Negative Pressure Wound Therapy with Instillation and Dwell for the Management of a Complex Burn: A Case Report and Review of the Literature

Padilla, Pablo L.; Freudenburg, Elliott; Kania, Katarzyna; Laney, Rece W; Branski, Ludwik K.; Herndon, David N.

doi:10.7759/cureus.3514

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…With the combination of debridement and NPWT prior to the skin grafting, we could further achieve a relevant reduction of the bacterial load in the treated defects of all three different injury groups, which is in accordance with the results of other groups [20,[24][25][26][27][28][29]. But not all defects were free of pathogens when we performed the skin grafting augmented with Matriderm®, which is in stark contrast to the methods described by other studies [2,30].…”

Section: Discussionsupporting

confidence: 84%

Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

Lempert

Halvachizadeh

Salfelder

et al. 2021

Langenbecks Arch Surg

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Purpose The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden. Methods In this study, 45 wounds (44 affecting lower extremities (97.7%)), resulting from different types of injuries: soft tissue (ST), soft tissue complications from closed fracture (F), and open fracture (OF) in 43 patients (age 55.0 ± 18.2 years, 46.7% female), were treated with the simultaneous application of MD and split-thickness skin grafting. The study was designed as a retrospective cohort study from March 2013 to March 2020. Patients were stratified into three groups: ST, F, and OF. Outcome variables were defined as the recurrence of treated wound defects, which required revision surgery, and the reduction of bioburden in terms of reduction of number of different bacterial strains. For statistical analysis, Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, and Pearson’s chi-squared test were used. Results There was no significant difference in the rate of recurrence in the different groups (F: 0%; OF: 11.1%; ST: 9.5%). The duration of VAC therapy significantly differed between the groups (F: 10.8 days; OF: 22.7 days; ST: 12.6 days (p < 0.05)). A clinically significant reduction of bioburden was achieved with NPWT (bacterial shift (mean (SD), F: − 2.25 (1.89); OF: − 1.9 (1.37); ST: − 2.6 (2.2)). Conclusion MD-augmented split-thickness skin grafting is an appropriate treatment option for full-thickness wounds with take rates of about 90%. The complexity of an injury significantly impacts the duration of the soft tissue treatment but does not have an influence on the take rate. NPWT leads to a relevant reduction of bioburden and is therefore an important part in the preconditioning of full-thickness wounds.

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Section: Discussionsupporting

confidence: 84%

Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

Lempert

Halvachizadeh

Salfelder

et al. 2021

Langenbecks Arch Surg

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“…While in the past full thickness burns were left to spontaneously separate, today early excision and grafting has become the standard procedure as until the burn is covered, the patient will be left in a hypermetabolic state, immunocompromised, and liable to life threatening infections [9]. Despite all these advances in burns management, infection is still a major cause of mortality in the burn patient [10].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, NPWT with instillation has been used in management of complex infected wounds [21,22]. This was used in burns in only one case study that reported successful management of extensive infection of a skin graft [10].…”

Section: Discussionmentioning

confidence: 99%

The Use of Negative Pressure Wound Therapy in Infected Burn Wounds: Bridging the Gap

Nawar

Abodan

Ismail

2023

The Egyptian Journal of Plastic and Reconstructive Surgery

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Background: Burns represent one of the most devastating modes of trauma with significant morbidity and mortality. Despite advances in burns care, infection remains one of the leading causes of death. Burn excision is mandatory in infected cases and need to be temporarily covered with allografts, however this is not available in many settings. Negative pressure wound therapy (NPWT) has become an integral part of wound management, and is being used in burns with different indications.Objective: The use of NPWT as a temporary coverage after excision of infected burns for wound bed preparation before autografting, and to compare the outcomes with those of early excision and grafting.Patients and Methods: Ten patients with 15 burn wounds were allocated to 2 groups; group A patients presented late with infected burns while group B presented early. Group A had excision followed by NPWT and autografting when ready, and Group B had early excision and grafting. Both groups' outcomes were compared in terms of wound size, graft take and laboratory markers.Results: Both groups included different mechanisms of burns, various age groups, total burn surface area (TBSA) up to 30%. Most Group A patients had a reduction of wound size (mean 5.1%) with using NPWT, and the average graft take was 83.9% and 85% for Group A and Group B respectively. Inflammatory markers were reduced in Group A patients, who also showed an increase in serum albumin compared to Group B.Conclusions: NPWT should be considered for temporary coverage after excision of infected burns before autografting. It may minimize the size of the wound, and can increase graft take that can be comparable to cases excised and grafted early. Further work is needed to assess NPWT against allografts in infected burns, and to investigate its use with early excision.

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“…Subsequently, burns are the most prevalent and calamitous type of wound that requires surgical management. Nevertheless, this global public health issue has been reported to be preventable [25,[39][40][41][42].…”

Section: Burn-related Morbidity and Mortalitymentioning

confidence: 99%

Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast

Moniruzzaman¹,

Khan²,

Haq³

et al. 2022

Cureus

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BackgroundThe cardinal area of managing fire wounds is guided by adequately evaluating the burn-induced lesion's profundity and size. Superficial second-degree burns are often treated through daily reinstating with fresh sterile bandaging with appropriate topical antimicrobials to allow rapid spontaneous epithelialization. Around the world, a wide variety of substances are used to treat these wounds, from honey to synthetic biological dressings. ObjectiveThis study intended to determine honey's therapeutic potential compared with 1% silver sulfadiazine (Ag-SD) in arsenal-caused contusion medicament fulfillment. MethodsA total of 70 cases were evaluated in this research work after fulfilling the required selection criteria during the study period of January 2014 to December 2014 and January 2017 to December 2017. Purposive selection criteria were adopted in the study to select research patients. The patients in Group-1 (n = 35) relied on honey as medication, while patients in Group-2 (n = 35) relied on 1% Ag-SD. ResultsIn Group-1, exudation (68.4%) and sloughing (82.9%) were substantially reduced by Days 3 and 5 of therapeutic intervention, respectively. However, in Group-2, a reduction of exudation (17.1%) and sloughing (22.9%) occurred after Days 3 and 5 of treatment, respectively. Completion of the epithelialization process was observed among Group-1 and Group-2 cases. It was detected after Days 7 and 10 of treatment at 36.3% and 77% (Group-1) and 27% and 67% (Group-2), respectively. Around 3 ml of 1% honey was required per body surface area per dressing in Group-1. On the other hand, in Group-2, 2 gm Ag-SD was needed per body surface area per dressing. ConclusionPatients treated with honey found better clinical outcomes in managing superficial partial-thickness burns.

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Negative Pressure Wound Therapy with Instillation and Dwell for the Management of a Complex Burn: A Case Report and Review of the Literature

Cited by 6 publications

References 13 publications

Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

The Use of Negative Pressure Wound Therapy in Infected Burn Wounds: Bridging the Gap

Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast

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