Outcome of foam versus gauze dressing in negative pressure wound therapy for the management of acute traumatic wounds with soft tissue loss at Kenyatta national hospital.
Abstract
Background: Wounds have provided a challenge to the clinicians for centuries and this scenario
persists to the 21st century. Negativepressure wound therapy (NPWT) is one of the latest
additions in wound management. It has been widely adopted in developed countries with foam
as the default wound dressing although it has some limitations. This study aimed to investigate
the effectiveness of gauze as wound dressing in NPWT compared to foam and if gauze dressing
can overcome some of the shortcomings observed with foam dressing in NPWT.
Objective: To determine the difference in outcome between the use of gauze versus foam as
wound dressing in NPWT for the management of acute traumatic wounds with soft tissue loss.
Design: Prospective randomized comparative interventional study.
Methodology: The study involved patients aged 12 years and above admitted in the surgical
wards at KNH with class III or IV acute traumatic wounds with soft tissue loss involving the
lower limbs. Fifty two wounds from 51 patients were randomized into either the gauze or foam
group after surgical debridement. Patient demographics and wound characteristics were
recorded after consenting for the study and NPWT applied. After every 72 hours, the wound
was exposed, level of granulation assessed, wound surface area estimated and any presence of
infection noted.
Outcome measures: The main outcome measure is the time taken to achieve 100% wound
granulation. Comparisons were also made on the mean pain scores during dressing change and
the percentage change in wound surface area.
Results:Wounds took an average of 8.4 days in the gauze group and 8.1 days in the foam group
(p=0.698) to achieve full granulation. The percentage change in wound surface area was 5.3
versus 5.5 (P=0.769) in the gauze and foam groups respectively. The infection rates were
comparable between the two groups (28% for gauze and 23.1% for foam, p=0.697) and there
was no significant difference in the median pain scores (gauze= 4.5, foam=4.8 with p=0.174).
However, outcomes with gauze dressing were influenced significantly by the time to application
of NPWT, initial wound surface area and wound infection while with foam dressing outcomes
tended to be affected less so by the above factors.
Conclusion:In the use of NPWTfor the management of acute traumatic wounds, there is no
difference in terms of time to full wound granulation, change in wound surface area, wound
infection and pain during dressing change whether gauze or foam is used as the wound dressing
material.
Citation
Julius Gisore Ondieki. (2013). Outcome Of Foam Versus Gauze Dressing In Negative Pressure Wound Therapy For The Management Of Acute Traumatic Wounds With Soft Tissue Loss At Kenyatta National Hospital. A dissertation submitted in part fulfillment for the requirements of the degree of Master of Medicine (M.MED) in Surgery of the University of Nairobi.Publisher
University of Nairobi School of Medicine