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CC BY-NC-ND 4.0 · Indian J Plast Surg 2012; 45(02): 302-315
DOI: 10.4103/0970-0358.101304
Review Article
Association of Plastic Surgeons of India

Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing

Pramod Kumar
Department of Plastic Surgery and Burns, Kasturba Medical College, Manipal University, Karnataka, Manipal, India
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Publication History

Publication Date:
27 November 2019 (online)

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ABSTRACT

Role of negative pressure dressing and moist wound healing are well established in the treatment of both acute and chronic wounds with certain advantages and disadvantages in both the techniques. Both these techniques prevents wound colonization, but the negative pressure dressing method has proved to have a greater potency to remove secretions, prevent wound invasion and eradication established infection. In both these techniques there is no accessibility to wound environment. Limited access dressing (LAD) is a moist wound dressing with negative pressure. It provides limited access to the wound through two small ports for both dressers and pathogens. The LAD design has notable advantages like wound isolation that reduces chance of wound colonization and safe disposal of infected materials (important factor to reduce hospital-acquired infections), while avoiding some major disadvantages such as opacity of dressing materials, inaccessible offensive smelling wound environment, and relatively high treatment costs. In LAD a definite intermittent negative pressure regimen is followed. The intermittent negative pressure (cycle of 30 minutes suction and 3 1 / 2 hours rest) is effective. Overall, the LAD is a safe and effective alternative to conventional dressing methods. LAD is an excellent research tool for wound healing as frequent/continuous record of wound healing is possible without disturbing the wound healing process. LAD is an effective dressing for limb salvage in cases of acute and chronic complex wounds. Leech effect prevents wound related systematic response syndrome and sepsis. Suction-assisted dressing (SAD) is a combination of semiocclusive dressing with negative pressure. It works by removal of fluids by intermittent (like LAD) negative pressure and preventing bacterial invasion. SAD is especially advantageous where soakage is less, there is no dead tissue covering the wound (e.g., following skin grafting), superficial skin wounds (e.g., donor area) and also where LAD is technically difficult to apply over circumferential trunk and neck dressings under anesthesia.

KEY WORDS

Limited access dressing - negative pressure wound therapy - suction-assisted dressing
 
  • 1 Orgill DP, Bayer LR. Update on negative-pressure wound therapy. Plast Reconstr Surg 2011;127 Suppl 1:105S-115S.
  • 2 Gupta S, Bates-Jensen B, Gabriel A, Holloway A, Niezgoda J, Weir, D. Differentiating Negative Pressure Wound Therapy Devices: An Illustrative case series. Wounds 2007;19:1-9.
  • 3 Winter GD. Epidermal regeneration studied in the domestic pig. In: Maibach HI, Rovee DT, editors. Epidermal Wound Healing: Chicago, III Year Book Medical Publishers; 1972. p. 71-112.
  • 4 Bennett RG. The debatable benefit of occlusive dressings for wounds. J Dermatol Surg Oncol 1982;8:166-7.
  • 5 Geronemus RG, Robins P. The effect of two new dressings on epidermal wound healing. J Dermatol Surg Oncol 1982;8:850-2.
  • 6 Ryan TJ. Current management of leg ulcers. Drugs 1985;30:461-8.
  • 7 Gilchrist B, Reed C. The bacteriology of chronic venous ulcers treated with occlusive hydrocolloid dressings. Br J Dermatol 1989;121:337-44.
  • 8 Aly R, Shirley C, Cunico B, Maibach HI. Effect of prolonged occlusion on the microbial flora, pH, carbon dioxide and transepidermal water loss on human skin. J Invest Dermatol 1978;71:378-81.
  • 9 Marples RR, Kligman AM. Growth of bacteria under adhesive tapes. Arch Dermatol 1969;99:107-10.
  • 10 Eriksson E. Comparative study of hydrocolloid dressing and double layer bandage in treatment of venous stasis ulceration. In: Ryan TJ, editor. An Environment for Healing: The Role of Occlusion: London, Royal Society of Medicine; 1985. p. 45-9.
  • 11 Finegold SM. Pathogenic anaerobes. Arch Intern Med 1982;142:1988-92.
  • 12 Kumar P. Limited Access Dressing. Wounds 2008;20:49-59.
  • 13 Kumar P. Limited Access Dressing (Review Article). Journal SWCR 2011;4:55-56.
  • 14 Kannon GA, Garrett AB. Moist wound healing with occlusive dressings. A clinical review. Dermatol Surg 1995;21:583-90.
  • 15 Kumar P. Suction Assisted Dressing (SAD). Journal SWCR 2011;4:74-6.
  • 16 Guyton AC, Hall JE. The microcirculation and the lymphatic system: capillary fluid exchange. 9 th editon. Interstitial fluid and lymph flow. Textbook of Medical Physiology. S.B. Saunders Company: USA; 1998. p. 183-97.
  • 17 Simmons EM, Himmelfarb J, Sezer MT, Chertow GM, Mehta RL, Paganini EP, et al. Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int 2004;65:1357-65.
  • 18 Kumar P. Limited Access Dressing and Maggots. WOUNDS 2009;21:150-2
  • 19 Kumar P, Sethi N, Friji MT, Poornima S. Wound healing and skin grafting in ehlers-danlos syndrome. Plast Reconstr Surg 2010;126:214 e-215 e.
  • 20 Kumar P. Improved LAD II design (Letter). Journal SWCR 2011;4:77-9.
  • 21 Beasley RW. The stiffened hand. In: Evarts CM(editors). Surgery of the Musculoskeletal System. Vol 1. Churchill Livingstone: New York, NY; 1983. p. 693-706.
  • 22 Kumar P, Sharma A. The limited access dressing for damage control in trauma patients. Wounds. 2010;22:188-92.
  • 23 Sieggreen MY, Maklebust J. Debridement: choices and challenges. Adv Wound Care 1997;10:32-7..
  • 24 Téot L, Otman S, Hussenet P, Moles J. Expression of angiogenic factors in chronic wounds treated with negative pressure therapy. Presented at: the 10 th Annual Meeting of the European Tissue Repair Society; May 2000; Brussels, Belgium.
  • 25 Giovannini UM, DemariaRG, Teot L. Interest of negative pressure therapy in the treatment of postoperative sepsis in cardiovascular surgery. Wounds 2001;13:82-7.
  • 26 Urbankova J, Quiroz R, Kucher N, Goldhaber SZ. Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients. Thromb Haemost 2005;94:1181-5.
  • 27 Eaglstein WH. Moist wound healing with occlusive dressings: a clinical focus. Dermatol Surg 2001;27:175-81.
  • 28 Turner TD. Semi-occlusive and occlusive dressings. In: Ryan TJ (editor). An Environment for Healing: The Role of Occlusion. London: Royal Society of Medicine; 1985. p. 5-14.