A portable, disposable system for negative-pressure wound therapy Tanya Brandon
Negative-pressure wound therapy (NPWT) imparts a number of clinical effects that promote a healing response and, as such, is a well-established means of treating a variety of wound types. Historically, the technique has been primarily used in the hospital setting; however, the introduction of more portable devices has led to an increase in the use of NPWT in the homecare setting, thereby facilitating early discharge of patients from hospital and continuity of care in the community. Portable NPWT devices also have the potential to impact positively on patients’ quality of life, allowing increased mobility and freedom to undertake normal activities of daily living. Following the development of its standard Avance® NPWT system and associated dressing kits, Mölnlycke Health Care (Gothenburg, Sweden) has introduced a single-patient-use, disposable NPWT system; Avance Solo. This has been developed with a view to maximising patient freedom and mobility, providing a single-patientuse NPWT solution for multi-week treatment to allow quick and easy discharge of patients from hospital to home, and reducing some of the challenges of logistics and administration associated with the provision of NPWT for the caregiver. As with the standard NPWT system, the single-patient use system is supplied with a number of products incorporating Safetac® adhesive technology to minimise the risk of patients suffering unnecessary pain and trauma associated with dressing changes. This article presents a series of case studies describing procedures and outcomes following the application of the Avance Solo single-patient-use system. Key words: Negative-pressure wound therapy ■ Wound healing ■ Quality of life ■ Activities of daily living
N
egative-pressure wound therapy (NPWT) has gained rapid acceptance by surgeons and physicians in the management of both hardto-heal and acute wounds (Moues et al, 2005). Delivery of NPWT to the wound takes two forms with the major difference between them being the type of dressing used to cover the wound. Either foam (Argenta and Morykwas, 1997) or gauze (Chariker et al, 1989) is used, depending on the type of wound and the clinical challenges under
Tanya Brandon, Plastics Nurse Specialist, St John’s Hospital, Livingston Accepted for publication: January 2015
98
consideration. NPWT enables the drainage of excessive fluid and debris from the wound to which it is applied and induces mechanical deformation of the wound-edge tissue (Argenta and Morykwas, 1997; Morykwas et al, 1997; Morykwas et al, 2006). It is postulated that the mechanical tension from the application of negative pressure may also directly stimulate the cellular proliferation of reparative granulation tissue (Webb, 2002). NPWT also creates a moist wound environment (Banwell, 1999) that is conducive to optimal healing. Studies demonstrate that NPWT reduces bacterial load (Morykwas et al, 1997), increases granulation tissue formation (Lu et al, 2003), reduces oedema (Gouttefangeas et al, 2001; Lu et al, 2003), stimulates cell-mediated immune responses (Gouttefangeas et al, 2001; Chen et al, 2005), decreases blood vessel permeability (Evans and Land, 2001; Lu et al, 2003), stimulates angiogenesis and blood flow to the wound margins, and decreases matrix metalloproteinase (MMP) activity in hard-to-heal wounds (Greene et al, 2006). Additionally, the available evidence suggests that NPWT helps to remove inhibitory cytokines and activated polymorphonuclear leukocytes present in the wound bed. These entities are responsible in part for hard-to-heal wounds becoming suspended in an inflammatory state (Lambert et al, 2005), hence their removal potentially allows progression of healing beyond the inflammatory stage. A review of the published literature indicates that NPWT has been most commonly applied to acute wounds (Braakenburg et al, 2006; Shweiki and Gallagher, 2013), burns requiring skin grafts (Nugent et al, 2005; Terrazas, 2006; Sahin et al, 2012), venous or arterial insufficiency ulcers unresponsive to standard therapy (Kieser et al, 2011), traumatic wounds (i.e., flap or meshed graft) (Garner et al, 2001; Bollero et al, 2007; Brandi et al, 2007), pressure ulcers (Ford et al, 2002; Wanner et al, 2003; Gupta and Ichioka, 2012), diabetic foot ulcers and partial foot amputations (Armstrong and Lavery, 2005; Blume et al, 2008; Stansby et al, 2010), chronic leg ulcers (Vuerstaek et al, 2004; Vuerstaek et al, 2006), chronic open wounds (Vig et al, 2011), flaps and grafts (Schipper et al, 2003; Jeschke et al, 2004; Eggert et al, 2007; Hanasono and Skoracki, 2007), dehisced surgical wounds (Fife et al, 2004; Morton, 2004), sternal wounds (Agarwal et al, 2005; Bapat et al, 2008; Chen et al, 2008), abdominal wounds (Kaplan, 2004) and necrotising fasciitis (Sarani et al, 2009; Rafter, 2012).
Principles of application To date, negative pressure has largely been delivered via open-cell polyurethane foam, but increasing interest has been directed toward delivering it via gauze. Clinical evidence for
© 2015 MA Healthcare Ltd
Abstract
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 15, 2015. For personal use only. No other uses without permission. . All rights reserved.
NPWT and patient quality of life With regard to studies addressing QoL-related issues in the context of NPWT, Augustin and Zschocke (2006) noted that the mean disease-specific QoL for patients undergoing NPWT improved significantly according to the patients’ total score for all diagnoses from 3.3 ± 0.7 to 2.6 ± 0.7 (p
Negative-pressure wound therapy (NPWT) imparts a number of clinical effects that promote a healing response and, as such, is a well-established means of treating a variety of wound types. Historically, the technique has been primarily used in the hospital setting; however, the introduction of more portable devices has led to an increase in the use of NPWT in the homecare setting, thereby facilitating early discharge of patients from hospital and continuity of care in the community. Portable NPWT devices also have the potential to impact positively on patients’ quality of life, allowing increased mobility and freedom to undertake normal activities of daily living. Following the development of its standard Avance® NPWT system and associated dressing kits, Mölnlycke Health Care (Gothenburg, Sweden) has introduced a single-patient-use, disposable NPWT system; Avance Solo. This has been developed with a view to maximising patient freedom and mobility, providing a single-patientuse NPWT solution for multi-week treatment to allow quick and easy discharge of patients from hospital to home, and reducing some of the challenges of logistics and administration associated with the provision of NPWT for the caregiver. As with the standard NPWT system, the single-patient use system is supplied with a number of products incorporating Safetac® adhesive technology to minimise the risk of patients suffering unnecessary pain and trauma associated with dressing changes. This article presents a series of case studies describing procedures and outcomes following the application of the Avance Solo single-patient-use system. Key words: Negative-pressure wound therapy ■ Wound healing ■ Quality of life ■ Activities of daily living
N
egative-pressure wound therapy (NPWT) has gained rapid acceptance by surgeons and physicians in the management of both hardto-heal and acute wounds (Moues et al, 2005). Delivery of NPWT to the wound takes two forms with the major difference between them being the type of dressing used to cover the wound. Either foam (Argenta and Morykwas, 1997) or gauze (Chariker et al, 1989) is used, depending on the type of wound and the clinical challenges under
Tanya Brandon, Plastics Nurse Specialist, St John’s Hospital, Livingston Accepted for publication: January 2015
98
consideration. NPWT enables the drainage of excessive fluid and debris from the wound to which it is applied and induces mechanical deformation of the wound-edge tissue (Argenta and Morykwas, 1997; Morykwas et al, 1997; Morykwas et al, 2006). It is postulated that the mechanical tension from the application of negative pressure may also directly stimulate the cellular proliferation of reparative granulation tissue (Webb, 2002). NPWT also creates a moist wound environment (Banwell, 1999) that is conducive to optimal healing. Studies demonstrate that NPWT reduces bacterial load (Morykwas et al, 1997), increases granulation tissue formation (Lu et al, 2003), reduces oedema (Gouttefangeas et al, 2001; Lu et al, 2003), stimulates cell-mediated immune responses (Gouttefangeas et al, 2001; Chen et al, 2005), decreases blood vessel permeability (Evans and Land, 2001; Lu et al, 2003), stimulates angiogenesis and blood flow to the wound margins, and decreases matrix metalloproteinase (MMP) activity in hard-to-heal wounds (Greene et al, 2006). Additionally, the available evidence suggests that NPWT helps to remove inhibitory cytokines and activated polymorphonuclear leukocytes present in the wound bed. These entities are responsible in part for hard-to-heal wounds becoming suspended in an inflammatory state (Lambert et al, 2005), hence their removal potentially allows progression of healing beyond the inflammatory stage. A review of the published literature indicates that NPWT has been most commonly applied to acute wounds (Braakenburg et al, 2006; Shweiki and Gallagher, 2013), burns requiring skin grafts (Nugent et al, 2005; Terrazas, 2006; Sahin et al, 2012), venous or arterial insufficiency ulcers unresponsive to standard therapy (Kieser et al, 2011), traumatic wounds (i.e., flap or meshed graft) (Garner et al, 2001; Bollero et al, 2007; Brandi et al, 2007), pressure ulcers (Ford et al, 2002; Wanner et al, 2003; Gupta and Ichioka, 2012), diabetic foot ulcers and partial foot amputations (Armstrong and Lavery, 2005; Blume et al, 2008; Stansby et al, 2010), chronic leg ulcers (Vuerstaek et al, 2004; Vuerstaek et al, 2006), chronic open wounds (Vig et al, 2011), flaps and grafts (Schipper et al, 2003; Jeschke et al, 2004; Eggert et al, 2007; Hanasono and Skoracki, 2007), dehisced surgical wounds (Fife et al, 2004; Morton, 2004), sternal wounds (Agarwal et al, 2005; Bapat et al, 2008; Chen et al, 2008), abdominal wounds (Kaplan, 2004) and necrotising fasciitis (Sarani et al, 2009; Rafter, 2012).
Principles of application To date, negative pressure has largely been delivered via open-cell polyurethane foam, but increasing interest has been directed toward delivering it via gauze. Clinical evidence for
© 2015 MA Healthcare Ltd
Abstract
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 15, 2015. For personal use only. No other uses without permission. . All rights reserved.
NPWT and patient quality of life With regard to studies addressing QoL-related issues in the context of NPWT, Augustin and Zschocke (2006) noted that the mean disease-specific QoL for patients undergoing NPWT improved significantly according to the patients’ total score for all diagnoses from 3.3 ± 0.7 to 2.6 ± 0.7 (p
