Circumferential Closed Incision NPWT: Case Insights

I'm Omer Sadeh, a general surgery resident at Florida Atlantic University in Boca Raton, Florida, speaking on behalf of Dr. Anthony Dardano. My place of practice is Delray Medical Center in Boca Regional Hospital in Boca Raton, Florida. I am a second-year general surgery resident. 

How does circumferential negative pressure wound therapy differ from traditional NPWT?

So, the idea or the concept behind circumferential negative pressure wound therapy is that essentially it takes the idea of the entire lower extremity and tackles that issue as far as the lower extremity edema versus just a negative pressure wound therapy that sort of focuses on one smaller area of a wound. This focuses on the entire lower extremity to tackle the edema. 

Can you share some details from your case report presented in your poster at SAWC Fall?

So, what happened was he developed lower extremity trauma from motor vehicle collision, had orthopedic surgery done, and there was a closed incision with staples. Now he developed lower extremity edema along the entire lower extremity. So, we took two large XL Granufoam. First of all, we took-- and so what we did was we took multiple sheets of xeroform, covered the entire lower extremity, right above the upper thigh, down to the ankle. We then took two large Granufoam XL sheets, one anterior, one on the front, and one posterior. We created what is called a pita method, basically sandwiched. We then took iodoban, and we laid down the foot on the iodoban from behind, from the posterior section, and on top we laid another sheet of iodoban from the front, from the anterior portion. And then we essentially used what's called circumferential coverage,

So essentially five days of using the circumferential method of the NPWT, we saw a significant decrease in lower extremity edema. Measuring the lower extremity prior to wound vac placement versus after five days of placement, there was a four-centimeter difference in circumference of the lower extremity it shows that really there is a significant effect of the circumferential method with the NPWT, all while distal lower extremity perfusion is not compromised. So we essentially took daily measurements using a pulse ox monitor on the lower extremity of the toes,and we saw that there was no compromise of a basket of perfusion or oxygenation saturation to the lower extremity, to the foot. And, while, even though that the foot was not wrapped, nothing was interrogated with the foot, only, you know, from the ankle up, the edema in the foot also significantly decreased with this method. So it's an effective, simple method for tackling the edema in the entire lower extremity. So, you know, the take home message here really shows that you can use circumferential negative pressure wound vac therapy over a closed incision using our method that does not, you know, sort of, you know, really wrap the leg around in a circumferential matter, but rather a sandwich method. You can significantly reduce edema in the lower extremities all while vascular profusion is not compromised.