Kairinos N, Voogd AM, Botha PH, Kotze T, Kahn D, Hudson DA, Solomons M, et al.
Plastic and reconstructive surgery. Date of publication 2009 Feb 1;volume 123(2):601-12.
1. Plast Reconstr Surg. 2009 Feb;123(2):601-12. doi: 10.1097/PRS.0b013e318196b97b.
Negative-pressure wound therapy II: negative-pressure wound therapy and increased
perfusion. Just an illusion?
Kairinos N(1), Voogd AM, Botha PH, Kotze T, Kahn D, Hudson DA, Solomons M.
Author information:
(1)Department of Plastic Surgery, University of Cape Town, Cape Town, South
Africa. nickykairinos@gmail.com
BACKGROUND: A recent study demonstrated that negative-pressure wound therapy
increases underlying tissue pressure. This finding is incongruous with studies
using laser Doppler that show that perfusion is immediately increased on
initiation of suction. This study investigated perfusion in negative-pressure
wound therapy using two alternative modalities.
METHODS: Radioisotope perfusion imaging was used to determine perfusion beneath
circumferential negative-pressure wound therapy dressings on 20 healthy hands (n
= 20). Ten hands received suction pressures of -400 mmHg and 10 received -125
mmHg, with the contralateral hand used as a control without any suction.
Transcutaneous partial pressure of oxygen was used to determine perfusion beneath
noncircumferential negative-pressure wound therapy dressings on 12 healthy legs
(n = 12), with each volunteer being sequentially randomized to receive suction
pressures of -400 and -125 mmHg, respectively.
RESULTS: Tissues undergoing circumferential negative-pressure wound therapy
demonstrated a mean reduction in perfusion of 40 +/- 11.5 percent (p < 0.0005)
and 17 +/- 8.9 percent (p < 0.0005) at suction pressures of -400 mmHg and -125
mmHg, respectively. Perfusion reduction at -400 mmHg was significantly greater
than at -125 mmHg (p < 0.015). In the noncircumferential negative-pressure wound
therapy group, there was a mean reduction in transcutaneous partial pressure of
oxygen of 7.35 +/- 7.4 mmHg (p < 0.0005) and 5.10 +/- 7.4 mmHg (p < 0.0005) at
suction pressures of -400 mmHg and -125 mmHg, respectively. There was a tendency
for greater reductions in the -400 mmHg group, but this was not significantly
different from the -125 mmHg group (p = 0.07).
CONCLUSIONS: These findings demonstrate that perfusion beneath negative-pressure
wound therapy decreases for increasing suction pressure. Thus, it is suggested
that negative-pressure wound therapy should be used with caution on tissues with
compromised vascularity, particularly when used circumferentially.
DOI: 10.1097/PRS.0b013e318196b97b
PMID: 19182619 [Indexed for MEDLINE]
