This document summarizes the use of simplified negative pressure wound therapy (sNPWT) in pediatrics. sNPWT uses a portable, canisterless device to apply negative pressure between 25-125 mmHg to wounds. It promotes healing through microcirculation, tissue oxygenation, and bacterial reduction. The document finds sNPWT has benefits over traditional NPWT like improved tolerance, ability to be used as outpatients, and reduced dressing changes and pain. However, sNPWT has limited duration and inability to modulate pressure. Overall, sNPWT was found to achieve over 90% total wound healing.
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Simplified Canisterless NPWT in Children
1. Simplified Negative Pressure
Wound therapy in pediatrics
Serena Crucianelli and Guido Ciprandi
Unit of Plastic and Maxillofacial Surgery
Bambino Gesù Children’s Hospital
IRCCS, Rome - Italy
Wound Care Team- Unit of Plastic and Maxillofacial Surgery
2. 2
Negative Pressure Wound Therapy
• Atmospheric pressure is 760 mmHg
• “NPWT is applying a negative pressure regimen over a wound bed for healing purpose”
• Pressure range for pediatric NPWT is from 25 to 125 mmHg
How does it work?
Microcirculation
(Angiogenesys)
Migration
Tissutal Oxigenation
Granulation Tissue
Fibroblast proliferation
and rooter facilities.
Edema and moisture
Bacterical charge
Wound Care Team- Unit of Plastic and Maxillofacial Surgery
3. 3
Simplified NPWT for Children
• 5star clinical acceptance
• No noise
• No impairment of activities
• Specific Exclusion criteria: NONE
• Infected lesions: YES, accepted
• Visual assessment (the shadow-effect): YES
• Body site: everywhere
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
4. 4
Simplified NPWT• Leak rate
• Seal activity (no-alarming)
• 2/3 weeks closure
• Continuous delivering of NP
• Costs and transports
• Easy to find/ease of use
• Technical support: needless
• Nursing of caregivers
• An every-day device
• Home-caring
• Small size – small patients
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
5. 5
How to apply Simplified NPWT in children
• Reshape and modeling: YES
• Age: Premature YES
• Spinal lesions: YES
• To be centered
• Perfect and proper WBedP
• Exudate absorption/evaporation
• Early discharge from acute care
• < wound healing complications
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
6. 6
What’s traditional, what‘s simplified…..
TRADITIONAL:
SIMPLIFIED:
tNPWT
sNPWT
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
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FIELDS OF APPLICATION IN PEDIATRICS
Complex
Wounds
Acute
Wounds
Chronic
Wounds
Surgical Wound
Necrotizing
Fascitiis
Vascular lesions
Pressure ulcers
Deiscence
Infected wounds
Traumatic Wound
Open Abdomen
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
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• TRAUMATIC WOUNDS
• DEEP BURN INJ.
• HIGH STAGE PRESSURE ULCERS
• STERNOTOMY DEISCENCE
• OPEN ABDOMEN
• NECROTIZING FASCITIIS
• DERMAL GRAFT,
• AT RISK SURGICAL WOUNDS
• INFECTED WOUNDS
• BITES, VENOM INOCULATION
• UNEXPLORED FISTULA
• PALLIATIVE WOUND CARE
Inclusion Criteria
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
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•LACK OF COOPERATION
•NEGATIVE PSYCHOLOGICAL EFFECT
◦REFUSE TREATMENT
•HIGH RISK OF BLEEDING
• WOUNDS NOT AT RISK
• SUPERFICIAL WOUNDS
•IF DEBRIDEMENT IS PREVIOUSLY REQUIRED
•EXPOSED VESSEL , ORGANS, NERVES
•NECROSIS/ESCHAR NOT TREATED YET
•UNTREATED OSTEOMIELITHIS
•UNEXPLORED ENTERIC FISTULA
•NEOPLASTIC LESIONS
Exclusion Criteria
GENERAL CAUSES:
LOCAL CAUSES:
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
10. 10
Pressure range for pediatric patients
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
from- 25 to 50 mmHg
sometimes 75 mmHg
Newborns(LBW),prematures,occipits,
Open Abdomen, Ears,
Exposed carthilage and bones
from -25 to -75 mmHg
Children > 3 years
Sternal Wounds
from - 25 mmHg up to
mmHg Rest of pediatric
population
SPIRACUR
75mmHg
PICO
80mmHg
SPIRACUR
100mmHg
NANOVA
SPIRACUR
120mmHg
SPECIFIC FOR AGE AND SITE!
11. 11
NPWT in children
1. The use of NPWT in children is reported from 2006 (adults from
1996)
2. All studies confirm its benefits and multiple fields of application in
a pediatric population.
3. Simplified, portable device NPWT has been
introduced in 2011:
10 pubblications in adults.
Just 4 single case report in children
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
All studies affirm more PROS in sNPWT (in selected Wounds) than tNPWT ….
12. 12
OPBG study: 77 patients (2011-2016)
Traditional NPWT Canisterless NPWT
0%
50%
100%
Occipit
Back,Torax
Abdomen
Sacro-Gluteal
Lower Leg
Wound
Loc.
Infection
NPWT WOUNDS
DISTRIBUTION vs % OF INFECTION
33% Lower Leg 12%
24% Sacro-gluteal 82%
21%Abdomen 65%
19%Back/Thorax 15%
5%Occipit 9%
Girls
Average 5.3 years
Lower LEG
Thorax, abdomen
S-g and Abdominal Wounds > infected
(Dott.G Ciprandi unpublished data)
346Patients globally unde rgone NPWT
269 patients for traditional NPWT.
77 for Canisterless NPWT.
50
100
150
200
250
300
101
33
168
44
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
13. 13
Comparing Therapies
0 50 100
Dressings Traditional
Advanced Dressings
traditional NPWT
Canisterless NPWT
90
50
16
10
7
60
80
95
30
80
90
99
% politherapy healing
% monotherapy healing
Healing time
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
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Outcomes NPWT
0% 20% 40% 60% 80% 100%
HEALING; 55%
PROGRESSION
TROUGH HEALING
35%
RECRUDESCENCE;
10%
Total Healing >85%
0% 50% 100% 150% 200%
HEALING; 90% PROGRESS ; 9% RECRUDESCENCE<
1%
NPWT SIMPLIFIED Total Healing -99%
NPWT TRADITIONAL
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
16. 16
CONCLUSIONS:
Traditional
NPWT
Simplified
NPWT
sNPWT CANISTERLESS, PORTABLE DEVICE
PROS:
< device related cost
Patient’s tollerance
> out-patients
No patient’s functional limitation
< Dressing change time required
< pain referred at dressing change
Almoust no adverse reaction
CONS:
Limited duration (aspiration pump expire)
No Modulation of pressure regimen.
Multiple lesions
Too wide or exudating wounds
sNPWT… Pro and Cons
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
17. 17
IMPROVING …..THE IMPROVABLE
COLLABORATING FOR NEW PEDIATRIC DESIGNS:
More Durable and silenced pumps
More funny and endearing Designs
A Wider spectrum of available pressure range
( now just 80 or 120 mmHg)
Lower Pressures and dimensionally reduced dressings, miniaturized dressing
for the smallest babies.
(NICU e PICU)
Wound Care Team, Unit of Plastic and Maxillofacial Surgery
