Pre-placement,of,adhesive,tape,around,wound,sites,can,prevent,air,leakage,in,negative,pressure,wound,therapy,procedures

Ran Tao,Yukun Yang,Chunyu Xue ,Chuan Lv

Department of Plastic Surgery,Shanghai Changhai Hospital Affiliated to Second Military Medical University,Shanghai 200433,China

Keywords:Negative pressure wound therapy Air leakage Adhesive tape

ABSTRACT The introduction of negative pressure wound therapy has revolutionized the management of complicated wounds.However,the maintenance of an effective negative pressure environment is difficult in some instances,such as wounds in close proximity to an intestinal stoma or wounds surrounded by external fixations.We found that adhesive tape adheres more easily to itself than to wet skin or uneven surfaces.Therefore,we placed adhesive tape around surgical wounds prior to covering them with foam and sealing them with more tape.As a result of the strong adhesive force between pieces of tape,this method could provide a better environmental seal,even in situations where space is limited.Pre-placed adhesive tape around the wound site prior to foam placement could provide sufficient adhesion to maintain a continuous negative pressure environment during treatment.

Negative pressure wound therapy (NPWT) and variations thereof have been widely used in the treatment of complex wounds.The benefits of NPWT include reduction in wound size,improved granulation tissue formation,continuous wound cleansing,a localized environmental seal,and improved perfusion of the wound.1

Recently,we reviewed a published study by Kaneko et al.using NPWT to reduce perineal wound infection after abdominoperineal resection.2In this article,the authors attached film tape to the skin surrounding the wound prior to foam placement in order to prevent potential skin damage caused by direct contact with the foam.Similar procedures have been implemented in our clinic for similar purposes when NPWT has been necessary for some complicated wounds.

The benefits of NPWT are mainly due to the maintenance of a proper negative pressure environment.In other words,the maintenance of a proper negative pressure environment is an essential prerequisite for desirable,predictable clinical outcomes.However,it is not easy to maintain proper or continuous negative pressure under certain circumstances,such as incisions near the inguinal fold,infected abdominal incisions abutting intestinal stomas,or wounds situated near external fixations in the extremities.Under such circumstances,film tape cannot properly adhere to the surrounding skin with sufficient strength to maintain a seal,and air leakage frequently occurs.This can result in both physical and psychological discomfort for patients while simultaneously frustrating attending doctors.

We found that pieces of adhesive tape provided in packaging bags(KCI,San Antonio,Texas) adhered easily to one other and were subsequently quite difficult to separate.In contrast,the tape was easy to separate from wet skin,skin folds,and uneven surfaces.Thus,we attached adhesive tape to the skin surrounding the wound site prior to placement of the foam.Thereafter,foam was placed and another piece of tape was attached to the previously placed tape.

Due to the strong adhesive force between the pieces of tape,the foam was successfully sealed off from the external environment,and a stable vacuum was created.The following are examples of typical application scenarios.

3.1.Case one

The first case was a 35-year-old man who suffered an accident,which led to a fracture of the left tibia and soft tissue necrosis (Fig.1).After external fixation surgery,the open wound was a problem,which required a prompt solution.In this case,NPWT was a sensible choice,but there was limited space for the application of foam and tape.Air leakage is common in such cases.Interestingly,air leakage did not occur with throughout the course of treatment with the use of our pre-placed tape technique.

Fig.1.An open wound over a reduced tibial fracture,surrounded by external fixations,with limited space for foam application.(A)Adhesive tape was placed around the wound site prior to foam placement.(B) The foam shrunk well with no signs of air leakage.The yellow arrows indicate pre-placed film tape.

3.2.Case two

The second case was a 54-year-old man whose incision became infected,with subsequent wound dehiscence,following Miles surgery with colostomy placement(Fig.2).In addition,a urostomy was present in the contralateral abdominal wall as a result of a radical cystectomy performed 10 years earlier.A negative pressure environment was successfully maintained throughout the course of the treatment,despite these challenging conditions.

Fig.2.(A)An abdominal wound flanked by stomas on both sides.(B)The foam shrunk well following the pre-placement of adhesive tape.The black and red arrows indicate colonic and ureteric stomas,respectively.

Negative pressure wound therapy (NPWT) has been widely used in the treatment of complex wounds.Maintenance of a proper negative pressure environment is an essential prerequisite for NPWT.However,negative pressure is not always easy to maintain in certain instances due to poor adhesion between film tape and the skin surrounding a wound site.This could reduce the efficacy of NPWT.

In our study,we placed adhesive tape around the wound prior to foam placement.Due to the strong adhesive force between pieces of tape,a stable vacuum environment was created and air leakage rarely occurred.This simple procedure could be used in cases where wound conditions make NPWT difficult,including the application to wounds with limited space,wet skin,skin folds,or uneven surfaces.In our experience,preplaced film tape with a width of approximately 1 cm could provide enough adhesive force to maintain a stable negative pressure environment.

In conclusion,pre-placement of adhesive tape to the area surrounding a negative pressure dressing site does not only protect sensitive skin but also prevent air leakage in NPWT.This procedure can be used in cases where the application of negative pressure dressing may prove difficult,such as in areas with limited space,wet skin,skin folds,or uneven surfaces.

Ethics approval and consent to participate

The need for ethical approval and consent to participate was waived due to the retrospective nature of this study.

Consent for publication

All patients included in this study provided written informed consent to publish the data contained within this study.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Tao R:Writing-Original draft,Methodology.Yang Y:Data curation.Lv C:Conceptualization,Writing-Review and Editing.Xue C:Supervision,Validation.