Abstract
Introduction Management of bedsores in traumatic paraplegia has been a challenge since time immemorial. Conventional serial debridement and dressings require prolong hospitalization, imply posible complications and are an economic burden. Modalities like hyperbaricoxygen, electrical stimulation, altered cultured keratinocytes are cumbersome, expensive, and not readily available. Negative pressure to promote wound healing is under evolution. This study evaluates the effect of negative pressure in bedsore management.
Methods The Negative Pressure Device (NPD) included sterilized foam, a low power continuous suction apparatus (Romovac) and a transparent polyurethane adhesive dressing. NPD was exclusively a bedside procedure. The perforated end of a drainage tube was placed on the wound surface and other end exited 10 cms away from wound margin, connected to Romovac. Sterilized foam was trimmed to size and geometry of wound as cover. Opsite closed the wound with an airtight seal. The bellow of Romovac was charged to attain negative pressure. Recharging was done after five to six hours. The wound inspected and dressings changed every five to seven days.
Results NPD converted an open wound into a close controlled wound. By drawing away fluid from the wound it prevented collection of secretions and decreased purulence. Negative pressure increased vascularity, enhanced granulation tissue and rapidly reduced the size and depth of wound. Airtight sealing prevented soiling and odor enabling universal acceptance. In controlled based study, NPD: Reduced the frequency of dressing from once daily to once in five to seven days (cost effective). Reduced bacterial contamination and substantially increased granulation tissue. Serial microbial assessment of wound revealed efficacy in controlling bacterial growth and achieving a sterile culture within 10 days. Prooved itself to be an efficient and painless method of serial debridement. Reduced wound size and depth to one third of the original within three weeks. Was well tolerated by patients. The drawbacks of NPD were: Failure in low sacral bedsores close to the natal cleft. Difficulty in getting an airtight seal using Opsite. The tendency of the sterile foam to disintegrate, making the secretions viscous and clogging the drain. Tendency to increase bleeding, during changes of dressings, from the exuberant granulation tissue which formed.
Conclusions NPD is a bedside procedure, easy to apply, with minimal side effects. It reduces the frequency of dressings and duration of hospitalization. By converting an open wound into a close-controlled wound it decreases purulence, hastens recovery and prevents soiling and the characteristic odor. The NPD apparatus suggested is innovative, cost-effective.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
