Die Anwendung der kombinierten Unterdrucktherapie mit Instillation von Spülflüssigkeiten bei Komplikationswunden

Zusammenfassung

Hintergrund: Die Unterdrucktherapie (negative pressure wound therapy, NPWT) hat sich in den vergangenen Jahren zum Goldstandard in der Behandlung von Komplikationswunden entwickelt. Die sog. „negative pressure wound therapy with instillation (NPWTi)“ gilt als Weiterentwicklung, bei der neben der Aufrechterhaltung eines Unterdrucks intermittierend Spülflüssigkeit in die Wunde instilliert wird. Ziel der Arbeit: Ziel dieser Übersichtsarbeit war es, Ergebnisse der NPWTi in der Behandlung von akuten und chronischen Wunden darzustellen. Material und Methoden: Es erfolgte eine Recherche der verfügbaren Literatur aus PubMed und der Cochrane Library. Eingeschlossen wurden ausschließlich Artikel in deutscher und englischer Sprache. Ergebnisse: Aus der Analyse der Studien erweist sich die NPWTi als innovative Therapieoption mit breiten klinischen Einsatzmöglichkeiten und erfolgversprechenden klinischen Ergebnissen. Diskussion: Die NPWTi stellt einen wertvollen Baustein in der Behandlung von infizierten, chronischen und akuten Wunden dar. Noch liegen zu wenige prospektive klinische Studien vor, um die beobachteten Effekte wissenschaftlich zu untermauern oder allgemeingültige Aussagen über optimale Therapieeinstellungen treffen zu können.

Abstract

Background: In recent decades, negative pressure wound therapy (NPWT) has become the gold standard in the treatment of infected wounds. Negative pressure wound therapy with instillation (NPWTi) is a new development, that combines conventional NPWT with instillation of fluids. Objectives: The purpose of this study was to review the results of current literature on the clinical use of NPWTi in acute and chronic wounds. Material and Methods: A literature search was performed using Pubmed and the Cochrane Library, including articles in English and German. Results: The data suggest that NPWTi is a promising therapeutic option in the treatment of wounds, and applicable in various fields. Conclusions: NPWTi appears to be a useful adjunct in the treatment of critical wounds. However, data from prospective randomised trials to support the validity of the results are sparse.

Schlüsselwörter

Unterdrucktherapie - Negative Pressure Wound Therapy - Instillation - Wundmanagement - Antiseptika

Key words

V. A. C.-therapy - negative pressure wound therapy - instillation - wound management - antiseptics

• Literatur

• 1 Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 2003; 290: 1868-1874
• 2 Janda JM, Abbott SL, Brenden RA. Overview of the etiology of wound infections with particular emphasis on community-acquired illnesses. Eur J Clin Microbiol Infect Dis 1997; 16: 189-201
• 3 Nichols RL. Surgical wound infection. Am J Med 1991; 91: 54-64
• 4 Colsky AS, Kirsner RS, Kerdal FA. Analysis of antibiotic susceptibilities of skin wound flora in hospitalized dermatology patients. The crisis of antibiotic resistance has come to the surface. Arch Dermatol 1998; 134: 1006-1009
• 5 Kim PJ, Attinger CE, Steinberg JS et al. Negative-pressure wound therapy with instillation: international consensus guidelines. Plast Reconstr Surg 2013; 132: 1569-1579
• 6 Hunt TK. The physiology of wound healing. Ann Emerg Med 1988; 17: 1265-1273
• 7 Morykwas MJ, Argenta LC, Shelton-Brown EI et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-562
• 8 Greene AK, Puder M, Roy R et al. Microdeformational wound therapy: effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg 2006; 56: 418-422
• 9 Lessing MC, James RB, Ingram SC. Comparison off the effects of different negative pressure wound therapy modes – continuous, noncontinuous, and with instillation-on porcine excisional wounds. Eplasty 2013; 13: e51
• 10 Urschel JD, Scott PG, Wiliams HTG. The effect of mechanical stress on soft and hard tissue repair: a review. Br J Plast Surg 1988; 41: 182-186
• 11 Wild T. Consensus of the German and Austrian societies for wound healing and wound management on vacuum closure and the VAC treatment unit. MMW Fortschr Med 2013; 145: 97-101
• 12 Ford CN, Reinhard ER, Yeh D et al. Interim analysis of a prospective, randomised trial of vacuum assisted closure versus healthpoint system in the management of pressure ulcers. Ann Plast Surg 2012; 49: 55-61
• 13 Fleischmann W, Strecker W, Bombelli M et al. [Vacuum sealing as treatment of soft tissue damage in open fractures]. Unfallchirurg 1993; 96: 488-492
• 14 Lee JY, Jung H, Kwon H et al. Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients. World J Emerg Surg 2014; 9: 29
• 15 Benech A, Arcuri F, Pogolio G et al. Vacuum-assisted closure therapy in reconstructive surgery. Acta Otorhinolaryngol Ital 2012; 32: 192-197
• 16 Schrank C, Mayr M, Overesch M et al. [Results of vacuum therapy (V.A.C) of superficial and deep dermal burns]. Zentralbl Chir 2004; 129 (Suppl. 01) S59-S61
• 17 Dumville JC, Munson C, Christie J. Negative pressure wound therapy for partial-thickness burns. Cochrane Database Syst Rev 2014; (12) CD006215
• 18 Riot S, de Bonnecare G, Garrido I et al. Is the use of negative pressure wound therapy for a malignant wound legitimate in a palliative context? “The concept of NPWT ad vitam”: a case series. Palliat Med 2015; 5: 470-473
• 19 Mermerkaya U, Bekmez S, Alkan E et al. Evaluation of vacuum-assisted closure in patients with wound complications following tumor surgery. Int Wound J 2014; [Epub ahead of print]
• 20 Stinner DJ, Hsu JR, Wenke JC. Negative pressure wound therapy reduces the effectiveness of traditional local antibiotic depot in a large complex musculoskeletal wound animal model. J Orthop Trauma 2012; 26: 512-518
• 21 FDA Safety Communication. Update on Serious Complications Associated with Negative Pressure Wound Therapy Systems (2001).. Im Internet: http://www.fda.gov Stand: 12.04.2015
• 22 Fagerdahl AM, Boström L, Ulfwarson J et al. Risk factors for unsuccessful treatment and complications with negative pressure wound therapy. Wounds 2012; 22: 168-177
• 23 Peinemann F, Sauerland S. Vakuumtherapie von Wunden: Systematische Übersicht randomisierter Studien. Dtsch Arztebl Int 2011; 108: 381-389
• 24 Svedman P. Irrigation treatment of leg ulcers. Lancet 1983; 2: 532-534
• 25 Fleischmann W, Russ M, Westhauser A. [Vacuum sealing as carrier for controlled local drug administration in wound infection]. Unfallchirurg 1998; 101: 649-654
• 26 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
• 27 Brinkert D, Ali M, Naud M et al. Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J 2013; 10 (Suppl. 01) S56-S60
• 28 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 observation study. Int Orthop 2011; 35: 1415-1420
• 29 Bernstein BH, Tam H. Combination of subatmospheric pressure dressing and gravity feed antibiotic instillation in the treatment of post-surgical diabetic foot wounds: a case series. Wounds 2005; 17: 37-48
• 30 Köster G. Management of early periprosthetic infection in the knee using the vacuum-instillation therapy. Infection 2009; 37: 18-20
• 31 Schintler MV, Prandl EC, Kreuzwirt G et al. The impact of V.A.C. Instill in severe soft tissue infections and necrotizing fasciitis. Infection 2009; 37: 31-32
• 32 Timmers MS, Graafland N, Bernards AT et al. Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation. Wound Repair Regen 2009; 17: 278-286
• 33 Wolvos T. Wound instillation – the next step in negative pressure wound therapy. Lessons learned from initial experiences. Ostomy Wound Manage 2004; 50: 56-66
• 34 Petrisor B, Jeray K, Schemitsch E et al. Fluid lavage in patients with open fractures wounds (FLOW): an international survey of 984 surgeons. BMC Musculoskelet Disord 2008; 9: 7
• 35 Hübner NO, Kramer A. Review on the efficacy, safety and clinical applications of polihexanide, a modern wound antiseptic. Skin Pharmacol Physiol 2010; 23: 17-27
• 36 Drosou A, Falabella A, Kirsner RS. Antiseptics on wounds: an area of controversy. Wounds 2003; 15: 149-166
• 37 Minnich KE, Stolarick R, Wilkins RG. The effect of a wound care solution containing polyhexanide and betaine on bacterial counts: results of an in vitro Study. Ostomy Wound Manage 2012; 58: 32-36
• 38 Rogers DM, Blousin GS, OʼLeary JP. Povidone-iodine wound irrigation and wound sepsis. Surg Gynecol Obstet 1983; 157: 426-430
• 39 Willenegger H. Lokale Antiseptika in der Chirurgie – Wiedergeburt und Weiterentwicklung. Unfallchirurg 1994; 20: 94-110
• 40 Atiyeh BS, Dibo SA, Hayek SN. Wound cleansing, topical antiseptics and wound healing. Int Wound J 2009; 6: 420-430
• 41 Gilmore OJ, Reid C, Strokon A. A study off the effects of povidone-iodine on wound healing. Postgrad Med J 1977; 53: 122-125
• 42 Kahn MN, Naqvi AH. Antiseptics, iodine, povidone iodine and traumatic wound cleansing. J Tissue Viability 2006; 16: 6-10
• 43 Nicks BA, Ayello EA, Woo K et al. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations. Int J Emerg Med 2010; 3: 399-407
• 44 Thomas GW, Rael LT, Bar-Or R et al. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma 2009; 66: 82-90
• 45 Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38: 563-577
• 46 Lessing C, Slack P, Hong KZ et al. Negative pressure wound therapy with controlled saline instillation (NPWTi): dressing properties and granulation response in vivo. Wounds 2011; 23: 309-319
• 47 Allen D, Labarbera LA, Bondre IL et al. Comparison of tissue damage, cleansing and cross-contamination potential during wound cleansing via two methods: lavage and negative pressure wound therapy with instillation. Int Wound J 2014; 11: 198-209
• 48 Kujath P, Shekarriz H. [Management of soft tissue infections in the region of the extremities and the trunk]. Unfallchirurg 2011; 114: 217-226
• 49 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