Negative pressure wound therapy in the treatment of purulent wounds of the maxillofacial superficial cellular spaces

Abstract

Relevance. The choice of the method for purulent wound management (open or closed) is a relevant problem in surgery. The way of drainage is the fundamental factor of the effect on the wound. The open-drainage systems are most frequent in maxillofacial surgery, and the drain is passive, combined with various drug administration. It has significant drawbacks: the short action of the injected substances, painful dressing changes, long wound healing time, etc. The instillation drainage therapy is not widely available and is used only in clinics with appropriate equipment. Active draining (negative pressure suction drainage system) allows closed wound management. Though, it is still rarely used in maxillofacial surgery.Purpose. The study aimed to increase the effectiveness of the treatment of maxillofacial purulent wounds formed after the incision of odontogenic soft tissue purulent inflammatory processes using negative pressure wound therapy.Material and methods. The study was a comparative analysis of clinical and laboratory indicators of 303 patients with purulent wounds formed after incision of superficial cellular spaces’ abscesses and phlegmons. The patients formed two groups: the main group had negative pressure wound therapy (NPWT), and the comparison group had wound treatment with the traditional open method. NPWT methodology included the tubular drain placement into the purulent cavity formed after the incision and administration of a surgical film on the wound. The distal tube end was attached to a vacuum source that simultaneously was a canister for exudate collection and analysis. We followed up on clinical manifestations and endointoxication indicators and studied the wound content toxicity and the dynamics of the respiratory enzyme succinate dehydrogenase activity.Results. The negative pressure system appears to allow fast and atraumatic wound management, reducing the inflammatory stage of the wound healing process, promoting quick normalization of endointoxication parameters, which improves the patient’s general condition (fast resolution of the clinical signs), and the effect of vacuum-assisted closure allows avoiding secondary wound closure.Conclusion. Low-dose negative pressure provides the wound healing process with specific characteristics. Continuous exudate aspiration promotes rapid elimination of bacteria and detoxification of the wound and surrounding tissues, normalization of endointoxication parameters, provides anti-oedematous and analgesic effects, early restoration of impaired functions, and the time of wound healing process reaches that of healing by primary tension, which allows us to reduce the number of medications, as well as treatment and rehabilitation time.