Vacuum therapy in the treatment of purulent wounds

Abstract

Introduction. Negative pressure wound treatment (NPWT) consists of applying a special dressing to the internal wound’s environment, controlled by subatmospheric pressure. Sterile sponges with an impermeable membrane connected to a pump delivering subatmospheric pressure are applied to wound’s edges. The sponges don’t allow bacteria to multiply, and lead to reducing wound’s size until healing occurs. Aim of the study. To evaluate the NPWT benefits in purulent wounds treatment. Materials and methods. The study was based on 19 cases presented with various purulent wounds of soft tissues treated at the Department of General Surgery, Municipal Clinical Hospital No.1 (Chisinau). There were 12 (63.15%) male and 7 (36.85%) female patients. Age of subjects varied between 32 and 76 years. The NPWT system was used if local signs of wound suppuration during its surgical secondary processing were noticed. Patients were treated under local or general intravenous anesthesia, in aseptic conditions. After the removing of sutures, hydrogen peroxide was used, necrotic masses – removed, and hemostasis – applied. Then a piece of sterile sponge was adjusted and installed into the wound channel. External tip of a tube, placed inside the sponge, exiting through a separate incision. The wound was partially sutured. Wound’s edges were treated with alcohol solution, and then dried. Hermetic film was then applied to cover the wound. The drain was connected to the NPWT system set at the pressure of -125 to -75 mm Hg. The dressings were changed once every 72 hours. During the application of another dressing, the sponge and the previously installed system was removed from the wound, examining the persistence of the necrotic masses. The state of the granulation tissue was also checked. The number of sessions depended on the above listed findings. In the absence of necrotic masses and pathological discharge secondary sutures were applied. Results. In 3 (15.8%) cases dressings were changed only 2 times – enough for granulation tissue appearance. Twelve (63.15%) patients required 4 and another four (21%) – 6 sessions (exchanges of NPWT system) until sufficient proliferation of the granulation tissue. Conclusions. We proved the usefulness of NPWT system that has been able to prepare the wounds to secondary sutures applying. Vacuum therapy in the treatment of purulent wounds is associated with shorter period of hospitalization and more effective pain management.