Negative pressure wound therapy is useful in pediatric burn patients, a retrospective review
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INTRODUCTION: Negative pressure wound therapy (NPWT) has proved to be a powerful tool in facilitating the healing of difficult wounds of a variety of etiologies. The pediatric experience with NPWT has been limited because of concerns about vascular compression and pain associated with treatment. METHOD: A retrospective review (2004-2014) was conducted at Shriners Hospital for Children-Boston to evaluate the therapeutic effect of NPWT on children with difficult wounds due to burns or soft-tissue trauma. Information was collected on patient demographics, wound size and depth, burn injury etiology, length of hospital stay, number of operating room visits, and other treatment procedures. NPWT was instituted in the operating room under general anesthesia using a commercially available system. NPWT was not initiated until all necrotic material had been removed from the wounds. A negative pressure varying between -50 and -125 mmHg was applied to the wound as continuous suction, with younger children being prescribed the lower negative pressures. NPWT dressings were changed every 5-7 days in the operating room. When wounds were clean and granulated, they were closed with split-thickness skin grafts. RESULTS: Twenty-nine children with an average age of 9.43 +/- 1.95 years (range 2 months to 18 years) were treated with NPWT. The average total wound size was 24.8 +/- 8.9% (range 0%-95%) of the body surface in patients who had suffered burns and non-burn injuries. Injury mechanisms were categorized as hot liquid (2 children), contact with hot object (4 children), electricity (7 children), flame (9 children), and other non-burn injuries such as abrasion and degloving (7 children). Over 90% of the patients required central venous or bladder catheters. Perceived benefits of the treatment included reduced numbers of dressing changes and more rapid wound granulation. There were no episodes of bleeding associated with NPWT. All patients healed their wounds, were successfully grafted, and survived. CONCLUSION: NPWT has a useful role in the pediatric burn unit in facilitating wound healing and improving quality of life. A significant correlation between the size of third-degree burn wounds and the number of negative pressure therapies suggests that NPWT may be more effective in treating complicated burn wounds. Overall, NPWT appears safe and effective when applied to well-debrided wounds, and the treatment does not seem to be associated with excessive bleeding or discomfort in children.