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.