Key Insights On Advanced Wound Care Treatments
There are a variety of advanced treatment options that can help expedite wound healing. Accordingly, these expert panelists offer insights on the use of negative pressure wound therapy (NPWT) and growth factors, and the emergence of stem cell therapy.
Q: Do you have any pearls in prescribing NPWT?
A: Lawrence Lavery, DPM, cites NPWT as one of his standard therapies for open amputations or patients with exposed tendon or capsule after a debridement of foot ulcerations. He says negative pressure facilitates drainage and the formation of granulation tissue over structures that are otherwise difficult if not impossible to cover. Dr. Lavery cites research showing significant differences in the quality of granulation tissue in patients treated with NPWT for open amputation wounds and diabetic foot ulcers.1,2
Kazu Suzuki, DPM, recommends NPWT for patients with any gaping wound or large defect that may need assistance in granulation. He says any diabetic foot amputation wound or heel pressure ulcer warrants NPWT unless the wound or ulcer is very small and shallow (less than 0.5 cm depth) with minimal drainage.
For Eric Travis, DPM, NPWT plays an integral part in wound treatment and he praises the modality’s versatility and consistent results. He will use NPWT after ensuring that he has addressed the essential variables with non-healing or “difficult” wounds. Dr. Travis notes the importance of addressing variables such as infection, circulation, oxygenation, nutrition and pressure (edema/ morphological) and consulting with infectious disease, endocrinology and vascular surgery if necessary.
After addressing these variables, Dr. Travis addresses the wound environment. In his experience, NPWT is most successful after debridement and with continuous 125 mmHg suction. For inflamed and/or painful wounds, he lowers the settings and will switch to intermittent suction with chronic ulcers. Dr. Travis utilizes enzymatic debridement with NPWT when sharp debridement is not indicated as with some venous stasis ulcerations and in patients with connective tissue disorders. He has also used NPWT for a majority of his graft applications and when there is wound dehiscence in high-risk patients.
While he does not have artificial age restrictions on NPWT, Dr. Suzuki has had problems with the patients with dementia who ripped out the dressing repeatedly. He emphasizes caution with frail patients who may have trouble carrying the device and may recommend a wheelchair as needed when these patients are using negative pressure.
Dr. Suzuki uses VAC therapy (KCI) exclusively for negative pressure in his wound care center, citing his familiarity with how VAC therapy works and its ordering process.
“KCI’s VAC therapy has been on the market over 10 years. I have no reason to try the competing products until they show comparative or better clinical outcomes,” says Dr. Suzuki.
He praises the efficacy of NPWT for securing skin graft and flaps, as well as its “graft-take” rate. When it comes to this application, Dr. Suzuki uses a non-adherent interface such as Mepitel (Molnlycke) and lowers the suction pressure of NPWT down to a 75 to 100 mmHg continuous setting.
“My ‘sales pitch’ of VAC therapy to my patients is, ‘This device will make you better two to three times faster’ and most patients would agree to try it,” says Dr. Suzuki.
Q: Do you use stem cell therapy or other growth factor medications in the wound care setting?
A: Along with his Japanese collaborators, Dr. Suzuki has tried autologous stem cell injections in ischemic lower extremity wounds. Although the profession does know that such injections often help relieve the ischemic wound pain, he says definitive data on wound healing or angiogenesis has yet to emerge. He feels it will be a few more years before the development of evidence-based treatment protocols on autologous stem cell injections.