Betz Caren
Rehabilitation Services, University Medical Center at Brackenridge, Austin, TX, USA.
Ostomy Wound Manage. 2009 Mar;55(3):34-6, 38-40.
Chronic, recurring limb ulcers require a comprehensive approach that addresses the wound pathology, vascular status, and swelling. Although studies have shown that compression, especially high compression, is more effective than dressings alone, evidence to support one particular method of compression is limited. A sequential intermittent pneumatic compression (IPC) device was evaluated in four patients (two men, two women, age range 47 to 59 years) with nonhealing (history of 1 to 6 months) venous insufficiency (n = 2), postsurgical complication (n = 1), and radiation burn (n = 1) wounds and minimal to extensive clinically observable edema. All patients received standard wound care (debridement and/or appropriate dressings). Wounds were protected with an anti-shear wound dressing during pneumatic treatment. Each week, the various wounds and limb girths decreased until the site healed or limb volume normalized for that individual; 100% of the wounds healed. One patient, who had minimally observable edema, also responded positively when IPC was added to his standard wound care regimen. The pneumatic system was well tolerated in all patients. The results obtained suggest that combining appropriate standard wound care with this IPC treatment may facilitate closure of chronic, nonhealing wounds. Additional studies are needed to ascertain the effectiveness and cost-effectiveness of this treatment modality.
慢性复发性肢体溃疡需要一种综合方法来处理伤口病理、血管状况和肿胀问题。尽管研究表明，加压，尤其是高压力加压，比单纯使用敷料更有效，但支持某一种特定加压方法的证据有限。对4例患者（2男2女，年龄47至59岁）进行了序贯间歇性气动加压（IPC）装置评估，这些患者有不愈合伤口（病史1至6个月），包括静脉功能不全（2例）、术后并发症（1例）和放射性烧伤（1例），且伴有轻度至重度临床可观察到的水肿。所有患者均接受标准伤口护理（清创和/或适当敷料）。在气动治疗期间，用抗剪切伤口敷料保护伤口。每周，各种伤口和肢体周长都在减小，直到伤口愈合或个体肢体体积恢复正常；所有伤口均愈合。1例仅有轻度可观察到水肿的患者，在其标准伤口护理方案中加入IPC后也有积极反应。所有患者对气动系统耐受性良好。所得结果表明，将适当的标准伤口护理与这种IPC治疗相结合可能有助于慢性不愈合伤口的闭合。需要进一步研究以确定这种治疗方式的有效性和成本效益。
