The Use of Negative Pressure Wound Therapy in Infected Burn Wounds: Bridging the Gap

Nawar, Ahmed; Abodan, Mohamed; Ismail, Mariam T

doi:10.21608/ejprs.2023.291376

The Use of Negative Pressure Wound Therapy in Infected Burn Wounds: Bridging the Gap

Document Type : Research article

Authors

The Department of Plastic Surgery, Faculty of Medicine, Cairo University

10.21608/ejprs.2023.291376

Abstract

Background: Burns represent one of the most devastating
modes of trauma with significant morbidity and mortality.
Despite advances in burns care, infection remains one of the
leading causes of death. Burn excision is mandatory in infected
cases and need to be temporarily covered with allografts,
however this is not available in many settings. Negative
pressure wound therapy (NPWT) has become an integral part
of wound management, and is being used in burns with
different indications.
Objective: The use of NPWT as a temporary coverage
after excision of infected burns for wound bed preparation
before autografting, and to compare the outcomes with those
of early excision and grafting.
Patients and Methods: Ten patients with 15 burn wounds
were allocated to 2 groups; group A patients presented late
with infected burns while group B presented early. Group A
had excision followed by NPWT and autografting when ready,
and Group B had early excision and grafting. Both groups'
outcomes were compared in terms of wound size, graft take
and laboratory markers.
Results: Both groups included different mechanisms of
burns, various age groups, total burn surface area (TBSA) up < br />to 30%. Most Group A patients had a reduction of wound size
(mean 5.1%) with using NPWT, and the average graft take
was 83.9% and 85% for Group A and Group B respectively.
Inflammatory markers were reduced in Group A patients,
who also showed an increase in serum albumin compared to
Group B.
Conclusions: NPWT should be considered for temporary
coverage after excision of infected burns before autografting.
It may minimize the size of the wound, and can increase graft
take that can be comparable to cases excised and grafted early.
Further work is needed to assess NPWT against allografts in
infected burns, and to investigate its use with early excision.

Keywords

Main Subjects

New technologies and products

References

Dissanaike S. and Rahimi M.: Epidemiology of burn
injuries: Highlighting cultural and socio-demographic
aspects. Int. Rev. Psychiatry, 21: 505-511, 2009.
2- Church D., Elsayed S., Reid O., Winston B. and Lindsay
R.: Burn wound infections. Clin. Microbiol. Rev., 19 (2):
403-34, 2006.
3- ISBI Practice Guidelines Committee: Steering Subcommittee;
Advisory Subcommittee. ISBI Practice Guidelines
for Burn Care. Burns, 42 (5): 953-1021, 2016.
4- Azizian M., Ghasemi Darestani N., Mohammadzadeh
Boukani L., Ghahremanloo K. and Nourian S.M.A.: The
effectiveness of skin allografts in survival rate of patients
with major burns. Int. J. Burns Trauma, 12 (2): 45-51,
2022.
5- Iyun A.O., Ademola S.A., Olawoye O.A., Michael A.I.,
Aderibigbe R.O., Iyun O.I. and Oluwatosin O.M.: Glycerolised
Skin Allografts for Extensive Burns in Low- and
Middle-income Countries. J. West Afr. Coll Surg., 11 (3):
35-41, 2021.
6- Thompson G.: An overview of negative pressure wound
therapy (NPWT). Br. J. Community Nurs., 13: S23-S30,
2008.
7- Lin D.Z., Kao Y.C., Chen C, Wang H.J. and Chiu W.K.:
Negative pressure wound therapy for burn patients: A
meta-analysis and systematic review. Int. Wound J., 18
(1): 112-123, 2021.
8- Zuo K.J., Medina A. and Tredget E.E.: Important Developments
in Burn Care. Plast. Reconstr. Surg., 139 (1):
120e-138e, 2017.
9- Trop M., Herzog S.A., Pfurtscheller K., Hoebenreich
A.M., Schintler M.V, Stockenhuber A. and Kamolz L.P.:
The past 25 years of pediatric burn treatment in Graz and
important lessons been learned. An overview. Burns, 41
(4): 714-20, 2015.
10- Padilla P.L., Freudenburg E.P., Kania K., Laney R.W.,
Branski L.K. and Herndon D.N.: Negative Pressure Wound
Therapy with Instillation and Dwell for the Management
of a Complex Burn: A Case Report and Review of the
Literature. Cureus, 29; 10 (10): e3514, 2018.
11- J. Kraatz, MD, S. Wolf, BSc, S.E. Wolf, MD, FACS, D.
N. Herndon, MD, FACS: Delayed Presentation Burns: Is
Allografting Necessary?, The Journal of Burn Care &
Rehabilitation, 23 (Suppl 2): S44, 2002.
12- Dumville J.C., Munson C. and Christie J.: Negative
pressure wound therapy for partial-thickness burns. Cochrane
Database Syst. Rev., 2014 (12): CD006215, 2014.
13- Lin D.Z., Kao Y.C., Chen C., Wang H.J. and Chiu W.K.:
Negative pressure wound therapy for burn patients: A
meta-analysis and systematic review. Int. Wound J., 18
(1): 112-123, 2021.
14- Kamolz L.P., Andel H., Haslik W., Winter W., Meissl G.
and Frey M.: Use of subatmospheric pressure therapy to
prevent burn wound progression in human: First experiences.
Burns, 30 (3): 253-258, 2004.
15- Honari S., Gibran N.S. and Engrav L.H.: Three years'
experience with 52 Integra (artificial skin) patients since
FDA approval. J. Burn Care Rehabil, 21: 190, 2000.
Egypt, J. Plast. Reconstr. Surg., April 2023 95
16- Bloemen M.C., van der Wal M.B., Verhaegen P.D., et al.:
Clinical effectiveness of dermal substitution in burns by
topical negative pressure: a multicenter randomized controlled
trial. Wound Repair Regen., 20: 797-805, 2012.
17- Petkar K.S., Dhanraj P., Kingsly P.M., Sreekar H., Lakshmanarao
A., Lamba S., et al.: A prospective randomized
controlled trial comparing negative pressure dressing and
conventional dressing methods on split-thickness skin
grafts in burned patients. Burns, 37 (6): 925-929, 2011.
18- Chong S.J., Liang W.H. and Tan B.K.: Use of multiple
VAC devices in the management of extensive burns: The
total body wrap concept. Burns: J. Int. Soc. Burn Inj., 36
(7): e127-9, 2010.
19- Low O.W., Chong S.J. and Tan B.K.: The enhanced Total
Body Wrap - the new frontier in dressing care for burns.
Burns, 39 (7): 1420-142, 2013.
20- Nuutila K., Siltanen A., Peura M., Harjula A., Nieminen
T., Vuola J., et al.: Gene expression profiling of negativepressure-
treated skin graft donor site wounds. Burns, 39
(4): 687-693, 2013.
21- Kim P.J., Applewhite A., Dardano A.N., Fernandez L.,
Hall K., McElroy E., Mendez-Eastman S., Obst M.A.,
Thomas C., Waddell L., Wirth G. and Téot L.: Use of a
Novel Foam Dressing With Negative Pressure Wound
Therapy and Instillation: Recommendations and Clinical
Experience. Wounds, 30 (3 Suppl): S1-S17, 2018.
22- Lee G. and Murray P.: Use of Negative Pressure Wound
Therapy With Instillation and Dwell Time in All Phases
of Care for the Management of Complex, High-risk
Wounds: Two Case Reports of Necrotizing Fasciitis.
Wounds, 32 (12): E76-E83, 2020.
23- Kantak N.A., Mistry R. and Halvorson E.G.: A review of
negative-pressure wound therapy in the management of
burn wounds. Burns, 42 (8): 1623-1633, 2016.
24- Sahin I., Eski M., Acikel C., Kapaj R., Alhan D. and Isik
S.: The role of negative pressure wound therapy in the
treatment of fourth-degree burns. Trends and new horizons.
Ann. Burns Fire Disasters, 30; 25 (2): 92-7, 2012.
25- Teng S.C.: Use of negative pressure wound therapy in
burn patients. Int. Wound J., 13 (Suppl 3): 15-8, 2016.
26- Ren Y., Chang P. and Sheridan R.L.: Negative wound
pressure therapy is safe and useful in pediatric burn
patients. Int. J. Burns Trauma, 7: 12-16, 2017.
27- Koehler S., Jinbo A., Johnson S., Puapong D., de Los
Reyes C. and Woo R.: Negative pressure dressing assisted
healing in pediatric burn patients. J. Pediatr. Surg., 49:
1142-1145, 2014.
28- Pedrazzi N.E., Naiken S. and La Scala G.: Negative
Pressure Wound Therapy in Pediatric Burn Patients: A
Systematic Review. Adv. Wound Care (New Rochelle),
10 (5): 270-280, 2021.
29- Borgquist O., Gustafsson L., Ingemansson R. and Malmsjö
M.: Micro- and macromechanical effects on the wound
bed of negative pressure wound therapy using gauze and
foam. Ann. Plast. Surg., 64 (6): 789-93, 2010.
30- Torbrand C., Ugander M., Engblom H., Arheden H.,
Ingemansson R. and Malmsjö M.: Wound contraction and
macro-deformation during negative pressure therapy of
sternotomy wounds. J. Cardiothorac. Surg., 30 (5): 75,
2010.
31- Normandin S., Safran T., Winocour S., Chu C.K., Vorstenbosch
J., Murphy A.M. and Davison P.G.: Negative Pressure
Wound Therapy: Mechanism of Action and Clinical
Applications. Semin Plast. Surg., 35 (3): 164-170, 2021.
32- Yin Y., Zhang R., Li S., Guo J., Hou Z. and Zhang Y.:
Negative-pressure therapy versus conventional therapy
on split-thickness skin graft: A systematic review and
meta-analysis. Int. J. Surg., 50: 43-48, 2018.
33- Surowiecka A., Korzeniowski T. and Struz
.
yna J.: Early
burn wound excision in mass casualty events. Military
Med. Res., 9: 42, 2022.
34- Bandeira N.G., Barroso M.V.V.S., Matos M.A.A., Filho
A.L.M., Figueredo A.A., Gravina P.R. and Klein S.O.T.:
Serum Albumin Concentration on Admission as a Predictor
of Morbidity and Mortality in Patients with Burn Injuries.
J. Burn Care Res., 42 (5): 991-997, 2021