Professor, University of Massachusetts Medical School
Chief, Division of Plastic Surgery
Dr. Raymond M Dunn is Professor of Plastic Surgery at University of Massachusetts Medical Center and Chief of the Plastic Surgery Division at UMass Medical School.
...there is value to having multiple wound interfaces and advanced wound dressings available from a single manufacturer.
- Dr. Raymond Dunn
Professor, University of Massachusetts Medical School
Chief, Division of Plastic Surgery
"When Smith & Nephew entered Negative Pressure Wound Therapy, it was clear to me that the company would take NPWT to a new level of innovation."
Dr. Dunn has been using NPWT in his clinical practice since the commercial inception of its availability. He pointed out that NPWT started as a chronic wound therapy and treatment for pressure ulcers was the most common indication. Clinicians used it conservatively because of its high cost. Over time, clinicians began trying different approaches to NPWT and applying different dressings at varying levels of pressure to diverse wound types. As a result, best practices for NPWT were further identified throughout a range of clinical applications. But while NPWT's efficacy is now almost universally accepted, Dr. Dunn observed that this process of clinical discovery is still very much ongoing.
"In many ways, NPWT is still maturing as a therapy," said Dr. Dunn. "We're still doing a lot of basic research to understand how it works, and to identify protocols and best practices for its use on different wounds."
He believes that this process of clinical discovery is supported by the range of devices and dressings available from Smith & Nephew. "It is a very exciting time to work with Smith & Nephew's flexible technology. We can apply it easily in different clinical settings, and there is value to having multiple wound interfaces and advanced wound dressings available from a single manufacturer."
Dr. Dunn believes that the devices and products provided by Smith & Nephew provide clinicians with options that will ultimately lead to less risk and further the potential for health care cost savings, better patient care and improved outcomes.
"We treat a lot of trauma patients at UMass, this involves lots of reconstructive surgery that requires skin grafting. NPWT helps to stabilize the skin graft to the wound surface. We've found that gauze dressings are better suited for this than foam dressings. Likewise, large surface area wounds, irregularly shaped wounds, wounds around an extremity or an external fixation device are difficult to treat with foam, and benefit from a gauze interface."
One patient at UMass suffered a severe open fracture of his left humerus in a motor vehicle accident with de-gloving and tissue loss. After orthopedic management the patient had an open, irregular wound cavity with exposed bone. Ordinarily, this patient would have required complex flap graft reconstruction, with a failure risk of 10%, due to vascular thrombosis. Dr. Dunn treated his wound with three to four days of NPWT before performing a skin graft, and then resumed treatment of the skin graft with NPWT for an additional seven days. The result was 100% healing of his skin graft requiring less complex and risky surgery and with a more rapid recovery time.
This case was included in a poster that Dr. Dunn and his colleagues presented at the 2009 Symposium on Advanced Wound Care. The poster highlighted results of a prospective study of 23 split thickness skin grafts treated with post-operative application of NPWT for an average of five days. The average STSG percentage take was 83%, with the average STSG percentage take for diabetics at 50% and non-diabetics at 95% 1 .
"Our study sought to validate several concepts, principally that NPWT improves overall graft survival, likely by more optimally immobilizing the graft, thereby limiting shear, eliminating fluid accumulation in the wound bed and decreasing bacterial contamination. We found that skin graft take on these irregular and mobile surfaces was dramatically enhanced by the application of NPWT. NPWT also allows greater patient mobility and potentially decreases length of hospital stay, resulting in higher patient satisfaction, better clinical outcomes, less risk and lower cost."
Dr. Dunn's team is also studying the economic and clinical results of leaving NPWT dressings on for a longer period of time than the previous experience in certain types of wounds. "In certain indications, we'd recommend leaving a NPWT dressing on longer than in our previous experience. This diminishes the number of dressing changes required, decreasing the demand on acute care nursing time and staffing for both inpatient and outpatient dressing changes. We hope to do a larger study to prove these preliminary findings. We believe that we can achieve superior clinical results as well as achieve significant cost savings in care.
"A 20 to 30 percent reduction in NPWT costs at an institution like UMass can mean $100,000 or more in annual savings. Savings of this size can have a significant impact on an institution. These costs can be re-allocated to fund staff salaries, or for investment in new equipment or medical technologies, and other things that directly impact patient care."
"As a practicing physician and academician, I need three things from a medical device manufacturer: I need it to help me deliver the very best care for my patients; I need it to provide me with options and flexibility so that I can do research and identify best practices; and I need it to help me deliver economic value to my institution. Smith & Nephew's approach to NPWT helps me in all of these areas."
Dr. Dunn conducted a clinical in-market evaluation of the RENASYS* EZ. "We used the RENASYS EZ to treat a wide range of acute, chronic and peri-operative wounds. The study showed improved outcomes in the healing of skin grafts, including grafts for very complex wounds. "The RENASYS line of devices is a comprehensive upgrade of NPWT. It is a step forward in terms of ease of use, portability, battery life, and intuitive operation."
Dr. Dunn also appreciates the full range of wound care products available from Smith & Nephew. "We use ACTICOAT* as a wound contact layer with application of NPWT on skin grafts because of the antimicrobial barrier properties that may have a positive impact on skin graft take. "By entering the market with foam and gauze dressings and the RENASYS EZ and RENASYS GO NPWT devices, Smith & Nephew jump-started innovation in NPWT, and is providing clinicians with an exceptional level of support."
1 Raymond Dunn, Ron Ignotz, Heather Strom, Theresa Hurd, Julien Cote, Vicki Vasquez, John Cockwill, Trevor Mole and Jenny Smith. "A prospective multi-centre clinical evaluation of gauze-based Negative Pressure Wound Therapy: Results from 131 patients." Clinical Symposium on Advances in Skin & Wound Care 2009.
The preceding testimonial was provided by Raymond M. Dunn, MD, FACS based on his clinical experience and use of the included products in his practice. Dr. Dunn also provides consulting services to Smith & Nephew, lending his expertise in wound care to help increase patient outcomes through innovation and education.
