Using low pressure, NPWT for wound preparation & the management of split-thickness skin grafts in 3 patients with complex wound.

The use of negative pressure wound therapy (NPWT) is well established in the management of hard-to-heal wounds. One institution, familiar with NPWT's capabilities as well as its shortcomings (eg, pain at dressing changes and pain with the maximum recommended setting of 125 mm Hg), sought a viable alternative. A low pressure, negative pressure wound therapy (LP-NPWT) system, using subatmospheric pressure levels of 75 mm Hg and a low-adherence dressing, was evaluated to prepare the wound bed for split-thickness skin graft (STSG) on three patients. One patient was a healthy 23-year-old man with extensive trauma-related soft tissue wounds. The two women--54 and 47 years old--had multiple comorbidities. One had a lower extremity fasciotomy wound and the other had a dehisced surgical wound with a history of irradiation. Wound area was reduced >60% in all three wounds in 3 to 6 weeks as new granulation tissue developed. The average pain reported was moderate (4 to 5 on a Visual Analogue Scale), ranging from 2 to 10 during dressing changes to 1 to 7 between dressing changes; pain levels reported tended to decrease as therapy progressed. Little or no trauma on dressing removal and no signs of infection were noted. In all cases, STSGs, followed by 4 days of LP-NPWT were applied and all wounds healed. The results from these three cases suggest that the LP-NPWT system is a useful healing adjunct for complex wound bed preparation and graft management. Clinical studies to quantify the effects of LP-NPWT technology and compare its safety and efficacy to other negative pressure systems are needed.