Abstract: Facilitating Wound Closure Using Wound Reapproximation Techniques with Negative Pressure Wound Therapy (WOCNext 2019)

Claudia Engle, RN, CWOCN¹, Adora Lucius, RN, CWON², Kristin Kania, RN CWOCN³, Michele Houghton, BSN, RN CWON³, Lesile Dillard, RN CWOCN³, Carol Hall, BSN, RN, CWOCN⁴, Joane Grissett, RN CWON³, Elizabeth Gahwiler, RN CWOCN³, Maile Roman, RN CWOCN³, Stephanie Georgoudiou, AGACNP CWCN¹ and Jean de Leon, MD, FAPWCA⁵, (1)UT Southwestern Medical Center, Dallas, TX, (2)UT Southwestern Medical Center, UT Southwestern Medical Center, Dallas, TX, (3)WOC Nursing, University of Texas Southwestern Medical Center, Dallas, TX, (4)U.T. Southwestern Hospital at Zale Lipshy, WOCN, Dallas, TX, (5)UT Southwestern Medical Center, Professor Dept of Physical Medicine and Rehabilitation, Dallas, TX

Wound healing by secondary intention is a complex and prolonged process. Granulation tissue forms to help close the wound by contraction. The volume of tissue needed to fill the wound defect results in a more scar tissue formation. As the scar tissue matures, it will only reach 80% of the original tensile strength. [1] This significantly reduced loading capacity poses a risk for herniation and wound erosion.

The technique of wound re-approximation utilized by the WOC Department uses a systematic approach that includes: identifying appropriate candidates; using Negative Pressure Wound Therapy to stimulate granulation, reduce bacterial load, perfuse the wound bed, and reduce wound edema; gradual re-approximation of the epithelium using skin closure strips and NPWT as an incisional closure; and advancement of the re-approximation based on assessment and healing.

The use of Negative Pressure Wound Therapy to assist with wound perfusion and granulation tissue stimulation, along with manual re-approximation techniques, can dramatically expedite wound closure. Furthermore, the technique of re-approximation preserves the initial architecture of the tissue and protects the underlying organs. When tissue can be re-approximated, rather than replaced with granulation, the overall tensile strength is improved.

[1] Forrester JC, Zederfeldt BH, Hayes TL, et al. Wolff’s law in relation to the healing skin wound. J Trauma. 1970;10:770–779.

CS15 Facilitating Wound Closure Using Wound Reapproximation Techniques with Negative Pressure Wound Therapy