Dr Emma Lumsden^1,2,3, Professor Roy  Kimble^1,3, Professor Robert Ware², Associate Professor Bronwyn Griffin^2,3

¹Queensland Children’s Hospital, South Brisbane, Australia, ²Griffith University , Gold Coast, Australia, ³Centre for Children’s Health Research, South Brisbane, Australia

Abstract:

Negative Pressure Wound Therapy (NPWT) is broadly used in surgical wound management; however, there remains a debate around the mechanism of action and application within burn care. This study was done to help understand the tissue pressure changes beneath NPWT with varying pressures, layers of Kerlix™ and distribution of dressings.

Utilising a cadaveric porcine model, a Codman intracranial pressure Express™ monitor and Microsensor™ transducer was used to assess pressure. The transducer was inserted under ultrasound guidance via cannulation to the skin, dermis, subcutaneous or muscular layer. Smith and Nephew’s Mepitel™, Acticoat™, Kerlix™ (10, 20 or 30 layers) and NPWT (Smith and Nephew Renays Touch™) were then applied either circumferentially or non-circumferentially. Each set of results is indicative of the ICP probe reading when NPWT was delivered at -40, -60, -80, -100 and -120mmHg.

At the skin, the median pressures were: -42, -60.5, -80.5, -99mmHg; with a decrease in pressure by 0.78mmHg with each increment of 10 layers (p <0.02).  At the dermis, there was a slight but significant (p<0.00) increase in pressure: 1, 2, 3, 4, 5.5mmHg which was decreased by 1.2mmHg (p 0.000) with circumferential dressings compared to non-circumferential dressings. Muscular median pressures were 0, 0, 0, 0, 0 mmHg. The subcutaneous layer had marked variation with no observed trend.

These data suggest negative pressure paradoxically exerts a positive pressure on the dermis. However, circumferential dressings and increased layers of Kerlix™ may reduce this positive pressure. This knowledge has impacted our burn NPWT dressing selection at Queensland Children’s Hospital.

Biography:

Dr Emma Lumsden is a Paediatric Surgery Principal House Officer at Queensland Children’s Hospital where she is the Ross Walker research fellow and scholarship recipient. She is a Griffith University PhD candidate and recently won the research prizes for paediatric surgery and burns research at the RACS Annual Scientific Congress.