Company insight
Good pressure makes for better wound closure
Chronic wounds can profoundly impact the lives of patients – limiting mobility, causing pain and diminishing quality of life. For many, these wounds represent not just a physical challenge but an emotional and psychological burden as well. Thankfully, advancements in medical technology like single use and portative Negative Pressure Wound Therapy (sNPWT), are changing the narrative in acute and community settings. Dr Hajnal Gabriela Illes, infectious diseases physician and EWMA member, explains why the technology could be such a gamechanger for hard-to-heal wounds.
What are the key challenges of hard-to-heal wounds in community settings? Dr Illes: Hard-to-heal wounds are wounds that don’t heal within four to six weeks. The patient might have a lot of oedema and exudates, along with significant amounts of bacteria that form biofilms. Unfortunately, we have an ageing population, including many people with comorbidities such as diabetes. We also have patients who have been smoking for many years, leading to peripheral artery disease. So these hard-to-heal wounds are becoming increasingly prevalent.
The longer a wound takes to heal, the more likely it is that a patient will experience complications, including the risk of hospitalisation and amputation. If the patient has recurrent infections, that means using a lot of antibiotics, which leads to increasingly resistant bacteria.
Patients with hard-to-heal wounds experience an impaired quality of life. They may not have much social life, they may have chronic pain, they may not be able to work. So it’s a very human burden, but an economic burden too. And not all countries have the same resources to deal with this problem.
What is the standard of care for hard-to-heal wounds?
When you have a hard-to-heal wound, the first and most important step is the cleaning and debridement of the wound. The nurse can do this mechanically at home, using tools to remove the necrosis and the biofilm. But this can be very painful, and after 24 hours, the biofilm reappears, because the bacteria are so abundant.
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If you have a lot of exudate, you have bacteria like Pseudomonas aeruginosa, which is naturally resistant to many antibiotics. It will form like a blanket with the biofilm and protect all the other bacteria (Staphylococcus aureus, Streptococcus spp.), which can lead to sepsis and soft tissue infections. That’s why it’s so important to debride the wound and diminish the exudate. With venous ulcers, you also need to do compression. It’s a very bad idea to use topical antibiotics because they’re not effective against biofilm bacteria but they can increase the antibiotic resistance for them. And the systemic antibiotics will heal only the skin infection, but will not diminish the bacterial burden of the biofilm. So we must fight against all these problems in the standard of care.
Why is the standard of care sometimes insufficient? The problem is, often the nurse comes by only once a day. Today, we don’t have enough outpatient nurses. We also have patients with a lot of comorbidities. Patients with diabetes can have necrosis or gangrene, and if you don’t take care of that quickly, it can lead to sepsis. So it’s important to take really good care of the wound, and also to care for the patient holistically in terms of nutrition, hygiene etcetera. In an ideal world, we would very quickly find the patients whose wounds hadn’t healed in four weeks and refer them to a wound specialist. At that point, it would be sensible to consider active treatment.
PICO single-use Negative Pressure
Wound Therapy (sNPWT) is emerging as a promising new approach. Why so? What
does this treatment involve? Negative pressure wound therapy (NPWT) is a therapeutic technique to promote healing in wounds. It uses suction to remove exudate, which leads to rapid wound contraction and better control over the exudate. You can manage the local infection and the biofilm, as well as enhancing blood flow and oxygenation. That promotes tissue granulation. NPWT has been around for years. However, traditional devices weren’t portable and could only be used in hospital or home- based settings, which isn’t great for the patient or the economy.
This is why PICO single use NPWT (sNPWT) is such a great tool. The PICO system includes a portable pump, which delivers a constant negative pressure of -80mmHg, along with a dressing-canister that can handle up to 300ml of fluid. You can leave the dressing on the wound for up to a week if it is used without filler. It’s lightweight, so it can be used within community care settings and the patient can go to work or school.
How effective is PICO sNPWT? What does the clinical data show? In a 2022 clinical trial, involving more than 323 patients, 52% of the patients’ wounds were healed at 12 weeks when they used the sNPWT compared to standard care dressings. They also required 1.7 fewer dressing changes per week (from 4.7 to three).1 Another study from 2020 found a healing rate of 84.6% for wounds of less than three months in duration (n=13), along with a reduction in dressing frequency and cost savings compared to
Practical Patient Care /
www.practical-patient-care.com
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