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Pearls for Practice: A Hydroconductive Dressing as a Potential Alternative to Negative Pressure Wound Therapy
Negative pressure wound therapy (NPWT) involves the controlled application of subatmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump.1 This therapy can help convert an open wound into a controlled, closed wound while removing excess fluid from the wound bed, reducing edema, and creating a moist healing environment.2,3 But NPWT has several drawbacks. Having the tubing constantly connected to a vacuum source can limit mobility for ambulatory patients, a problem partially alleviated by recent modifications involving portable NPWT devices. Some anatomical locations require imaginative solutions to maintain the seal. The cost of NPWT is greater than standard advanced wound care dressings. Additional care, often performed by nursing personnel, is required to empty the reservoir and re-establish the vacuum, which further increases the cost of therapy.
Recently, a hydroconductive dressing (Drawtex, SteadMed Medical, LLC, Ft. Worth, TX) was introduced to the wound care market that exhibits many of the attributes of NPWT. This dressing helps control exudate and decrease edema, reducing the substances that cause biofilm formation4 as well as cytokines such as matrix metalloproteinase-9, known to be detrimental to wound healing.5 Because these actions are similar to those shown to influence NPWT effectiveness, a hydroconductive dressing potentially could be used as an alternative to NPWT in selected cases.
The hydroconductive dressing has served well as a substitute for NPWT in a number of different scenarios. One illustrative case involves a 66-year-old man who was post lateral neck dissection. The patient declined the reconstructive surgeon’s recommendation for flap coverage for the large operative defect. NPWT would have been a natural choice in another anatomic location; however, due to the proximity to major vessels and the depth and extent of the wound, clinicians decided NPWT would pose a great danger, even under close supervision. Instead, the hydroconductive dressing was used as a temporizing measure until the patient might eventually decide to have surgery (he did not). The wound healed completely by secondary intention and re-epithelialization using only the hydroconductive dressing as the treatment agent. Initially, the dressing was changed daily; as wound healing progressed, applications lessened to fit the decreasing drainage pattern. The patient was discharged from the outpatient facility with a closed and mature wound. No evidence of severe scarring or contracture has been noted, and the patient’s range of motion is limited only by the nature of his initial surgical defect.
A second case involves a 60-year-old woman with diabetes who presented with severe, bilateral, deep abscesses on the buttocks. Following debridement and drainage, NPWT was contemplated, but positioning the device would have been complicated because of the inter-gluteal crease, and NPWT would have limited the patient’s mobility and activities. Daily hydroconductive dressing changes were implemented, which resulted in excellent drainage control, no limits on mobility, rapid improvement in wound tissue quality, and closure by secondary intention.
In inguinal wounds following vascular surgery in which dehiscence or hematoma drainage resulted in an open wound, the inguinal crease is a difficult anatomical area for NPWT; plus, ambulation is desirable following vascular reconstructive procedures. In these cases, multiple layers of the hydroconductive dressing often are stacked to control the lymphatic drainage and to create a contoured dressing. This treatment facilitated progression to a healing trajectory in rapid fashion without the cost or inconvenience of NPWT.
Orthopedic surgery involving removal of infected prostheses or debridement of osteomyelitis often produces a large amount of purulent drainage. NPWT use commonly results in significant wound edge maceration. Stacked hydroconductive dressings have controlled the purulent drainage and not resulted in wound edge maceration, allowing epithelialization to proceed and healing to be accelerated.
In a recent case of an above-knee amputation, NPWT was difficult to maintain while the patient was ambulating; NPWT also inhibited the fitting of a prosthesis. Stacked hydroconductive dressings allowed wound healing to occur while rehabilitation was not inhibited.
Although NPWT has been a great advance in the management of many complex wounds, situations exist in which it is not helpful for patients. In these cases, hydroconductive dressings provide an excellent alternative. The dressings can be changed as necessary and used in single or multiple layers. Plus, because they facilitate mobility and ambulation, they have great patient acceptance.
Pearls for Practice is made possible through the support of SteadMed, Fort Worth, TX (www.steadmed.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and are not necessarily those of SteadMed Medical, LLC, OWM, or HMP Communications.
This article was not subject to the Ostomy Wound Managment peer-review process.
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4. Wolcott R, Rhoads D, Dowd S. Biofilms and chronic wound inflammation. J Wound Care. 2008;17:333–341.
5. Ochs D, Umberti MG, Donate GA, Abercrombie M, Mannari RJ, Robson MC, Payne WG. Evaluation of mechanisms of action of a hydroconductive dressing for chronic wounds. Poster presented at the Symposium on Advanced Wound Care, Atlanta, GA. April 19–22, 2012.
