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Negative wound pressure therapy is safe and useful in pediatric burn patients.

INTRODUCTION
Negative Pressure Wound Therapy (NPWT) has proven to be a powerful tool in facilitating healing of difficult wounds of a variety of etiologies. The pediatric experience with NPWT has been limited due to concerns about vascular compression and pain associated with treatment.


METHOD
A retrospective review was performed to evaluate the therapeutic effect of NPWT on children with difficult wounds due to burns or soft-tissue trauma. NPWT was instituted in the operating room under general anesthesia using a commercially available system. NPWT was not initiated until all necrotic material was removed from the wounds. Negative pressure applied ranged from 50-125 mmHg continuous suction, with younger children being prescribed less negative pressures. NPWT dressings were changed every 5-7 days, in the operating room. When wounds were clean and had granulated they were closed with split-thickness skin grafts.


RESULTS
29 children with an average age of 9.34 ± 1.95 years (range 2 months to 18 years) were treated with NPWT. Average total wound size was 24.8 ± 8.9 (range 0 to 95) percent of the body surface in those patients who had suffered burns and non-burn injuries. Injury mechanisms included hot liquid (2 children), contact with hot object (4 children), electricity (7 children), flame (9 children), and other non-burn injuries such as abrasion and Stevens-Johnson syndrome (7 children). Over 90% of the patients required central venous or bladder catheters. Perceived benefits of the treatment included reduced numbers of dressing changes and more rapid wound granulation. There were no episodes of bleeding associated with NPWT. All patients healed their wounds, were successfully grafted, and survived.


CONCLUSION
NPWT has a useful role in the pediatric burn unit in facilitating wounds healing and improving life qualities. We also found that a significant correlation between third degree burned wound size and the number of negative pressure therapies received, which indicated that NPWT could be more effective in treating complicated burned wounds. NPWT seems safe and effective when applied to well-debrided wounds. It does not seem to be associated with excessive bleeding or discomfort in children.