Introduction: Negative pressure wound therapy (NPWT) is a recent therapeutic option in wound healing, where a vacuum source is used to create sub-atmospheric pressure in the wound bed with airtight dressings. The aims were to study the indications for the use of NPWT in a whole country and evaluate the outcome of treatment.

Material and methods: This was a retrospective study that included all patients that were treated with NPWT in Iceland between January and December 2008. Information on indication, duration and outcome of treatment was collected from patient charts. Factors that are known to affect wound healing, such as diabetes, smoking and age, were also registered.

Results: During the 12 month study period a total of 65 NPWT-treatments were given to 56 patients; 35 (63%) males and 21 (37%) females, with an average age of 62 yrs (range; 8 - 93). The indications for treatment were: wound infection (40%), promotion of wound healing (42%) and keeping cavities open (19%). The lower limbs (26%) and chest area (25%) were the most common sites for treatment. Six patients died during the treatment period, none of them due to complications related to NPWT, and these patients were excluded from analysis of wound healing. In the other 59 treatments, 40 wounds (68%) healed successfully, but healing was incomplete in 19. Treatment related complications were recorded in 19 (32%) cases; wound pain (12%) and skin problems (11%) being the most common ones.

Conclusion: NPWT has been used considerably in Iceland, especially for infected surgical wounds and chronic wounds. In two thirds of cases a complete wound healing was achieved, which must be regarded as a favorable outcome.

Gudmundsdottir I¹, Steingrimsson S², Gudbjartsson T^2,3

¹Department of Vascular surgery, ²Cardiothoracic surgery, Landspitali University Hospital, ³Faculty of Medicine, University of Iceland.

 

Table I. Number and length of negative-pressure wound therapy by speciality.

Specialties	n	Number of treatments	Total number of days in treatment	Mean length of treatment (days)
Vascular surgery	18	23	447	19
Cardiothoracic surgery	17	17	233	14
Plastic surgery	12	13	408	31
Orthopedic surgery	4	5	153	31
Rehabilitation medicine	1	1	17	17
General surgery	4	4	98	25
Infectious disease medicine	1	2	237	119
Total	57*	65	1,593	25

* One patient was treated within two specialities for unrelated problems and is counted twice.

 

Table II. Types of wound treated with negative-pressure wound therapy in Iceland 2008. Number of patients is given with % in parenthesis.

	n	(%)
Chronic foot ulcer	13	(20)
Surgical site infection (other than sternum)	9	(14)
Sternal wound infection	9	(14)
Pressure ulcer	9	(14)
Toe amputation wound, non-healing	8	(12)
Non-infected sternal wound	6	(9)
Open abdomen due to intra-abdominal bleeding	3	(5)
Extremity compartment syndrome	2	(3)
Fistulas	2	(3)
Burn wound	1	(2)
Skin graft	1	(2)
Non-healing stump wound	1	(2)
Abdominal compartment syndrome	1	(2)
Total	65	(100)

 

 

Table III. Indication for negative-pressure wound therapy and outcome of wound healing. Number of patients is given with % in parenthesis.

Indication for treatment	Healed wound		Incompleate wound healing
	n	(%)	n	(%)
Wound infection	18	(69)	8	(31)
Stimulate granulation	16	(59)	11	(41)
Open cavity	6	(100)	0	(0)
Total	40		19

 

Table IV.  Comparison of wound healing and underlying diseases and treatments plus smoking history, gender, age and body mass index (BMI). The numbers of patients is shown, with the percentage of total given in parentheses, except for age and BMI where means are reported.

Factors	Healed wound (n=40)	Incomplete wound healing (n=19)	p-value
Mean age (year)	58	68	0.04
Male	24 (60)	13 (68)	0.58
Body mass index (kg/m2)	28	27	0.59
History of smoking	8 (20)	3 (16)	0.71
Peripheral arterial dissease	17 (43)	13 (68)	0.10
Diabetes mellitus	10 (25)	11 (58)	0.02
Spinal cord injury	5 (13)	2 (11)	‡
Venous disease	3 (8)	4 (21,1)	‡
Corticosteroid treatment	2 (5)	0	‡
Radiation therapy	2 (5)	1 (5)	‡

‡ = too few individuals for statistical analysis

Some patients had more than one underlying condition. In 16 cases information on patients underlying conditions was not available. The BMI for 10 patients could not be calculated due to the lack of weight or height information. The smoking history of four patients was not available.

Figure 1. Location of wounds treated with negative-pressure wound therapy in Iceland in 2008. Number of patients is given and % in parenthesis.

Figure 2. Kaplan Meier survival curves showing the overall survival of patients in negative pressure wound therapy 2008. The six patients that died during the treatment period were included in the calculations.