Effectiveness of Negative-Pressure Wound Therapy
Condition: Pressure Ulcers Stage III; Pressure Ulcer, Stage IV
MeSH terms: Pressure Ulcer; Ulcer
Study type: Interventional

Summary: 
      This study aims to compare the effects of Negative-Pressure Wound Therapy and wet-to-dry
      dressing on Stages 3 and 4 pressure injuries, and to investigate the consistency of
      Three-Dimensional Wound Measurement Device findings with Pressure Ulcer Scale for Healing
      Tool scores. This study is a randomized controlled trial. A total of 30 patients with Stages
      3 and 4 pressure injuries were included in the study. The patients were divided into two
      groups: the experimental group or Negative-Pressure Wound Therapy group and the control or
      wet-to-dry dressing group. All patients received 3 rounds of treatment. Data were collected
      with a Patient Identification Form, Pressure Ulcer Scale for Healing Tool and the findings of
      Three-Dimensional Wound Measurement Device. We found that granulation tissue formation was
      more significant in the experimental group (p < .05), and that there was more significant
      wound shrinkage (p < .05) with a more significant decrease in the Pressure Ulcer Scale for
      Healing Tool scores (p < .05). The wounds were assessed with the Tool and the
      Three-Dimensional Wound Measurement device. Device measurements were found to be correlated
      with Pressure Ulcer Scale for Healing Tool Tool findings (p < .05) There was a significant
      correlation between device-measured granulation findings and PUSH Tool score results of the
      experimental group's third measurements (p < .05). We conclude that Negative-Pressure Wound
      Therapy is an effective treatment method for pressure injuries, and Three-Dimensional Wound
      Measurement device is an usable wound assessment tool.
    

Detailed description: 
      Pressure injuries are a major health problem in that they are difficult to treat, reduce the
      patients' quality of life, and increase length of hospital stay and overall health care
      costs. Furthermore, several possible wound healing complications, such as infections, can
      lead to mortality. That said, the prevalence of pressure injuries is an important indicator
      of quality in hospitals. Pressure injuries do not only impact health, but also cause social
      isolation and dependency, resulting in further psychological problems.

      Our review of the literature revealed that the incidence of pressure ulcers varies between
      0.4% and 38% in hospitalized patients, between 2.2 and 23.9% in intensive care units and
      between 0-17% in home care. NPUAP (National Pressure Ulcer Advisory Panel) reports that the
      cost of treating pressure ulcers has been gradually increasing. It was estimated that
      treating pressure injuries costs around $11 billion annually in the United States alone.
      Treating a pressure ulcer can cost anywhere between $500 to $70,000, the most substantial
      fraction being nursing services. In the UK, it costs £1,064 to treat a Stage 1 pressure
      injury, and this number can reach £10,551 for more advanced ulcers. This illustrates the
      direct link between the stage of pressure injury and the cost of treatment. On average, it
      costs the UK healthcare system £1.4-2.1 billion annually to treat pressure ulcers.

      There are many products and methods available for pressure ulcer treatment, but the most
      well-known and most commonly preferred method is wet-to-dry dressing. That said, researchers
      have tried and developed several novel methods for the treatment of pressure injuries
      including NPWT (Negative-Pressure Wound Therapy), hyperbaric oxygen therapy, ultrasonography,
      hydrotherapy, magnetic field therapy, ultraviolet rays, electrical stimulation, phototherapy
      and growth hormone application. Together with these non-invasive treatment methods, surgical
      intervention can also be a treatment option, especially for non-healing wounds. The European
      and US National Pressure Ulcer Advisory Panels' (EPUAP and NPUAP) guidelines recommend NPWT
      for deep-tissue pressure injuries, namely Stages 3 and 4, as a supportive tool for
      early-stage treatment. This method is based on applying negative pressure to promote wound
      healing. Several studies report that NPWT increases granulation tissue formation and reduces
      wound area. It is indicated that NPWT provides continuous and effective wound debridement in
      the wound area and increases blood supply to the wound.

      Pressure injuries are among the most significant current health problems that are handled by
      a medical nurse. As the primary caregiver for the hospitalized patient, the nurse must
      prioritize preventing wound formation and eliminating any risk factors. If a pressure sore
      does form, the primary goal is to plan and implement appropriate care and nursing
      interventions in collaboration with the patient and their family to ensure proper wound
      healing .

      It is the nurse's responsibility to keep up with scientific developments in patient care and
      try to integrate them into their work. PUSH is a tool that is used for monitoring pressure
      ulcers; however, it has yet to become a part of routine practice in Turkey. The
      Three-Dimensional Wound Management (3-DWM) device has been used in medical service since
      2015, but with only a limited number of studies that evaluate its effectiveness. Currently,
      the wet-to-dry dressing method is the most commonly preferred treatment method for wound care
      in Turkish healthcare. There are indeed numerous studies that demonstrate the effectiveness
      of wet dressings in wound healing. Wet dressings provide the appropriate medium for the
      accumulation of patient's own body fluids between wound surface and dressing while preventing
      dehydration. This study aims to compare the effects of Negative-Pressure Wound Therapy (NPWT)
      and wet-to-dry dressing on Stages 3 and 4 pressure injuries, and to investigate the
      consistency of 3-DWM device measurement findings with PUSH Tool scores.
    

Intervention name(s): Negative-Pressure Wound Therapy group; contol group
Intervention type(s): Device; Other
Intervention description(s): The wounds were initially evaluated for any necrotic findings and debrided if needed, and then washed with an antiseptic solution. 3-DWM was used to measure the pressure sores by taking pictures.The length and width of wounds were measured with disposable paper rulers. Wound depth was determined in centimeters with a sterile cotton-tip applicator by measuring against a ruler. The wound was closed using a Wound Care Kit that includes foam dressing, film drape, TRAC pad with tubing and a drainage canister. Foam material was placed inside the wound and was attached to the canister through tubing.The canister was attached to the Vacuum-Assisted Closure device, which is a portable device that applies intermittent or continuous negative pressure.The device was operated at 125 mmHg pressure for 5 minutes with and 2 minutes without active vacuum.Wound dressings were changed every 48 hours.Wound area was measured after all three rounds of treatment.; Wounds were finally covered with gauze dressing soaked with saline. Wounds were treated three times a day, and measurements were repeated every 48 hours. Every wound was measured a total of four times: one pre-treatment (baseline) and three post-treatment measurements.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: REPEATIVE MEASUREMENT EXPERİMENTAL AND CONTROL GROUPS
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Negative-Pressure Wound Therapy; Pressure injuries; vacuum assisted closure; wound care; Wound Measurement