Modified Negative-Pressure Wound Therapy Using A Silver-Impregnated, Atraumatic Silicone Foam Dressing-Clinical Experience in a Single Hospital

使用具有不傷害傷口的防黏矽膠面之含銀泡綿敷料，做為改良之負壓傷口治療的材料－單一醫院的臨床治療經驗

呂佾欣(Yi-Shin Lu) ； 林育賢(Yu-Hsien Lin) ； 林煌基(Hwang-Chi Lin) ； 鄭舉緒(Chu-Hsu Jeng) ； 謝承翰(Cheng-Han Hsieh) ； 陳柵君(Cha-Chun Chen)

《臺灣整形外科醫學會雜誌》 24卷4期 (2015/12) Pp. 307-315

摘要

背景：Negative-pressure wound therapy (NPWT)（又稱VAC）負壓傷口療法可以促進傷口癒合。但常常在更換傷口敷料時，病人常抱怨非常疼痛，甚至可能會對傷口床 及其底下的組織造成傷害。因此我們思考是否有更抗菌以拉長傷口更換的時間間隔，以及對傷口較不傷害出血的敷料可供使用。也對病人的舒適度有所改善。目的及目標：以增加病人舒適度為目標，改良原本負壓傷口裝置，其目的一為漸少病人更換敷料時的疼痛，目的二為增加抗菌功能以試圖延長更換傷口的時間間隔，其目的三，減少更換敷料時對傷口床的傷害以增加負壓傷口裝置在臨床上的應用，如凝血功能不佳的病人；但又能兼具治療效果的改良方式。方法及材料：我們收集12位病人（包括急性傷口6位，慢性傷口6位）。從2011年三月至2012年三月。病人年紀42-83歲。使用我們改良後的負壓傷口裝置。我們利用其泡綿敷料的silicone此底層及銀離子的抗菌效果，結合壁式負壓抽吸來治療這些病人。並以疼痛指數紀錄病人舒適度的改善。結 果：平均治療時間爲9.3天。住院期間爲3-13星期。傷口更換時間間隔爲3-5天。所有病人的疼痛都有所改善。結 論：在這成功傷口重建的12病人當中，其中我們第一個目的是改善疼痛，有達到此目標。另外一個目標是保護其傷口床及其底下組織，包括肌腱，胸骨傷口下方，及凝血功能不足的病人控制其傷口更換時的出血。包含在這12位病人當中。另外也將傷口更換時間的間距稍微延長。此改良與敷料的結合，應有潛力可以改善以上這些目標。

並列摘要

Background: Negative-pressure wound therapy (NPWT) can promote healing in acute and chronic wounds. However, dressing changes can be very painful for patients and can cause new wound trauma, especially when organs are exposed or in the presence of coagulopathy. Because most dressing materials have limited or no antimicrobial activity and the dressings might be changed at least every 2-3 days to prevent infection, further traumatizing the wound. Aim and Objectives: To address these issues and increase overall patient comfort, we combined NPWT with a soft silicone, silver-impregnated foam dressing. Materials and Methods: We treated 12 patients with acute (n = 6) and chronic (n = 6) wounds between March 30, 2011, and March 15, 2012. Patients ranged in age from 42 to 83 years. Wound sizes ranged from 54 x 20 cm2 to 5 x 3 cm^2. We used the visual analog scale to record each patient's pain score during dressing changes both before and during the use of our modified NPWT system. Results: The mean treatment time was 9.3 days (median 7 days), and the total hospital stay was between 3 and 13 weeks. Dressings were only changed every 3-5 days, and the patients' pain scores decreased in all cases. Our modified NPWT system controlled wound exudate and promoted the formation of granulation tissue, enabling us to successfully reconstruct all 12 wounds. Conclusion: Our modifications to NPWT achieved our goal of providing a more comfortable NPWT system that promoted the healing of complex wounds despite the presence of serious comorbidities, including exposed organs, coagulopathy, and impaired circulation. In this series of 12 patients, we achieved our goals. For example, vital structures such as tendons and nerves were protected, and there was less wound trauma during dressing. The adjuvant use of silver with NPWT helped reduce the bioburden of the wound and suppressed infection, resulting in fewer dressing changes and decreased wound manipulation, all of which increased patient comfort. The non-adherent, silicone layer enabled us to use the dressing even in the presence of exposed vital organs and coagulopathy, protecting the underlying organ and decreasing bleeding. The use of our modified NPWT system decreased the VAS pain scores in all patients.

並列關鍵字

NPWT ； negative-pressure wound therapy ； modified ； silver ； atraumatic ； Mepilex ； VAC