Burns & Negative Pressure Wound Therapy

Negative Pressure Wound Therapy for Burns

Skin is not only the largest organ in the body; it is also one of the most important. The skin fends off countless insults every day such as ultraviolet light, temperature changes, and infectious microorganisms. After a serious burn, however, the damaged skin cannot offer that same protection, leaving the victim susceptible to fluid loss, hypothermia, and life-threatening infection. Fortunately, modern burn care has evolved to the point where most victims of burns can expect to survive their injuries and recover.

The superiority of negative pressure wound therapy

One major innovation that has helped improve recovery rates among patients who have sustained burn injury is negative pressure wound therapy. In negative pressure wound therapy a constant or intermittent vacuum is applied to a wound through a specialized dressing. The dressing usually contains a foam layer that is placed against the healing wound and a thin plastic covering that covers the foam and healthy surrounding skin. 

Negative pressure wound therapy is superior to standard burn care for several reasons. During the early stages of healing after burn injury, the wound produces a considerable amount of exudate. This fluid, full of white blood cells, proteins, and other substances, interferes with the wound’s ability to heal properly. Negative pressure wound therapy draws off this exudate, keeping it away from the fragile, healing, granulation tissue that lies beneath.1 This form of dressing also increases blood flow to the wound and decreases inflammation, which promotes healing.1 While any barrier protection will help protect the wound from contamination, a negative pressure wound dressing further minimizes the risk of wound infection by removing infectious materials.1 Once healthy granulation tissue has formed over the wound, the patient is ready for the next major innovation in modern burn care: the skin graft. 

Using negative pressure wound therapy after skin graft

In skin grafting, surgeons removed a portion of skin from a large, unburned region of the body and place it over the wound. Once the grafted skin is in place, physicians again use negative pressure wound therapy to cover the surgical wound.1 This helps bolster the skin graft, secure the graft to the wound bed, and help to ensure that the graft will “take,” i.e., persist as viable skin.1 Research suggests that negative pressure wound therapy after skin graft coverage of burn wounds helps the new skin take substantially more often than standard dressings (Vaseline, dry gauze).2,3 In fact, the technology has advanced to such a degree that skin graft patients can be discharged with an at-home vacuum-assisted closure device.4

Ensure pain control

After initial treatment, dressing changes are the most painful part of burn care. Unlike moist saline dressings that need to be changed 3 times a day, negative pressure wound closure, on the other hand, only needs to be change every 3 days. The discomfort that occurs during dressing changes can be managed by pretreating with pain medications, following the proper technique, and choosing the right tape.

When using negative pressure wound therapy, proper technique during dressing changes can make a profound difference in patient care and satisfaction. Prior to a dressing change, make sure the patient has adequate oral or IV pain control on board as prescribed. Unless contraindicated, caregivers can apply a 1% lidocaine solution through the vacuum tubing and into the foam dressing prior to 15 minutes dressing change. The pump can be set at a positive pressure to make sure the lidocaine solution reaches the entire area (max 50 mmHg). If the area is too dry, it can be moistened with normal saline immediately prior to dressing removal so that the foam releases cleanly.

Make sure the bandage fits the wound

Once the old dressing has been removed, make sure the new foam dressing is cut to fit the unique shape of the wound. Most wounds are irregularly shaped, so that the wound’s unique shape be your guide. Remember the foam will compress under vacuum and occupy a smaller volume, so it is essential to account for this shrinkage during sizing. Use a thin foam dressing for shallow wounds (and the perineal area) and the thick dressings for deeper wounds.

The importance of maintaining a vacuum seal

It is absolutely critical that the negative pressure dressing is completely covered and that it maintains a tight seal over its entire area. Even a small leak in the clear plastic covering can prevent a true vacuum. Without a proper vacuum, patients cannot reap the benefits of negative pressure wound therapy. 

To ensure a tight, continuous seal, clean and dry the area around the wound prior to affixing the new dressing. This will allow a clean surface for adhesives. The clear plastic covering included in negative pressure dressing kits should extend beyond the foam dressing on every side and make contact with healthy skin. Unfortunately, the adhesive on this clear plastic covering does not always hold fast and is prone to leaks. Remember to create a tight seal by framing the border on every side with medical tape. The tape should straddle the edge of the plastic covering and affix to healthy skin.

Adding Hy-Tape to your negative pressure wound therapy regimen

Hy-Tape is the ideal medical tape to use in negative pressure wound therapy. The original “pink tape” uses a unique adhesive that provides the perfect combination of hold and release. The adhesive resists moisture, so it holds tightly even during the early exudative phases of burn healing. Hy-Tape holds strong over several days, maintaining a vacuum seal between dressing changes.  Keep in mind that Hy-Tape is not sterile and like, all medical tapes, should never be placed directly in a burn wound or on unhealthy skin. 

When it is time for a dressing change, Hy-Tape releases cleanly and without traumatizing the skin. Selecting a gentle-release tape like Hy-Tape helps reduce patient discomfort during dressing changes. The zinc-based adhezive soothes the skin, maximizing patient comfort.

Hy-Tape is also a great choice for affixing negative pressure wound therapy dressings because it is thin and conforms to the underlying healthy skin. Morevoer, Hy-Tape has unique thermal properties that allows it to adhere even more strongly once it reaches body temperature. Hy-Tape comes in rolls and strips, providing the flexibility to form a tight border seal on even the most irregularly shaped burn wounds. If Hy-tape is correctly placed around the border of the negative pressure wound dressing, the vacuum seal will hold.

References

1. Teng SC. Use of negative pressure wound therapy in burn patients. Int Wound J. Sep 2016;13 Suppl 3:15-18.

2. Petkar KS, Dhanraj P, Kingsly PM, et al. A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients. Burns. Sep 2011;37(6):925-929.

3. Waltzman JT, Bell DE. Vacuum-assisted closure device as a split-thickness skin graft bolster in the burn population. J Burn Care Res. Sep-Oct 2014;35(5):e338-342.

4. Mushin OP, Bogue JT, Esquenazi MD, et al. Use of a home vacuum-assisted closure device in the burn population is both cost-effective and efficacious. Burns. May 2017;43(3):490-494.