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Case Study
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Treating large post amputation stump wounds using negative pressure wound therapy*Ñtwo difficult cases Michael Miller, DO, FACOS, FAPWCA, CWS, Cheryl McDaniel, LPN There is considerable literature support of Negative Pressure for efficacy, cost effectiveness and ease of use in promoting healing of open wounds. In post amputation stump wounds, healing becomes even more challenging due to the position, function and nature of the exposed tissues including exposed fascia, muscle and bone. The more well known foam based negative pressure wound therapy is associated with bleeding, fragmentation, and severe pain with application and removal. Despite its efficacy, these problems mandate that other alternatives be considered. A new product concept called The Versatile 1TM by Blue Sky Medical of La Costa, CA offers a variation through the use of non-foam contact and non-contact NPWT. These products and the conceptual variation are based on extensive, well documented experience in the Russian literature. It differs from the conventional product in multiple parameters including suction strength, timing of therapy, length of therapy and use of a non-foam wound interface..Two cases are presented of non-healing post-amputation stump wounds. The first involved an AKA stump with dehiscence and exposure of muscle and fascia. The patient refused debridement due to severe, unrelenting pain. Because of concerns over pain related to application and removal of foam, the Versatile 1 and Chariker-Jeter kit was used to promote healing while minimizing pain related to treatment and dressing changes. The second case involved a BKA dehiscence with exposure of tibial bone and subsequent osteomyelitis. Though the patient was treated with intravenous antibiotics, he wanted to be otherwise unencumbered during the day to allow activities with his family. The Versatile 1 and Miller DermiVex drain allowed him to be treated in the evenings while at rest. Complete healing of the wound was obtained including coverage of the exposed bone using only this therapy *BlueSky Medical Versatile 1TM La Costa, CA Chariker ME, Jeter KF, et al. Effective management of incisional and cutaneous fistulae with closed suction wound drainage. Contemp Surg. 1989:34:59Ð63 Argenta LC, Morykwas MJ. Vacuum assisted closure: a new method for wound control and treatment: Clinical experience. Ann Plast Surg. 1997;38:563Ð576 Mullner T, Mrkonjic L, Kwasny O, Vecsei V. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg. 1997;50(3):194Ð199. Miller MS, Lowery CA. Negative pressure wound therapy: a rose by any other name. Ostomy Wound Manage. 2005;51(3):44Ð49. |
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