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Negative pressure wound therapy ncbi11/16/2023 The mean time of instillation was 20 seconds. The NPWTi unit instilled normal saline for 20 or 30 seconds, depending on patient and wound conditions. The distal end of the suction tubing was attached to the canister within the negative pressure unit and the distal end of the solution delivery tubing was attached to the saline bag fastened to the unit arm. VeraT.R.A.C.™ Pad KCI USA, Inc.) was secured over a hole cut in the dressing, thereby allowing contact with the foam. In a few cases, a white polyvinyl foam (V.A.C.® WhiteFoam Dressing KCI USA, Inc.) was applied to the wound in order to reduce the pain at dressing change.Īn integrated set of suction and solution delivery tubing (V.A.C. VeraFlo™ Dressing KCI USA, Inc.) that was placed into the wound and sealed with a semi‐occlusive dressing, and was used in the vast majority of cases. The NPWTi system consisted of a reticulated open‐cell foam (V.A.C. In cases of persistent thick exudate or lack of wound improvement, additional debridement was performed, and NPWTi was reinitiated. In cases of exposed hardware or bone, NPWTi was continued until sufficient granulation coverage was achieved. All patients and wounds were assessed at each dressing change during which time a decision was made to convert to conventional NPWT or close the wound. The decision to apply or discontinue NPWTi was made by consensual agreement of all involved team members at each facility. Duration of the antibiotic treatment was determined under the supervision of the infectiology department and in accordance with the type of germ and level of involvement of bone and deep structures. Postoperatively, all patients were treated with systemic antibiotics according to bacteriological biopsies performed during the surgical debridement. NPWTi was applied as the primary therapy to the remaining 85 patients (64♹%) after radical surgical bone and soft tissue debridement. A total of 46 patients (35♱%) received conventional NPWT prior to NPWTi. All patients consented to participate in this study. Patients who were already being treated with conventional NPWT were also eligible to receive NPWTi. Patients aged 18 years or older with an infected wound or wound at risk of infection were eligible to receive NPWTi (V.A.C. VeraFlo Therapy by three teams in three different facilities: (i) Wound Healing Unit at Montpellier University Hospital, (ii) Department of Orthopaedic and Traumatologic Surgery at Orléans Hospital and (iii) Department of Orthopaedic and Traumatologic Surgery at Strasbourg University Hospital. The purpose of this study was to evaluate the outcomes of complex wounds treated with the new NPWTi technology.īetween January 2012 and December 2012, a total of 131 patients were prospectively treated with NPWTi using V.A.C. Three centres in France (Montpellier, Orléans and Strasbourg) collaborated to collect data on a series of 131 wounds of various aetiologies, including orthopaedic infected wounds, complex traumas, DFUs, postoperative sepsis and necrotising fasciitis that were treated with NPWTi using saline. The instillation principle involves irrigating and soaking the wound, followed by removal of the fluid via application of negative pressure at timed, regular intervals, while the foam dressing remains in place. VeraFlo™ Therapy (NPWTi KCI USA Inc.), with volumetric distribution and removal of topical solutions that could be used as adjunctive treatment for infected wounds, wounds at high risk of infection and/or wounds that have not responded to conventional NPWT. For these reasons, a technically improved NPWT system with instillation was designed, V.A.C. However, some wounds remain difficult to treat. The most visible clinical effect is wound reduction linked to subsequent granulation tissue formation. Mechanisms of action for NPWT include drawing wound edges together, removing infectious materials, reducing oedema, promoting perfusion and creating tissue microdeformations, leading to cell stretching and subsequent cellular activity important for wound healing 5, 6, 7, 8, 9, 10, 11. NPWT can be applied to most types of acute and chronic wounds. 4 also carried out randomised controlled trials, demonstrating successful use of NPWT for diabetic foot wounds and DFUs, respectively. This advancement has been considered one of the most innovative technologies to simplify the coverage of highly complex wounds, such as post‐traumatic wounds and chronic wounds (e.g. Negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy (KCI USA, Inc., San Antonio, TX), was introduced by Argenta and Morykwas 1, 2 in 1997.
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