Limited added value of negative pressure wound therapy compared with calcium alginate dressings for second intention healing in a noncontaminated and contaminated equine distal limb wound model.

BACKGROUND: Distal limb wounds in horses often show aberrant healing due to a slow inflammatory response. In human medicine, negative pressure wound therapy (NPWT) is used for the treatment of chronic wounds with a similar inflammatory response. OBJECTIVES: To compare the effect of NPWT to calcium alginate dressings on the healing of (non) contaminated equine distal limb wounds. STUDY DESIGN: Controlled experiment. METHODS: Circular wounds were created on the left and right dorsomedial metacarpus of 10 horses. In five horses, the wounds were contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. In all horses, one limb was treated with NPWT, the other with calcium alginate dressings. Treatments were applied during nine days for noncontaminated wounds and six days for contaminated wounds. Noninvasive (clinical assessment, bacteriology swabs, thermographic images and wound dimensions) and invasive (biopsies for histology and growth factor analysis) measurements were taken regularly for 71 and 29 days respectively. Effects of selected parameters on continuous dependent variables were analysed using ANOVA, while for discrete dependent variables, logistic regression was applied. RESULTS: In noncontaminated wounds, there was significantly less wound retraction in the early healing stages when treated with NPWT (mean difference [95% CI] = 19.2% [13.3%-25.1%]; P = .005), although wound size was not significantly different between NPWT and control wounds at later healing stages. Noncontaminated control wounds had a significantly higher neutrophil influx (OR [95% CI] = 1.99 [1.49-2.66]; P < .001) and lower macrophage influx (OR [95% CI] = 0.75 [0.60-0.93]; P = .008) compared with NPWT-treated wounds. Bacterial load and the presence of growth factors did not differ between treatments in noncontaminated wounds. In contaminated wounds, no differences between treatments were observed in wound size, histological parameters, bacterial load or growth factor concentration. MAIN LIMITATIONS: Sample size is small. CONCLUSIONS: No long-term advantage was detected with NPWT compared with calcium alginate dressings in noncontaminated or contaminated equine distal limb wounds healing by second intention.

[ALGINATE versus negative-pressure therapy: Comparison of the clinical effectiveness, tolerance and costs in management of patients after surgical excision. Multicenter, randomized non-inferiority clinical trial on 113 patients]. / ALGINATE versus traitement par pression négative : comparaison de l'efficacité, de la tolérance et des coûts de prise en charge de patients après exérèse chirurgicale. Étude clinique multicentrique, randomisée de non-infériorité sur 113 patients.

INTRODUCTION: Pure calcium alginate dressing (ALGINATE) and Negative Pressure Wound Therapy (NPWT) are frequently used for the preparation of skin excisions for a split thickness skin graft take. The trial compared the healing efficacy, safety and cost of patient care for these two treatments. PATIENTS AND METHODS: This randomized, non-inferiority trial enrolled 113 patients who underwent skin excision (>30 cm2) and received ALGINATE or NPWT. The primary outcome was the time to obtain optimal granulation tissue for a split thickness skin graft take. Secondary outcomes were the occurrence of adverse events (AEs) and the impact of the patient care cost on the Social Security budget. RESULTS: The mean time to optimal granulation was similar between ALGINATE and NPWT: approximately 20 days. No AE was reported with ALGINATE while 24 % of patients treated with NPWT presented an AE. Following hospitalization, 94 % of ALGINATE patients were cared for at home by a private nurse, while 90 % of NPWT patients were followed up in aftercare and rehabilitation facilities or home hospitalization. Therefore, the cost of treatment per patient for the French Social Security was 498 € with ALGINATE and 2104 € with NPWT. CONCLUSION: This trial has demonstrated that ALGINATE has a similar healing efficacy to that of NPWT, and that it is markedly better with regard to patient safety and cost savings. ALGINATE should therefore be preferred to NPWT in this indication.

[The Evaluation of Calcium Alginate Dressing Helping Wound Healing of Nail Surgery].

OBJECTIVE: To determine the effect of calcium alginate dressing therapy on wound healing after nail surgery. METHODS: Patients with nail surgery on nail bed of great toe were divide into two groups (20 caces for each group) randomly based on random number table. Calcium alginate dressing were used in treatment group after nail surgery and the vaseline gauze were applied in control group after surgery. The number of wound remain bleeding and the rating of pain [visual analogue scale (VAS)] scores were observed for three times (24 h, 48 h and 72 h). Median time of pain bearing and time of wound healing were also observed. RESULTS: There were 16 males and 4 females in control group [mean age (37.45±3.30) yr.]. There were 12 males and 8 females in treatment group [mean age (33.40±3.13) yr.].There were no significant differences in sex ratio and age between the two groups (P>0.05). No infection was found in the treatment group, but 1 case in the control group. The number of bleeding cases in treatment group was less than that in control group (P<0.05), as well as the VAS scores 24 h after nail surgery (P<0.05). At 48 h, no bleeding occurred in the traetment group, while there were 2 cases of bleeding in the control group (P>0.05); the VAS score in treatment group was less than that in control group (P<0.05). At 72 h, no bleeding was observed in both groups, and the difference in VAS score between the two groups was not statistically significant (P>0.05). The median time of pain bearing was 24 h in treatment group while 72 h in control group. Wound healing time of treatment group (9.40 d) and control group (11.35 d) was statistically significant (P<0.05). CONCLUSION: Calcium alginate dressing therapy can promote postoperative wound recovery and block bleeding and pain after nail surgery.

Curative effect of soft silicone dressing combined with calcium alginate dressing in treating skin graft donor sites of burned patients / 第二军医大学学报

Objective To observe the curative effect of soft silicone dressing combined with calcium alginate dressing for treatment of skin graft donor sites of burned patients. Methods A total of 80 burned patients were randomly divided into treatment group (n=39) and control group (n=41). In the treatment group the donor sites were covered with calcium alginate dressing (Sorbalgon) inside and soft silicone dressing (Mepilex) outside, and the donor sites in the control group were covered with chlorhexidine gauze inside and multilayer sterile gauze outside. The wound healing, pain improvement and scar formation were evaluated in the two groups. Results The wound healing rates at post-operative 7, 10 and 12 d in the treatment group were significantly higher than those in the control group (treatment group:[51. 31±7. 09]%, [78. 77±8. 80]% and[96. 44±3. 24]%; control group:[45. 85±5. 54]%, [73. 63±7. 73]% and[93. 12±4. 08]%; P<0. 01). The wound healing time of the treatment group was significantly shorter than that of the control group ([10. 95±1. 41] d vs[11. 93±1. 44] d, P<0. 01). Visual analogue scale (VAS) scores at post-operative 1, 3, 7 and 10 d in the treatment group were significantly lower than those in the control group (treatment group:5. 36±1. 21, 4. 29±1. 25, 4. 00±0. 46 and 1. 00±0. 45; control group:7. 34±1. 34, 5. 89±1. 39, 4. 50±0. 74 and 1. 35±0. 52; P<0. 01). The Vancouver scar scale (VSS) scores at post-operative 1, 3, 6 and 12 month in the treatment group were also significantly lower than those in the control group (treatment group:3. 82±1. 47, 6. 00±1. 61, 3. 77±2. 28 and 2. 59±1. 39; control group:5. 80±1. 68, 7. 80±1. 65, 5. 24±1. 67 and 4. 05±1. 41; P<0. 01). Conclusion Soft silicone dressing combined with calcium alginate dressing in treatment of the skin graft donor sites can greatly improve the wound healing rate, shorten the wound healing time, relieve pain in dressing change and improve the wound healing quality, and it may serve as an effective method for protecting the donor sites.