Traumatic wound difficult to heal: use of negative pressure therapy: case report
Keywords:Contused wound, Negative pressure therapy, Wound infection, Degloving
The skin is one of the largest organs of the anatomy. It is the barrier between the exterior and the first line of defense against aggression. A wound is a loss of continuity of the soft parts of the organism generating an interruption in the structure of the tissue, as a consequence of this loss of continuity, there is a loss of sterility existing inside and infection can occur. Another consequence of discontinuity are possible lesions in adjacent tissues or organs. Trauma results in complex wounds that are difficult to manage due to large skin loss or avulsion of large areas of tissue. Among the factors that can prevent proper healing can be systemic (malnutrition, chemotherapy, steroids) or local (infection, prosthetic material, bone exposure). Among the therapeutic options for complex wounds is negative pressure therapy which generates wound contraction, stabilization of the environment, reduction of edema, removal of exudate and micro-deformations of the surface, increase of angiogenesis, granulation tissue formation and decreased bacterial count. We described a clinical case of traumatic injury at the level of the right pelvic limb in a 70-years-old woman with diabetes and hypertension, in which surgical washing was performed, debridement and use of negative pressure therapy with adequate evolution in a second level public hospital.
Dutta AK. Introduction to skull. In: Dutta AK, eds. Essentials of Human Anatomy Head and neck Part II. 3rd ed. Calcutta: Current Books International; 1999:1-69.
Gonzalez F, Malagón H, Gerez K. Use of vacuum assisted closure (VAC) systems in infected surgical wounds in the cervicofacial region (presentation of a clinical case and review of the literature). Mexican Assoc Oral Maxillofacial Surg. 2017:7(2):40-50.
Schuster R, Moradzadeh A, Waxman K. The use of vacuum-assisted closure therapy for the treatment of a large infected facial wound. Am Surg. 2006;72(2):129-31.
Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE, Gurtner GC, et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146(1):40-51.
Scherer S, Pietramaggiori G, Mathews J, Prsa M, Huang S, Orgill DP. The mechanism of action of the vaccum assisted closure device. Plast Reconstr Surg. 2008;122:786-97.
Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg. 1993;96(9):488-92.
Deva AK, Buckland GH, Fisher E, Liew SC, Merten S, McGlynn M, et al. Topical negative pressure in wound management. Med J Aust. 2000;173(3):128-31.
Orgill DP, Bayer LR. Update on negative-pressure wound therapy. Plast Reconstr Surg. 2011;127(1):105-15.
Jones DA, Neves FWV, Guimarães JS, Castro DA, Ferracini AM. The use of negative pressure wound therapy in the treatment of infected wounds. Case studies. Rev Bras Ortop. 2016;51(6):646-51.
Gregor S, Maegele M, Sauerland S, Krahn JF, Peinemann F, Lange S. Negative pressure wound therapy: a vacuum of evidence? Arch Surg. 2008;143(2):189-96.
McNulty AK, Schmidt M, Feeley T, Kieswetter K. Effects of negative pressure wound therapy on fibroblast viability, chemotactic signaling, and proliferation in a provisional wound (fibrin) matrix. Wound Repair Regen. 2007;15(6):838-46.
Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg. 2006;117(7):121-6.