Aseer, S (2009) Device assisted wound bed preparation. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Preparation of wound bed is an important foundation for successful wound treatment. Understanding complex and dynamic interaction of multiple factors that control the healing proces is vital for successful outcome. Science of wound bed preparation comes from technological advances and their application in clinical practice. This concept of wound bed preparation was introduced in United States in late 1990, when certain advanced therapeutic products like growth factor got regulatory approval by FDA. However it was formulated in November-2000 by European tissue repair society meeting, held in oxford. The therapeutic products used by them were. 1. Slow and sustained release iodine hexomer, 2. Negative pressure therapy, 3. Enzymatic preparation like collagenase. This concept has provided a structured and systemic approach in wound management with better utilization of technological advances of recent past. The concept of wound bed preparation was developed to describe the process by which chronic wounds are made suitable for surgical intervention and get benefited from available wound care technology. Acute wounds also require wound bed preparation to prime the wound surface for healing. AIM OF THE STUDY: Electrical Stimulation - 1. To study the changes which occur in the wound bed following electrical stimulation and comparing with control. 2. To study the effects of electrical stimulation in controlling the bacterial bio burden of chronic wounds. 3. To compare the healing rates of chronic wounds treated with and without electrical stimulation. Negative Pressure Wound Therapy - 1. To analyse the efficacy of negative pressure wound therapy in preparing the wound bed of post traumatic wounds. 2. To compare the efficiency of negative pressure wound therapy in wound bed preparation of post traumatic wounds with control, using biochemical parameters. MATERIAL AND METHODS: This study was done in department of plastic surgery, Stanley medical college. The study period was between Jan 2007 and Dec 2008. In this study 2 devices were used as follows & results were analysed. 1) Chronic wounds - Electrical stimulation. 2) Post traumatic wounds – Negative pressure wound therapy. Chronic Wounds - Electrical Stimulation During this study period, 37 patient with chronic superficial wounds registered in our department were included in this study. Patients with 1) Malignant ulcer, 2) Ischaemic ulcer, 3) Chronic Osteomyelitis, 4) Patient with cardiac Pacemaker, were not included for the study. Thirty Seven Patients with chronic superficial wounds were randomly divided into 2 groups. 1) Group I - for whom electrical stimulation was given for 3 weeks. 2) Group II - Regular saline dressing were done for 3 weeks. None of the group was treated either with antibiotics (or) analgesics. Out of the 37 patients, two patients had two ulcers and among that one was kept as control and other was kept as study group. Two patients were initially treated as control group for 3 week subsequently these two patients were treated by electrical stimulation for 3 week. All the patients included in the study were examined as per our protocol. The patients included in the study were evaluated for systemic co-morbid illness like Diabetes mellitus, malnutrition, anemia etc, and treated accordingly. Detailed clinical examination of the local wounds done as per the clinical Proforma. The response of the wounds for either electrical stimulation or saline dressing were analyzed based on the serial assessment results. The serial assessment were done initially before the treatment is started. Similar assessment were repeated at the end of week 1, week 2 and week 3 and analysed. RESULTS: Chronic Wounds Treated By Electrical Stimulation: In this study of chronic superficial wounds there were 37 patients. Among the 37 patients, 2 patients had multiple wounds. Two patients who were initially kept as control were later treated by electrical stimulation. All patients included in the study had wounds in the extremity. All except 2 patients had wounds in the lower extremity. On analysis of the aetiology of chronic wound in the study diabetes mellitus was most common cause. In the next common category no specific aetiology could be ascertained. Out of the 11 patients who fall in this group 8 patients were habitual smokers. Most of the patients were in the age group between 41-60 yrs. The youngest patient was 23 years of Age and the oldest was 76 years. Most of the patients with chronic ulcer were males. Patients who were treated with electrical stimulation had significant decrease in pain, oedema and exudates. The granulation tissue became pink in 16 out of 22 cases at the end of first week. The healing rates of the wounds treated with electrical stimulation were significantly better when compared to the control. The average healing rate of the wound treated by electrical stimulation was 23.04 % / week, and that of the control was 17% per week. A healing rate of 15% per week is the accepted standard for chronic non-healing wounds. The effective rate of healing even in control in the study can be explained by the fact that all this wounds are superficial. The healing rate of the wound treated with electrical stimulation ranges between 17.1% - 29.3%. For control the range is from 9.8 to 22.8% CONCLUSION: Electrical Stimulation: 1. Electrical stimulation improves the local vascularity in 3 -7 days and converts the unhealthy wound bed of chronic superficial wound in to one that is fit for skin cover. 2. Electrical stimulation drastically reduces the bacterial bio-burden to insignificant level over a period of 3 weeks. 3. On an average electrical stimulation increases the healing rate to 23% per week which amounts to 18% more as compared with control over a period 3 weeks. Negative Pressure Wound Therapy: 1. The NPT treated wounds are converted from extension phase to transition phase in 6 days which is half the period that is required for control. 2. Bio chemical analysis has shown that cases treated with negative pressure wound therapy had a significant increase in collagen synthesis and increased utilization of hydroxy proline than control, indicating increased production and utilization of components of wound healing. 3. Negative pressure therapy simplifies the surgical management even in cases with extensive exposure of bone. A complex wound which needs a flap cover can be converted in to simple wound which will accept a split skin graft. This is quiet evident in the case shown in photograph.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Device assisted wound ; bed preparation. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:50 |
| Last Modified: | 12 Oct 2017 01:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3509 |
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