Page 315 - Read Online

Kumar et al. Plast Aesthet Res 2020;7:29 I http://dx.doi.org/10.20517/2347-9264.2019.71 Page 9 of 11

MDR (multi drug resistant) organisms can be effectively treated: Multi-drug resistant organisms are not
resistant to the negative pressure of LAD.

2. Control of SIRS
LAD reduces systemic symptoms and signs of toxicity related to traumatized tissues, burns and gangrene.
In a study of two groups comprising 54 burn patients (27 in each of LAD and control groups; at the time of
induction, both groups showed no significant difference), there was no statistical difference in SIRS on day 1,
but SIRS and organ dysfunction on day 5 was significantly lower (P-values of 0.029 and 0.017 respectively)
in the LAD treated group [30,37] .

Protection of ischemia induced oxidative damage in LAD treated wounds
Ischemia induced anaerobic respiration leads to reduced ATP production, and reduced antioxidant
[44]
[41]
protection . Studies on LAD treated burn wounds [42,43] , diabetic wounds and chronic wounds [45,46]
have shown significant reduction in oxidative stress (malondialdehyde level), and significant increase in
antioxidants and nitric oxide levels.

Clinical study to find role of LAD in trauma
[30]
In a case series of 20 consecutive cases of musculoskeletal extremity trauma treated with LAD without
specific controls, 14 cases had exposed, problematic structures with exposed bone in 8 cases, exposed
tendons in 3 cases, exposure of both bone and tendon in 2 cases, and an exposed injured brachial artery in
1. Results were quite encouraging. Edema under LAD in these cases was minimal. There was a reduction
in the number of debridements: total number of debridement procedures was 23 in 20 patients (average
1.15/patient; range 0-3). Wound bed preparation time was excellent in 5/18 cases, fair in 11/18 cases and
poor in 2/18 cases. Excellent (> 99% of grafted area) graft take was seen in 18/20 cases. Conversion rates
from cases that required complex reconstructive procedures (e.g., flap) for exposed vital structures to
simple reconstructive procedures (SSG) was 11/13 × 100 = 84.6%. Functional recovery of the hand was
excellent in 4/10 cases, fair in 2/10 cases, and poor in 4/10 cases.

The average cost of treatment was less than one-third of the treatment cost for similar procedures using
wet-to-dry dressing (cost calculation was done based on reduced number of debridements, reduced
anesthetic requirement, excellent graft take, reduced post-treatment physiotherapy, and rehabilitation
costs).

From an administrative point of view, the quality of care was improved due to the reduction in required
resources in emergency.

CONCLUSION
It was concluded that in addition to available medical and surgical interventions, substituting conventional
closed dressings with LAD in cases of musculoskeletal trauma helps in reducing secondary damage as
evidenced by the reduced number of debridements, reduced wound coverage time, and reduction in total
length of hospital stay while lowering treatment costs and improving quality of care.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Kumar P
Made substantial contributions to data acquisition and performed data analysis and interpretation: Gupta A,
Gupta A