title: Extra-large negative pressure wound therapy dressings for burns - Initial experience with technique, fluid management, and outcomes.
abstract: OBJECTIVE
  The use of negative-pressure-wound-therapy (NPWT) is associated with improved outcomes in smaller burns. We report our experience using extra-large (XL) NPWT dressings to treat ≥15% total body surface area (TBSA) burned and describe our technique and early outcomes. We also provide NPWT exudate volume for predictive fluid resuscitation in these critically ill patients.
  
  
  METHODS
  We retrospectively reviewed patients treated with XL-NPWT from 2012 to 2014. Following excision/grafting, graft and donor sites were sealed with a layered NPWT dressing. We documented wound size, dressing size, NPWT outputs, graft take, wound infections, and length of stay (LOS). Mean NPWT exudate volume per %TBSA per day was calculated.
  
  
  RESULTS
  Twelve burn patients (mean TBSA burned 30%, range 15-60%) were treated with XL-NPWT (dressing TBSA burned and skin graft donor sites range 17-44%). Average graft take was 97%. No wound infections occurred. Two patients had burns ≥50% TBSA and their LOS was reduced compared to ABA averages. XL-NPWT outputs peaked at day 1 after grafting followed by a steady decline until dressings were removed. Average XL-NPWT dressing output during the first 5 days was 101±66mL/%BSA covered per day. 2 patients developed acute kidney injury.
  
  
  CONCLUSIONS
  The use of XL-NPWT to treat extensive burns is feasible with attention to application technique. NPWT dressings appear to improve graft take, and to decrease risk of infection, LOS, and pain and anxiety associated with wound care. Measured fluid losses can improve patient care in future applications of NPWT to large burn wounds.
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States; Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, Research Group "Trauma meets Burn", University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fischer
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wall
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Riviello
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, MA, United States. Electronic address: ehalvorson@partners.org.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Halvorson
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Burn wound; Fluid resuscitation; Negative pressure wound therapy; Vacuum assisted closure device