Development of a Soft Tissue Reconstructive Ladder in Trauma Patients to Improve Patient and Health Care Outcomes With the Use of Negative Pressure Wound Therapy Systems and Cellular Tissue Products

My name is Elizabeth Faust. I'm a nurse practitioner. I oversee the Inpatient Wound Care Department at Reading Hospital, part of Tower Health in West Reading, Pennsylvania.

I did a poster with Dr. Esther Kim, who's one of our general surgery residents, on the development of a reconstructive ladder in trauma patients. It's basically to help augment the patient and healthcare organizations' use of negative-pressure wound therapy with installation and dwell, as well as cellular tissue products.

It's no secret that we are short on supplies and staff nowadays, and what we found was what our staff called a vac floor. It was patients that were hanging out for months on end, getting repeat negative-pressure applications and maintenance, and waiting for the right time for final closure. So I said, "This is kind of silly."

And so, I worked with the surgical residents at the time to develop what does literature say and what can we do about it. So we proposed that we look at what we've done over the last six months with our trauma patients, and we had inclusion and exclusion criteria. So we looked at large soft tissue injuries that were complex, that required an operative debridement and negative-pressure wound therapy application.

So we had 10 patients that qualified for that over the last six months. What we found was that seven had early initiation of installation and dwell therapy with... I'm sorry, seven did not have that. Three did. So, of the 10, three were in our treatment group and seven were in our control group. And what we found was quite astonishing and I think really adds to the care continuum bundle, where we were able to initiate installation and dwell therapy in order to get appropriate wound bed preparation to apply a cellular tissue product. Or I guess, now we're calling it a cellular acellular matrix product, CAMP, in order to get the patient to discharge sooner.

So in those patients that had that protocol in place, we were able to discharge them 23 days sooner than those who did not have that. And the time to closure was 13 days sooner. One of kind of the novel things that we discovered was that we were able to also decrease the number of dressing changes because once we apply that CAMP product to the wound bed, we were able to use a bolster negative pressure and then change that weekly. So that decreased the care that was needed.

We've had a real shortage of home health agencies in our area. And so, finding somebody to perform routine dressing changes on these patients has been a barrier to discharge and obviously increasing length of stay. So we think that it was a little bit of both, the social aspects and operational logistical things, in addition to the added clinical benefits that this reconstructive ladder found. So we think that more research obviously needs to be done, but we've adopted this as our go-to when we have a large soft tissue injury of either infectious or traumatic nature.