Management of large chronic venous leg ulcers with negative pressure wound therapy

  • Dominik Andrzej Walczak 1) Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland 2) Department of Experimental Surgery, Medical University of Lodz, Lodz, Poland http://orcid.org/0000-0001-9009-5039
  • Michał Wojtyniak Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Rajmund Jaguścik Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Joanna Jadwiga Porzeżyńska Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Wojciech Fałek Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Monika Czerwińska Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Karolina Ptasińska Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Leokadia Kozaczek Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Bartosz Szymański Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
  • Piotr Wojciech Trzeciak Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland
Keywords: venous ulcers, negative pressure wound therapy, chronic wound, chronic venous insufficiency, skin graft, silver, pain.

Abstract

Introduction: Venous leg ulcers (VLU) occur in 1\% of the adult population and are associated with chronic disability, diminished quality of life and high health-care costs. Treatment is often slow, difficult and recurrence is high because of inappropriate conditions of the wound bed.

Patients and Methods: This study involves 14 patients with chronic venous ulcers larger than 100 cm\textsuperscript{2} treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalized tissues and partial stripping of an insufficient great saphenous vein in the first operation. After adequate haemostasis, NPWT kit was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Dressing impregnated with neutral triglycerides and silver ions was used as a first layer and the black polyurethane NPWT foam was applied over it. The pain assessment was performed for 7 patients using 10 cm visual analog scale (VAS).

Results: The mean number of NPWT dressing changes prior to grafting was 5.8. The mean number of NPWT foam changes was 2.8 after skin grafting. We accomplished complete healing of 92\% of applied skin grafts surface. One patient had recurrence of venous ulcers in the follow-up period. Moreover, one patient required regrafting.

Conclusions: The application of NPWT provides quick wound-bed preparation and high graft take in venous ulcer treatment.

Published
2017-12-21
Section
Case Reports