![]() ![]() Afterward, we cut up the foam to make it correspond to the wound, in size and depth (Fig. We start our installation by protecting the surrounding skin using strips of tulle gras. 14, 16, or 18, the hydrocolloid for the protection of wound edges by tulle gras (vaseline gauze), the adhesive film ensuring sealing by an incise drape and the therapy unit by wall suction and exudates collection bottle. 1), we replaced polyurethane foam by that from surgical scrub brushes, the tubing, and its suction port by nasogastric tube or bronchial suction tube No. In order to use our “low cost” technique (Fig. Debridement, which is a capital step, must be meticulous and repeated at each dressing change if necessary. Materials and MethodsĪs a first step, all patients underwent flattening with surgical debridement, cleaning, excision of devitalized or necrotic tissues, elimination of fibrin, abundant irrigation using saline solution, and an antibiotic therapy adapted to the results of bacteriological findings. ![]() ![]() This adaptation allows us to set up a genuine care protocol for wounds, including complex ones, by supporting with NPWT the entire healing process up to the epidermization phase. While some teams with a similar device to ours reduce the costs to 15 USD, in our experience the cost has never exceeded 4 USD for each dressing change. Therefore, we opted for a “low-cost” but yet effective alternative which requires both wall suction as described in the original technique but using a foam whose properties are similar to polyurethane or polyvinyl alcohol foams used in more modern devices. Working in a remote and limited resources hospital, access to such medical devices is not always easy task to manage (7,500 USD per unit and 75 USD for each dressing change). The granulation tissue obtained through this new approach was thicker and more ventilated, but the financial costs of acquisition and operation of this device were higher, making it inaccessible to low-income countries. It was Argenta and Morykwas who eventually popularized the technique using a combined system of open-cell polyurethane foam and NP applied in a controlled manner. ![]() successfully applied this new NP wound therapy (NPWT) to 15 patients with open fractures using foam dressing for an extended period of time in order to promote granulation and healing. It was only in the early 90s that Fleischman et al. Three years later, Chariker and Jeter published a method of NP dressing connecting wall suction via a drain to moist gauze pads covered with adhesive film, allowing a thin and dense granulation tissue. demonstrated, in a study of 116 patients, the superiority of NP dressing for infected wounds after surgical debridement compared to surgical debridement alone. And even if the widespread use of this technique in many surgical specialties is due to the commercial development of many innovative devices, the fact remains that the principle of its use goes back further. In the 1970s, pioneering Russian surgeons were already applying the principle of a vacuum chamber placed above the wound. The idea of using negative pressure (NP) to assist wound healing is not new. We present the technique used in our department and its results through a series of 3 cases with both acute and chronic lesions evolving in septic environment and where NPWT enabled us to ensure a genuine care protocol until healing while reducing the cost of therapy, the number of dressings and the length of hospital stay. However, the exorbitant cost of VAC (vacuum-assisted closure) devices for our limited resources health facilities and their unavailability led us to opt for a “low cost” solution using wall suction and disposable materials readily available in all surgical departments. With cellular, extracellular effects and bacterial clearance, it leads to the rapid formation of healthy budding granulation tissue, which provides wound bed for directed healing or secondary coverage by skin graft or flap. Negative pressure wound therapy (NPWT) is an alternative to standard treatment of acute wounds (such as traumatic or postoperative wounds) but also in that of chronic wounds (such as ulcers or stage 3 and 4 pressure ulcers). ![]()
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