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The use of a rigid disc to protect exposed structures in wounds treated with negative pressure wound therapy: Effects on wound bed pressure and microvascular blood flow.

Anesäter, Erik; Borgquist, Ola LU ; Torbrand, Christian LU ; Roupé, Markus LU ; Ingemansson, Richard LU ; Lindstedt Ingemansson, Sandra LU and Malmsjö, Malin LU (2012) In Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 20(4). p.611-616
Abstract
There are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT). Bleeding may occur in patients when NPWT is applied to a wound with exposed blood vessels or vascular grafts, possibly due to mechanical deformation and hypoperfusion of the vessel walls. Recent evidence suggests that using a rigid barrier disc to protect underlying tissue can prevent this mechanical deformation. The aim of this study was to examine the effect of rigid discs on the tissue exposed to negative pressure with regard to tissue pressure and microvascular blood flow. Peripheral wounds were created on the backs of eight pigs. The pressure and microvascular blood flow in the wound bed were measured... (More)
There are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT). Bleeding may occur in patients when NPWT is applied to a wound with exposed blood vessels or vascular grafts, possibly due to mechanical deformation and hypoperfusion of the vessel walls. Recent evidence suggests that using a rigid barrier disc to protect underlying tissue can prevent this mechanical deformation. The aim of this study was to examine the effect of rigid discs on the tissue exposed to negative pressure with regard to tissue pressure and microvascular blood flow. Peripheral wounds were created on the backs of eight pigs. The pressure and microvascular blood flow in the wound bed were measured when NPWT was applied. The wound was filled with foam, and rigid discs of different designs were inserted between the wound bed and the foam. The discs were created with or without channels (to accommodate exposed sensitive structures such as blood vessels and nerves), perforations, or a porous dressing that covered the underside of the discs (to facilitate pressure transduction and fluid evacuation). When comparing the results for pressure transduction to the wound bed, no significant differences were found using different discs covered with dressing, whereas pressure transduction was lower with bare discs. Microvascular blood flow in the wound bed decreased by 49 ± 7% when NPWT was applied to control wounds. The reduction in blood flow was less in the presence of a protective disc (e.g., -6 ± 5% for a dressing-covered, perforated disc, p = 0.006). In conclusion, NPWT causes hypoperfusion of superficial tissue in the wound bed. The insertion of a rigid barrier counteracts this effect. The placement of a rigid disc over exposed blood vessels or nerves may protect these structures from rupture and damage. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society
volume
20
issue
4
pages
611 - 616
publisher
Wiley-Blackwell
external identifiers
  • WOS:000305896300019
  • PMID:22672059
  • Scopus:84863468899
ISSN
1524-475X
DOI
10.1111/j.1524-475X.2012.00801.x
language
English
LU publication?
yes
id
a538a869-8318-4436-96e5-95569ef303f7 (old id 2859750)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22672059?dopt=Abstract
date added to LUP
2012-07-04 11:54:47
date last changed
2016-10-28 15:18:39
@misc{a538a869-8318-4436-96e5-95569ef303f7,
  abstract     = {There are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT). Bleeding may occur in patients when NPWT is applied to a wound with exposed blood vessels or vascular grafts, possibly due to mechanical deformation and hypoperfusion of the vessel walls. Recent evidence suggests that using a rigid barrier disc to protect underlying tissue can prevent this mechanical deformation. The aim of this study was to examine the effect of rigid discs on the tissue exposed to negative pressure with regard to tissue pressure and microvascular blood flow. Peripheral wounds were created on the backs of eight pigs. The pressure and microvascular blood flow in the wound bed were measured when NPWT was applied. The wound was filled with foam, and rigid discs of different designs were inserted between the wound bed and the foam. The discs were created with or without channels (to accommodate exposed sensitive structures such as blood vessels and nerves), perforations, or a porous dressing that covered the underside of the discs (to facilitate pressure transduction and fluid evacuation). When comparing the results for pressure transduction to the wound bed, no significant differences were found using different discs covered with dressing, whereas pressure transduction was lower with bare discs. Microvascular blood flow in the wound bed decreased by 49 ± 7% when NPWT was applied to control wounds. The reduction in blood flow was less in the presence of a protective disc (e.g., -6 ± 5% for a dressing-covered, perforated disc, p = 0.006). In conclusion, NPWT causes hypoperfusion of superficial tissue in the wound bed. The insertion of a rigid barrier counteracts this effect. The placement of a rigid disc over exposed blood vessels or nerves may protect these structures from rupture and damage.},
  author       = {Anesäter, Erik and Borgquist, Ola and Torbrand, Christian and Roupé, Markus and Ingemansson, Richard and Lindstedt Ingemansson, Sandra and Malmsjö, Malin},
  issn         = {1524-475X},
  language     = {eng},
  number       = {4},
  pages        = {611--616},
  publisher    = {ARRAY(0xc556410)},
  series       = {Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society},
  title        = {The use of a rigid disc to protect exposed structures in wounds treated with negative pressure wound therapy: Effects on wound bed pressure and microvascular blood flow.},
  url          = {http://dx.doi.org/10.1111/j.1524-475X.2012.00801.x},
  volume       = {20},
  year         = {2012},
}