Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds

Georg Daeschlein, Matthias Napp, S. Lutze, Sebastian von Podewils, G. Jukema, W. Fleischmann, H. Haase, J. Leitgeb, A. Ekkernkamp, O. Assadian

Research output: Contribution to journalArticle

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Abstract

Background: Negative pressure wound therapy (NPWT) has established successfully as a treatment option for acceleration of wound healing in a broad range of clinical indications. Systematic research investigating the bacterial kinetics on wounds is lacking and no studies are available comparing the microbiological difference of repeated instillation of polyhexanide (PHMB) against continuous NPWT without instillation of an antiseptic. The aim of this study was to investigate the bacterial bio-burden on wounds and to measure the bacterial kinetic during application of NPWT with and without intermitted instillation of 0.02% PHMB. Methods: A cohort of 18 patients with chronic (n = 16) and acute (n = 2) wounds was treated either with NPWT alone or with additional intermitted instillation of 0.02% PHMB. Wound healing and bacterial load were assessed at every dressing change. All wounds were closed by split-thickness skin grafts or local Reverdin flaps. According to the manufacturer of the investigated NPWT system (V.A.C. therapy unit, Kinetic Concepts Inc. KCI) wounds were filled with a polyurethane sponge (pore size 0.4-0.6 mm) and occluded with a polyurethane foil (KCI Inc., USA). The NPWT-device was connected to the wound and operated at 100 mm Hg sub-atmospheric pressure utilizing an alternating pressure cycle of 5 min of suction followed by 2 min pause. The automated intermittent instillation lasted for 4-20 s, the exposure time was 20 min. After 60 min of NPWT, the instillation was started again. Results: Seven split-thickness skin grafts, 3 Reverdin-flaps and one combined closure (Reverdin + split-thickness skin grafts) exhibited excellent wound healing after successful transplantation 4 weeks after intervention. The quality of wound granulation was excellent in all wounds, regardless of NPWT application with or without instillation of 0.02% PHMB. The bacterial spectrum remained mostly unchanged after treatment and had no influence on the outcome. Conclusion: It was demonstrated that management of infected wounds with NPWT, with or without instillation of 0.02% PHMB, did not reduce the number of bacteria on wounds. Bacteria proliferate below a NPWT dressing and increase in numbers. Independently of bacterial kinetics, all wounds showed excellent granulation and healed with no complications. This observation challenges the concept that bacterial bioburden correlates with impaired wound healing.

Original languageEnglish
Pages (from-to)5-11
Number of pages7
JournalWound Medicine
Volume13
DOIs
Publication statusPublished - 1 Jun 2016

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Negative-Pressure Wound Therapy
Wounds and Injuries
Wound Healing
Polyurethanes
Bandages
Transplants
Skin
Vantocil
Bacteria
Atmospheric Pressure
Local Anti-Infective Agents
Bacterial Load
Suction
Porifera
Therapeutics
Transplantation

Cite this

Daeschlein, Georg ; Napp, Matthias ; Lutze, S. ; von Podewils, Sebastian ; Jukema, G. ; Fleischmann, W. ; Haase, H. ; Leitgeb, J. ; Ekkernkamp, A. ; Assadian, O. / Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds. In: Wound Medicine. 2016 ; Vol. 13. pp. 5-11.
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title = "Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds",
abstract = "Background: Negative pressure wound therapy (NPWT) has established successfully as a treatment option for acceleration of wound healing in a broad range of clinical indications. Systematic research investigating the bacterial kinetics on wounds is lacking and no studies are available comparing the microbiological difference of repeated instillation of polyhexanide (PHMB) against continuous NPWT without instillation of an antiseptic. The aim of this study was to investigate the bacterial bio-burden on wounds and to measure the bacterial kinetic during application of NPWT with and without intermitted instillation of 0.02{\%} PHMB. Methods: A cohort of 18 patients with chronic (n = 16) and acute (n = 2) wounds was treated either with NPWT alone or with additional intermitted instillation of 0.02{\%} PHMB. Wound healing and bacterial load were assessed at every dressing change. All wounds were closed by split-thickness skin grafts or local Reverdin flaps. According to the manufacturer of the investigated NPWT system (V.A.C. therapy unit, Kinetic Concepts Inc. KCI) wounds were filled with a polyurethane sponge (pore size 0.4-0.6 mm) and occluded with a polyurethane foil (KCI Inc., USA). The NPWT-device was connected to the wound and operated at 100 mm Hg sub-atmospheric pressure utilizing an alternating pressure cycle of 5 min of suction followed by 2 min pause. The automated intermittent instillation lasted for 4-20 s, the exposure time was 20 min. After 60 min of NPWT, the instillation was started again. Results: Seven split-thickness skin grafts, 3 Reverdin-flaps and one combined closure (Reverdin + split-thickness skin grafts) exhibited excellent wound healing after successful transplantation 4 weeks after intervention. The quality of wound granulation was excellent in all wounds, regardless of NPWT application with or without instillation of 0.02{\%} PHMB. The bacterial spectrum remained mostly unchanged after treatment and had no influence on the outcome. Conclusion: It was demonstrated that management of infected wounds with NPWT, with or without instillation of 0.02{\%} PHMB, did not reduce the number of bacteria on wounds. Bacteria proliferate below a NPWT dressing and increase in numbers. Independently of bacterial kinetics, all wounds showed excellent granulation and healed with no complications. This observation challenges the concept that bacterial bioburden correlates with impaired wound healing.",
keywords = "Bacteria, Colonization, Negative pressure wound therapy, NPWT, Pathogens, Polihexanide, Sub-atmospheric pressure dressing, VAC, Wound, Wound antisepsis",
author = "Georg Daeschlein and Matthias Napp and S. Lutze and {von Podewils}, Sebastian and G. Jukema and W. Fleischmann and H. Haase and J. Leitgeb and A. Ekkernkamp and O. Assadian",
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Daeschlein, G, Napp, M, Lutze, S, von Podewils, S, Jukema, G, Fleischmann, W, Haase, H, Leitgeb, J, Ekkernkamp, A & Assadian, O 2016, 'Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds', Wound Medicine, vol. 13, pp. 5-11. https://doi.org/10.1016/j.wndm.2016.02.001

Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds. / Daeschlein, Georg; Napp, Matthias; Lutze, S.; von Podewils, Sebastian; Jukema, G.; Fleischmann, W.; Haase, H.; Leitgeb, J.; Ekkernkamp, A.; Assadian, O.

In: Wound Medicine, Vol. 13, 01.06.2016, p. 5-11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds

AU - Daeschlein, Georg

AU - Napp, Matthias

AU - Lutze, S.

AU - von Podewils, Sebastian

AU - Jukema, G.

AU - Fleischmann, W.

AU - Haase, H.

AU - Leitgeb, J.

AU - Ekkernkamp, A.

AU - Assadian, O.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background: Negative pressure wound therapy (NPWT) has established successfully as a treatment option for acceleration of wound healing in a broad range of clinical indications. Systematic research investigating the bacterial kinetics on wounds is lacking and no studies are available comparing the microbiological difference of repeated instillation of polyhexanide (PHMB) against continuous NPWT without instillation of an antiseptic. The aim of this study was to investigate the bacterial bio-burden on wounds and to measure the bacterial kinetic during application of NPWT with and without intermitted instillation of 0.02% PHMB. Methods: A cohort of 18 patients with chronic (n = 16) and acute (n = 2) wounds was treated either with NPWT alone or with additional intermitted instillation of 0.02% PHMB. Wound healing and bacterial load were assessed at every dressing change. All wounds were closed by split-thickness skin grafts or local Reverdin flaps. According to the manufacturer of the investigated NPWT system (V.A.C. therapy unit, Kinetic Concepts Inc. KCI) wounds were filled with a polyurethane sponge (pore size 0.4-0.6 mm) and occluded with a polyurethane foil (KCI Inc., USA). The NPWT-device was connected to the wound and operated at 100 mm Hg sub-atmospheric pressure utilizing an alternating pressure cycle of 5 min of suction followed by 2 min pause. The automated intermittent instillation lasted for 4-20 s, the exposure time was 20 min. After 60 min of NPWT, the instillation was started again. Results: Seven split-thickness skin grafts, 3 Reverdin-flaps and one combined closure (Reverdin + split-thickness skin grafts) exhibited excellent wound healing after successful transplantation 4 weeks after intervention. The quality of wound granulation was excellent in all wounds, regardless of NPWT application with or without instillation of 0.02% PHMB. The bacterial spectrum remained mostly unchanged after treatment and had no influence on the outcome. Conclusion: It was demonstrated that management of infected wounds with NPWT, with or without instillation of 0.02% PHMB, did not reduce the number of bacteria on wounds. Bacteria proliferate below a NPWT dressing and increase in numbers. Independently of bacterial kinetics, all wounds showed excellent granulation and healed with no complications. This observation challenges the concept that bacterial bioburden correlates with impaired wound healing.

AB - Background: Negative pressure wound therapy (NPWT) has established successfully as a treatment option for acceleration of wound healing in a broad range of clinical indications. Systematic research investigating the bacterial kinetics on wounds is lacking and no studies are available comparing the microbiological difference of repeated instillation of polyhexanide (PHMB) against continuous NPWT without instillation of an antiseptic. The aim of this study was to investigate the bacterial bio-burden on wounds and to measure the bacterial kinetic during application of NPWT with and without intermitted instillation of 0.02% PHMB. Methods: A cohort of 18 patients with chronic (n = 16) and acute (n = 2) wounds was treated either with NPWT alone or with additional intermitted instillation of 0.02% PHMB. Wound healing and bacterial load were assessed at every dressing change. All wounds were closed by split-thickness skin grafts or local Reverdin flaps. According to the manufacturer of the investigated NPWT system (V.A.C. therapy unit, Kinetic Concepts Inc. KCI) wounds were filled with a polyurethane sponge (pore size 0.4-0.6 mm) and occluded with a polyurethane foil (KCI Inc., USA). The NPWT-device was connected to the wound and operated at 100 mm Hg sub-atmospheric pressure utilizing an alternating pressure cycle of 5 min of suction followed by 2 min pause. The automated intermittent instillation lasted for 4-20 s, the exposure time was 20 min. After 60 min of NPWT, the instillation was started again. Results: Seven split-thickness skin grafts, 3 Reverdin-flaps and one combined closure (Reverdin + split-thickness skin grafts) exhibited excellent wound healing after successful transplantation 4 weeks after intervention. The quality of wound granulation was excellent in all wounds, regardless of NPWT application with or without instillation of 0.02% PHMB. The bacterial spectrum remained mostly unchanged after treatment and had no influence on the outcome. Conclusion: It was demonstrated that management of infected wounds with NPWT, with or without instillation of 0.02% PHMB, did not reduce the number of bacteria on wounds. Bacteria proliferate below a NPWT dressing and increase in numbers. Independently of bacterial kinetics, all wounds showed excellent granulation and healed with no complications. This observation challenges the concept that bacterial bioburden correlates with impaired wound healing.

KW - Bacteria

KW - Colonization

KW - Negative pressure wound therapy

KW - NPWT

KW - Pathogens

KW - Polihexanide

KW - Sub-atmospheric pressure dressing

KW - VAC

KW - Wound

KW - Wound antisepsis

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U2 - 10.1016/j.wndm.2016.02.001

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JO - Wound Medicine

JF - Wound Medicine

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