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INTRODUCTION Table 1: Patient and wound characteristics at
baseline (n = 66)
Negative pressure wound therapy (NPWT) has fundamentally Patient characteristics
changed complex wound management, such that it is now Age at NPWT application, median (range) 13 years (10 months-18
considered an independent rung on the “reconstructive years)
ladder.” [1-4] NPWT therapy has been studied extensively Gender 31 females; 35 males
2
in adults, where it has found applications in chronic Body mass index (kg/m ), median (range) 21.5 (14.1-45.9)
wounds, open abdominal wounds, and open fractures, Serum albumin (g/dL), median (range) 4.2 (2.5-4.8)
22
Patients using NPWT during chemotherapy
amongst others. [5-8] Recent studies have showed Patients receiving chemotherapy 56
that outcomes in the pediatric population are often Patients receiving radiation 24
equivalent to those reported in adults. [9-12] However, no Wound size (cm ), median (range) 27 (4-250)
2
large studies have examined the use of NPWT in the Time until wound closure (days), 21 (3-236)
pediatric oncology population, a group which is unique median (range)
given the frequent utilization of extensive surgery,
systemic chemotherapy, radiotherapy, and (in some Duration of wound NPWT (days), 21 (3-236)
cases) stem cell transplantation. [13] In this study, we median (range)
reviewed our single-center experience with NPWT in NPWT: negative pressure wound therapy
pediatric oncology patients and reported our outcomes
with respect to efficacy, safety, and technical innovation Table 2: Pathologic diagnosis of primary tumors
in wound treatment. Primary disease Number of patients
Osteosarcoma 30
Ewing sarcoma 6
METHODS Retinoblastoma 2
Acute lymphoblastic leukemia 6
Records of patients treated with NPWT at a single Acute myeloid leukemia 2
center between April 2005 and September 2013 were Adrenocortical carcinoma 1
reviewed. Approval for the study was obtained from the Dermatofibrosarcoma protuberans 1
institutional review board of the respective institution. Epitheloid sarcoma 1
Patient data included demographics, diagnosis, and Glioma 1
duration of NPWT, adjunctive treatment, wound size, Hodgkins lymphoma 1 2
Melanoma
definitive wound closure technique, complications, Malignant fibrous histiocytoma 1
chemotherapy, radiation, recurrent disease, and general Malignant peripeheral nerve sheath tumor 2
outcomes. Soft tissue high grade polyphenotypic sarcoma 1
Rabdomyosarcoma 1
All NPWT systems used in this study were designed Sickle cell anemia 1
and manufactured by Kinetic Concepts, Incorporated Synovial sarcoma 5
(KCI Inc, San Antonio, TX, USA). The device includes a Malignant teratoma of the sacral bone 1
®
vacuum-assisted cosure (VAC) dressing (wound VAC ® Thalamic glioblastoma 1
dressing), consisting of a polyurethane or polyvinyl
sponge placed directly over a wound site. The sponge Our sample had 35 males to 31 females. The median body
2
2
is then sealed with plastic tape and connected to a mass index (BMI) was 21.5 kg/m (range, 14.1-45.9 kg/m ).
negative pressure device with a tube. The vacuum Only 5 patients had serum albumin less than 3.4 mg/L,
pump in the device creates a sub-atmospheric negative and only 1 patient had serum albumin less than 3.1 mg/L. There
pressure in the wound bed, and it is reported to was no association between serum albumin level and
reduce edema, increase local blood supply, increase adverse events (P > 0.05). Wounds were primary wounds
the formation of granulation tissue, reduce bacterial in 62 patients, and recurrent in 4 patients.
colonization, improve patient tolerance, and accelerate
wound healing overall. [14,15] Patient primary diagnoses are reported in Table 2.
Fifty-six patients received chemotherapy at some point
RESULTS during their cancer therapy, and 22 of these patients
had wounds requiring NPWT during chemotherapy. In
Between April 2005 and September 2013, a total of these latter patients, NPWT was used for a range of
66 patients were identified for study inclusion. Seven 21-206 days. Twenty-four patients received radiation
patients required multiple wound VAC, or a wound therapy at some point during their cancer treatment.
VAC at multiple times, for a total number of 74 wounds Of these patients, the radiation dose was administered
treated with NPWT. Patient and wound characteristics at to the site of the wound in all but nine cases.
baseline are reported in Table 1. The median patient age
was 13 years, with a range of 10 months to 18 years. NPWT was used in total of 66 patients. Three patients
Plast Aesthet Res || Volume 3 || July 14, 2016 249