Negative Pressure Wound Therapy better known as Topical Negative Pressure (TNP), stands to be a vacuum assisted procedure for the treatment of ulcer by employing a negative pressure of 60-125 mm Hg on the bed of the wound. The procedure has been employed ever since the year 1995 for the treatment of surgical wounds, severe wounds and more rarely for the ulcers that are hard to heal. Treatment with TNP is employed within the departments of high technology like the department of cardiothoracic surgery, wherein the procedure has been widely assessed for mediastintis post heart surgery (Sjogren J. Vacuum, 2005).
The experiences of patients of treatment with TNP for mediastintis has been elucidated in one Swedish doctoral thesis (Swenne C. L. , 2006). Plurality of research rest upon the V. A. C. therapy, that was brought forth in the American market in the year 1995 and in Europe in the year 1997(Argenta L. C, Morykwas M. J. Vacuum, 1997).
The objective of this research was to assess if the negative pressure would be a clinically feasible alternative for the management of wound in primary care, when taking into consideration the time for the healing of ulcer (gauged in weeks), change in the size of the ulcer (measured in cm?using a digital planimeter) and formulation of the granulation tissue (examined by visual observation).
Albeit the calculation costs was not the chief objective, it was thought that it was imperative to report the costs for employing TNP in primary care. Materials and Methods: The cases in this research were being treated at Blekinge Wound Healing Center during the years of 2006 to 2008, which stands to be a leg ulcer center for the patients who are diagnosed with ulcers that are hard to heal.
The center holds an expertise in primary care and occupies the entire county of Blekinge. Experiences reported from the wound managent care center have given rise to a nationwide quality register for the ulcers that are hard to heal, where prognosis, treatment agenda and follow up till the time of healing of ulcer or side-effects are lodged. Criteria for Treatment with TNP: A total of 12 patients were selected the moment access to the pump was required.
The period of research was between the dates of 14th August 2006 and 15th December 2008. Eight patients were diagnosed with ulcers that are hard to heal with symptoms of delayed healing, which is recorded when the size of the ulcer does not reduce within a period of three or four weeks even apart from accurate prognosis, correct topical treatment and sufficient compression therapy (Flanagan M. , 2003). An ulcer that is hard to heal is described as an ulcer, which has not cured appropriately within a period of six weeks.
Conclusion: It was found that the treatment with TNP for the wound management in almost half of the patients in primary care, gave rise to comprehensive healing of ulcer and in all patients it accelerated the formulation of granulation tissue. The experience of the author of the study demonstrated that treatment with TNP could be employed as a feasible method in primary care for the treatment of pressure ulcers and multi-factorial ulcers that had symptoms of delayed healing and post-operative wounds or traumatic ulcers.
The average time of treatment in this research was seven weeks and three days (median three weeks). Costs for treatment with NPWT/TNP in one study were found to amount to approximately half the costs for conventional therapy (Philbeck T. E. Jr, Whittington K. T, Millsap M. H. Briones R. B, Wight D. G. Schroeder W. J. , 1999). In our study we found that weekly costs for treatment with NPWT/TNP varied between €279 and €339 (at 2009 price levels) which would be roughly twice as high as was earlier reported for conventional therapy.
From the author’s experience the greatest benefit from using NPWT/TNP for patients with hard-to-heal ulcers or complicated postoperative wounds in primary care, is the formation of granulation tissue, which is a fundamental requirement in ulcer healing. Considering the small study size, the population heterogeneity and the treatment regimens before TNP/NPWT, our experience is that treatment with negative pressure could be used as a manageable alternative for wound management in primary care.
References 1. Argenta L. C, Morykwas M. J. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997; 38(6): 563-76. 2. Philbeck T. E. Jr, Whittington K. T, Millsap M. H. Briones R. B, Wight D. G. Schroeder W. J. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage 1999; 45(11): 41-50. 3. Gustafson R.
Vacuum-Assisted Closure Therapy – A new Treatment Modality in Poststernotomy Mediastinitis. Department of Cardiothoracic Surgery, Lund University, Lund. 2004. 4. Sjogren J. Vacuum-assisted closure in cardiac surgery – clinical outcome and vascular effects. Department of Cardiothoracic Surgery, Lund University, Lund. 2005. 5. Mokhtari A. Vacuum-Assisted Closure Therapy after Cardiac Surgery. Sternal Stability, Cost of Care, Learning Curve and Hemodynamic Outcome. Department of Cardiothoracic Surgery, Lund University, Lund.
2008. 6. Swenne C. L. Wound Infection Following Coronary Artery Bypass Graft Surgery: Risk Factors and the Experiences of Patients. Department of Public Health and Caring Sciences, Uppsala University, Uppsala. 2006. 7. Blume P. A, Walters J, Payne W, Ayala J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 2008; 31(4): 631-6.