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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2011 September;9(3):129-45
language: English, Italian
Home care treatment for chronic skin wounds: a controlled study of treatment with advanced dressings alone versus combination negative pressure therapy and advanced dressings
Orsatti V. 1, De Ascentis G. 2, De Vitis C. 3, Di Vincenzo K. 2, Concetta Marino M. 2
1 Area Distrettuale Sangro-Aventino ASL 2 Abruzzo, Villa Santa Maria, Chieti, Italy
2 DSB Villa Santa Maria ASL 2 Abruzzo, Villa Santa Maria, Chieti, Italy
3 DSB Lama dei Peligni ASL 2 Abruzzo, Lama dei Peligni, Chieti, Italy
Chronic skin wounds are generally treated in inpatient facilities (hospitals, skilled nursing and long-term care facilities, and residential care facilities). With the reorganization of the delivery of health care services, the management of chronic illnesses is being shifted to the community and the medical care for acute diseases to hospitals. Common recurrent conditions include chronic pressure ulcers which are increasingly treated in home care. The treatment of chronic skin wounds relies on various therapeutic options involving a range of medical devices, costs and complexity. The aim of this study was to show the impact of negative pressure wound therapy (NPWT) on the clinical evolution of chronic skin wounds.
Methods. The specific aim was to evaluate the effectiveness and the cost of a protocol using advanced dressings versus a protocol using a combination of NPWT and advanced dressings. The study population was 48 patients, primarily receiving home care for stage 3 or 4 chronic skin wounds as classified by 2006 National Pressure Ulcer Advisory Panel (NPUAP) criteria, and with complicated diabetes mellitus and/or underweight (body-mass index [BMI, weight in kg divided by height in meters squared] <18.5).
Results. The results of the two treatment modalities were compared: advanced dressings alone (polyurethane foam, alginates, hydrocolloid, collagen) vs. advanced dressings in combination NPWT. A cost-effectiveness and cost-benefit analysis of the two therapeutic options was then performed.
Conclusion. The study showed that use of NPWT in an initial phase of treatment has a positive effect on treatment duration, reducing it by at least 1.5 months and has two consequences: 1) an economy of scale in the reduction of material and nursing costs; 2) an improvement in the patient’s quality of life with a mean period of around 45 ulcer-free days.