Clinical evaluation of gauze-based negative pressure wound therapy in challenging wounds

Abstract

The aim of this randomised clinical study was to evaluate the effectiveness and safety of gauze-based negative pressure wound therapy (NPWT) in patients with challenging wounds. A total of 50 consecutive patients who had wound drainage for more than 5 days, required open wound management and had existence of culture positive infection were included the study. In this study, gauze-based NPWT was compared with conventional dressing therapy in the treatment of patients with difficult-to-heal wounds. The patients were randomly divided into two groups. Group I (n = 25) was followed by conventional antiseptic (polyhexanide solution) dressings, and group II (n = 25) was treated with saline-soaked antibacterial gauze-based NPWT. The wounds' sizes, number of debridement, bacteriology and recurrence were compared between group I and group II. The mean age of the patients was 59·50 years (range 23-97). In group I, average wound sizes of pre- and post-treatment periods were 50·60 ± 55·35 and 42·50 ± 47·92 cm(2), respectively (P < 0·001). Average duration of treatment was 25·52 ± 16·99 days, and average wound size reduction following the treatment was 19·99% in this group. In group II, the wounds displayed considerable shrinkage, accelerated granulation tissue formation, decreased and cleared away exudate. The average wound sizes in the pre- and post-treatment periods were 98·44 ± 100·88 and 72·08 ± 75·78 cm(2) , respectively (P < 0·001). Average duration of treatment was 11·96 ± 2·48 days, and average wound size reduction following the treatment was 32·34%. The patients treated with antibacterial gauze-based NPWT had a significantly reduced recurrence (2 wounds versus 14 wounds, P = 0·001), and increased number of the culture-negative cases (22 wounds versus 16 wounds, P < 0·047) in a follow-up period of 12 months. There was a statistically significant difference between two groups in all measurements. As a result, we can say that the gauze-based NPWT is a safe and effective method in the treatment of challenging infective wounds when compared with conventional wound management.

Figure 1

(A) Post‐amputation wound in a patient with diabetes. After referred to the clinic, the wound was debrided three times and followed by polyhexadine solution dressing. (B) The wound was ready for closure with a split‐thickness skin graft after 17 days of treatment.

Figure 2

(A) Ischial pressure ulcer in a 45‐year‐old male. (B) The wound debridement was performed before the application of gauze‐based negative pressure therapy. The dressing changes were made thrice a week. Total application time was 12 days. (C) Photograph shows that enhanced granulation tissue formation and improved wound healing. (D) The wound was closed with gluteus maximus myocutaneous island flap.

Figure 3

(A) The patient with sacral pressure sore. (B and C) After debridement, the wound was treated by gauze‐based NPWT. (D) The wound was ready to cover by a myocutaneous flap after 12 days of NPWT. (E) The wound was covered by V‐Y advancement myocutaneous flap.

Figure 4

Changes of wound areas between pre‐ and post‐treatments.