Sound Evidence - November 2008 - (Page 57) clinical literature has described the effectiveness of APWT in studies of acute and chronic wounds.6 Some clinical evidence also suggests that APWT reduces wound-related pain and in vitro data found that APWT destroys bacterial cells.7,8 Because of increasingly stricter federal regulations for PUs,2 the author’s LTC facility recently added APWT to standard of care for Stage II PUs. This sixpatient case series describes the outcomes of APWT in the treatment of Stage II PUs in LTC residents with impaired mobility. Methods Data were collected retrospectively from the medical records of six nonconsecutive patients. This is a representative sample of patients with Stage II pressure ulcers treated with APWT and standard of care at this LTC facility. Patients or their legal guardians provided informed consent for treatment and inclusion in this case series. Patients were treated with APWT as an adjunct to standard wound care that included balsam of Peru/castor oil/trypsin ointment, hydrogel, hydrocolloid dressings, and silver dressings and pressurerelieving devices such as mattresses and wheelchair cushions to provide offloading. The effect of APWT was Wound location Wound area cm2 Number of APWT Days to healing Median days to healing with treatments with APWT + SOC SOC alone based on wound size4 PrePostAPWT APWT 73 12 28 5.22 0.00 1.56 0.00 12 28 53 Right, ischial tuberosity Right ischium Coccyx 0.21 0.44 4.16 0.00 Coccyx 13 Ongoing 24 Ongoing 33 n/a Mid-back 0.25 5.58 Right distal calf 0.00 0.28 5 37 9 Discontinued 33 73 TABLE 1 DEMOGRAPHIC CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH STAGE II PUS TREATED WITH APWT Patient Gender/Race Age Medical history (year) 1 Female/Caucasian 89 2 Female/ African American 61 3 Female/Caucasian 89 4a Male/Caucasian 75 5 Female/Caucasian 92 November 2008 Vol. 54 Issue 11 6b Male/Caucasian 83 Alzheimer’s disease; hypertension Parkinson’s Disease; hemiplegic; gunshot wound; morbid obesity; neuropathy Alzheimer’s disease; osteoporosis Parkinson’s Disease; diabetes mellitus; hypertension; atherosclerosis; anemia; cholecystitis Diabetes mellitus; hypertension; Atrial fibrillation; paralysis agitation; status post hip fracture; restless leg syndrome; recurrent knee infection; anemia; depression 57 APWT = acoustic pressure wound therapy n/a = not applicable SOC = standard of care a. Wound worsened when APWT was interrupted twice due to hospitalization; however, 2 weeks following second hospitalization and APWT resumption, wound area decreased 79%. b. APWT was discontinued when the wound was 95% healed. The wound healed completely <1 month later.
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