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Advanced Wound Healing

Potential Future Applications for Negative Pressure Wound Therapy and Installation Devices
Reuben A. Falola, MPH, Medical Student Research Scholar, Caitlin M. Ward, BA, Student, Madison J. Kim, Student, Tammer Elmarsafi, DPM, MBBCh, Diabetic Limb Salvage Fellow, John S. Steinberg, DPM, Attending Physician, Karen K. Evans, MD, Attending Physician, Christopher E. Attinger, MD, Attending Physician, Paul J. Kim, DPM, MS, Attending Physician, Department of Plastic Surgery, Center for Wound Healing, Georgetown University Hospital, Washington, DC

 

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Abstract


Negative-pressure wound therapy (NPWT) applies vacuum pressure to a wound bed sealed by an adhesive dressing to improve wound healing. A cleansing solution, often antibiotics or saline, may be instilled into the wound bed concurrently and removed via suction, thus enhancing the therapeutic effect. The therapeutic effect results from improved blood flow and removal of inflammatory factors. Since 1995, the FDA has approved NPWT for medical use. Since then, this technology has been applied to different types of wounds, including diabetic and decubitus ulcers and postsurgical incisional wounds. There are many applications for NPWT that remain to be explored. In this article, we postulate on novel and future uses for NPWT, including application in targeted drug delivery, stem cell therapy, and the prospect of combination with filtration devices, adaptable smart dressings, and remote monitoring.

 

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Use of an Ovine Collagen Dressing with Intact Extracellular Matrix to Improve Wound Closure Times and Reduce Expenditures in a US Military Veteran Hospital Outpatient Wound Center
Daniel T. Ferreras, DPM, FAPWCA, AAWC, Chief/Lead Podiatrist, Surgical Services, Carl Vinson VA Medical Center, Dublin, Georgia, Sean Craig, RN, CWCN, Wound Care Nurse, Nursing, Alexandria VA Health Care System, Pineville, Louisiana, Rebecca Malcomb, RN, RN Care Manager for Primary Care, Nursing, Alexandria VA Health Care System, Pineville, Louisiana

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Abstract

A novel, comprehensive decision-making and treatment algorithm was established within a US government-run military veteran hospital in an attempt to standardize the process of outpatient wound care and streamline costs. All patients were systematically evaluated and treated using the comprehensive algorithm over a span of nine months. After three months of adherence to the algorithm, the algorithm was modified to include ovine-based collagen extracellular matrix (CECM) dressings as a first-line conventional treatment strategy for all appropriate wounds. The purpose of this retrospective analysis was to evaluate the hospital’s change in cellular and/or tissue-based graft usage and cost, as well as wound healing outcomes following modification of the wound care standardization algorithm. Data from the first quarter (Q1; three months) of protocol implementation were compared to the subsequent two quarters (six months), during which time the first-line dressing modification of the protocol was implemented. Results showed that between quarters 1 and 3, the percentage of wounds healed increased by 95.5% (24/64 to 80/109), and the average time to heal each wound decreased by 22.6% (78.8 days to 61.0 days). Cellular and/or tissue-based graft unit usage decreased by 59.7% (144 units to 58 units), and expenditures on cellular and/or tissue-based grafts decreased by 66.0% ($212,893 to $72,412). Results of this analysis displayed a trend toward decreased expenditures, faster healing times, and a greater number of healed wounds following modification of an evidence-based algorithm to incorporate CECM dressings as a first-line treatment strategy in managing chronic wounds.

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