Accession Number:

ADA629618

Title:

Negative-Pressure Wound Therapy: A Hemostatic Adjunct for Control of Coagulopathic Hemorrhage in Large Soft Tissue Wounds

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2012-01-01

Pagination or Media Count:

8.0

Abstract:

BACKGROUND Negative-pressure wound therapy has been commonly used for treating chronic wounds and recently applied for treatment of traumatic wounds. We investigated the potential hemostatic benefit of negative-pressure wound therapy for control of refractory hemorrhage in a soft tissue wound model in swine. METHODS Coagulopathy was induced in pigs n 38, 36 kg by hemodilution and hypothermia. Next, a large soft tissue wound diameter, approximately 20 cm was created by slicing the gluteus maximus muscle. Free bleeding was allowed for 1 minute, and wounds were then randomly dressed with either laparotomy gauze G alone or TraumaPad TP, a kaolin-coated dressing alone or in combination with negative pressure NP, approximately 500 mm Hg. All wounds were sealed with adhesive drapes. Fluid resuscitation was administered and targeted to mean arterial pressure of 60 mm Hg. Pigs were observed for 150 minutes or until death after which tissues were sampled for histologic examination. RESULTS Induced coagulopathy as measured by increases in prothrombin time 12 and activated partial thromboplastin time 22 and decreases in fibrinogen 48 were similar in all groups. There were no differences in initial bleeding rates 4.5 mLkgmin. Dressing the wounds with G or TP produced hemostasis only in one pig 1 of 18 pigs. Addition of NP to these dressings secured hemostasis in 70 G and 90 TP of animals with average hemostasis time of 34 minutes and 25 minutes, respectively. Blood losses and fluid resuscitation requirements were significantly less, and survival times were significantly longer in NP adjunct groups than in the other groups. Survival rates were 80 GNP and 90 TPNP versus 0 G and 10 TP in the respective groups. Histologic examination showed similar superficial myofibril damages in all groups.

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research
  • Medical Facilities, Equipment and Supplies

Distribution Statement:

APPROVED FOR PUBLIC RELEASE