The Usefulness of Topical Negative Pressure (TNP) As a Supporting Method for the Surgical Treatment of Venous Ulcers with the use of Middle-Split Thickness Skin Graft

• Authors: Maciej Zieliński , Fryderyk Pukacki , Grzegorz Oszkinis , Marcin Gabriel , Krzysztof Waliszewski , Wacław Majewski
• Languages of publication: EN

Abstracts

EN

The most effective method of treatment for venous ulcers resistant to conservative therapy is operation.The surgical procedure consists of resection of the entire ulceration followed by perforated middle-split thickness skin graft transplant. Postoperative treatment requires both long term elevation of the patient's leg and frequent dressing changing.The aim of the study was to assesses the effectiveness of TNP as a method supporting surgical treatment.Material and methods. From 2004 to 2006 in the Poznań Clinic of General and Vascular Surgery of Medical University, 25 patients (16 women and 9 men) were treated for venous ulcers resistant to conservative treatment. The patients' ages varied from 50 to 82 years (average: 69), and the time of ulceration presence ranged from 6 months to 6 years (average: 2 years and 5 months). Patients were divided into two groups: all patients in group I (n=14) underwent surgical treatment with the use of middle split thickness skin grafting, whereas all patients in group II (n=11) underwent surgical treatment with support of TNP - VAC® Subsequent parameters, including the time of hospitalization, time and effectiveness of skin graft healing, and patient's subjective comfort of the therapy, were analyzed.Results. The average hospitalization time was significantly shorter in group II than group I (18 vs 24 days, p<0.0005). The average healing time in group II was significantly shorter than that in group I (31 vs 42 days, p<0.00002). Additional skin grafting was necessary in four cases from group I but none from group II. Subjective therapy comfort was higher among patients from group II than group I.Conclusions. TNP is a useful method supporting the surgical treatment of venous ulcers that are resistant to conservative treatment.

Keywords

EN

ulceration; skin graft; VAC therapy; topical negative pressure

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2008
• Volume: 80
• Issue: 3
• Pages: 124-131

Dates

published

1 - 3 - 2008

online

7 - 4 - 2008

Contributors

author

Maciej Zieliński

• Department of General and Vascular Surgery, K. Marcinkowski Medical University, Poznań

author

Fryderyk Pukacki

• Department of General and Vascular Surgery, K. Marcinkowski Medical University, Poznań

author

Grzegorz Oszkinis

• Department of General and Vascular Surgery, K. Marcinkowski Medical University, Poznań

author

Marcin Gabriel

• Department of General and Vascular Surgery, K. Marcinkowski Medical University, Poznań

author

Krzysztof Waliszewski

• Department of General and Vascular Surgery, K. Marcinkowski Medical University, Poznań

author

Wacław Majewski

• Department of General and Vascular Surgery, K. Marcinkowski Medical University, Poznań

References

• Staniszewski R, Stanisić M, Winckiewicz M i wsp.: Przydatność przeszczepów skóry w leczeniu rozległych owrzodzeń żylnych. Postępy Dermatologii i Alergologii XXII 2005; 2: 70-76.
• Williams D, Enoch S, Miller D et al.: Effect of sharp debridement using curette on recalcitrant nonhealing venous leg ulcers: a concurrently, controlled, prospective cohort study. Wound Repair Regen 2005; 13: 131-37.[Crossref][PubMed]
• Fowler E, van Rijswijk L: Using wound debridement to help achieve the goals of care. Ostomy Wound Manage 1995; 41: 23S-35S.
• Harold B, Robert K, Falanga V: Protocol for successful treatment of venous ulcers. Am J Surg 2004; 188: 1S-8S.
• Scherer LA, Shiver S, Chang M et al.: The vacuum assisted closure device: a method of securing skin grafts and improving graft survival. Arch Surg 2002; 137: 930-33.
• Bradley M, Cullum N, Sheldon T: The debridement of chronic wounds: a systematic review. Health Technol Assess 1999; 3: iii-iv, 1-78.
• Valencia IC, Falabella A, Kirsner RS et al.: Chronic venous insufficiency and venous leg ulceration. J Am Acad 2001; 44: 401-21.[Crossref]
• Morykwas MJ, Argenta LC, Shelton-Brown EL et al. Vacuum-assissyted closure. A new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-562.
• Zapalski S, Oszkinis G: Ambulatoryjne leczenie chorób żył kończyn dolnych. Via Medica, Gdańsk 2001.
• Kucharzewski M, Franek A: Krótki rys historyczy leczenia owrzodzeń podudzi. Przegl Flebolog 2001; 9(4): 65-69.
• Kózka M: Wrzód żylny goleni. Magazyn Med Flebolog 2003; 1: 27-34.
• Omarr AA, Major AID, Jones AM et al.: Treatment of venous ulcers with dermagraft. Eur J Vasc Endovasc Surg 2004; 27: 666-72.[Crossref]
• Ruckley CV: Socioeconomic impact of chronic venous insufficiency and leg ulcer. Angiology 1997; 48: 67-69.[PubMed][Crossref]
• Argenta LC, Morykwas MJ: Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38: 562-76.
• Morykwas MJ: External application of sub-atmospheric pressure and healing: mechanisms of action. Wound Healing Soc Newsletter 1998; 8: 4-5.
• Blackburn JH, Boemi L, Hall WW: Negative pressure dressing as a bolster for skin grafts. Ann Plast Surg 1998; 40: 453-57.
• Weed T, Ratliff C, Brake D: Quantifying bacterial biobrden during negative pressure wound therapy. Ann Plast Surg 2004; 52: 276-80.
• Schneider AM, Morykwas MJ, Argenta LC: A new reliable method of securing skin grafts to the difficult recipient bed (stratum). Plast Reconstr Surg 2000; 105: 174-77.
• Llanos S, Danilla S, Barazza C et al. Effectiveness of negative pressure closure in the integration of split thickness skin grafts. Ann Surg 2006; 244(5): 700-05.

Identifiers

DOI

10.2478/v10035-008-0014-5