الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 199 |  |  |
| | | from | 199 | | |
Abstract
Wound streatment is always a challenging issue. Delaying in wounds healing of is a major problem in the society; besides causing morbidity and disability in the patient, is a bioburden in health resources. Therefore is a need for application of new advanced technologies in wounds management. Negative pressure wound therapy promote healing of woundsand has a highly positive significantinfluence on healing process by growth of granulation tissue and wound repair, thus providing standard wound care system for the patients at an affordable financial cost.
Negative pressure wound therapy is recent developed therapeutic wound modality depends on sealing of drainage by suction force to create local uniform application of intermittent negative pressure environment to the wound bed transmittedthrough openpore foam. The study findings found negative pressure wound therapy a lifesaving method for open post-traumatic wound care. Negative pressure wound therapy can be beneficial by promoting wound healing and decreasing potential wound complications.
The aim of this study was to assess the effectiveness of negative pressure wound therapy on post-traumatic wound healing.
Materials
Research design:
A quasi-experimental research design, one-group posttest only was used to conduct this study.
Setting:
The study was conducted at the Plastic Surgery Department of Alexandria Main University Hospital (EL AMIRY). The inpatient Plastic Surgery Department of Alexandria Main University Hospital is located at the third floor and has the total capacity of 38 beds. 11 beds for male patients and 27 beds for females. The inpatient Plastic Surgery Department receives patients who have different types of wounds such as traumatic and crushed wounds to be treated by wound exploration, tissue repair, reconstructive surgery, flaps or skin grafts.
Subjects:
Sample of this study comprised a convenience sample of 25 adult patients with post-traumatic wounds admitted to Plastic Surgery Department at Alexandria Main University Hospital (EL AMIRY).
The study sample was estimated based on Epi info 7 program ,which used to determine the sample size using the following parameters: -
1-Total Population = 100 patients over a year 2018.
2-Confidence Level = 95%
3-Acceptable error = 5%
4-Expected frequency = 50 %
5- Minimum sample size = 22 Patients.
The final sample size was 25 patients.
The patient’s inclusion criteria are:-
1- Adult patients age from 18 to 60 years.
2- Both genders (male and female).
3- Healthy Patients without co-morbid conditions such as diabetics or peripheral vascular diseases.
4- Having post-traumatic wounds such as open contaminated and/or infected wounds with delayed primary closure.
5- Not on medication that may interfere with healing process as steroids, anti-inflammatory drugs and chemotherapy.
Tool:
To fulfill the objectives of the study, a tool was developed by the researcher to collect the necessary data for this study. One tool was used in this study.
Wound Healing Assessment Tool (WHAT)
This tool was adapted from El-Shatby A, (2003), Desokey G, (2008) and Ibrahim N, (2018).It was used to assess wound healing process for adult healthy patients using negative pressure wound therapy technique. It was consisted of three parts as follows:-
Part I: Patient’s socio-demographic data:-
It included personal data such as patient’s serial number, age, gender, level of education, occupation, marital status, area of residence and date of entry to the study.
PartII:Patient’s clinical data:-
It included: patient’s history for associated medical diseases or previous surgeries, date of injury, mechanism of injury, site of injury. Patient body temperature and hematological laboratory investigations such as hemoglobin, albumin and anthropometric measurements including patient’s weight, height and body mass index as criteria of nutritional assessment. White blood cells, C-reactive protein, erythrocyte sedimentation rate and microbiological wound culture if indicated as criteria for assessing local and systemic infection. Coagulation profile as criteria for assessing bleeding tendency.
PartIII A: Wound healing observation checklist for patients with traumatic wounds:-
This observation checklist was used for initial assessment of the wound pre NPWT application and posttest after NPWT application with weekly follow-up, through ongoing wound assessment of the healing process for (3-4 weeks) regarding the effect of NPWT on wound healing.
Wound healing was assessed for morphology and description of wound condition against certain parameters such as type of open post-traumatic wound , wound size in centimeters, depth of wound ,exposure of inner structures as well as wound conditions which includes granulation and epithelial tissue formation, type of wound drainage or exudates, amount of wounddrainage or exudates , wound edges, odor, signs of wound infection, necrotic tissue, wound surrounding and extent of wound healing as complete healing, partial healing or non-healing which mean as failure to progress through an ordinary sequence of wound repair process in a timely fashion and no improvement in wound characteristics.
Part III B:Photographic pictures:-
Photographic pictures were taken to record and compare different stages of wound healing process by healthy granulation tissue formation to be ready for closure by tertiary intention or skin graft, if indicated.
Method
An approval from the ethical committee, Faculty of Nursing Alexandria University was obtained. An official letter was issued from the Faculty of Nursing, Alexandria University to the study settings to obtain permission to collect necessary data. An official permission was obtained from the directors and head of the departments of the selected hospital setting after explanation of the aim of the study.
The tool was revised by experts in the field of the study for content validity and the necessary modifications were done.Reliability of the tool was tested using Alpha Cronbach’s statistical test. A pilot study was carried out on 10% of total number of the study subjects using study tool in order to check and ensure its clarity and feasibility. The necessary modifications were done, according to the results.Data were collected throughout a period of 5 months started from January2020 to end of May2020.
Statistical analysis:
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp) Qualitative data were described using number and percent Quantitative data were described using mean, standard deviation. Significance of the obtained results was judged at the 5% level.
Main results of the present study:
• The majority of the studied patients (72%) were within the age group ranged from 18 to less than 40 years.
• More than two third (68%) of patients were males. (56%) of them were illiterate and more than three quarters (76%) of them were married.
• More than half (56%) of studied patients were manual workers. More than half of the studied patients (60%) were from urban areas.
• The majority of the studied patients (68%) had no associated medical diseases and (64%) of patients had no previous surgical experience.
• The majority of the studied patients (68%) had post-traumatic wound from (1 day to less than 7 days) among the patients with post -traumatic wound, the common cause of injury was Road Traffic Accident (84%) of patients and the most common anatomical site of the post-traumatic wound was in the lower limb (32%) of studied patients had wound in the legs.
• The majority of the studied patients (72%) had a normal body temperature.
• Concerning hematological laboratory investigations (52%) of studied patients had below normal range of hemoglobin. As regards to white blood count (68%) of studied patients were above normal range. more than three quarters (76%) of patients had above normal range of C-reactive protein. (64%) of patients had erythrocyte sedimentation rate above normal. more than three quarters (80%) of patients had a normal albumin value, the result showed that (100%) of patients had normal coagulation profile.
• More than half (56%) of patients did not have a wound culture and sensitivity analysis.
• All of studied patients had a clean open wound in the follow up dressing period with significant differences between the three vacuum dressing periods.
• Statistical significant reduction in wound size in centimeters for length and width (cm) during three times follow up vacuum dressing was found as p value was (<0.001).
• Statistical significant differences in the depth of wound in last vacuum dressing after 3rd-4th weeks at the follow up periods was found as p value was (p <0.001).
• The majority of the studied patients (96%) had absent exposure of inner structure in of patients after the last vacuum dressing after 3rd-4th weeks of follow up period (p <0.001).
• The majority of the studied patients(72%) had normal granulation tissue formation:(100%) wound covered, surface intact or partial thickness wound with statistical significant differences in granulation tissue formation was present where p value<0.001 after last vacuum dressing.
• More than half (52%) of patients had no presence of epithelial tissue at the end of the last vacuum dressing after 3rd-4th weeks.
• The majority of the studied patients (64%) had serosanguineous: thin, watery, pale red/pink at the end of the last vacuum dressing after 3rd-4th weeks and statistical significant difference were found between different vacuum dressing periods.
• The majority of the studied patients (64%) had scant (<100 ml of drainage) in the last vacuum dressing after 3rd-4th weeks with highly statistical significant difference were present between the different vacuum dressing periods where p value<0.001.
• All of the studied patients (100%) had no wound odor in the last vacuum dressing after 3rd-4th weeks with significant differences between the different vacuum dressing periods where p value<0.001
• All studied patients (100%) had absence of local signs of wound infection and absence of necrotic tissue with significant differences after different vacuum dressing periods where p value <0.001.
• The majority of the studied patients (96%) had absence of inflammatory signs with statistical significant difference between the different vacuum dressing periods.
• The majority of the studied patients (96%) had no attached wound edges. with statistical significant difference were found between the different vacuum dressing periods as p value <0.001
• All of the studied patients (100%) had apartial wound healing in the last vacuum dressing after 3rd-4th weeks.
• There were statistical significant relations between granulation tissue formation and patient’s age and gender.
• There were statistical significant relations observed between granulation tissue formation and hemoglobin percent.
Based on these results, the following recommendations were suggested:
o Negative pressure wound therapy should be considered as a first-line therapy for delayed and non-healing wounds and to be the choice for infected, difficult and not responding wounds to conventional dressing.
o Negative pressure wound therapy can be used as a portable devices and home-care protocols are also expanding’s usage beyond the hospital setting.
o In service education program should be carried out for nurses and physicians regarding to using Negative pressure wound therapy technique and assess the different stages of wound healing. Negative pressure wound therapy is simple, quick and easily applied to use and appears to be promising alternative for the management of various wound types.
o Consideration that application of suction force not excessed than 125 mmHg in negative pressure wound therapy to avoid increase in pain sensation for patients.
o Study the impact of negative pressure wound therapy on Diabetic non healing wound.
o Study the impact of negative pressure wound therapy in management of chronic wounds.
o Study the impact of negative pressure wound therapy in the management of non-healing ulcer of the lower extremities.
o Efficacy of negative pressure wound therapy in the treatment of patients with burns.
o Study the effect of negative pressure wound therapy on post skin graft application surgery.
o Comparative study between negative pressure wound therapy versus conventional dressings in chronic wound.