Terapia de presión negativa: una nueva modalidad terapéutica en el manejo de heridas complejas, experiencia clínica con 87 casos y revisión de la literatura
Palabras clave:
úlcera cutánea, cicatrización de heridas, heridas y lesiones, presión atmosféricaResumen
Las heridas crónicas o agudas de difícil cicatrización son un reto para los profesionales de la salud y un problema de salud pública dados los altos costos y la morbilidad que generan.
La terapia de presión negativa es un método avanzado de cuidado de heridas, que utiliza presión negativa para el cierre de múltiples lesiones en diferentes zonas del cuerpo. La presión negativa favorece el cierre de las heridas por diferentes mecanismos, entre ellos la remoción de líquido intersticial, estimulación de la angiogénesis y mitosis, y disminución de la carga bacteriana.
El sistema utiliza presión subatmosférica, entre -50 y -200 mm Hg, generados por una bomba eléctrica con un microcomputador y un sistema de esponjas de características especiales.
Nuestro objetivo fue evaluar el sistema de presión negativa en heridas de difícil manejo y de diferentes características, en un periodo de un año comprendido (junio de 2005 y junio de 2006), durante el cual se manejaron 87 pacientes con heridas de diferente etiología, luego de obtener consentimiento informado para su utilización.
Los hallazgos más importantes del estudio fueron el cierre rápido y óptimo de diferentes heridas crónicas con el sistema de presión negativa, disminución de costos directos e indirectos, disminución del tiempo de enfermería y de atención médica, disminución el tiempo de hospitalización y mejoramiento de la calidad de vida de los pacientes.
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Referencias bibliográficas
1. Krasner D, Rodeheaver T, Sibbald G. Chronic Wound Care. Third edition. West Valley Road, Pensylvania: HMP Communications; 2001;1-759.
2. Sheffield P, Smith A, Fife C. Wound Care Practice. Second edition. Flagstaff Arizona: Best Publishing Company; 2004;1-800.
3. Mendez-Eastman S. Guidelines for using negative wound pressure. Advances in Skin & Wound Care. 2001;14(6):314-25.
4. Song DH, Wu LC, Lohman RF, Gottlieb LJ, Franczzykm. Vacuum assisted closure for the treatment of eternal wounds: the bridge debridement and definitive closure. Plastic and Reconstructive Surgery. 2003;111(1):92-7.
5. Kaplan M, Banwell P, Orgill D, Ivatury R, Demetriades D, Moore F, Millar P, Nichotes J, Henry S. Guidelines for the management of the open abdomen, supplement to wounds: A compendium of clinical research and practice. October 2005.
1. Subnas G, Leon J, Page J, Lentz C, Polvos T. Nacional VAC Education Conference, supplement to ostomy and wound management. February 2005.
2. Webb L. New techniques in wound management: Vaccum assisted closure. Perspectivas on Modern Orthopaedics. 2005;10:5.
3. KCI Inc., The Clinical Advantage, VAC theraphy, Directrices Clínicas, junio 2003
4. Bookout K, McCord S, McLane K. Case studies of an infant, a toddler and an adolescent treated with a negative pressure wound treatment system. JWOCN. 2004;31(4):184-92.
5. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vaccum assisted closure: A new method for wound control and treatment: Animal studies and Basic foundation. Annals of Plastic Surgery. 1997;38(6):553-62.
6. Saxena V, SM, Orgill DP, et al. Vacuum assisted closure: Microdeformations of wounds and cell proliferation. Plastic and Reconstructive Surgery. 2004;114(5):1086-96.
7. Krasher DL. Managing wound pain in patients with vaccum assisted closure devices. Ostomy Wound Management. 2002;48(5):38-43.
8. Fabian TS, Kaufman HJ, Lett ED, Thomas JB, Raíl DK, Lewis PL, Summit JB, Merryman JI, Schaeffer TD, Sargent LA, Burns RP. The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full thickness wound healing. The American Surgeon. 2000;66(812):1136-43.
9. Orgill DP, Austen WG, Butler CE, Fine NA, Horvath KA, Mihaljevic T, Song DH, Wolfe WG. Guidelines for treatment of complex chest wounds with negative pressure wound therapy. Wounds. 2004;16(suppl. B):1-23.
10. Yuan-Innes MJ, Temple CLF, Lacey MS. Vacuum assisted closure: a new approach to spinal wounds with exposed hardware. Spine. 2001;26(3):E30-3.
11. Wu SH, Zecha PJ, Feitz R, Hovius SER. Vacuum assisted closure therapy as an intermediate phase in wound closure: a clinical experience. European Journal of Plastic Surgery. 2000;23:174-7.
12. Creer SE, Durthie E, Carlotano B, Koehler KM, Maydick-Youngberg D, Longaker MT. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. Journal of Wound, Ostomy and Continente Nursing. 1999:26(5):250-3.
13. Gupta S, Baharastani M, Baranoski S, de Leon J, Ángel SJ, Mendez Eastman S, Niezgoda JA, Pompeo MQ. Guidelines for managing pressure ulcers with negative pressure wound therapy. Advances in Skin & Wound Care. 2004;17(Suppl. 2):1-16.
14. Shcwien T, Gilbert J, Lang C. Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes. Ostomy Wound Management. 2005;51(9):47-60.
15. Kaplan M. Abdominal compartment syndrome. Ostomy Wound Management. 2004;50(Suppl.4A):20-1.
16. Meara JG, Guo L, SmIth JD, Privas, Breuing KH, Orgill DP. Vacuum assisted closure in the treatment of degloving injuries. Annals of Plastic Surgery. 1999;42(6):589-94.
17. Agarwall JP, Ogilvie M, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M, Song DH. Vacuum assisted closure for eternal wounds: a first line therapeutic management approach. Plat Reconstructive Surg. 2005;116 (4):1035-40;1041-3.
18. Tang ATM, Ohri SK, Hawk MP. Novel applications of vacuum assisted closure technique to the treatment of sternotomy wound infection. European Journal of Cardio-thoracic Surgery. 2000;17:482-4.
19. Andros G, Armstrong D, Attinger C, Boulton A, Frykberg R, Joseph W, Lavery L, Morbach S, Niezgoda J, Toursarkissian B. Consensus statement on negative pressure wound therapy (VAC therapy) for the management of diabetic foot wounds. Osomy and Wound Management. 2006;52(6) suppl.
20. DeFranzo AJ, Marks MW, Argenta LC, Genecov DV. Vacuum assisted closure for the treatment of degloving injuries. Plastic and Reconstructive Surgery. 1999;104(7):2145-8.
21. Delange MY, Schasfoort RA, Obdeijn MC, van der Werf JFA, Nicolai JPA. Vacuum assisted closure: Indications and clinical experience. European Journal of Plastic Surgery. 2000;23(4):178-82.
22. Meara JG, Breuing KH. Vacuum assisted closure in the treatment of orthopaedic injuries. Annals of Plastic Surg. 1998;35(3):123-7.
23. Joseph E, Hamovic C, Bergman S, Roaf E, Swan N. A prospective randomized trial of vacuum assisted closure versus standard therapy of chronic non healing wounds. Wounds. 2000;12(3)
24. Pieper B. A paraplegic with stage IV pressure ulcers: Risks factors and wound care. Journal of Wound and Ostomy & Continence Nursing. 2003;30(2)
25. Philbeck T, Whittington K. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home health care medicare patients. Ostomy and Wound Management. 1999;45(11):41-50.
26. Chescher E. Use of vacuum-assisted closure in the community primary intention. The Australian Journal of Wound Management. 1998;6(1)
27. Armstrong DG, Attinger CE, Boulton AJM, Frykberg RG, Kirsner RS. Guidelines regarding negative pressure wound therapy (NPWT) in the diabetic foot: results of the Tucson Expert Consensus Conference (TECC) on VAC therapy. Ostomy Wound Management. 2004;50(4 suppl. B):3s-27s.
28. Morykwas MJ, Faler BJ, Pearce DJ, Argenta LC. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Annals of Plastic Surgery. 2001;47(5):547-51.
29. Joseph Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective randomized trial of vacuum assisted closure versus standard therapy of chronic nonhealing wounds. Wounds. 12(2):60-67.
30. Amstrong D, Laverel L, Abs-Rumman P, Espensen E. Outcomes of sub atmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy and Wound Management. 2002;48(4):64-8.
31. McCallon S, Knight C, Valiulus J, Cunningham M. Vacuum assisted closure versus saline moistened gauze in the healing of post operative diabetic wounds. Ostomy and Wound Management. 2000;46(8):28-34.
32. Eginton M, Brown K, Seabrook G, Towne J. A prospective randomized evaluation of negative pressure wound therapy for diabetic wounds. Annals of Vascular Surgery. 2003;17:645-9.
33. Gabriel A, Hinrich C, Shores JT, Baqai WK, Rogers FR, Gupta S. Reducing bacterial bioburden in infected wounds with vacuum assisted closure and a new siler dressing- a pilot study. Wounds. 2006;18(9):245-55.
34. Deva AK, Siu C, Nettle WJS. Vacuum assisted closure of a sacral pressure sore. Journal of Wound Cre. 1997;6(7):311-2.>
35. Page JC, Newswander B, Schwenke DC, Hansen M, Fergusson J. Retrospective analysis of negative pressure wound therapy in open foot wounds with significant soft tissue defects. Advances in Skin & Wound Care. 2004;17(7):354-64.
36. Parret BM, Matros E, Pribaz JJ, Orgill DP. Lower extremity trauma: trends in the management of soft tissue reconstruction of open tibia-fibula fractures. Plastic and Reconstructive Surgery. 2006;117(4):1315-22.
37. De Franzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX, Ward WG, Teasdall RG. The use of vacuum assisted closure therapy for the treatment of lower extremity wounds with exposed bone. Plastic and Reconstructive Surgery. 2001;108(5):1184-91.
38. Yuan-Innes MJ, Temple CLF, Lacey MS. Vacuum assisted closure: A new approach to spinal wounds with exposed hardware. Spine. 2001;26(3):E30-3.
39. Argenta LC, David LR. The use of vacuum assisted closure in the treatment of burns. Plastic and Reconstructive Surgery. 2000;100(3):567-73.
40. Fabian TS, Kaufman H, Lett ED, Thomas JB, Rawl DK, Lewis PL, Summit JB, Meryman JI, Scaeffer TD, Sagent LA, Burns RP. The evaluation of sub atmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. The American Surgeon. 2000;66(12):1136-43.
41. Chantal M, Moues et al. An economic evaluation of the use of TNP on full thickness wounds. Journal of Wound Care. 2005;14(5):1-6. >
42. Bickls J, Kollender Y, Witting J. Vacuum assisted closure after resection of musculoskeletal tumors. Clinical Orthopedics and Related Research. 2005;441:346-50.
43. Morykwass MJ, Argenta LC. Use of subatmosperic pressure to prevent doxorubicin extravasation ulcers in a swine model. Journal of Surgical Oncology. 1999;72:14-7.
44. Cadena M, et al. Terapia de presión negativa en el manejo de físitulas gastrointestinales. Revista Colombiana de Cirugía. 2004;23(2).
45. Bookout K, Mccord S, McLane K. Case studies of an infant, a toddler and an adolescent treated with a negative pressure wound treatment system. JWOCN. 2004:31(4):84-194.
46. Orgill D, Austern W, Butter C, Fine N. Guidelines for treatment of complex chest wounds with negative pressure wound therapy. Wounds. supplement B to December 2004.
47. Wongworat M, Schalls S, Holton P. Negative pressure woun
2. Sheffield P, Smith A, Fife C. Wound Care Practice. Second edition. Flagstaff Arizona: Best Publishing Company; 2004;1-800.
3. Mendez-Eastman S. Guidelines for using negative wound pressure. Advances in Skin & Wound Care. 2001;14(6):314-25.
4. Song DH, Wu LC, Lohman RF, Gottlieb LJ, Franczzykm. Vacuum assisted closure for the treatment of eternal wounds: the bridge debridement and definitive closure. Plastic and Reconstructive Surgery. 2003;111(1):92-7.
5. Kaplan M, Banwell P, Orgill D, Ivatury R, Demetriades D, Moore F, Millar P, Nichotes J, Henry S. Guidelines for the management of the open abdomen, supplement to wounds: A compendium of clinical research and practice. October 2005.
1. Subnas G, Leon J, Page J, Lentz C, Polvos T. Nacional VAC Education Conference, supplement to ostomy and wound management. February 2005.
2. Webb L. New techniques in wound management: Vaccum assisted closure. Perspectivas on Modern Orthopaedics. 2005;10:5.
3. KCI Inc., The Clinical Advantage, VAC theraphy, Directrices Clínicas, junio 2003
4. Bookout K, McCord S, McLane K. Case studies of an infant, a toddler and an adolescent treated with a negative pressure wound treatment system. JWOCN. 2004;31(4):184-92.
5. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vaccum assisted closure: A new method for wound control and treatment: Animal studies and Basic foundation. Annals of Plastic Surgery. 1997;38(6):553-62.
6. Saxena V, SM, Orgill DP, et al. Vacuum assisted closure: Microdeformations of wounds and cell proliferation. Plastic and Reconstructive Surgery. 2004;114(5):1086-96.
7. Krasher DL. Managing wound pain in patients with vaccum assisted closure devices. Ostomy Wound Management. 2002;48(5):38-43.
8. Fabian TS, Kaufman HJ, Lett ED, Thomas JB, Raíl DK, Lewis PL, Summit JB, Merryman JI, Schaeffer TD, Sargent LA, Burns RP. The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full thickness wound healing. The American Surgeon. 2000;66(812):1136-43.
9. Orgill DP, Austen WG, Butler CE, Fine NA, Horvath KA, Mihaljevic T, Song DH, Wolfe WG. Guidelines for treatment of complex chest wounds with negative pressure wound therapy. Wounds. 2004;16(suppl. B):1-23.
10. Yuan-Innes MJ, Temple CLF, Lacey MS. Vacuum assisted closure: a new approach to spinal wounds with exposed hardware. Spine. 2001;26(3):E30-3.
11. Wu SH, Zecha PJ, Feitz R, Hovius SER. Vacuum assisted closure therapy as an intermediate phase in wound closure: a clinical experience. European Journal of Plastic Surgery. 2000;23:174-7.
12. Creer SE, Durthie E, Carlotano B, Koehler KM, Maydick-Youngberg D, Longaker MT. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. Journal of Wound, Ostomy and Continente Nursing. 1999:26(5):250-3.
13. Gupta S, Baharastani M, Baranoski S, de Leon J, Ángel SJ, Mendez Eastman S, Niezgoda JA, Pompeo MQ. Guidelines for managing pressure ulcers with negative pressure wound therapy. Advances in Skin & Wound Care. 2004;17(Suppl. 2):1-16.
14. Shcwien T, Gilbert J, Lang C. Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes. Ostomy Wound Management. 2005;51(9):47-60.
15. Kaplan M. Abdominal compartment syndrome. Ostomy Wound Management. 2004;50(Suppl.4A):20-1.
16. Meara JG, Guo L, SmIth JD, Privas, Breuing KH, Orgill DP. Vacuum assisted closure in the treatment of degloving injuries. Annals of Plastic Surgery. 1999;42(6):589-94.
17. Agarwall JP, Ogilvie M, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M, Song DH. Vacuum assisted closure for eternal wounds: a first line therapeutic management approach. Plat Reconstructive Surg. 2005;116 (4):1035-40;1041-3.
18. Tang ATM, Ohri SK, Hawk MP. Novel applications of vacuum assisted closure technique to the treatment of sternotomy wound infection. European Journal of Cardio-thoracic Surgery. 2000;17:482-4.
19. Andros G, Armstrong D, Attinger C, Boulton A, Frykberg R, Joseph W, Lavery L, Morbach S, Niezgoda J, Toursarkissian B. Consensus statement on negative pressure wound therapy (VAC therapy) for the management of diabetic foot wounds. Osomy and Wound Management. 2006;52(6) suppl.
20. DeFranzo AJ, Marks MW, Argenta LC, Genecov DV. Vacuum assisted closure for the treatment of degloving injuries. Plastic and Reconstructive Surgery. 1999;104(7):2145-8.
21. Delange MY, Schasfoort RA, Obdeijn MC, van der Werf JFA, Nicolai JPA. Vacuum assisted closure: Indications and clinical experience. European Journal of Plastic Surgery. 2000;23(4):178-82.
22. Meara JG, Breuing KH. Vacuum assisted closure in the treatment of orthopaedic injuries. Annals of Plastic Surg. 1998;35(3):123-7.
23. Joseph E, Hamovic C, Bergman S, Roaf E, Swan N. A prospective randomized trial of vacuum assisted closure versus standard therapy of chronic non healing wounds. Wounds. 2000;12(3)
24. Pieper B. A paraplegic with stage IV pressure ulcers: Risks factors and wound care. Journal of Wound and Ostomy & Continence Nursing. 2003;30(2)
25. Philbeck T, Whittington K. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home health care medicare patients. Ostomy and Wound Management. 1999;45(11):41-50.
26. Chescher E. Use of vacuum-assisted closure in the community primary intention. The Australian Journal of Wound Management. 1998;6(1)
27. Armstrong DG, Attinger CE, Boulton AJM, Frykberg RG, Kirsner RS. Guidelines regarding negative pressure wound therapy (NPWT) in the diabetic foot: results of the Tucson Expert Consensus Conference (TECC) on VAC therapy. Ostomy Wound Management. 2004;50(4 suppl. B):3s-27s.
28. Morykwas MJ, Faler BJ, Pearce DJ, Argenta LC. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Annals of Plastic Surgery. 2001;47(5):547-51.
29. Joseph Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective randomized trial of vacuum assisted closure versus standard therapy of chronic nonhealing wounds. Wounds. 12(2):60-67.
30. Amstrong D, Laverel L, Abs-Rumman P, Espensen E. Outcomes of sub atmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy and Wound Management. 2002;48(4):64-8.
31. McCallon S, Knight C, Valiulus J, Cunningham M. Vacuum assisted closure versus saline moistened gauze in the healing of post operative diabetic wounds. Ostomy and Wound Management. 2000;46(8):28-34.
32. Eginton M, Brown K, Seabrook G, Towne J. A prospective randomized evaluation of negative pressure wound therapy for diabetic wounds. Annals of Vascular Surgery. 2003;17:645-9.
33. Gabriel A, Hinrich C, Shores JT, Baqai WK, Rogers FR, Gupta S. Reducing bacterial bioburden in infected wounds with vacuum assisted closure and a new siler dressing- a pilot study. Wounds. 2006;18(9):245-55.
34. Deva AK, Siu C, Nettle WJS. Vacuum assisted closure of a sacral pressure sore. Journal of Wound Cre. 1997;6(7):311-2.>
35. Page JC, Newswander B, Schwenke DC, Hansen M, Fergusson J. Retrospective analysis of negative pressure wound therapy in open foot wounds with significant soft tissue defects. Advances in Skin & Wound Care. 2004;17(7):354-64.
36. Parret BM, Matros E, Pribaz JJ, Orgill DP. Lower extremity trauma: trends in the management of soft tissue reconstruction of open tibia-fibula fractures. Plastic and Reconstructive Surgery. 2006;117(4):1315-22.
37. De Franzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX, Ward WG, Teasdall RG. The use of vacuum assisted closure therapy for the treatment of lower extremity wounds with exposed bone. Plastic and Reconstructive Surgery. 2001;108(5):1184-91.
38. Yuan-Innes MJ, Temple CLF, Lacey MS. Vacuum assisted closure: A new approach to spinal wounds with exposed hardware. Spine. 2001;26(3):E30-3.
39. Argenta LC, David LR. The use of vacuum assisted closure in the treatment of burns. Plastic and Reconstructive Surgery. 2000;100(3):567-73.
40. Fabian TS, Kaufman H, Lett ED, Thomas JB, Rawl DK, Lewis PL, Summit JB, Meryman JI, Scaeffer TD, Sagent LA, Burns RP. The evaluation of sub atmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. The American Surgeon. 2000;66(12):1136-43.
41. Chantal M, Moues et al. An economic evaluation of the use of TNP on full thickness wounds. Journal of Wound Care. 2005;14(5):1-6. >
42. Bickls J, Kollender Y, Witting J. Vacuum assisted closure after resection of musculoskeletal tumors. Clinical Orthopedics and Related Research. 2005;441:346-50.
43. Morykwass MJ, Argenta LC. Use of subatmosperic pressure to prevent doxorubicin extravasation ulcers in a swine model. Journal of Surgical Oncology. 1999;72:14-7.
44. Cadena M, et al. Terapia de presión negativa en el manejo de físitulas gastrointestinales. Revista Colombiana de Cirugía. 2004;23(2).
45. Bookout K, Mccord S, McLane K. Case studies of an infant, a toddler and an adolescent treated with a negative pressure wound treatment system. JWOCN. 2004:31(4):84-194.
46. Orgill D, Austern W, Butter C, Fine N. Guidelines for treatment of complex chest wounds with negative pressure wound therapy. Wounds. supplement B to December 2004.
47. Wongworat M, Schalls S, Holton P. Negative pressure woun
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2007-12-20
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Jiménez Jiménez, C. E. Terapia De presión Negativa: Una Nueva Modalidad terapéutica En El Manejo De Heridas Complejas, Experiencia clínica Con 87 Casos Y revisión De La Literatura. Rev Colomb Cir 2007, 22, 209-224.
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