IMMOBILIZED PATIENTS Wound Dimensions APWT Duration Pre APWT Post APWT 5 weeks Area: 18 cm2 Area: 2.3 cm2 Volume: 1.8 cm3 Volume: 0.23 cm3 2 Area: 12.0 cm 10 weeks Area: 21 cm2* 3 Volume: 2.4 cm Volume: 84 cm3* Area: 84 cm2 4.5 months Area: 24 cm2 Volume: 378 cm3 Volume: 24 cm3 Area: 20.0 cm2 5.5 months Area: 4.0 cm2 Volume: 8.0 cm3 Volume: 2.0 cm3 Area: 98.6 cm2 4 months Area: 2.7 cm2 3 Volume: 216.9 cm Volume: 1.4 cm3 Tissue Characteristics Pre APWT Post APWT 50% adherent 100% granulation yellow slough in 12 days 40% black 100% granulation eschar in 10 weeks 50% yellow 100% granulation slough in 1 week 80% yellow 100% granulation slough in 4 weeks 10% black 100% granulation eschar in 3 weeks Subsequent Treatments Silver foam 2 weeks ES with silver alginate: 3 months NPWT: 3 weeks; ES with silver alginate: ongoing ES with silver alginate: 4 weeks; 3-D polymer foam: 1 week ES with silver alginate: 4 weeks 1 2 3 4 5 * Removal of necrotic tissue using APWT exposed a larger wound bed. APWT=acoustic pressure wound therapy, ES=electrical stimulation, NPWT=negative pressure wound therapy for 3 months along with silver alginate dressing (Seasorb AG, Coloplast US, Minneapolis, Minn). Wound volume decreased to 4.8 cm3, at which time the patient was rehospitalized and physical therapy wound care discontinued. She continues to be medically fragile and the wound remains open. Patient 3. A 26-year-old quadriplegic man was admitted with a small, unstageable sacral wound that declined rapidly secondary to uncontrolled pressure. Following surgical debridement and 1 week of APWT, 50% slough was replaced with 100% granulation tissue. After 4 weeks, drainage diminished from copious purulent to moderate serous. After 4.5 months, wound volume had decreased from 378 cm3 to 24 cm3, at which time negative pressure wound therapy (NPWT — V.A.C.®, KCI, San Antonio, Tex) was administered to hasten closure and limit bedrest in this young patient. After 3 weeks of NPWT, ES was initiated and is ongoing combined with silver alginate dressing. Wound volume is currently 9.6 cm3. Patient 4. A 57-year-old paraplegic man was admitted with a Stage III sacral pressure ulcer. Multiple hospitalizations for urosepsis resulted in continued decline to Stage IV with 80% yellow slough. Full granulation was achieved with 4 weeks of APWT and hydrofiber with alginate dressing, despite repeated interruption of therapy from Day 2 to Week 3 due to hospitalizations. After 5.5 months of APWT, wound volume decreased from 8 cm3 to 2 cm3. Therapy was changed to ES and silver alginate dressing for 4 weeks. The wound closed after 1 additional week of 3-D polymer foam dressing (Biatain, Coloplast US, Minneapolis, Minn). Patient 5. A 65-year-old woman with a traumatic brain injury developed a large, unstageable, sacral pressure ulcer following multiple hospitalizations. She is ventilator-dependent, mobility-dependent, and unable to communicate her needs to the healthcare team. After 4 months of APWT, wound volume decreased from 216.9 cm3 to 14 cm3 but remained unchanged after an additional month of APWT. Treatment was changed to ES with silver alginate dressing. After 4 weeks, wound size remained relatively unchanged and the patient was discontinued from physical therapy wound care. The wound remains open. Discussion Acoustic pressure wound therapy was used to nonsurgically remove necrosis and bacteria and promote the development of granulation tissue sufficient for initiating ES or NPWT. In these patients with severely compromised mobility and advanced-stage pressure ulcers, substantial necrotic tissue was replaced with 100% granulation tissue in four out of five patients after 1 to 4 weeks of APWT and appropriate moist 52 OstomyWound Management
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