The Hanikoda Method: 3-Layered NPWT in Wound Bed Preparation

In This Article

Abstract and Introduction

Abstract

Introduction. Negative pressure wound therapy is a widely used method of wound dressing with various commercially available brands. The authors created the Hanikoda Method (HM) for effective wound bed preparation or definite wound closure.

Methods. In this case series, the authors discuss 8 different wound cases that presented to their Plastics Unit from January 2014 to June 2015. Patients with traumatic or infected wounds were selected for treatment with the HM. Selected patients underwent multiple cycles of this method until their wounds were ready for definite wound closure or the wounds had closed by secondary closure.

Discussion. The purpose of any wound dressing is to encourage epithelization while ensuring no factors impede wound healing. An additional benefit is to reduce wound bed size so that it may close by secondary intention or require less skin graft coverage. Each layer of the dressing is described, along with its function in wound bed preparation or in closure.

Conclusion. The HM facilitates reduction of wound size, wound bed preparation, and overall management.

Introduction

Negative pressure wound therapy (NPWT) has gained significant popularity as a modality for treating difficult wounds, and the further advancement of this technique is making great inroads into wound therapy. Although its physiology and exact mechanism of action has been postulated upon, there is still ongoing research into the exact mechanisms that will help mold future NPWT application.

The most basic NPWT performed is by using open-pore foam and a semiocclusive dressing with a tube connecting the dressing to wall suction or a suction device. Typically, the dressing is kept for 2–3 days^[1] before being changed, and suction is typically set between -75 mm Hg to -125 mm Hg.^[2]

At the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia, the authors developed a combination multilayer NWPT by combining hydrogel, paraffin tulle, and NPWT and named the new design the Hanikoda Method (HM).

Developed out of necessity to help manage patients who refused soft tissue reconstruction and/or were unsuitable candidates for immediate reconstruction, the HM was subsequently applied to patients requiring wound bed preparation (WBP) who were referred to the UKMMC Wound Care Team. The HM provided an effective solution for WBP and definitive soft tissue closure in this patient population.

Table 1. Characteristics of each layer of the Hanikoda Method
	Indications	Advantages	Disadvantages
Hydrogel	Dry or slightly moist wounds Wounds with granulation tissue, eschar, or slough Primary wound contact layer Irregular wound surface	Irregular wound surface Painless removal	May require secondary dressing as it is difficult to secure May cause periwound maceration Can cause dehydration of wound if not covered well
Paraffin gauze	Secondary dressing	Relatively inexpensive Does not adhere to wound Maintains the surface contact with the primary hydrogel layer	Semiocclusive nature may prevent movement of exudate away from the wound, causing maceration
Negative pressure wound therapy	Open gaping wound requiring a decrease in size before a delayed primary closure or split-thickness skin graft	Reduces wound size Reduces bioburden of wound	Requires the patient be attached to suction Requires skill to prepare dressing May cause periwound maceration if used without periwound protection