Michael N. Desvigne, MD, FACS, CWS, FACCWS:
Hi there. My name is Michael Desvigne. I'm a plastic and reconstructive surgeon. I come from Phoenix, Arizona. I work at the Arrowhead Abrazo Wound Clinic and Hospital. I have joining with me today my assistant, Jody Wolfe, who is an RN and CWOCN, who is director of our wound program at Abrazo, and we also have our assistant and now patient who we are going to demonstrate today some use of negative pressure wound therapy.
So a little bit about negative pressure wound therapy. It's now evolved over the last 30 years, and it's something that we utilize to help treat wounds. It is negative pressure that is applied through a foam dressing and a machine, which then allows negative pressure to be delivered. What we've learned is that the use of negative pressure wound therapy can help with wound bed preparation.
Firstly, we have a negative pressure wound therapy dressing that is designed to deliver installation and dwell, and what we mean by that is fluid will be instilled into the foam and then delivered to the wound bed to allow for an installation and dwell time. What we have now is a reticulated open cell foam, as Jody is turning on the machine to allow it to warm up. What she is demonstrating is cutting the foam to size to fit the wound bed. This waffle-type dressing and foam will allow for cleansing of the wound bed as we instill fluid and allow it to drain.
As she's carefully cutting the dressing to size, she is then going to cut the hybrid drape, which is also a specialized drape to allow for protection of the periwound. This kind of cut-and-paste technique is unique to this more traditional type of negative pressure dressing and also with the installation and dwell dressing. As she prepares the hybrid drape. She uses the 2 ends almost like a handlebar, and the reason that's so important is some of the other more classic dressings we've needed to cut further prior to placement. She's carefully placing the foam onto the wound bed, again with the waffle side, with the reticulated open cell foam onto the wound bed, and then placing the hybrid drape to allow for coverage so she can maintain a seal, as you saw her do. This dressing is special in that it's allowed to reposition up to 20 minutes, and so if there is a small wrinkle, that can be taken care of by repositioning the dressing.
Again, she's using what might appear to be an excessive amount of the drape, but because the drape has this hybrid technology, it is very protective of the periwound, so there's no fear of causing any tissue damage of the periwound. The tabs are easily removed, and again, she's smoothing out that drape to make sure that she can maintain a seal. She's now cutting an area for the track pad. Once again, there's a fair amount of cutting and sort of customizing of this particular dressing, and as we'll see in comparison to the newer dressing available, it’s slightly different and takes a little bit more time.
As she's taking out the track pad, I want to note that there are sets of tubing. One is for the installation of fluid and then the other is for the negative pressure. As she places the track pad over the area of the foam, she's carefully once again removing the tabs and allowing for the dressing to create a seal. As she's doing that, she's also considering how the patient will be lying in bed or sitting so that she can basically appropriately place the tubing so that it's not in the way of ambulation. Again, she's now hooking up the tubing to the system again, which will allow installation of fluid as well as a dwell time as we're starting to get a drawdown to make sure that we have an adequate seal. Jody is now pointing out the areas where she can now choose the type of therapy. There are several therapies available with this particular unit, which is available in the acute care setting.
She chooses the appropriate installation in dwell therapy, which is what is designed for this particular dressing, and you can hear the machine as it starts and ramps up. We have a nice seal and you see the drawdown of the dressing itself. The options of this dressing will allow for several different volumes of fluid, and you can basically customize based on the size of the wound bed and the amount of fluid that you would like to instill and then allow for dwell. The benefit of this dressing once again, is to allow for a removal of exudate, and this particular dressing with the reticulated open foam will also, because of the ability to fracture any debris, can actually allow for a hydromechanical debridement as well.
