NPWTRCT.docx

NPWTRCT.docx

《NPWTRCT.docx》由会员分享，可在线阅读，更多相关《NPWTRCT.docx（12页珍藏版）》请在冰豆网上搜索。

NPWTRCT

Geneexpressionprofilingofnegative-pressure-treatedskingraftdonorsitewounds.

NuutilaK,SiltanenA,PeuraM,HarjulaA,NieminenT,VuolaJ,KankuriE,AarnioP.

Source

InstituteofBiomedicine,Pharmacology,Biomedicum,UniversityofHelsinki,Haartmaninkatu8,00290Helsinki,Finland.kristo.nuutila@helsinki.fi

Abstract

Negative-pressurewoundtherapy（NPWT）iswidelyusedtoimproveskinwoundhealing.AlthoughNPWThasbeenstudiedasatreatmentforwoundclosureandhealing,themolecularmechanismsexplainingitstherapeuticeffectsremainunclear.ToinvestigatetheeffectofNPWTongeneexpression,andtodiscoverthegenesmostdominantlyrespondingtothistreatmentduringskinwoundhealing,weappliednegativepressureonsplit-thicknessskingraftdonorsitesfromthefirstpostoperativeday（POD）totheseventhPOD.Biopsieswerecollectedfrom4NPWT-treatedand2controlpatients.Twobiopsysamplesweretakenfromeachpatient:

onefromintactskinbeforegraftharvesting,andoneontheseventhPODfromthedonorsitewound.Genome-widemicroarrayswereperformedonallsamples.GeneexpressionchangesontheseventhPODwerecomparedbetweenNPWTandcontrolpatients,andwereanalyzedforstatisticalsignificance.Inaddition,weanalyzedwoundexudatesforvolume,andforconcentrationsofleukocytes,erythrocytes,andhaemoglobin.NPWTinducedmajorchangesingeneexpressionduringhealing.Thesechangesrangedfrom10-foldinductionto27-foldsuppression.Thegenesmostinducedwereassociatedwithcellproliferationandinflammation,andthemostdown-regulatedgeneswerelinkedtoepidermaldifferentiation.OurresultsprovidethefirstinsightintothemolecularmechanismsbehindNPWT,andsuggestthatNPWTenhancesspecificinflammatorygeneexpressionattheacutephaseassociatedwithepithelialmigrationandwoundhealing.However,itscontinuedusemayinhibitepithelialdifferentiation.

Copyright©2012ElsevierLtdandISBI.Allrightsreserved.

PMID:

23141686

[PubMed-indexedforMEDLINE

Clinicalevaluationofgauze-basednegativepressurewoundtherapyinchallengingwounds.

TuncelU,ErkorkmazÜ,TuranA.

Source

UTuncel,DepartmentofPlasticReconstructiveandAestheticSurgery,FacultyofMedicine,GaziosmanpaşaUniversity,Tokat60150,Turkey.drumuttuncel@

Abstract

Theaimofthisrandomisedclinicalstudywastoevaluatetheeffectivenessandsafetyofgauze-basednegativepressurewoundtherapy（NPWT）inpatientswithchallengingwounds.Atotalof50consecutivepatientswhohadwounddrainageformorethan5days,requiredopenwoundmanagementandhadexistenceofculturepositiveinfectionwereincludedthestudy.Inthisstudy,gauze-basedNPWTwascomparedwithconventionaldressingtherapyinthetreatmentofpatientswithdifficult-to-healwounds.Thepatientswererandomlydividedintotwogroups.GroupI（n=25）wasfollowedbyconventionalantiseptic（polyhexanidesolution）dressings,andgroupII（n=25）wastreatedwithsaline-soakedantibacterialgauze-basedNPWT.Thewounds'sizes,numberofdebridement,bacteriologyandrecurrencewerecomparedbetweengroupIandgroupII.Themeanageofthepatientswas59·50years（range23-97）.IngroupI,averagewoundsizesofpre-andpost-treatmentperiodswere50·60±55·35and42·50±47·92cm

（2）,respectively（P<0·001）.Averagedurationoftreatmentwas25·52±16·99days,andaveragewoundsizereductionfollowingthetreatmentwas19·99%inthisgroup.IngroupII,thewoundsdisplayedconsiderableshrinkage,acceleratedgranulationtissueformation,decreasedandclearedawayexudate.Theaveragewoundsizesinthepre-andpost-treatmentperiodswere98·44±100·88and72·08±75·78cm

（2）,respectively（P<0·001）.Averagedurationoftreatmentwas11·96±2·48days,andaveragewoundsizereductionfollowingthetreatmentwas32·34%.Thepatientstreatedwithantibacterialgauze-basedNPWThadasignificantlyreducedrecurrence（2woundsversus14wounds,P=0·001）,andincreasednumberoftheculture-negativecases（22woundsversus16wounds,P<0·047）inafollow-upperiodof12months.Therewasastatisticallysignificantdifferencebetweentwogroupsinallmeasurements.Asaresult,wecansaythatthegauze-basedNPWTisasafeandeffectivemethodinthetreatmentofchallenginginfectivewoundswhencomparedwithconventionalwoundmanagement.

©2012TheAuthors.InternationalWoundJournal©2012BlackwellPublishingLtdandMInc

Burns.2012Jun;38（4）:

573-7.doi:

10.1016/j.burns.2011.10.010.Epub2011Nov17.

Anoveloptioninnegativepressurewoundtherapy（NPWT）forchronicandacutewoundcare.

Rahmanian-SchwarzA,WillkommLM,GonserP,HirtB,SchallerHE.

Source

DepartmentofPlastic,Reconstructive,HandandBurnSurgery,BG-TraumaCenter,EberhardKarlsUniversityTuebingen,Germany.arahmanian@bgu-tuebingen.de

Abstract

INTRODUCTION:

Negativepressurewoundtherapy（NPWT）hasbecomeawidelyacceptedtechniqueintreatmentofallkindsofwounds.AfteralongperiodofclinicalapplicationoftheV.A.C.™system（KCIInc.,SanAntonio,Texas,USA）anumberofoptionsfordeliveryofNPWTarenowcommerciallyavailable.AnurgentneedexistsforevidencedemonstratingclinicalefficacyofthesenewdevicestosupportcliniciansregardingtheirchoiceofNPWT.

METHODS:

42patientswithanacuteorchronicwoundwererandomlyassignedtoeithertreatmentbyV.A.C.™（groupA）ortherapywithanalternativenewlyavailablepolyurethanefoam-basedNPWTsystem（RENASYSGO™-F/P,Smith&NephewGmbH）（groupB）.InbothgroupsNPWTwasappliedaftersurgicaldebridementtopreparethewoundbedforskingrafting.AfterskingraftingNPWTwasappliedadditionallytosecureskingraftsandimprovegraftssurvival.Primaryoutcomemeasureswerethetimetocompletehealing（days）anddurationoftheNPWTapplication（days）.Secondaryoutcomemeasureswerethenumberofdressingchangesandreportedcomplications.Inaddition,weevaluatedthecost-benefitintheclinicalimplementation.

RESULTS:

Therewerenosignificantdifferencescomparingtheinvestigatedparametersbetweenbothgroups.EspeciallyaveragetimetocompletehealingandaveragetimeNPWTwasapplieddidnotdiffer（p>0.05）.Nocomplicationsoccurredineithergroup.ByanalmostidenticalsupplyagreementofbothprovidersforourhospitalRENASYS™systemappearedtobemorecost-effective.

CONCLUSION:

AfteralongperiodofpreservingamonopolymarketpositionoftheV.A.C.™system,anewcomparableoptionwassuccessfullytestedinthispreliminarystudy.Thepolyurethanefoam-basedNPWTsystem（RENASYSGO™-F/P,Smith&NephewGmbH）isanefficientandcost-effectivealternativeNPWTsystem,whichweeffectivelyimplementedintherapeuticmanagementofdifferentkindsofwounds.

ApilotrandomisedcontrolledtrialofnegativepressurewoundtherapytotreatgradeIII/IVpressureulcers[ISRCTN69032034].

AshbyRL,DumvilleJC,SoaresMO,McGinnisE,StubbsN,TorgersonDJ,CullumN.

Source

DepartmentofHealthSciences,TheUniversityofYork,York,UK.

Abstract

BACKGROUND:

Negativepressurewoundtherapy（NPWT）iswidelypromotedasatreatmentforfullthicknesswounds;however,thereisalackofhigh-qualityresearchevidenceregardingitsclinicalandcosteffectiveness.AtrialofNPWTforthetreatmentofgradeIII/IVpressureulcerswouldbeworthwhilebutprematurewithoutassessingwhethersuchatrialisfeasible.TheaimofthispilotrandomisedcontrolledtrialwastoassessthefeasibilityofconductingafuturefulltrialofNPWTforthetreatmentofgradeIIIandIVpressureulcersandtopilotallaspectsofthetrial.

METHODS:

Thiswasatwo-centre（acuteandcommunity）,pilotrandomisedcontrolledtrial.EligibleparticipantswererandomisedtoreceiveeitherNPWTorstandardcare（SC）（spunhydrocolloid,alginateorfoamdressings）.Outcomemeasuresweretimetohealingofthereferencepressureulcer,recruitmentrates,frequencyoftreatmentvisits,resourcesusedanddurationoffollow-up.

RESULTS:

Threehundredandtwelvepatientswerescreenedforeligibilityintothistrialovera12-monthrecruitmentperiodand12/312participants（3.8%）wererandomised:

6toNPWTand6toSC.Onlyonereferencepressureulcerhealed（NPWTgroup）duringfollow-up（timetohealing79 days）.Themeannumberoftreatmentvisitsperweekwas3.1（NPWT）and5.7（SC）;6/6NPWTand1/6SCparticipantswithdrewfromtheirallocatedtrialtreatment.Themeandurationoffollow-upwas3.8（NPWT）and5.0（SC）months.

CONCLUSIONS:

Thispilottrialyieldedvitalinformationfortheplanningofafuturefullstudyincludingprojectedrecruitmentrate,requireddurationoffollow-upandextentofresearchnursesupportrequired.Datawerealsousedtoinformthecost-effectivenessandvalueofinformationanalyses,whichwereconductedalongsidethepilottrial.

Dopatientandnurseoutcomedifferencesexistbetween2negativepressurewoundtherapysystems?

AlbertNM,RockR,SammonMA,BenaJF,MorrisonSL,WhitmanA,KatoI,Landis-ErdmanJC.

Source

NursingInstitute,ClevelandClinic,Ohio44195,USA.albertn@ccf.org

Abstract

PURPOSE:

Weprospectivelycomparedtheeffectivenessoffoam-andgauze-basednegativepressurewoundtherapy（NPWT）systemsonwoundhealing,pain,cost,andhospitallengthofstay.Wealsocompareeaseofuseandtimeinperformingdressingchangesreportedbynurses.

DESIGN:

Randomized,controlledclinicaltrialcomparingfoam-andgauze-basedNPWTsystems.

SUBJECTSANDSETTING:

ElevenadultsubjectswithphysicianordersforNPWTparticipatedinthestudy.Subjectsweremiddle-aged,white,andmale.

METHODS:

Sixsubjectswererandomlyallocatedtofoam-basedand5togau