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Behçet’s disease is a chronic, relapsing, inflammatory disorder. This case report describes how use of an improvised topical negative pressure (TNP) device in a patient with a non-healing para-ileostomal ulcer with Behçet’s disease

Objective: To discover the impact of topical negative pressure (TNP) on quality of life. Method: An exploratory prospective cohort study was conducted on 26 patients undergoing TNP. The Cardiff Wound Impact Schedule (CWIS), a wound-specific tool, was used to investigate quality-of-life scores before therapy and four weeks after therapy or at wound closure. Wound dimensions were measured at both assessments, and the values for the CWIS domains (physical symptoms, social functioning, well-being and overall quality of life) were investigated using parametric and non-parametric tests. Results: The mean duration of TNP therapy was 3.3 ± 1.7 weeks. Topical negative pressure therapy helped to achieve complete wound closure in 14 patients (54%), and there was a mean reduction in wound surface area from 52.2cm2 (range 4–150) to 26.8cm2 (0–120). While there was no significant change in quality of life in patients whose wounds healed (1 ± 11.9), the physical-functioning domain improved in obese patients (20 ± 21, p

Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy (TNP), is a topical treatment that uses negative pressure applied directly to the wound bed to promote healing in acute and chronic wounds.

Objective: The objective assessment of chronic wound therapies for exudate management (WRAP study) tested a variety of methods that could be used to improve understanding of dressing performance in the presence of wound exudate, including measurement of the levels of exudate production. The aim of this study was to identify a valid and reliable method of measuring wound exudate production per unit area of wound surface. Method: Two methods were tested. Method A measured the weight of exudate collected in dressings by ‘before and after’ weighing of all dressing materials that came into contact with wound exudate. Method B measured wound exudate collected as part of topical negative pressure (TNP) therapy. Results: Method A: Complete data were collected on three patients (at which point the study was halted), but it was only possible to obtain accurate measurements for two of these. Exudate production was 0.10g/cm2/24 hours and 0.21g/cm2/24 hours. It was time-consuming and required special equipment. Method B: Fifteen measurements from five patients were analysed and showed a mean exudate production of 1.3g/cm2/24 hours. Conclusion: There are problems with both methods of exudate measurement, but measuring wound fluid collected in TNP canisters seems simpler than weighing dressings and deserves further investigation. Declaration of interest: This study was part of the Wrap project and was funded by the Engineering and Physical Science Research Council.

A review of the development and use of sub-atmospheric pressures in the management of patients with different types of wound

This case report discusses the use of topical negative pressure therapy on a suture line infected with methicillin-resistant Staphylococcus aureus in a patient with diabetes who had undergone a femoropopliteal bypass using an artifi cial graft

Implanted prosthetic materials such as polypropylene (Prolene) and polyester mesh are routinely used in surgical abdominal hernia repair. These materials provide strength, permit tension-free repair and are associated with lower rates of hernia recurrence than when open suture techniques are used. However, complications include

Foot infection is a frequent and potentially devastating complication of diabetes mellitus. Approximately 25% of patients with diabetes mellitus develop foot ulcers during their lifetime and more than half of these ulcers become infected.1 Such complications are the leading cause of hospitalisation among patients with diabetes mellitus and are often the precursors to lower extremity amputation.2-4

Although maggot debridement therapy (MDT) was introduced in the US in 1931 by William Baer, it had been used in both the Napoleonic and American civil wars. It was largely abandoned following the introduction of antibiotics and new surgical approaches, but today it is used to debride intractable wounds and ulcers that do not respond to conventional therapy.

Laparostomy is the technique of leaving the abdomen open following a laparotomy; it is sometimes referred to as an open abdomen. The most common reason for laparostomy formation is dehiscence of a laparotomy wound, but it is also a favoured surgical technique employed if further abdominal exploration will be needed, or in the case of abdominal compartment syndrome.

Laparostomy is a technique in which the abdomen remains open after a laparotomy. It is indicated when initial treatment is followed by abdominal compartment syndrome, or when relaparotomies for other complications are expected. Laparostomy is also effective and practical in patients with severe intra-abdominal infection.

As many have reported, wound care has benefited over the past decade from major advances in understanding the biology of wound healing. This has led to impressive innovations in fields such as tissue engineering, gene therapy and in understanding the role of growth factors. However, as identified by Banwell (pages 79-84), while these technologies have the potential to improve healing and quality of life, for the moment they remain ‘high tech’ and expensive, and are unlikely to be available for routine use in the near future. He advocates the need to adopt ‘low-tech’ treatment modalities which are both clinically effective and cost-effective and discusses the use of topical negative pressure therapy in wound care.

Management of the open abdomen in the presence of severe abdominal infection remains a challenge. Septic dehiscence after a laparotomy or partial loss of the abdominal wall often precludes early definitive closure of the abdomen. Techniques advocated in such scenarios include progressive abdominal closure, topical negative pressure (TNP) therapy or the use of biological mesh2 for abdominal wall reconstruction. We describe two cases in which porcine dermal collagen graft was successfully used in conjunction with TNP therapy to achieve closure of a septic abdomen.

The rate of wound infection in groin wounds is high, and such wounds are difficult to treat. Topical negative pressure (TNP) has become the mainstay in the treatment of these wounds.

Postoperative perineal wounds can be difficult to manage as sepsis, dehiscence and pain commonly occur. This paper describes the management of a patient who experienced wound failure following perineal resection subsequent to irradiation and grafting. Topical negative pressure therapy resulted in wound closure and the eradication of MRSA.

It will come as something of a blow to enthusiasts of topical negative pressure therapy (TNP) that a recent review in Drug and Therapeutics Bulletin casts doubt on the therapy’s effectiveness in treating chronic wounds. The review is critical of the relatively little research that has been done to support it, and contains lessons for all researchers in wound care as well as those who use research evidence to support practice.