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Case Study
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Combining wound debridement modalities with negative pressure wound therapy Janet Davis, MSN, RN, APRN-BC, CWOCN, MD Anderson Cancer Center, Houston, TX Statement of Problem:.Inadequate surgical debridement of an infected abdominal surgical wound delays wound healing and puts patients at risk for continued infection. Since negative pressure wound therapy (NPWT) is recommended to be used in wounds with < 25% necrosis, then use of it with a wound containing greater than 75% necrosis is considered off-label use. . .Rationale:.Combined debridement methods were utilized to optimize the wound bed in preparation for secondary healing Methodology:.A variety of debriding modalities were used in conjunction with negative pressure wound therapy to expedite the removal of necrotic tissue. Twenty-four hours after sub-optimal surgical debridement, 30-g of papain urea debriding ointment was employed under NPWT to promote synergistic debridement. On three subsequent wound care visits, bedside pulsed lavage, conservative sharp debridement (CSD) and papain-urea debriding ointment were utilized. The next four dressing changes required decreasing doses of the papain-urea debriding ointment as the necrotic tissue emulsified. Copious wound exudate (500-1000cc per day) was attributed to necrotic tissue breakdown using the papain urea debriding ointment under the NPWT Results:.Using a variety of debriding methods (mechanical, enzymatic, sharp, & autolytic) along with negative pressure wound therapy provided a synergistic effect in cleaning the wound base and preparing the bed for granulation, contraction and epithelialization. The patient experienced less pain with non-sharp debridement methods Conclusion:.Combining debridement methods/therapies can provide a synergistic effect of promoting orderly wound healing by expediting wound debridement, promoting faster granulation and wound contraction. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;(38)6:563Ð576 Ford CN, Reinhard ER, Yeh D, et al. Interim analysis of a prospective, randomized trial of vacuum-assisted closure versus the Healthpoint system in the management of pressure ulcers. Ann Plast Surg. 2002;49(1):55Ð31 Hobson D, White E, Anderson L, Lira L. Development and use of a quantitative method to evaluate the action of enzymatic wound debriding agents in vitro. WOUNDS. 1998;10(4):105Ð110 Loree S, Dompmartin A, Penven K, Harel D, Leroy D. Is vacuum assisted closure a valid technique for debriding chronic leg ulcers? J Wound Care. 2004;13(6):249Ð252 Melano E, Rodriquez HL, Carrillo R, Dillion L. The effects of Panafil when using topical negative pressure to heal an infected sternal wound. J Wound Care. 2004;13(10):425Ð426. Niezgoda JA. Combining negative pressure wound therapy with other wound management modalities. Ostomy Wound Manage. 2005:51(suppl 2A):36SÐ38S Schoemann MB. Treating Surgical Wound Dehiscence with Negative Pressure Dressings. Ostomy Wound Manage. 2005;51(suppl 2A):15SÐ20S Wongworawat MD, Schnall SB, Holtom PD, Moon C, Schiller F. Negative pressure dressings as an alternative technique for the treatment of infected wounds. Clin Orthop Relat Res. 2003;(414):45Ð48 Wu SH, Zecha PJ, Feitz R, Hovius SER. Vacuum therapy as an intermediate phase in wound closure: a clinical experience. Eur J Plast Surg. 2000;23:174Ð177 Wound Bed Preparation for Optimal Use of Advanced Therapeutic Products. Available at: http://www.bu.edu/woundbiotech/woundcare/Woundbedpr.html. Accessed: June 23, 2005.. |
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