| 1. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Comparative study of the microvascular blood flow in the intestinal wall during conventional negative pressure wound therapy and negative pressure wound therapy using paraffin gauze over the intestines in laparostomy
- 2012
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Ingår i: International Wound Journal. - 1742-4801 .- 1742-481X. ; 9:2, s. 150-155
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Tidskriftsartikel (refereegranskat)abstract
- Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) than with other kinds of wound management. We have recently shown that NPWT decreases the blood flow in the intestinal wall, and that the blood flow could be restored by inserting a protective disc over the intestines. The aim of the present study was to investigate whether layers of Jelonet (TM) (Smith & Nephew) dressing (paraffin tulle gras dressing made from open weave gauze) over the intestines could protect the intestines from hypoperfusion. Midline incisions were made in ten pigs and were subjected to treatment with NPWT with and without four layers of Jelonet over the intestines. The microvascular blood flow was measured in the intestinal wall before and after the application of topical negative pressures of -50, -70 and -120 mmHg, using laser Doppler velocimetry. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced, to 61 +/- 7% (P < 0.001), after the application of -50 mmHg using conventional NPWT, and to 62 +/- 7% (P < 0.001) after the application of -50 mmHg with Jelonet dressings between the dressing and the intestines. The blood flow was significantly reduced, to 38 +/- 5% (P < 0.001), after the application of -70 mmHg, and to 42 +/- 6% (P < 0.001) after the application of -70 mmHg with Jelonet dressings. The blood flow was significantly reduced, to 34 +/- 9% (P < 0.001), after the application of -120 mmHg, and to 38 +/- 6% (P < 0.001) after the application of -120 mmHg with Jelonet dressings. The use of four layers of Jelonet over the intestines during NPWT did not prevent a decrease in microvascular blood flow in the intestinal wall.
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| 2. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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The effect of negative wound pressure therapy on haemodynamics in a laparostomy wound model
- 2013
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Ingår i: International Wound Journal. - 1742-4801 .- 1742-481X. ; 10:3, s. 285-290
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Tidskriftsartikel (refereegranskat)abstract
- We have recently shown that negative pressure wound therapy (NPWT) induces a decrease in microvascular blood flow in the small intestinal loop close to the dressing. The effect of NPWT is thus thought to be local. In this study, we investigate whether the application of NPWT in laparostomy affects the haemodynamics. Midline incisions were made in six pigs followed by NPWT at 120 mmHg for 20 minutes. The cardiac output, mean systemic arterial pressure, mean pulmonary artery pressu re, central venous pressure, left atrial pressure and superior mesenteric artery blood flow were recorded. The blood flow in a small branch of the superior mesenteric artery was then recorded under NPWT between 50 and 175 mmHg. Cardiac output was not affected by NPWT [P = not significant (n.s.)]. Neither the mean arterial pressure nor the mean pulmonary artery pressure was affected by NPWT (P = n.s.). Negative pressures of 50, 75, 100 and 125 mmHg did not alter the blood flow in the small branch of the superior mesenteric artery (P = n.s.). After application of 150 mmHg, a significant decrease in blood flow was seen (P < 0 center dot 01), while the application of 175 mmHg resulted in only a slight decrease in blood flow (P = n.s.). The effect of NPWT in laparotomy seems to be local and to have no influence on central haemodynamics or the blood flow to the superior mesenteric artery.
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| 3. |
- Bastami, Salumeh, et al.
(författare)
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Topical morphine gel in the treatment of painful leg ulcers, a double-blind, placebo-controlled clinical trial : a pilot study
- 2012
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Ingår i: International Wound Journal. - : Blackwell Publishing. - 1742-4801 .- 1742-481X. ; 9:4, s. 419-427
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Tidskriftsartikel (refereegranskat)abstract
- Chronic painful wounds, a major health problem, have a detrimental impact on the quality of life due to associated pain. Some clinical reports have suggested that local administration of morphine could be beneficial. The aim of this study was to evaluate the analgesic effect of topically applied morphine on chronic painful leg ulcers. Twenty-one patients were randomly assigned to receive either morphine or placebo in a randomised, placebo-controlled, crossover pilot study. Each patient was treated four times in total. Pain was measured by the visual analogue score (VAS) before application of gel, directly after and after 2, 6, 12 and 24 hours. Although an overall, clinically relevant, reduction of pain was observed upon treatment with morphine, the difference was not statistically significant. Morphine reduced pain scores more than placebo on treatment occasions 1 and 2. The difference was statistically significant only 2 hours after dressing on the first treatment occasion. Thus, our study did not demonstrate a consistent and globally significant difference in nociception in patients treated with morphine. However, the relatively small number of patients included in our study and other methodological limitations makes it difficult for us to draw general conclusions regarding efficacy of topically applied morphine as an effective treatment for some painful ulcers. Further studies are warranted to evaluate the value of topically applied morphine in the treatment of patients with chronic painful leg ulcers.
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| 4. |
- Gunningberg, Lena, et al.
(författare)
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Hospital-acquired pressure ulcers in two Swedish County Councils : cross-sectional data as a foundation for future quality improvement
- 2011
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Ingår i: International Wound Journal. - : Blackwell Munksgaard. - 1742-481X .- 1742-4801. ; 8:5, s. 465-473
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of the study were to examine the prevalence of pressure ulcers and hospital-acquired pressure ulcers (HAPU) and identify modifiable factors in patients who develop HAPU as the basis for subsequent quality assurance studies and improvement in hospital care. The study was conducted in five hospitals in two Swedish County Councils. A 1-day prevalence study (n = 1192) using the standards of the European Pressure Ulcer Advisory Panel and Collaborative Alliance for Nursing Outcomes was conducted. The prevalence of ulcers was 14·9% and 11·6% were HAPU. Older age, more days of hospitalisation, less activity, problems with shear and friction and reduced sensory perception contributed significantly to HAPU. Pressure ulcer prevention strategies used more often in those with HAPU were risk assessment at admission, provision of a pressure relief mattress, having a turning schedule and using a heel or chair cushion. The prevalence of pressure ulcers continues to be a significant issue in acute care and the prevalence of HAPU is high. There is significant room for quality improvement in pressure ulcer prevention in Swedish hospitals. Future research needs to address both HAPU and community-acquired pressure ulcers and focus on preventive strategies, including when they are initiated and which are effective in mitigating the high HAPU rate.
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| 5. |
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| 6. |
- Acosta, Stefan, et al.
(författare)
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Clinical outcome and microvascular blood flow in VAC® and Sorbalgon® treated peri-vascular infected wounds in the groin after vascular surgery - an early interim analysis.
- 2013
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Ingår i: International Wound Journal. - 1742-481X. ; 10:4, s. 377-382
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Tidskriftsartikel (refereegranskat)abstract
- Vacuum-assisted wound closure (VAC®) therapy is considered to be superior to conventional dressings in the treatment of peri-vascular groin infections after vascular surgery at our department. Therefore, we wanted to perform an early interim analysis of clinical outcome in these seriously ill patients at risk for amputation and death. Patients were randomised to either VAC® (n = 5) or Sorbalgon® (n = 5; best other treatment) therapy after surgical debridement. Non-invasive laser Doppler perfusion imaging (LDPI) studies of the skin adjacent to the undressed wound were performed after 14 days of wound treatment. There were no difference in LDPI values in VAC® versus Sorbalgon® treated patients (P = 0·46). One patient in the VAC® group suffered from two re-bleeding episodes, leading to vascular resection and transfemoral amputation and in the Sorbalgon® group two had a complete wound healing time of more than 4 months and one had a visible interposition bypass graft in the groin after 1 month of treatment. No patient died due to the groin infection. Although not statistically proven, fewer wound treatment failures were recorded in the VAC® group, justifying this early interim analysis. LDPI studies were feasible.
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| 7. |
- Anesäter, Erik, et al.
(författare)
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The influence of different sizes and types of wound fillers on wound contraction and tissue pressure during negative pressure wound therapy.
- 2011
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Ingår i: International Wound Journal. - 1742-481X. ; 8, s. 336-342
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Tidskriftsartikel (refereegranskat)abstract
- Negative pressure wound therapy (NPWT) contracts the wound and alters the pressure in the tissue of the wound edge, which accelerates wound healing. The aim of this study was to examine the effect of the type (foam or gauze) and size (small or large) of wound filler for NPWT on wound contraction and tissue pressure. Negative pressures between -20 and -160 mmHg were applied to a peripheral porcine wound (n = 8). The pressure in the wound edge tissue was measured at distances of 0·1, 0·5, 1·0 and 2·0 cm from the wound edge and the wound diameter was determined. At 0·1 cm from the wound edge, the tissue pressure decreased when NPWT was applied, whereas at 0·5 cm it increased. Tissue pressure was not affected at 1·0 or 2·0 cm from the wound edge. The tissue pressure, at 0·5 cm from the wound edge, was greater when using a small foam than when using than a large foam. Wound contraction was greater when using a small foam than when using a large foam during NPWT. Gauze resulted in an intermediate wound contraction that was not affected by the size of the gauze filler. The use of a small foam to fill the wound causes considerable wound contraction and may thus be used when maximal mechanical stress and granulation tissue formation are desirable. Gauze or large amounts of foam result in less wound contraction which may be beneficial, for example when NPWT causes pain to the patient.
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| 8. |
- Anesäter, Erik, et al.
(författare)
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The influence on wound contraction and fluid evacuation of a rigid disc inserted to protect exposed organs during negative pressure wound therapy.
- 2011
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Ingår i: International Wound Journal. - 1742-481X. ; 8, s. 393-399
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Tidskriftsartikel (refereegranskat)abstract
- The use of a rigid disc as a barrier between the wound bed and the wound filler during negative pressure wound therapy (NPWT) has been suggested to prevent damage to exposed organs. However, it is important to determine that the effects of NPWT, such as wound contraction and fluid removal, are maintained during treatment despite the use of a barrier. This study was performed to examine the effect of NPWT on wound contraction and fluid evacuation in the presence of a rigid disc. Peripheral wounds were created on the backs of eight pigs. The wounds were filled with foam, and rigid discs of different designs were inserted between the wound bed and the foam. Wound contraction and fluid evacuation were measured after application of continuous NPWT at -80 mmHg. Wound contraction was similar in the presence and the absence of a rigid disc (84 ± 4% and 83 ± 3%, respectively, compared with baseline). Furthermore, the rigid disc did not affect wound fluid removal compared with ordinary NPWT (e.g. after 120 seconds, 71 ± 4 ml was removed in the presence and 73 ± 3 ml was removed in the absence of a disc). This study shows that a rigid barrier may be placed under the wound filler to protect exposed structures during NPWT without affecting wound contraction and fluid removal, which are two crucial features of NPWT.
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| 9. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Blood flow response in small intestinal loops at different depths during negative pressure wound therapy of the open abdomen.
- 2013
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Ingår i: International Wound Journal. - 1742-481X. ; 10:4, s. 411-417
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Tidskriftsartikel (refereegranskat)abstract
- High closure rates of the open abdomen have been reported following negative pressure wound therapy (NPWT). However, the method has occasionally been associated with increased development of intestinal fistulae. We have previously shown that the application of NPWT to the open abdomen causes a decrease in microvascular blood flow in the small intestinal loop and the omentum adjacent to the visceral protective layer of the dressing. In this study we investigate whether the negative pressure affects only small intestinal loops lying directly below the dressing or it also affects small intestinal loops that are not in direct contact with the dressing. Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow was measured in four intestinal loops at different depths from the visceral protective layer, at two different locations: beneath the dressing and at the anterior abdominal wall, before and after the application of NPWT of -50, -70, -100, -120, -150 and -170 mmHg, using laser Doppler velocimetry. Negative pressures between -50 and -170 mmHg caused a significant decrease in the microvascular blood flow in the intestinal loops in direct contact with the visceral protective layer. A slight, but significant, decrease in blood flow was also seen in the intestinal loops lying beneath these loops. The decrease in microvascular blood flow increased with the amount of negative pressure applied. No difference in blood flow was seen in the intestinal loops lying deeper in the abdominal cavity. A decrease in blood flow was seen in the upper two intestinal loops located apically and anteriorly, but not in the lower two, indicating that this is a local effect and that pressure decreases with distance from the source. A long-term decrease in blood flow in the intestinal wall may induce ischaemia and secondary necrosis in the intestinal wall, which could promote the development of intestinal fistulae. We believe that NPWT of the open abdomen is a very effective treatment, but that it could be improved by gaining more knowledge on the mechanisms involved.
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| 10. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Effects on drainage of the mediastinum and pleura during negative pressure wound therapy when using a rigid barrier to prevent heart rupture.
- 2011
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Ingår i: International Wound Journal. - 1742-481X. ; 8, s. 454-458
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Tidskriftsartikel (refereegranskat)abstract
- Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) following cardiac surgery. The use of a rigid disc has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up towards, and damaged by, the sharp sternum edges. The aim of the present study was to compare the wound fluid evacuation from the pericardium and the left pleura when using NPWT with such a disc between the sternal edges and the heart, and when using conventional NPWT. Six pigs underwent median sternotomy followed by NPWT at -120 mmHg, using foam, with or without a rigid plastic disc between the heart and the sternal edges. A 250 ml saline was infused into the pericardium, and the time required for fluid evacuation was measured. A 500 ml saline was infused into the left pleura and the time for fluid evacuation measured. The pericardium was effectively drained of 250 ml fluid in both cases [conventional NPWT: 24 ± 0·7 seconds, NPWT with the disc: 25 ± 1·1 seconds (n.s.)]. The left pleura was effectively drained when using NPWT with the disc, but was not drained at all when using conventional NPWT. The left pleura could be effectively drained of 500 ml fluid when a rigid perforated plastic disc was inserted between the sternal edges and the heart during NPWT. Significantly less drainage of the left pleura was possible when using conventional NPWT without the disc. The pericardium was equally good drained using NPWT with or without the disc.
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| 11. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Haemodynamic effects of negative pressure wound therapy when using a rigid barrier to prevent heart rupture.
- 2011
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Ingår i: International Wound Journal. - 1742-481X. ; 8, s. 385-392
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Tidskriftsartikel (refereegranskat)abstract
- Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up and damaged by the sharp sternum bone edges. The aim of this study was to investigate the haemodynamic effects of placing a rigid barrier over the heart to protect it from rupture during NPWT. Eight pigs underwent median sternotomy followed by NPWT at -70 and -120 mmHg, using foam, with or without a rigid plastic disc between the heart and the sternal edges. The heart frequency, cardiac output, mean systemic arterial pressure, mean pulmonary artery pressure, central venous pressure and left atrial pressure were recorded. Cardiac output was not affected by NPWT, regardless of whether a rigid barrier was used. Heart frequency decreased during NPWT without a disc, and showed a tendency towards a decrease when using a rigid disc. The blood pressure decreased during NPWT without a disc, and showed only a tendency towards a decrease when a disc was inserted between the heart and the sternum. In conclusion, the results of this haemodynamic study show that a rigid disc can safely be placed over the heart during NPWT, to prevent heart rupture. The haemodynamic effects of NPWT in sternotomy wounds are slightly reduced by the presence of the rigid disc.
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| 12. |
- Malmsjö, Malin, et al.
(författare)
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Comparison of bacteria and fungus-binding mesh, foam and gauze as fillers in negative pressure wound therapy - pressure transduction, wound edge contraction, microvascular blood flow and fluid retention.
- 2013
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Ingår i: International Wound Journal. - 1742-481X. ; 10:5, s. 597-605
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Tidskriftsartikel (refereegranskat)abstract
- Bacteria- and fungus-binding mesh binds and inactivates bacteria and fungus, which makes it interesting, alternative, wound filler for negative pressure wound therapy (NPWT). This study was conducted to compare the performance of pathogen-binding mesh, foam and gauze as wound fillers in NPWT with regard to pressure transduction, fluid retention, wound contraction and microvascular blood flow. Wounds on the backs of 16 pigs were filled with pathogen-binding mesh, foam or gauze and treated with NPWT. The immediate effects of 0, -40, -60, -80 and -120 mmHg, on pressure transduction and blood flow were examined in eight pigs using laser Doppler velocimetry. Wound contraction and fluid retention were studied during 72 hours of NPWT at -80 and -120 mmHg in the other eight pigs. Pathogen-binding mesh, gauze and foam provide similar pressure transduction to the wound bed during NPWT. Blood flow was found to decrease 0·5 cm laterally from the wound edge and increase 2·5 cm from the wound edge, but was unaltered 5·0 cm from the wound edge. The increase in blood flow was similar with all wound fillers. The decrease in blood flow was more pronounced with foam than with gauze and pathogen-binding mesh. Similarly, wound contraction was more pronounced with foam, than with gauze and pathogen-binding mesh. Wound fluid retention was the same in foam and pathogen-binding mesh, while more fluid was retained in the wound when using gauze. The blood flow 0·5-5 cm from the wound edge and the contraction of the wound during NPWT were similar when using pathogen-binding mesh and gauze. Wound fluid was efficiently removed through the pathogen-binding mesh, which may explain previous findings that granulation tissue formation is more rapid under pathogen-binding mesh than under gauze. This, in combination with its pathogen-binding properties, makes this mesh an interesting wound filler for use in NPWT.
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| 13. |
- Malmsjö, Malin, et al.
(författare)
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Influence on pressure transduction when using different drainage techniques and wound fillers (foam and gauze) for negative pressure wound therapy.
- 2010
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Ingår i: International Wound Journal. - 1742-481X. ; 7, s. 406-412
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Tidskriftsartikel (refereegranskat)abstract
- Pressure transduction to the wound bed in negative pressure wound therapy (NPWT) is crucial in stimulating the biological effects ultimately resulting in wound healing. In clinical practice, either foam or gauze is used as wound filler. Furthermore, two different drainage techniques are frequently employed. One involves the connection of a non-perforated drainage tube to the top of the dressing, while the other involves the insertion of perforated drains into the dressing. The aim of this study was to examine the efficacy of these two different wound fillers and drainage systems on pressure transduction to the wound bed in a challenging wound (the sternotomy wound). Six pigs underwent median sternotomy. The wound was sealed for NPWT using different wound fillers (foam or gauze) and drainage techniques (see earlier). Pressures between 0 and -175 mmHg were applied and the pressure in the wound was measured using saline-filled catheters sutured to the bottom of the wound (over the anterior surface of the heart) and to the side of the wound (on the thoracic wall). The negative pressure on the wound bed increased linearly with the negative pressure delivered by the vacuum source. In a dry wound, the pressure transduction was similar when using the different wound fillers (foam and gauze) and drainage techniques. In a wet wound, pressure transduction was better when using a perforated drainage tube inserted into the wound filler than a non-perforated drainage tube connected to the top of the dressing (-116 +/- 1 versus -73 +/- 4 mmHg in the wound at a delivered pressure of -125 mmHg for foam, P < 0.01), regardless of the type of wound filler. Gauze and foam are equally effective at delivering negative pressure to the wound bed. Perforated drainage tubes inserted into the wound filler are more efficient than a non-perforated drainage tubes connected to the top of the dressing. The choice of drainage technique may be particularly important in wounds with a large volume of exudate.
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| 14. |
- Torbrand, Christian, et al.
(författare)
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Changes in cardiac pumping efficiency and intra-thoracic organ volume during negative pressure wound therapy of sternotomy wounds, assessment using magnetic resonance imaging.
- 2010
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Ingår i: International Wound Journal. - 1742-481X. ; 7:2, s. 115-121
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge on the effects of negative pressure wound therapy (NPWT) on the intra-thoracic organs is limited. The present study was performed to investigate the effects of NPWT on the volume of the intra-thoracic organs, using magnetic resonance imaging (MRI), in a porcine sternotomy wound model. Six pigs underwent median sternotomy followed by NPWT at -75, -125 and -175 mmHg. Six pigs were not sternotomised. MR images covering the thorax and heart were acquired. The volumes of the thoracic cavity, lungs, wound fluid and heart were then determined. The volumes of the thoracic cavity and intra-thoracic organs increased after sternotomy and decreased upon NPWT application. The total heart volume variation, which is a measure of cardiac pumping efficiency, was higher after sternotomy and decreased during NPWT. NPWT did not result in the evacuation of wound fluid from the bottom of the wound. NPWT largely closes and restores the thoracic cavity. Cardiac pumping efficiency returns to pre-sternotomy levels during NPWT. This may contribute to the clinical benefits of NPWT over open-chest care, including the stabilizing effects and the reduced need for mechanical ventilation.
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| 15. |
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