Negative pressure wound therapy as an adjunct in healing of chronic wounds.

Negative pressure wound therapy (NPWT) has emerged as a cutting-edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.

Management of major limb injuries.

Management of major limb injuries is a daunting challenge, especially as many of these patients have severe associated injuries. In trying to save life, often the limb is sacrificed. The existing guidelines on managing such trauma are often confusing. There is scope to lay down such protocols along with the need for urgent transfer of such patients to a multispecialty center equipped to salvage life and limb for maximizing outcome. This review article comprehensively deals with the issue of managing such major injuries.

Enzymatic debridement of large burn wounds with papain-urea: Is it safe?

INTRODUCTION: Enzymatic debridement is a method by which burn wounds can be prepared for coverage by skin grafts in patients presenting late. Many agents have been used in the past but none of them have been thoroughly evaluated. The present study was undertaken to assess the efficacy of Debridace, a commonly available debriding agent with papain and urea as its constituents. MATERIAL AND METHODS: A prospective descriptive study design was used to evaluate our experience. Almost symmetrical areas of the burnt surface were assessed and used for comparison. On one half of the wound, Debridace was applied while on the other silver sulphadiazine was used. The primary end point of this study was the extent of the achieved debridement at the end of the study period. Secondary outcomes were the presence of adverse effects such as pain and fever. All patients with sepsis were excluded from the study. RESULTS: The age of the subjects ranged from 9 to 80 years with an SD of 16. Large areas ranging from 5% to 20% body surface area with an SD of 4.27 were debrided by Debridace. Only two patients (3.33%) could complete the study. The rest of the recruited patients either had high fever (63.33%), excruciating pain (13.33%) or both (16.66%), which brought an end to enzymatic debridement. CONCLUSION: Debridace, a papain-urea product, cannot be considered safe as an enzymatic debriding agent in its present form for use in major burn patients who present late with deep burn wounds that are large in size.

Evaluation of recombinant human platelet-derived growth factor as an agent for wound bed preparation in traumatic wounds.

BACKGROUND: In patients with life-threatening injuries, simple wounds requiring split-thickness skin grafts (SSG) often get neglected. These then need SSG once they are covered with granulation tissue through wound bed preparation. Traditionally, this is done by daily moist dressings. Recombinant human platelet-derived growth factor (rhPDGF) has been shown to improve healing in chronic wounds. AIM: The present study was undertaken to compare the efficacy of rhPDGF in wound bed preparation with the current practice of daily saline dressings. SETTING AND DESIGN: A prospective randomised, single-blinded study was carried out for evaluation in traumatic wounds. MATERIALS AND METHODS: The patients were randomised and divided into a control group that was subjected to saline dressings and a test group that was treated with rhPDGF gel. Both the groups were then compared. The statistical analysis was carried out using SPSS 16.0 and the quantitative variables were analysed using unpaired "t" test, while the pre- and post-intervention effects were assessed using paired "t" test. The 95% CI values were also included. RESULTS: Of the 155 wounds studied, time taken for appearance of granulation tissue (in days) in the test group had a mean of 13.81 ± 2.68, while that in the control group was 13.36 ± 3.81 (P = 0.401). Complete re-epithelialisation without discharge occurred in the control group with a mean value of 28.9 ± 3.67 days, while that in the test group had a mean of 31.17 ± 4.82 days. CONCLUSION: There was no difference in wound healing between the patients treated with rhPDGF compared to those treated by conventional moist dressings.