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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