An inexpensive method of negative pressure wound therapy for extremities

Abstract

Negative pressure wound therapy (NPWT) is an established method for the faster wound healing of chronic non‐healing wounds. It is also used for laparostomy wounds and healing of split skin grafts. The commercially available machine and the consumables for NPWT are very expensive and economically not feasible in developing and underdeveloped countries. So, we devised a NPWT system for wounds of the extremity using inexpensive, readily available materials in any hospital. The materials used are sterile glove, autoclaved sponge, Foley catheter, and a wall suction unit. The sponge was placed over the wound, and a sterile glove was pulled over it. A Foley catheter was placed over the sponge and taken out through one of the fingers of the glove. Adhesive plaster was used to air‐seal the glove. The Foley catheter was fixed with silk ties and connected to wall suction. Granulation and wound healing was faster in this system. This system was safe and inexpensive for the treatment of wounds of the extremity.

1. INTRODUCTION

Negative pressure wound therapy (NPWT) or vacuum‐assisted closure (VAC) has been used effectively in the treatment of chronic wounds for the past three decades.1 The VAC helps in early closure of wound and thereby reduces the hospital stay and the cost of treatment. The procedure involves the use of expensive equipment and consumables that are beyond the scope of public hospitals in underdeveloped and developing countries. Hence, we present this inexpensive method of NPWT for extremities using commonly available materials in the hospital.

2. MATERIALS AND METHODS

The materials needed are a sterilised sponge, a sterile glove, a 16 or 18 F Foley catheter, an adhesive plaster, and a source of suction (Figures 1 and 2). The sponge, which is commercially available in any grocery shop or supermarket, is autoclaved and later cut to fit the size of the wound of the extremity. The sponge is placed over the wound after cleaning and debriding it. The glove is slipped over the extremity covering the wound, and the edge of the glove is secured with an adhesive plaster. The tip of one of the fingers of the glove is cut, and a 16 or 18 F Foley catheter is inserted into it. The terminal hole of the Foley catheter is placed over the sponge, and the catheter is secured in place with a silk ligature around the finger of the glove (Figure 3). The catheter is connected to a source of suction. The strength of suction can be varied by adjusting the valve on the suction device. The pressure applied is usually between −125 and −100 mm Hg. The pressure was applied intermittently for 15 minutes every hour. The dressings are usually changed every second day but more frequently for unhealthy wounds.

Figure 1.

Sterilised sponge, sterile glove, and Foley catheter for the inexpensive negative pressure wound therapy

Figure 2.

Bedside wall suction set for negative pressure wound therapy

Figure 3.

Inexpensive negative pressure wound therapy for chronic non‐healing trophic ulcer wound of a diabetic patient

The method described was able to achieve and sustain the negative pressure for prolonged period of time. Wound healing and granulation formation was good after a week of VAC therapy (Figures 4 and 5). The patient did not report any discomfort. The total cost of this method for 10 days was approximately 7 US$. So, It is very cost‐effective when compared with commercially available VAC system.

Figure 4.

Infected chronic non‐healing trophic ulcer wound of a diabetic patient before negative pressure wound therapy

Figure 5.

Clean and granulated non‐healing trophic ulcer wound of a diabetic patient after 10 days of negative pressure wound therapy

3. DISCUSSION

The concept of modern NPWT was developed in the early 1990s, and it has been successfully used for chronic wounds for the past three decades.1 VAC therapy promotes wound healing by removing infectious material, exudate, and oedema. It also promotes perfusion, angiogenesis, and proliferation during granulation tissue formation. It is widely used for chronic wounds of extremities, laparostomy wounds of abdomen, and healing of split skin graft. Application of VAC dressing over the extremities is difficult because of the difficulty in achieving air seal.

The equipment and the consumables used in the conventional VAC therapy are very expensive and not economically feasible in underdeveloped and developing countries. It is not available, especially in rural areas. The method described here achieves the objective of providing negative pressure to the wound by using readily available and inexpensive materials.

Ruke et al described an indigenous NPWT for diabetic wounds.2 They used commonly available materials in any hospital setting, like autoclaved mattress foam, drain tube (rubber or vinyl), manual negative pressure device, and adhesive polyurethane dressing. In their study, the total cost of the indigenous system for 12 days was only 8 US$ compared with 440 US$ when a commercially available VAC system was used. The approximate treatment cost for 10 days in our study was around 7 US$. Bui et al described an inexpensive VAC dressing using an adhesive iodine‐impregnated drape, a flat Jackson‐Pratt drain, and foam sponges connected to wall suction.3

Saraiya and Shah described a system for diabetic wounds using polyurethane foam, transparent adhesive dressing, and a closed wound suction set.4 The advantage of this system is the mobility of the patient with the portable suction set. In our method, a closed wound suction set can also be used, and the patient can be made ambulant.

Sreelesh and Bhandari described a NPWT for extremities using collagen powder and gloves.5 In their system, the tubings were taken at the mouth area of gloves, and air sealing was carried out with the help of adhesive tape. In our system, a cut is made in one of the fingers of the gloves, and the tube is brought out. The chance of air leak is absolutely nil in our system when compared with other cheaper alternatives. The drawback of our method is that it can be used only for the extremity.

4. CONCLUSION

We conclude that this system of achieving NPWT is effective, inexpensive, and safe for the treatment of wounds of the extremities.

Gopal SV, Solomon A. An inexpensive method of negative pressure wound therapy for extremities. Int Wound J. 2019;16:131–133. 10.1111/iwj.13002