DOI: https://doi.org/10.22263/2312-4156.2018.2.63
Horehliad O.M.1,2
The change of wound contamination under the influence of local application of negative pressure
1Dnepropetrovsk Medical Academy of the Ukrainian Ministry of Public Health, Dnepr, Ukraine
2Dnepr Clinical Hospital Named after I.I. Mechnicov, Dnepr, Ukraine
Vestnik VGMU. 2018;17(2):63-69.
Abstract.
Objectives. To investigate the effect of vacuum-assisted closure (VAC) of the wounds on their bacterial load in patients with severe polystructural high-energy injuries.
Material and methods. 34 cases of severe osteomuscular injuries of the lower and upper extremities were examined. 18 patients were included into the experimental group with the application of negative pressure on the wound. Standard wound treatment with antiseptics and the application of gauze bandages were used in 16 patients of the control group. The evaluation of the results included the comparison of the bacterial load (the amount of colony forming units per gram of tissue) during the wound condition examination in the experimental and control groups. The specimens for bacteriological evaluation, which included the determination of the qualitative and quantitative composition of wound microbiocenosis, were collected from the wound bed before the application of treatment measures as well as 3 and 7 days later.
Results. The total bacterial load after the negative pressure wound treatment was significantly lower than that after the conventional wound treatment at each observation time period, whereas the bacterial load in the wound treated by means of the conventional saline-soaked gauze bandage was significantly lower after 7 days had elapsed than that in 3 days after application. The load of anaerobic bacteria was equally perceptible for both VAC and control group treatment, whereas the load of P. aeruginosa and S. aureus was significantly decreased even in 3 days after negative pressure application.
Conclusions. The application of wounds VAC leads to a significant decrease in the bacterial load of the wound, which means that negative pressure wound healing significantly reduces the level of wounds contamination, thus it can be applied for the successful treatment of complex polystructural wounds.
Key words: wound healing, vacuum-assisted closure, combat wound, polystructural injury, bacterial load, wound infection.
References
1. Abaev YuK. Guide surgeon. Wounds and wound infection. Rostov on Don, RF: Feniks; 2006. 428 р. (In Russ.)
2. Krug E, Berg L, Lee C, Hudson D, Birke-Sorensen H, Depoorter M, et al. Evidence-based recommendations for the use of negative pressure wound therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus. Injury. 2011 Feb;42 Suppl 1:S1-12. doi: http://dx.doi.org/10.1016/S0020-1383(11)00041-6
3. Birke-Sorensen H, Malmsjo M, Rome P, Hudson D, Krug E, Berg L, Bruhin A, et al. Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer) – steps towards an international consensus. J Plast Reconstr Aesthet Surg. 2011 Sep;64 Suppl:S1-16. doi: http://dx.doi.org/10.1016/j.bjps.2011.06.001
4. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997 Jun;38(6):553-62.
5. Mouës CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen. 2004 Jan-Feb;12(1):11-7. doi: http://dx.doi.org/10.1111/j.1067-1927.2004.12105.x
6. Weed T, Ratliff C, Drake DB. Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Ann Plast Surg. 2004 Mar;52(3):276-9.
7. Braakenburg A, Obdeijn MC, Feitz R, van Rooij IA, van Griethuysen AJ, Klinkenbijl JH. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg. 2006 Aug;118(2):390-7. doi: http://dx.doi.org/10.1097/01.prs.0000227675.63744.af
8. Patmo AS, Krijnen P, Tuinebreijer WE, Breederveld RS. The effect of vacuum-assisted closure on the bacterial load and type of bacteria: a systematic review. Adv Wound Care (New Rochelle). 2014 May;3(5):383-389. doi: http://dx.doi.org/10.1089/wound.2013.0510
9. Assadian O, Assadian A, Stadler M, Diab-Elschahawi M, Kramer A. Bacterial growth kinetic without the influence of the immune system using vacuum-assisted closure dressing with and without negative pressure in an in vitro wound model. Int Wound J. 2010 Aug;7(4):283-9. doi: http://dx.doi.org/10.1111/j.1742-481X.2010.00686.x
10. Steingrimsson S, Gottfredsson M, Gudmundsdottir I, Sjögren J, Gudbjartsson T. Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early reinfections. Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):406-10. doi: http://dx.doi.org/10.1093/icvts/ivs254
11. Gerkhardt F, red. Methods of General bacteriology: per s angl: v 3 t. Moscow, RF: Mir; 1984. 3 т. (In Russ.)
12. Khoult Dzh, Krig N, Snit P, Steynli Dzh, Uill'yams S, red. The determinant of bacteria Bergey: v 2 t: per s angl. Moscow, RF: Mir; 1997. 2 т.
13. Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, et al. A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series. Int Wound J. 2009 Oct;6 Suppl 2:1-25. doi: http://dx.doi.org/10.1111/j.1742-481X.2009.00628.x
Information about authors:
Horehliad O.M. – orthopedist-traumatologist, head of the Consultation Polyclinic, Dnepr Clinical Hospital Named after I.I. Mechnikov; postgraduate of the Chair of Medicosocial Expertise & Rehabilitation, Dnepropetrovsk Medical Academy of the Ukrainian Ministry of Public Health.
Correspondence address: Ukraine, 49005, Dnepr, 14 Sobornaya sq., Dnepr Clinical Hospital Named after I.I. Mechnicov. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Oleksii M. Horehliad Oleksii M. Horehliad.
