Initially negative pressure therapy was used to accelerate bedside preparation of wounds. Higher pressures (150 mmHg plus) are used for large cavity and exhudative wounds. The pressure setting can be kept low (50–75 mmHg) particularly for painful chronic wounds. Intermittent mode consists of a cycle of 5 min on and 2 min off phase. The negative pressure mode can be either continuous or intermittent, ranging from 50 to 125 mmHg. The dressing is usually changed on 3rd day. Drapes should cover the foam and tubing and at least 3–5 cm of surrounding healthy tissue to ensure a watertight/airtight seal. The wound is then sealed with an adhesive drape. 8 A fenestrated evacuation tube is fixed in the foam, which is connected to a vacuum pump. White (Polyvinyl alcohol, dense, hydrophilic with a pore size of 250 mm) used for superficial surface wounds. Two types of foam are commonly used, black (Polyurethane ether, lighter, hydrophobic with a pore size of 400–600 mm) used for thoracic and abdominal cavity wounds. Sterile foams are used for dressing as they provide an even distribution of negative pressure over the whole wound bed. Wound is thoroughly debrided, irrigated with normal saline, adequate haemostasis is achieved and peri-wound skin is made dry. VAC therapy appears to be a simple and more effective than conventional dressings for the management of difficult wound in terms of reduction in wound volume, depth, treatment duration and cost. All this improves the possibility of primary closure of wounds and reduce the need for plastic procedures. Negative pressure therapy stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis. The VAC dressings are changed on 3rd day. The machine delivers continuous or intermittent suction, ranging from 50 to 125 mmHg. The fenestrate tube is connected to a vacuum pump with fluid collection container. A fenestrated tube is embedded in the foam and wound is sealed with adhesive tape to make it air tight. Method of VAC application includes thorough debridement, adequate haemostasis and application of sterile foams dressing. Vacuum-assisted closure (VAC) is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. It leads to the pain, morbidity, prolonged treatment, and require major reconstructive surgery which imposes enormous social and financial burden. All rights reserved.Delayed wound healing particularly in difficult wounds and in elderly with co morbidities is a major concern. Comparative research to define differential costs, indications and advantages of the method, specific indications and limits of NWTP in Pediatrics is needed.Ībdominal compartment syndrome Complex wound Negative pressure wound therapy Pediatrics Tissue loss VAC-therapy Vacuum-therapy.Ĭopyright © 2017 Elsevier Inc. Extra care is needed to protect the delicate tissues of Pediatric patients. Adult devices and parameters have been adapted to children's use. A possible causal relationship between NPWY and enteric fistula remains unclear. Complications are uncommon and mostly manageable. NPWT is widely used in Pediatrics, including neonates and premature, but the evidence available about the method is scarce and low quality. The possibility of fistulae being caused by NPWT remains debatable. Complications are rare, mainly foam retention and dermatitis/skin maceration. Enteric fistulae are not contraindications. Debridement is needed before usage over necrotic areas. NPWT is contraindicated over blood vessels and exposed nerves. Less pain, quicker recovery, less frequent dressing changes, possible recovery of exposed surgical hardware, granulation and shrinkage of the wound are advantages of the method over other kinds of dressing. Periwound skin protection, monitoring of fluid losses and fine tuning of negative pressure levels according to age are necessary. The method shows good results to treat ACS, complicated wounds and abdominal wall malformations in neonates, including prematures. Papers referring to orthopedic problems, wound complications after Cardiac Surgery or burns were excluded. Our aim is to review the evidence available about NPWT in children.Īctive search for papers about NPWT in Pediatric patients. The method presents specific aspects, advantages and indications in Pediatrics. Negative pressure wound therapy (NPWT) has been widely adopted to treat laparostomy, abdominal compartment syndrome (ACS) and complicated wounds associated with tissue loss.
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