Negative pressure wound therapy in infants and children: a single-institution experience

Rentea, Rebecca M.; Somers, Kimberly K.; Cassidy, Laura D.; Enters, Jessica; Arca, Marjorie J.

doi:10.1016/j.jss.2013.05.056

Cited by 27 publications

(21 citation statements)

References 23 publications

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“…Scarring and Hurley III severity should be treated with surgical procedures. Negative pressure wound therapy in 30 HS patients (mean age 16 years) from a retrospective case series provide evidence that more 87 % of patients had successful outcomes with only 4 patients discontinuing because of side effects [14]. …”

Section: Epidemiologymentioning

confidence: 99%

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Gulliver

Zouboulis

Prens

et al. 2016

Rev Endocr Metab Disord

196

288

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Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patients should be offered adjuvant therapy as needed (pain management, weight loss, tobacco cessation, treatment of super infections, and application of appropriate dressings). The treating physician should be familiar with disease severity scores, especially Hurley staging, physician global assessment and others. The routine use of patient’reported outcomesincluding DLQI, itch and pain assessment (Visual Analogue Scale) is strongly recommended. The need for surgical intervention should be assessed in all patients depending upon type and extent of scarring, and an evidence-based surgical approach should be implemented. Evidence-based medical treatment of mild disease consists of topical Clindamycin 1 % solution/gel b.i.d. for 12 weeks or Tetracycline 500 p.o. b.i.d. for 4 months (LOE IIb, SOR B), for more widespread disease. If patient fails to exhibit response to treatment or for a PGA of moderate-to-severe disease, Clindamycin 300 p.o. b.i.d. with Rifampicin 600 p.o. o.d. for 10 weeks (LOE III, SOR C) should be considered. If patient is not improved, then Adalimumab 160 mg at week 0, 80 mg at week 2; then 40 mg subcutaneously weekly should be administered (LOE Ib, SOR A). If improvement occurs then therapy should be maintained as long as HS lesions are present. If the patient fails to exhibit response, then consideration of second or third line therapy is required. A growing body of evidence is being published to guide the treatment of HS. HS therapy should be based upon the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines. Treatment should include surgery as well as medical treatment. Future studies should include benefit risk ratio analysis and long term assessment of efficacy and safety, in order to facilitate long term evidence based treatment and rational pharmacotherapy.

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Section: Epidemiologymentioning

confidence: 99%

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Gulliver

Zouboulis

Prens

et al. 2016

Rev Endocr Metab Disord

196

288

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“…Several retrospective case series provide evidence that use of NPWT in neonates and children can augment wound healing in a variety of acute and chronic wounds, including infected wounds, those with exposed orthopedic hardware, and surgical wound dehiscence, with successful use reported in 92-100% of patients. 19,[59][60][61][62][63] Reported complications, including enteric fistula formation, bleeding, pain, and periwound skin breakdown, were uncommon and in the case of fistula formation, related at least in part to the patients' underlying disease process. In addition to facilitating wound healing, benefits of NPWT included decreased frequency of dressing changes, reduced need for use of pain medication, and decreased length of hospital stay.…”

Section: 58mentioning

confidence: 99%

Dressings and Products in Pediatric Wound Care

King

Stellar

Blevins

et al. 2014

Advances in Wound Care

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Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moistureassociated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations. SCOPE AND SIGNIFICANCEGiven the lack of consensus on the optimal strategies for common wound care management issues in the neonatal and pediatric populations and the large number of wound care products on the market today, it can be challenging to make informed decisions regarding wound care in these populations. A comprehensive review of the literature on the following specific areas of focus: pressure ulcers, surgical wounds, epidermal stripping, intravenous extravasation injuries, moisture-associated skin damage (MASD), and use of negative-pressure wound therapy (NPWT) is presented, along with management recommendations based on the clinical experience of the authors.

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“…Another weakness is the lack of patients below six months of age; this patient population may require different approaches and different settings for NPWT. [25] Another issue which was not addressed in our study is the use of continuous versus intermittent negative pressure. [26] All our patients except one had continuous NPWT.…”

Section: Discussionmentioning

confidence: 89%

Use of negative pressure wound therapy in pediatric oncology patients: a single-center review of 66 patients

Wong¹,

Eid²,

Southerland³

et al. 2016

PAR

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Aim: Negative pressure wound therapy (NPWT) has been studied extensively in adult patients, but less is known about pediatric patients. This study assesses the efficacy and safety of vacuumassisted closure ® usage in pediatric oncology patients. Methods: Retrospective data on all patients treated with NPWT at a single pediatric oncology hospital were collected between April 2005 and September 2013. Details on pre-treatment factors, treatment course, and post-treatment events were collected. No control group was available for comparison. Results: Sixty-six patients were identified, with a total of 74 wounds. Median age at the time of NPWT application was 13 years (range, 10 months-23 years). Median duration of treatment was 21 days (range, 3-236 days). NPWT therapy was started with continuous high negative pressures (125 mmHg) in most patients. Sixty-nine percent of patients had their wounds healed without intervention, and 20% of patients required surgical closure. NPWT was discontinued temporarily secondary to skin maceration or cellulitis in 12% of patients. NPWT was used in a number of non-standard clinical situations, including primarily-closed incisional wound NPWT and bridging NPWT through adjuvant chemotherapy. Conclusion: In pediatric oncology patients, NPWT is safe, effective, and well-tolerated. Although this study is retrospective in nature, and there was no control group for comparison, these data are important for clinicians to guide therapy as device monitoring agencies and payors increasingly require outcomes data for the approval of therapeutic decisions.

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Negative pressure wound therapy in infants and children: a single-institution experience

Cited by 27 publications

References 23 publications

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Dressings and Products in Pediatric Wound Care

Use of negative pressure wound therapy in pediatric oncology patients: a single-center review of 66 patients

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