Negative pressure wound therapy: A surgical treatment option for excised lower leg skin cancers (#216)
The ENT, Plastic and Reconstructive Surgery Unit at the Princess Alexandra Hospital specialises in surgical wound care. Of the approximate 500 surgical patients treated annually, 11% are treated for lower extremity cancerous wounds with split thickness skin grafts. The dressing applied during surgery is either a conventional bandage dressing or vacuum-assisted closure (VAC) negative pressure wound therapy (NPWT). Currently, the choice of dressing is the surgeon’s preference; with 86% of dressings applied being the conventional dressing and 14% of patients receiving NPWT. Current post-operative care is an average of 5 days inpatient immobilisation and limb elevation. This regimen of post-operative care has traditionally been prescribed to reduce the risk of seroma and haematoma formation. However, this period of immobilisation might also predispose patients to complications such as deep vein thrombosis and pressure ulcers. This presentation draws on the findings of a study that investigated the effectiveness of surgical graft take and wound healing of early discharged adult patients with completely excised lower leg cancers dressed with NPWT, to those treated with the standard post-operative regimen of 5 days bed rest with limb elevated and immobilised. The study also evaluated quality of life in the two groups utilising the SF12 questionnaire. The sample comprised thirty-four (n = 34) participants, 47% of whom were randomised to receive the intervention of early discharge and 53% were randomised to receive the standard hospital stay. At four (4) weeks from surgery, 100% graft take was noted in all participants in the intervention group and significant differences in the SF12 physical function and mental health subscales were identified in both groups (QoL physical function p = 0.01; QoL mental health p = 0.03). This study has significant implications for medical and nursing practice, health service delivery and importantly, patient outcomes. The results of this study show it is feasible for the early discharge of patients with NPWT in this context. Knowledge gained from this study will provide the foundation for a randomised phase III trial to further assess early discharge and NPWT in other contexts, in the near future.