Venous Ulcers and Negative Pressure Wound Therapy

Negative pressure wound therapy (NPWT) can assist in complete healing of venous leg ulcers with or without skin graft and pain reduction while keeping wound care cost relatively low.   The patient is a 63-year-old male with venous leg ulcers to the left lower extremity for 2 months prior to repair of an abdominal aortic aneurysm measuring 6.5 x 6.7 cm.  Past medical history consists of hypertension, atrial fibrillation and smoking x 30 years.   The patient underwent repair of the AAA along with revascularization on 5/14/10.  Prior to repair the ulcers on the LLE were open and weeping and covered with bandaids.  The patient was sent home from the hospital with orders to pain with betadine, adaptic, 4 x 4 gauze, bulkee gauze and Coban.  Home care orders were changed to microfiber dressing with silver, gauze,bulkee gauze and Coban to be changed daily or p.r.n. excessive drainage. Dressing changes created a pain level of 10/10.  On July 16, 2010, the patient was begun on NPWT in an effort to reduce edema and to help prepare the wound bed for a skin graft.  Prior to NPWT placement, the patient had serial sharp debridement at the vascular surgeon’s office which the patient required Valium and Percocet 10 to reduce the pain prior to and following debridement.  Within 3 weeks of NPWT therapy the wound bed had become beefy red, granular and moist.  Thirty-eight days post NPWT placement, the wound was covered with an artificial skin graft to encourage granulation over exposed tendon. Forty-three days post NPWT placement the wound was covered with a split-thickness skin graft. During this time, patient’s pain decreased to 3-4/10 after artificial skin placement and 2/10 following split-thickness skin graft.  NPWT decreases cost of dressings, nursing time and pain while healing venous leg ulcers.