Cargando…

Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds

BACKGROUND: Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the...

Descripción completa

Detalles Bibliográficos
Autores principales: Siegel, Herrick J., Herrera, Diego F., Gay, Jason
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916586/
https://www.ncbi.nlm.nih.gov/pubmed/23813240
http://dx.doi.org/10.1007/s11999-013-3123-3
_version_ 1782302736500391936
author Siegel, Herrick J.
Herrera, Diego F.
Gay, Jason
author_facet Siegel, Herrick J.
Herrera, Diego F.
Gay, Jason
author_sort Siegel, Herrick J.
collection PubMed
description BACKGROUND: Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested. QUESTIONS/PURPOSES: Does a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition? METHODS: We evaluated 42 patients with massive (> 200 cm(2)) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing. RESULTS: Hospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033). CONCLUSIONS: Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
format Online
Article
Text
id pubmed-3916586
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Springer US
record_format MEDLINE/PubMed
spelling pubmed-39165862014-02-12 Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds Siegel, Herrick J. Herrera, Diego F. Gay, Jason Clin Orthop Relat Res Symposium: Musculoskeletal Tumor Society 2012 Symposium BACKGROUND: Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested. QUESTIONS/PURPOSES: Does a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition? METHODS: We evaluated 42 patients with massive (> 200 cm(2)) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing. RESULTS: Hospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033). CONCLUSIONS: Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Springer US 2013-06-29 2014-03 /pmc/articles/PMC3916586/ /pubmed/23813240 http://dx.doi.org/10.1007/s11999-013-3123-3 Text en © The Author(s) 2013 https://creativecommons.org/licenses/by/2.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Symposium: Musculoskeletal Tumor Society 2012 Symposium
Siegel, Herrick J.
Herrera, Diego F.
Gay, Jason
Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds
title Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds
title_full Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds
title_fullStr Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds
title_full_unstemmed Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds
title_short Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds
title_sort silver negative pressure dressing with vacuum-assisted closure of massive pelvic and extremity wounds
topic Symposium: Musculoskeletal Tumor Society 2012 Symposium
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916586/
https://www.ncbi.nlm.nih.gov/pubmed/23813240
http://dx.doi.org/10.1007/s11999-013-3123-3
work_keys_str_mv AT siegelherrickj silvernegativepressuredressingwithvacuumassistedclosureofmassivepelvicandextremitywounds
AT herreradiegof silvernegativepressuredressingwithvacuumassistedclosureofmassivepelvicandextremitywounds
AT gayjason silvernegativepressuredressingwithvacuumassistedclosureofmassivepelvicandextremitywounds