Global Surgery & Anesthesia

It is important to be sure that new devises are effective before promoting them. The Cochrane review suggests that there is still too little evidence that they are effective. Let's see some randomized controlled trials of their effectiveness, please.
Cochrane review summary at http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001898/frame.html

You are exactly right and the reference is quite interesting- thank you. Negative pressure therapy has become an important part of wound care in the developed world and I have my concerns about its use, particularly as applied to chronic wounds. Complicated acute wounds, in my opinion are a better target for this modality and this therapy has been shown to be quite effective.

In resource poor areas, the challenges of limited nursing staff and limited dressing supplies make regular dressing changes difficult if not impossible. Negative pressure therapy offers a dressing that can stay in place for a few days at a time, keeps odor and drainage off of surrounding bedding/clothing and promotes healing- a huge benefit to appropriate patients.

Thank you. Perhaps other members can share information about wound care esp in resource poor areas. I have seen some clinicians use salt solution, sugar, magnesium sulfate etc and would like the opinion of surgeons regarding the use of these and other non-conventional methods. Thanks

An important question.

Certainly using salt solutions (normal saline) to moisten gauze to make a wet-to-dry dressing for an open wound that is changed a couple times daily is standard-of-care probably in most resource-poor settings.

Raw (unboiled) honey can be a helpful agent. There are good animal studies and decent human studies that honey is helpful in disinfecting dirty wounds, and in increasing wound healing. The proposed mechanism is its energy-producing properties, its hygroscopic effect on the wound, and its bacteriocidic properties.

Sugar would work in a similar fashion, though I don't know that it is as effective as honey. I have no experience with magnesium sulfate.

Overall, the best evidence for these sort of topical agents seems to be for daily raw honey applications. One Nigerian paper sites that of 58 wounds 57 closed well with honey application. The remaining wound was found to be a Buruli ulcer needing antibiotic treatment in addition.