Aim
Wound therapy represents a complex process and therefore, before the start of any treatment, we must know the answers to the following questions: IF, WHY, WHEN and HOW the NPWT should be used.
Currently, there already exist recommended procedures created by global and European associations followed by procedures issued by the national associations in the individual countries. In spite of all these preventive measures aimed at elimination of adverse events, there still occur cases of failures or treatments that failed to bring the desired outcome. The question “why” remains always there and we need to have the answer.
Methods
Prior application of NPWT, we have adhered to the following principle: select patients to be treated with NPWT carefully and only after reviewing the most recent device labeling and instructions. Know that NPWT systems are contraindicated for certain wound types, and patient risk factors must be thoroughly considered before use.We have performed the analysis of 249 cases treated with NPWT within the period VI/ 2012 – III/ 2017 with various diagnoses. More than 160 patients were aged 60+. The largest patient group consisted of the patients with postoperative abdominal wound infection (93 patients), 55 patients were treated for open abdomen, 43 patients were treated for defect in lower limb - majority of them after an injury. In 28 patients, NPWT was used for the treatment of chest and thoracic wall. Out of the total number of 249 cases, 11 patients died. The deaths were not related directly to the use of NPWT.
Results
Within our file, faults in application were detected only in isolated cases and these were always caused by a human error. In total there were 5 errors. In one case, it was a wrong position of a sponge with larger size than the wound. In line with the recommended procedures, the applied negative pressure was set to -125 mgHg in the patient suffering from decubitus. It resulted in necrosis of the defect. Poorly positioned foil at the lower extremity under pressure led to development of blisters, circular application resulted in creation of temporary paresthesias. Insufficient size of the abdominal foil caused eventration of small intestinal loops.
Discussion
The most serious complication found by the pub med browser regarding the complications caused by NPWT was bleeding and death described in UPDATE on Serious Complications Associated with Negative Pressure Wound Therapy Systems: FDA Safety Communication. Majority of the article was describing rather the therapy failure than the serious complication with NPWT application. Currently there are 38 freely accessible videos, the most popular one has reached more than 135 thousand viewings. Even these videos show just the generally known causes of the therapy failures.
Within our file with 249 cases of application with 3.92 dressing changes on average, the total number of performed dressing changes reached 976.08. The 5 failures thus account for 0.10% cases. Even though we need to see here complications affecting the patient.
The second cause of the treatment failure is the patients themselves. The basic precondition of success is
cooperation and acceptance of the therapeutic principle.
The third condition for elimination of potential complications is the use of reliable products and trust in their
manufacturer.
Conclusion
Holistic view of the patient, mutual trust between the physician and patient and quality product
are the guarantee of the optimal wound treatment.
