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Case Study
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Treating unusual thoracic pressure based wounds with negative pressure wound therapy* and drain** Michael Miller, DO, FACOS, FAPWCA, CWS, Cheryl McDaniel, LPN The use of negative pressure to promote healing of open wounds has considerable literature support for efficacy, cost effectiveness and ease of use. A new product concept called The Versatile 1TM by Blue Sky Medical of La Costa, CA offers a variation on the usual negative pressure wound therapy. The product and conceptual variations on NPWT are based on extensive experience, well documented in the Russian literature. It differs from the conventional product in multiple parameters including strength of suction, timing of therapy and length of therapy. Recent problems identified with foam based NPWT include bleeding, fragmentation of the foam in the wound and painful removal of the foam. These drawbacks mandate that alternative means of NPWT be developed. This article discusses a novel variation using both non-foam contact and non-contact application of NPWT to heal an unusual posterior thoracic wound A case is presented of an 82 year old woman hospitalized for pneumonia who, later developed tenderness of the upper thoracic region. Initial examination by her primary physician assumed the problem was due to a subcutaneous cyst which was subsequently incised and debrided leaving a large, irregularly-shaped, exquisitely painful wound. When this failed to heal, she was referred to The Wound Healing Center of Terre Haute. The history of the wound and examination suggested that the initial cause of this unusually-shaped mid/upper thoracic wound was probably a pressure based, deep tissue injury. Because of concerns over pain related to application and removal of foam, the Versatile 1 and Chariker-Jeter kit was used to promote excellent healing while minimizing pain related to treatment. After the tail of the wound healed, making the wound more circular, the Miller DermiVex drain was used to promote final healing *BlueSky Medical Versatile 1TM La Costa, CA.**Miller DermiVex Drain 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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