Use of Negative Pressure Wound therapy for Abdominal Wounds in Neonates and Infants: Critical Appraisal

Use of Negative Pressure Wound Therapy (NPWT) for Abdominal Wounds in Neonates and Infants, Journal of Pediatric Surgery (2012) 47, 1555-1559, Stoffan, Alexander P., et al.

Summary of Article:

The article described the use of NPWT for the past 10 years in Children's Hospital Boston and its outcome. There is no attempts in studying it effectiveness or in comparison to other methods of wound closure or treatment. Only 2 cases developed fistula after initiation of NPWT. Most of the other cases have already developed stoma and fistula before NPWT was applied. 6 died from the cohort but none were related to NPWT.

My 2 cents:

While the article describes the experience of NPWT in their institution, there is a lack useful description to describe the efficacy of NPWT in this age group which is understandable as the article does not intend to report on the subject.

The number of subjects are also too few (18) to be of much benefit.

The wide difference in diagnosis of wounds used for NPWT also makes it difficult to tell if the diagnosis makes a difference to the success of NPWT although some of their results sounds convincing.

Discussion:

Wounds and chronic wounds are a hassle to manage, especially post-operatively. Chronic wounds is a frustrating complications for all parties, including

While not exactly new, its use it being increasingly used in the treatment of especially chronic wounds although any wounds as long as it is not contraindicated, may be treated with this method. In my work in Queen Elizabeth Hospital in Kota Kinabalu, Sabah, its use is increasing especially in the orthopedic's department and general surgery and plastic surgery departments.

The principle to NPWT is that the negative pressure when applied in an air tight seal on a wound, will draw fluids from the wound decreasing edema and encouraging wound healing. It is also said to increase blood flow to the wound which is an important factor in the healing of the wound.

While it is being used in the treatment of wound in adults, its use in the pediatric age group, especially the infant and neonates are also increasing. However, there is a lack of evidence from literature to its efficacy. This is mostly due to the heterogenicity of diagnosis and types of wounds that makes controlled random clinical trials difficult without bias. Despite this, it cannot be denied that NPWT remains an important tool that needs to be utilized.

More research needs to be done surrounding the subject. Wound treatment in the infant and neonate age group may certainly benefit from this modality of treatment. Staff needs to be educated and trained in the application of this technique as it may provide a different alternative when traditional methods of wound care fails.


References:

1. Stoffan, Alexander P., et al., Use of Negative Pressure Wound Therapy (NPWT) for Abdominal Wounds in Neonates and Infants, Journal of Pediatric Surgery (2012) 47, 1555-1559

2. Gestring M, et al., Negative Wound Pressure Therapy, UpToDate Article (2012)

3. Gregor S., et al., Negative Pressure Wound Therapy: A Vacuum of Evidence? Arch Surg 2008

Future Topics:

• Wound closure methods
• Wound healing in children