ABSTRACT: The use of negative-pressure wound therapy (NPWT) has been shown to produce significant benefits in wound healing including surface tissue micro-deformation, decreased wound edema, and the removal of wound exudate. However, the effectiveness of NPWT on bioburden eradication is controversial. In fact, Weed et al (1) found bacterial colonization increased significantly with NPWT and remained in the range of 10(4)-10(6). Boone et al (2) found the bacterial burden continued to increase and broaden in a porcine wounds model. In another study, Yang et al (3) compared NPWT to negative pressure wound therapy installation (NPWTi) with a topical antimicrobial irrigation following sharp debridement of which the latter yielded a 48% reduction in biofilm. However, after one week, there was no difference in the wound size between the two groups. Furthermore, an interesting study performed by Moog et al (4) indicated that NPWT did not improve bacterial bioburden in 77% of the cases regardless of the duration of negative pressure, however, NPWT coupled with surgical debridement and jet lavage decreased bacterial load in approximately 60% of the cases.
PURPOSE: The literature is replete with focused studies on bioburden eradication and what methods yield the better results in its quantitative reduction in combination with NPWT (installation therapy, surgical debridement, jet lavage, etc). But what about the rate of wound closure and expense? Are there better bioburden eradication options when it comes to NPWT that are centric for wound bed preparation that are more beneficial, easier, and less expensive? Therefore, the intent of the author was to use a new innovative sharp debridement instrument (EZDebride) in conjunction with NPWT to determine its effectiveness in wound size reduction. Both planktonic and biofilm colonization are associated with delayed wound healing and the author wanted to examine wound healing variables by method of sharp debridement performed in a focused, precise, and controlled depth manner (EZDebride) in conjunction with just NPWT without installation therapy.
PATIENT PRESENTATION: This is a case of a 64 yr/o male who presented status post surgical debridement of a chronic diabetic left foot ulcer x 7 months duration. Following surgical debridement, a NPWT had been applied x 3 applications. The wound size following surgical debridement was 5.5 x 3.3 x 0.2 cms. PMH: DM Type II x 26 years (neuropathy), Diabetic Nephropathy stage 3, HTN, MI 2005 (s/p 2 heart stents 2005/2019) Meds: NovoLog 100 U/ml, Plavix 75 mg/qd, Diltiazem 120 mg/daily, Lisinopril 20 mg/daily, Vit D supplement, Simvastatin 20mg/daily. Allergies: NKDA
RESULTS: The EZDebride Wound Instrument has been shown to eradicate up to 75% biofilm with 100% complete removal in 19% of the cases (5). With the use of Surgical Debridement and NPWT x 1 week, the wound decreased in size by 10.1%. After one week of Sharp Debridement (EZDebride) and NPWT, the result was a 62.6% reduction in the overall wound size, and by week 2, the wound decreased in size by 72.9%. Overall, in just two weeks, with sharp debridement and NPWT, the wound decreased by 89.9%.
CONCLUSION: The Sharp Debridement (EZDebride) was very economical, feasible, and yielded excellent results. The reduction in wound size using sharp debridement with NPWT was significant even after one week with an overall 89% reduction in wound size after 2 weeks. No complications were encountered secondary to pain and bleeding. The Sharp Debridement Instrument should be highly considered with use of NPWT due to its controlled depth sharp debridement, eradication of Bioburden/Biofilm, and wound bed preparation capabilities: it could be the certainty of what is really missing in NPWT.