Abstract:
An integrated negative pressure bandage is constructed with a non-woven polyurethane matrix pad secured on the outside surface to a sheet of polyurethane film formed with an outer adhesive boundary to establish a seal against the skin of the patient around the wound site. The integrated negative pressure bandage is applied to a patient having said wound by removing said release member and attaching said adhesive layer exposed by the removal of said release member to said patient such that said adhesive layer is sealed to the patient around said wound with said non-woven polymer matrix pad being positioned over said wound, and attaching said connector port to said source of negative pressure. The non-woven pad does not stored fluids and exudate, but the source of negative pressure continuously removes the fluids and exudate to a remote location.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a division of U.S. patent application Ser. No. 13/207,391, filed Aug. 10, 2011, and granted as U.S. Pat. No. 8,795,247 on Aug. 5, 2014, and claims domestic priority on U.S. Provisional Patent Application Ser. No. 61/373,233, filed on Aug. 12, 2010, the content of which is incorporated herein by reference in its entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates generally to negative pressure bandages operable to remove exudates and fluids from a wound and, more particularly, to a bandage structure that is specifically contoured to fit body parts that present difficulties in affixing and applying negative pressure bandages. 
       BACKGROUND OF THE INVENTION 
       [0003]    Negative pressure therapy has been utilized for the treatment of a variety of wounds by medical practitioners. Conventional negative pressure bandages are generally large in size and often require the use of complicated equipment such as suction pumps, vacuum pumps and complex electronic controllers to apply a negative pressure within the bandage to draw exudates and fluids away from the wound to a remote collection container. Typically, negative pressure therapy involves other associated equipment, such as the exudates/fluid collection canisters, liquid transporting conduits, and pressure regulators/transducers/sensors. As a result, negative pressure bandages and related equipment tends to be bulky and relatively costly. Such complexity typically requires professional placement of the bandage and connection to the pump and collection canister, followed by consistent, regular patient supervision and monitoring. Generally, negative pressure bandages are applied for approximately two days, at which time the bandage must be removed and replaced by professional technicians. 
         [0004]    The rising costs of healthcare and of medical devices, such as negative pressure bandages, provide incentive to develop less expensive equipment, and procedures that are more easily utilized to reduce the costs associated with the use of negative pressure therapy while improving on the effectiveness of the therapy. Simplification of the procedures and the equipment can allow in-home use of such therapies with a minimum of professional supervision and monitoring of the patients. Furthermore, patients continue to demand devices that are more easily portable to allow travel and mobility while utilizing the therapy. 
         [0005]    Conventional applications of negative pressure therapy to wound sites typically incurs the cutting of a porous foam pad to fit into the wound, followed by an application of an adhesive surgical drape over the pad and wound site to seal against the skin of the patient around the wound site. The fluids and exudates from the wound can be removed from the bandage to a remote location through an application of a vacuum to a connector fitted into the adhesive surgical drape, such as is shown in U.S. Pat. No. 5,636,643, granted on Jun. 10, 1997, in U.S. Pat. No. 5,645,081, granted on Jul. 8, 1997, and in U.S. Pat. No. 7,216,651, granted on May 15, 2007, all of which were issued to Louis Argenta. Alternatively, the foam pad can be utilized as a storage reservoir by incorporating a hydrophobic filter at the connector to prevent the fluids from leaving the bandage, as is reflected below in greater detail. Negative pressure therapy is provided commercially by at least KCI, Smith &amp; Nephew, Kalypto, Medela, Mepilex and Convatec. An earlier negative pressure wound therapy embodiment is disclosed in U.S. Pat. No. 4,969,880, issued to David S. Zamierowski on Nov. 13, 1990. 
         [0006]    The application of conventional negative pressure bandages to certain parts of the body presents substantial difficulties in maintaining a seal against the skin around the wound. Without the negative pressure bandage being sealed against the skin of the patient, the negative pressure system will not operate. Certain body parts, such as heels, ankles and toes present a multi-faceted skin surface against which the negative pressure bandage must seal. Conventional practices with the negative pressure bandages, such as are described below, require the planar bandages to be cut, shaped and compromised with respect to the sealing portion of the bandage to fit against the contoured body part. 
         [0007]    In U.S. Pat. No. 7,615,036, granted to Ashok Joshi, et al on Nov. 10, 2009, a negative pressure bandage is disclosed in which the bandage has a housing that is sealed to the body surface of the patient and defines a liquid retention chamber coupled to a vacuum source to apply a negative pressure on the liquid retention chamber so that the exudates and fluids are drawn into an absorptive material within the liquid retention chamber. This liquid retention chamber is located adjacent to the wound from which the exudates and fluids are removed. 
         [0008]    Improvements to negative pressure wound therapy devices can be found in U.S. Patent Publication No. 2009/0299251 of John Buan published on Dec. 3, 2009, to enhance the sealing of the bandage to the body surface of the patient. In this negative pressure wound therapy device, a vacuum is applied to a collection chamber in which an absorptive pad is disposed to collect the exudates and fluids drawn away from the wound by the vacuum (negative pressure). To enhance the connection of the tubing extending between the vacuum pump and the negative pressure therapy device, an extended length connector is disclosed, which will accommodate connection when ace wrap or other coverings are applied to the exterior of the bandage. 
         [0009]    In U.S. Pat. No. 7,361,184, granted on Apr. 22, 2008, to Ashok Joshi, an attempt to provide a self-contained negative pressure wound therapy device is provided so that the device does not require connection to a remote vacuum source. In this negative pressure wound dressing, an absorptive pad is also disposed in the fluid collection chamber, which is located adjacent to the wound, the negative pressure drawing the exudates and fluids away from the wound into the absorptive pad. Several early embodiments of negative pressure bandages can be found in U.S. Pat. No. 5,636,643, granted to Louis Argenta, et al on Jun. 10, 1997, all of which, however, utilize a single chamber configuration in which a vacuum is applied to the fluid collection chamber and the exudates and fluid is drawn away through tubing to a remote pump and fluid retention chamber. 
         [0010]    It would be desirable to provide a contoured negative pressure bandage that will be adapted to be affixed to a specific contoured body part to remove exudates and fluid from a wound located on that contoured body part. 
       SUMMARY OF THE INVENTION 
       [0011]    It is an object of this invention to overcome the disadvantages of the prior art by providing an integrated negative pressure wound therapy bandage. 
         [0012]    It is another object of this invention to provide negative pressure wound therapy bandages that are contoured to fit specific areas of a patient&#39;s body that are conventionally difficult to provide a seal for use in negative pressure wound therapy. 
         [0013]    It is a feature of this invention that a negative pressure bandage is integrated into a single applicable bandage that can provide negative pressure wound therapy. 
         [0014]    It is an advantage of this invention that the components parts of the negative pressure bandage do not require individual installation on a patient to provide negative pressure wound therapy. 
         [0015]    It is another advantage of this invention that the integrated bandage is not inserted into the surface of the wound, but is positioned over top of the wound, to provide negative pressure wound therapy. 
         [0016]    It is another feature of this invention that the integrated bandage structure provides a non-woven polyurethane matrix mesh impregnated with silver nitrate to overlie the wound being treated. 
         [0017]    It is still another advantage of this invention that the silver nitrate mesh inhibits infection and promotes healing of the wound. 
         [0018]    It is yet another feature of this invention that the integrated bandage structure also includes a drain tube disposed within the non-woven polyurethane matrix for connection to a source of negative pressure to withdraw the exudates and fluids from the wound to a remote canister for collection thereof. 
         [0019]    It is yet another advantage of this invention that the non-woven matrix does not absorb the fluids and exudates, but allows the collection thereof into the drain tube for removal from the bandage and from the wound site. 
         [0020]    It is still another object of this invention to provide a therapy for wounds to keep the wound clear of excessive moisture and exudates, and to promote healing of the wound. 
         [0021]    It is yet another object of this invention to provide an integrated negative pressure bandage that is configured to fit onto portions of the human body that is difficult to attach a negative pressure bandage. 
         [0022]    It is an advantage of this invention that the contoured negative pressure bandages are configured to provide a seal around a wound found on certain difficult to fit portions of the human body. 
         [0023]    It is still another object of this invention to provide negative pressure bandages that are contoured to fit on the foot, at both the toe and heel portions of the foot, on limbs, and on the sacral region of the human body and provide a seal against the skin around the wound so that negative pressure therapy can be provided to the wound site. 
         [0024]    It is yet another advantage of this invention that the time to apply a negative pressure bandage to a wound site is reduced by the utilization of an integrated bandage that allows the wound fluids and exudates to be withdrawn from the bandage to a remote canister. 
         [0025]    It is a further feature of this invention that the contoured negative pressure bandage for application to the heel of a patient&#39;s foot is formed with junctions, such as cutouts, to facilitate the sealing of the bandage around the heel. 
         [0026]    It is still a further feature of this invention that the drain tube and associated connector can be oriented diagonally to the primary axes of the bandage to position the connector for attaching the vacuum source to the drain tube in an easily accessible and unobtrusive location. 
         [0027]    It is yet another object of this invention to provide an integrated negative pressure bandage that is durable in construction, inexpensive of manufacture, facile in assemblage, and simple and effective in use. 
         [0028]    It is a further object of this invention to provide a negative pressure bandage that is contoured to fit portions of the human body that are difficult to apply negative pressure wound therapy to establish an integrated negative pressure bandage that is simple and effective in use. 
         [0029]    These and other objects, features and advantages are accomplished according to the instant invention by providing an integrated negative pressure bandage having a non-woven polyurethane matrix pad secured on the outside surface to a sheet of polyurethane film formed with an outer adhesive boundary to establish a seal against the skin of the patient around the wound site. The inner surface of the non-woven matrix pad is covered with a silver nitrate mesh to promote healing of the wound site when the bandage is placed on top of the wound. A drain tube is contained within the non-woven matrix pad for connection with a source of negative pressure to draw the fluids and exudates from the wound for removal to a canister that is located remotely from the bandage. Contoured versions of the integrated bandage are provided for use on portions of the human body that present difficult locations for applications of negative pressure therapy, including the toes, heel, limbs, and sacral region. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0030]    The foregoing and other objects, features, and advantages of the invention will appear more fully hereinafter from a consideration of the detailed description that follows, in conjunction with the accompanying sheets of drawings. It is to be expressly understood, however, that the drawings are for illustrative purposes and are not to be construed as defining the limits of the invention. 
           [0031]      FIG. 1  is a perspective view of an integrated negative pressure bandage incorporating the principles of the instant invention, the bandage of  FIG. 1  being shaped for utilization for injuries or wounds to generally planar portions of the body; 
           [0032]      FIG. 2  is a side perspective view of the integrated negative pressure bandage shown in  FIG. 1 ; 
           [0033]      FIG. 3  is a cross-sectional view of the integrated negative pressure bandage corresponding to lines  3 - 3  of  FIG. 2 ; 
           [0034]      FIG. 4  is a top plan view of an integrated bandage similar to that of  FIG. 1 , but having a circular shape; 
           [0035]      FIG. 5  is a cross-sectional view of the integrated bandage corresponding to lines  5 - 5  of  FIG. 4 ; 
           [0036]      FIG. 6  is an exploded view of a different embodiment of the integrated negative pressure bandage similar to that shown in  FIGS. 1 and 4 ; 
           [0037]      FIG. 7  is an upper perspective view of a first embodiment of a drain tube and connector utilized in the planar bandage shown in  FIG. 1 ; 
           [0038]      FIG. 8  is a side elevational view of the drain tube and connector shown in  FIG. 7 ; and 
           [0039]      FIG. 9  is an upper perspective view of an alternate embodiment of a drain tube as shown in  FIG. 7 ; 
           [0040]      FIG. 10  is a side elevational view of the drain tube shown in  FIG. 9 ; 
           [0041]      FIG. 11  is a top plan view of a first embodiment of a contoured negative pressure bandage incorporating the principles of the instant invention for a patient&#39;s foot, shown in an opened configuration in which the bandage would be shipped to the patient, the release members not being shown for purposes of clarity; 
           [0042]      FIG. 12  is a side elevational view of the contoured negative pressure bandage for a foot as shown in  FIG. 11 , the release members not being shown for purposes of clarity; 
           [0043]      FIG. 13  is a perspective view of the contoured negative pressure bandage as shown in  FIG. 11  folded over the toes on the foot of a representative patient; 
           [0044]      FIG. 14  is a top plan view of a second embodiment of the contoured negative pressure bandage for a patient&#39;s foot, the release members not being shown for purposes of clarity; 
           [0045]      FIG. 15  is a top plan view of a third embodiment of the contoured negative pressure bandage for a foot, the bandage being shown in an unfolded configuration corresponding to the configuration in which the bandage would be shipped to the patient for subsequent use, the release members not being shown for purposes of clarity; 
           [0046]      FIG. 16  is a perspective view of a wedge member for use in conjunction with the contoured negative pressure bandage shown in  FIGS. 12-16 ; 
           [0047]      FIG. 17  is a top plan view of a contoured negative pressure bandage for use with a patient&#39;s heel; 
           [0048]      FIG. 18  is a bottom plan view of the contoured negative pressure bandage for heels as shown in  FIG. 17 , the release members not being shown for purposes of clarity; 
           [0049]      FIG. 19  is an exploded view of the contoured negative pressure bandage for heels as shown in  FIG. 17 ; 
           [0050]      FIG. 20  is a side elevational view of the contoured negative pressure bandage for heels; 
           [0051]      FIG. 21  is a top plan view of an alternative embodiment of the contoured negative pressure bandage for heels, similar to that shown in  FIG. 17 ; 
           [0052]      FIG. 22  is a top plan view of the contoured negative pressure bandage for use on the sacral region of a patient; and 
           [0053]      FIG. 23  is a perspective view of the contoured negative pressure bandage shown in  FIG. 22 . 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0054]    Referring to the  FIGS. 1-6 , integrated negative pressure bandages incorporating the principles of the instant invention can best be seen. One of ordinary skill in the art will recognize that the scale of the components of the negative pressure bandages is exaggerated to shown the details of the components. For example, the wound contact member depicted in each of the drawings is enlarged to shown the configuration thereof. The thicknesses and relative sizes of other components may also be distorted to show the invention. Specific contoured configurations of the integrated negative pressure bandages are depicted in  FIGS. 12-23 . 
         [0055]    The different embodiments of the contoured negative pressure bandages shown in the drawings have some common features relating to the formation of the integrated negative pressure bandage. Each of the bandages have an outer shaped cover formed from a liquid impermeable material, such as polyurethane film, that can be formed into the specific shape required for the bandage configuration, yet provide sufficient flexibility to allow attachment of the bandage to the skin surrounding the injury being treated. The outer cover is provided with an area of adhesive around a perimeter portion of the bandage where the cover would be engaged with the skin around the wound being treated to create a seal between the perimeter of the bandage and the skin. A protective release film would be applied to the adhesive portion until the bandage is to be applied to a patient, substantially covering the entire inner surface of the bandage. 
         [0056]    Furthermore, each of the bandages will have a wound contact member secured to the outer film cover to be positioned between the cover and the body part being treated. While this wound contact member can be formed from gauze padding covered by a mesh layer, preferably a polyethylene mesh impregnated with silver nitrate, the wound contact member is preferably formed with a permeable polymer matrix layer, more specifically a non-woven polyurethane matrix pad is preferred, that will allow the passage of liquids through the pad to keep the surface of the wound contact member against the wound site as dry as possible. Within this wound contact padding is a drain tube connected to an external connector to apply a negative pressure to the bandage that will draw the fluids and exudates from the wound being treated. The surface of the wound contact member, which is in direct contact with the wound being treated, is provided with a mesh layer, preferably a polyethylene mesh impregnated with silver nitrate, to protect the wound and promote healing. In operation, the negative pressure bandage keeps the wound dry and does not allow the fluid to accumulate within the bandage, thus keeping the bandage from bulking up with accumulated fluids that can disrupt the seal around the perimeter of the bandage. 
         [0057]    Referring now to  FIGS. 1-6 , an integrated negative pressure bandage  10  incorporating the principles of the instant invention can best be seen. The bandage  10  is formed with a non-woven polymer matrix pad  15  covered on an inside surface by a polyethylene mesh layer  12  that serves as a wicking function to draw fluids into the pad  15  and keeps the pad  15  from engaging the surface of the wound when the bandage  10  is applied. Preferably, the mesh layer incorporates a coating of, or is impregnated with, a compound of silver nitrate to promote healing and inhibit infection. The outer surface of the non-woven polymer pad  15  is attached to a polyurethane film  13  formed with an adhesive covered perimeter portion  14 . A drain tube  20  is positioned within the pad  15  and exits the bandage  10  through an opening within the polyurethane film  13  to terminate in a connector  22  adapted for connection to a conduit leading to a vacuum source (not shown) and an associated canister reservoir (not shown). A seal pad  23  can be provided at the opening through the polyurethane film  13  for engagement with the connector  22  to enhance the seal of the bandage  10  when applied to a patient. 
         [0058]    Preferably, the polyurethane film  13  can be formed with an inner transparent film member  13   a  and an outer opaque, or skin colored, film member  13   b . The adhesive-covered surface of the polyurethane film member  13   a  is preferably covered by a release member  16  that is removed from the bandage  10  when the bandage is to be applied to the patient to expose the adhesive boundary  14  for attachment to the patient&#39;s skin around the wound site. More preferably, the release member  16  covers the entire inside surface of the bandage  10  before being removed and can be formed as overlapping members  16   a  and  16   b . The outer film member  13   b  is preferably constructed from non-woven polyurethane to provide a covering that has a look somewhat like human skin. 
         [0059]    The general configuration of the drain tube  20  and connector  22  utilized in each of the bandages described above and below, is shown generically in  FIGS. 7-10 . One skilled in the art will recognize that the drain tube  20  can be shaped specifically to conform to any particular shape or configuration of the bandage  10 ; however,  FIGS. 7-10  depict the drain tube  20  as having a linear configuration. One skilled in the art will also understand that the length and width of the drain tube  20  is also dependent on the size and shape of the specific bandage  10 . The connector  22  is of a conventional size and shape for connection to tubing that would interconnect the connector  22  with a vacuum pump (not shown). 
         [0060]    The drain tube  20  in the first embodiment depicted in  FIGS. 7 and 8  is formed from a pair of opposing, relatively flat body fluid collection members  24  that are formed with slotted openings  26  in the top and bottom surfaces thereof to collect fluids and exudates from the wound through the wound contact member  15 . The opposing fluid collection members  24  are connected to a central collector member  27  that forms a “T” connection with the external connector  22  so that the negative pressure applied to the connector  22  extracts the fluids and exudates from the fluid collection members  24  through the central collector member  27  and out through the connector  22  to an storage device (not shown). 
         [0061]    A second embodiment of the drain tube  20  is depicted in  FIGS. 9 and 10  as a single tube configuration. The single flat body fluid collection member  24  is connected at one end thereof to the connector  22  which can pass through the seal pad  23 , and also through the polyurethane film  13 , for connection with the vacuum source (not shown). As depicted in the embodiment of  FIGS. 7 and 8 , the flat fluid collection member  24  is formed with openings  26  in the top and bottom surfaces. As depicted in  FIGS. 8 and 10 , the sides of the fluid collection member  24  can also be formed with openings  26  and those openings  26  can be in any shape from oval to circular, or other geometric shapes. 
         [0062]    A first embodiment of a contoured integrated negative pressure bandage  30  is shown in  FIGS. 11-13 , configured for use with the patient&#39;s toes. As with the integrated bandage described above with respect to  FIGS. 1-6 , this contoured bandage  30  is formed with an outer polyurethane film cover  13  formed with an outer adhesive boundary  14  located to the exterior of the mesh  12  which covers the non-woven polymer matrix pad  15 . In this embodiment of the contoured bandage  30 , the drain tube  20  is positioned at one end of the pad  15  such that the fluid collection member  24  extends substantially to the opposing end of the pad  15 . In  FIG. 14 , a second embodiment of the foot bandage  32  is shown in which the drain tube  20  is oriented diagonally across the pad  15  such that the connector  22  is positioned to one side of the bandage  30 . 
         [0063]    In the application of this first embodiment of the contoured bandage  30 , as is depicted schematically in  FIG. 13 , the bandage  30  is wrapped around the ends of the patient&#39;s toes in a manner where the pad  15  is located both above the patient&#39;s foot and below the patient&#39;s foot. The drain tube  20  is sufficiently flexible to allow the associated bend in the bandage  30  such that the fluid collection member  24  is also located above and below the patient&#39;s foot. The connector  22  is oriented over the top of the foot for connection to the vacuum pump (not shown). When the second embodiment of the bandage  32  is applied, the connector  22  is located at the top of the patient&#39;s foot, but to one side of the foot. 
         [0064]    Yet a third embodiment of the contoured negative pressure bandage  35  configured for application to a patient&#39;s foot is shown in  FIG. 15 . The non-woven polymer matrix pad  15  is formed smaller than the first embodiment shown in  FIGS. 11 and 14 , and preferably in a semi-circular shape. The pad  15  is located at one end of the polyurethane film cover  13 , terminating at a center fold line  28  so that the opposing half of the film cover  13  is devoid of a pad  15 . Furthermore, most of the opposing half of the film cover  13  can be covered with a layer of adhesive  14 . In application, the third embodiment of the foot bandage  35  is applied so that the pad  15  covers the open wound. 
         [0065]    If the wound is on the bottom of the patient&#39;s foot, then the opposing half of the film cover  13  is wrapped over the ends of the toes and sealed against the top of the foot. Since the drain tube  20  is oriented diagonally, the connector  22  will project from one side of the bandage  35  to be connected to the vacuum pump (not shown). The ends of the patient&#39;s toes should be positioned proximate to the middle of the pad  15  so that the fold line  28  is spaced from the ends of the patient&#39;s toes. The adhesive areas  14  on the opposing side of the film cover  13  and around the pad  15  and seal against each other and against the patient&#39;s foot to provide a seal around the pad  15  for the application of negative pressure therapy. 
         [0066]    In  FIG. 16 , a wedge member  29  is schematically shown. Preferably, for ease of manufacture, the wedge member  29  is rectangular in shape, but could be formed in a triangular or wedge shape as well. The purpose of the wedge member  29  is to separate the patient&#39;s toes prior to application of the bandage  30 ,  32  or  25  to the patient&#39;s foot. Often the open would on a patient&#39;s foot, whether on top or on the bottom of the foot, will extend between the patient&#39;s toes. Separating the toes adjacent the open wound with a wedge member  29  will increase the effectiveness of the negative pressure therapy. 
         [0067]    Referring now to  FIGS. 17-21 , an integrated bandage  40  contoured for application to a patient&#39;s heel is shown. As with the bandages described above, the heel bandage  40  has a shaped polyurethane film cover  13  on the outside surface of a non-woven polymer matrix pad  15  that has a silver nitrate mesh  12  on the inside surface. The polyurethane film cover  13  has a particular shape configured to be applied to the patient&#39;s heel. The film cover  13  has an upper rounded portion  42  surrounding an upper portion  46  of the pad  15  where the connector  22  is located. The lower portion  43  of the film cover  13  is formed with three flaps  44  projecting outwardly from the lower portion  47  of the pad  15 . The flaps  44  are separated by junctions  45  that provide flexibility in the application of the adhesive covered flaps  44  to the patient&#39;s skin. The junctions  45  between the flaps  44  can be formed as cutouts  45 , as is shown in  FIGS. 17 and 18 , or as a web  45   a , as is depicted in  FIG. 21 . The drain tube  20  in the first embodiment of the heel bandage  40  is oriented along the major vertical axis of the bandage  40 . 
         [0068]    In application, the heel bandage  40  is positioned so that the lower portion  47  covers the open wound and the fluids and exudates can be evacuated from the wound via the drain tube  20 . The rounded upper portion of the film cover  13  is easily applied to the lower part of the patient&#39;s calf irrespective of the orientation of the heel bandage  40  to the patient. The lower portion  43  of the film cover  13 , however, is typically applied to the patient&#39;s ankle, which is much more difficult to obtain a seal. The junctions  45  between the flaps  44  allow the flaps  44  to be oriented as needed to obtain a seal against the patient&#39;s ankle area. Furthermore, the junctions  45  provide a place where the medical service provider can tear the film cover  13  if further modifications become necessary. In  FIG. 21 , a second embodiment of the heel bandage  49  is depicted. The component parts are formed as described above, except for the orientation of the drain tube  20 , which is positioned diagonally across the pad  15  so that the connector  22  exits the polyurethane film cover member  13  at one side thereof. Furthermore, the junctions are depicted as perforated webs  45   a  between the flaps  44  to allow selective tearing of the webs  45   a  to accomplish the folding of the flaps  44  and the sealing of the bandage  10 . 
         [0069]    For wounds on the bottom of the heel, the heel bandage  40  is applied with the lower portion  47  of the pad  15  located under the foot against the open wound. The upper portion of the film cover  13  can be secured against the back portion of the patient&#39;s leg and the flaps  44  can be wrapped around the sides of the foot and along the sole. The connector  22  will be oriented vertically in back of the leg. If the wound is in the rear part of the heel, the lower part  47  of the pad  15  is positioned over the wound while the flaps  44  are wrapped around the sides of the ankle and underneath the heel. If the wound is on the ankle along the side of the foot, the lower part  47  of the pad  15  is placed over the wound with the upper portion  42  of the film cover  13  being oriented along the side of the leg. The flaps  44  can then be secured to the inside of the foot, behind the heel, and underneath the foot. The junctions  45  in each of the scenarios noted above enable the three respective flaps  44  to be secured against the patient&#39;s foot in different planes and in different orientations. 
         [0070]    An integrated negative pressure bandage  50  contoured to be applied to the sacral region of the patient is shown in  FIGS. 22 and 23 . As described above, the sacral bandage  50  is formed with a non-woven polymer matrix pad  15  having affixed to the outside surface thereof a polyurethane film cover  13  and to the inner surface thereof a mesh  12  impregnated with silver nitrate. The drain tube  20  terminates in a connector  22  above the film cover  13  and includes a fluid collection member  24  embedded into the pad  15 . The bandage  50  is formed with a curved indent  52 ,  53  at the top and at the bottom, respectively, to conform to the shape of the sacral region of the patient. Similarly, the pad  15  is formed with a curved indent  54  at the top central portion thereof. 
         [0071]    It will be understood that changes in the details, materials, steps and arrangements of parts which have been described and illustrated to explain the nature of the invention will occur to and may be made by those skilled in the art upon a reading of this disclosure within the principles and scope of the invention. The foregoing description illustrates the preferred embodiments of the invention; however, concepts, as based upon the description, may be employed in other embodiments without departing from the scope of the invention. The invention is not otherwise limited, except for the recitation of the claims set forth below.