Download PDF
Zentralbl Chir 2018; 143(06): 609-616
DOI: 10.1055/a-0713-0517
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Einsatz der Vakuuminstillationstherapie für die Wundbehandlung – Ergebnis einer Expertenkonsensuskonferenz

Use of Negative Pressure Wound Therapy with Instillation and Dwell Time for Wound Treatment – Results of an Expert Consensus Conference
Raymund E. Horch
1   Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
,
Chris Braumann
2   Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef Hospital, Deutschland
,
Joachim Dissemond
3   Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Deutschland
,
Burkhard Lehner
4   Sektion Orthopädische Onkologie und Klinik für Orthopädie und Unfallchirurgie, Heidelberg, Deutschland
,
Christoph Hirche
5   Klinik für Unfallchirurgie und Orthopädie, Luftrettungszentrum Rettungshubschrauber Christoph 5, Klinik für Unfallchirurgie an der Ruprecht-Karls-Universität Universität Heidelberg, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
,
Guido Woeste
6   Allgemein- und Viszeralchirurgie, Agaplesion Elisabethenstift gGmbH, Darmstadt, Deutschland
,
Gernold Wozniak
7   Klinik für Gefäßchirurgie, Knappschaftskrankenhaus Bottrop GmbH, Deutschland
,
Walter Wetzel-Roth
8   Chirurgie und Gefäßchirurgie, Wertachkliniken KH Schwabmünchen, Buchloe, Deutschland
,
Christian Willy
9   Unfallchirurgie, Bundeswehrkrankenhaus Berlin, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
11 December 2018 (online)

Also available at
    Permissions and Reprints

Corrected by:

Erratum: Einsatz der Vakuuminstillationstherapie für die Wundbehandlung – Ergebnis einer ExpertenkonsensuskonferenzZentralbl Chir 2019; 144(02): 152-152
DOI: 10.1055/a-0881-4595

Zusammenfassung

Das Spülen von Wunden mit einer Lösung zur Wundreinigung ist seit Langem ein anerkannter Eckpfeiler in der Wundbehandlung als Mittel zur Entfernung von Zelltrümmern und Oberflächenpathogenen in Wundexsudaten. In Kombination mit dem chirurgischen Débridement und einer lokalen Vakuumtherapie kann sie das Fortschreiten von der entzündlichen zur proliferativen Phase der Wundheilung erleichtern. Verfahren der topischen Vakuumtherapie mit Instillation und einer definierten Einwirk- bzw. Verweilzeit von topischen Lösungen unter zyklischer Kompression und Dekompression mit Schaumverbänden (Negative Pressure Wound Therapy with instillation and dwell time = NPWTi-d) können Rückstände entfernen, die ansonsten hemmend auf den Heilungsprozess wirken. Gleichzeitig helfen sie, die bakterielle Keimbelastung in kontaminierten oder infizierten Wunden zu verringern. Nachdem diese Technik nun kommerziell verfügbar und zunehmend verbreitet ist, wurden im Rahmen eines Konsensusmeetings durch eine interdisziplinäre Expertenkommission Empfehlungen zur Anwendung und zu den klinischen Indikationen erarbeitet. Auch wenn die Evidenzstufe von Expertenmeinungen einen geringeren Level besitzt, können allgemein gültige Richtlinien für einen sicheren und effizienten Einsatz von NPWTi-d ausgesprochen werden, die dem klinisch tätigen Arzt als Handlungsempfehlung dienen können. Die daraus abgeleiteten Konsensusempfehlungen umfassen basierend auf dem Stand der aktuellen wissenschaftlichen Datenlage die Ziele der Behandlung, die Anwendungsmodalitäten die Indikationsstellung bei verschiedenen Wunden einschließlich eventueller Kontraindikationen, Therapieeinstellungen sowie die Verwendung topischer Instillationslösungen, deren Volumen und Verweildauer (dwell time), die optimale Behandlungsdauer und zukünftige Weiterentwicklungen der NPWTi-d.

Abstract

Rinsing wounds with wound cleansing solutions has long been a recognised cornerstone in wound management as a means of removing cell debris and surface pathogens in wound exudates. In combination with surgical debridement and topical negative pressure wound therapy (NPWT), this can facilitate the intended progression from the inflammatory to the proliferative phase of wound healing. Procedures of topical negative pressure wound therapy with instillation and a defined exposure/dwell-time of topical solutions under cyclic compression and decompression with foam dressings (NPWTi-d) can remove cellular remnants and debris that may inhibit the healing process. At the same time, it can aid in reducing the bacterial load in contaminated or infected wounds. Since this newer technique is now commercially available and increasingly widespread, recommendations for the proper use and clinical indications were developed by a panel of interdisciplinary experts in the course of a consensus meeting. Although the level of evidence from expert opinions is low, general guidelines for a safe and effective use of NPWTi-d can be worked out that can be of assistance to the clinician. The consensus recommendations derived from this meeting include the objectives of the treatment, the administration modalities of NPWTi-d, the indications for various wounds, including their contraindications, therapy settings, as well as the use of topical instillation solutions, volume and duration (dwell time) based on current scientific data, optimal treatment duration and future developments of the NPWTi-d.

Schlüsselwörter

Wundinfektion - Wundheilung - Wunddébridement - V. A. C.®-Therapie - Vakuuminstillation

Key words

wound infection - wound healing - wound debridement - vacuum-associated closure (for) wound dressing - vacuum instillation
 

  • Literatur

  • 1 Fisichella L, Fenga D, Rosa MA. Surgical Site Infection in orthopaedic surgery: Correlation between age, diabetes, smoke and surgical risk. Folia Med (Plovdiv) 2014; 56: 259-263
    PubMedGoogle Scholar
  • 2 Triantafyllopoulos G, Stundner O, Memtsoudis S. et al. Surgery, and hospital related risk factors for surgical site infections following total hip arthroplasty. ScientificWorldJournal 2015; 2015: 979560
    PubMedGoogle Scholar
  • 3 Jaafar G, Hammarqvist F, Enochsson L. et al. Patient-related risk factors for postoperative infection after cholecystectomy. World J Surg 2017; 41: 2240-2244
    CrossrefPubMedGoogle Scholar
  • 4 Braumann C, Guenther N, Menenakos C. et al. Clinical experiences derived from implementation of an easy to use concept for treatment of wound healing by secondary intention and guidance in selection of appropriate dressings. Int Wound J 2011; 8: 253-260
    CrossrefPubMedGoogle Scholar
  • 5 Rodeheaver GT. Pressure ulcer debridement and cleansing: a review of current literature. Ostomy Wound Manage 1999; 45 (1A Suppl.): S80-S85
    PubMedGoogle Scholar
  • 6 Lehner B, Bernd L. [V.A.C.-instill therapy in periprosthetic infection of hip and knee arthroplasty]. Zentralbl Chir 2006; 131 (Suppl. 01) S160-S164
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev 2008; (01) CD003861
    PubMedGoogle Scholar
  • 8 Lehner B, Fleischmann W, Becker R. et al. First experiences with negative pressure wound therapy and instillation in the treatment of infected orthopaedic implants: a clinical observational study. Int Orthop 2011; 35: 1415-1420
    CrossrefPubMedGoogle Scholar
  • 9 Kim PJ, Attinger CE, Steinberg JS. et al. Negative-pressure wound therapy with instillation: international consensus guidelines. Plast Reconstr Surg 2013; 132: 1569-1579
    CrossrefPubMedGoogle Scholar
  • 10 Anderson DJ, Kirkland KB, Kaye KS. et al. Underresourced hospital infection control and prevention programs: penny wise, pound foolish?. Infect Control Hosp Epidemiol 2007; 28: 767-773
    CrossrefPubMedGoogle Scholar
  • 11 Stone PW, Braccia D, Larson E. Systematic review of economic analyses of healthcare–associated infections. Am J Infect Control 2005; 33: 501-509
    CrossrefPubMedGoogle Scholar
  • 12 Centers for Disease Control and Prevention. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Published 2009. Im Internet: https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf Stand: 25.01.2017
    PubMedGoogle Scholar
  • 13 DeFrances CJ, Podgornik MN. 2004 National Hospital Discharge Survey. Adv Data 2006; 371: 1-19
    PubMedGoogle Scholar
  • 14 Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. National Health Statistics Reports 11. Revised September 4, 2009. Im Internet: https://www.cdc.gov/nchs/data/nhsr/nhsr011.pdf Stand: 25.01.2017
    PubMedGoogle Scholar
  • 15 Umscheid CA, Mitchell MD, Doshi JA. et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011; 32: 101-114
    CrossrefPubMedGoogle Scholar
  • 16 Horch RE. [Changing paradigms in reconstructive surgery by vacuum therapy?]. Zentralbl Chir 2006; 131 (Suppl. 01) S44-S49
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kneser U, Leffler M, Bach AD. et al. [Vacuum assisted closure (V.A.C.) therapy is an essential tool for treatment of complex defect injuries of the upper extremity]. Zentralbl Chir 2006; 131 (Suppl. 01) S7-S12
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Horch RE, Dragu A, Lang W. et al. Coverage of exposed bones and joints in critically ill patients: lower extremity salvage with topical negative pressure therapy. J Cutan Med Surg 2008; 12: 223-229
    CrossrefPubMedGoogle Scholar
  • 19 Fletcher J, Jeffery S, Leak K. What is the future of negative pressure?. Wounds UK 2012; 8: 16-18
    PubMedGoogle Scholar
  • 20 Cutting K, Hermans M, Kwon-Lee S. Key considerations in choice of wound management therapeutics between an advanced wound care dressing utilising Hydration Response Technology and a durable medical device (NPWT) – a USA perspective. Wounds UK 2013; 4: 1-12
    PubMedGoogle Scholar
  • 21 von Beckerath O, Zapenko A, Dissemond J. et al. Ten-year analyses of the German DRG data about negative pressure wound therapy. Int Wound J 2017; 14: 501-507
    CrossrefPubMedGoogle Scholar
  • 22 Acosta S, Björck M, Wanhainen A. Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery. Br J Surg 2017; 104: 75-84
    CrossrefPubMedGoogle Scholar
  • 23 Cristaudo A, Jennings S, Gunnarsson R. et al. Complications and mortality associated with temporary abdominal closure techniques: a systematic review and meta-analysis. Am Surg 2017; 83: 191-216
    PubMedGoogle Scholar
  • 24 Glass GE, Murphy GRF, Nanchahal J. Does negative-pressure wound therapy influence subjacent bacterial growth? A systematic review. J Plast Reconstr Aesthet Surg 2017; 70: 1028-1037
    CrossrefPubMedGoogle Scholar
  • 25 von Lübken F, von Thun-Hohenstein H, Weymouth M. et al. [Pressure conditions under VVS-foams – an experimental in-vitro- and in-vivo-analysis]. Zentralbl Chir 2004; 129 (Suppl. 01) S95-S97
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Loos B, Kopp J, Hohenberger W. et al. Post-malignancy irradiation ulcers with exposed alloplastic materials can be salvaged with topical negative pressure therapy (TNP). Eur J Surg Oncol 2007; 33: 920-925
    CrossrefPubMedGoogle Scholar
  • 27 Fleischmann W, Russ M, Westhauser A. et al. [Vacuum sealing as carrier system for controlled local drug administration in wound infection]. Unfallchirurg 1998; 101: 649-654
    CrossrefPubMedGoogle Scholar
  • 28 Willy C, Scheuermann-Poley C, Stichling M. et al. [Importance of wound irrigation solutions and fluids with antiseptic effects in therapy and prophylaxis: Update 2017]. Unfallchirurg 2017; 120: 549-560
    CrossrefPubMedGoogle Scholar
  • 29 Back DA, Scheuermann-Poley C, Willy C. Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions – when, where and how to use: what does the evidence show?. Int Wound J 2013; 10 (Suppl. 01) S32-S42
    CrossrefPubMedGoogle Scholar
  • 30 Falola RA, Ward CM, Kim MJ. et al. Potential future applications for negative pressure wound therapy and installation devices. Surg Technol Int 2016; 30: 55-60
    PubMedGoogle Scholar
  • 31 Gupta S, Gabriel A, Lantis J. et al. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J 2016; 1: 159-174
    PubMedGoogle Scholar
  • 32 Apelqvist J, Willy C, Fagerdahl AM. et al. EWMA Document: negative pressure wound therapy. J Wound Care 2017; 26 (Suppl. 03) S1-S154
    CrossrefPubMedGoogle Scholar
  • 33 Kramer A, Dissemond J, Kim S. et al. Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol 2017; 31: 28-58
    PubMedGoogle Scholar
  • 34 Dow G, Browne A, Sibbald RG. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy Wound Manage 1999; 45: 23-40
    PubMedGoogle Scholar
  • 35 Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284: 1318-1322
    CrossrefPubMedGoogle Scholar
  • 36 Warriner R, Burrell R. Infection and the chronic wound: a focus on silver. Adv Skin Wound Care 2005; 18: 2-12
    CrossrefPubMedGoogle Scholar
  • 37 Phillips PL, Yang Q, Schultz GS. The effect of negative pressure wound therapy with periodic instillation using antimicrobial solutions on Pseudomonas aeruginosa biofilm on porcine skin explants. Int Wound J 2013; 10 (Suppl. 01) S48-S55
    CrossrefPubMedGoogle Scholar
  • 38 Wolvos T. Wound instillation with negative pressure wound therapy. Ostomy Wound Manage 2005; 51 (2A Suppl.): S21-S26
    PubMedGoogle Scholar
  • 39 Lessing MC, James RB, Ingram SC. Comparison of the effects of different negative pressure wound therapy modes – continuous, noncontinuous, and with instillation-on porcine excisional wounds. Eplasty 2013; 13: e51
    PubMedGoogle Scholar
  • 40 Gabriel A, Shores J, Heinrich C. et al. Negative pressure wound therapy with instillation: a pilot study describing a new method for treating infected wounds. Int Wound J 2008; 5: 399-413
    CrossrefPubMedGoogle Scholar
  • 41 Hospenthal DR, Murray CK, Andersen RC. et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma 2011; 71 (2 Suppl. 2): S210-S234
    CrossrefPubMedGoogle Scholar
  • 42 Hospenthal DR, Murray CK, Andersen RC. et al. Executive summary: Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma 2011; 71 (2 Suppl. 2): S202-S209
    CrossrefPubMedGoogle Scholar
  • 43 Petrisor B, Jeray K, Schemitsch E. et al. Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons. BMC Musculoskelet Disord 2008; 9: 7
    CrossrefPubMedGoogle Scholar
  • 44 Horch RE. Incisional negative pressure wound therapy for high-risk wounds. J Wound Care 2015; 24 (4 Suppl.): S21-S28
    CrossrefPubMedGoogle Scholar
  • 45 Spann CT, Tutrone WD, Weinberg JM. et al. Topical antibacterial agents for wound care: a primer. Dermatol Surg 2003; 29: 620-626
    PubMedGoogle Scholar