“To basically take a toilet plunger and produce negative pressure over a prolonged period of time, that is really great,” says Kristian Olson, a physician at Massachusetts General Hospital, in Boston, who was not involved in the project. “Not only do I see it answering this need in developing countries, I think it could really enhance home therapy for chronic wounds in the U.S.”
Zurovcik and Riviello had been planning a trial of the device in Rwanda–Riviello spends about half his time working in Africa–when the earthquake hit Haiti. Colleagues treating the first waves of injury victims told the duo that their device might be of help, so they joined a wound-care team headed for University Hospital, a few blocks from the leveled palace in Port-au-Prince. (Commercial negative-pressure devices, known as VACS, were employed in various relief efforts in Haiti, including $2 million worth of equipment donated by KCI.)
Working in stifling tents filled with patients, the team tended to those whose doctors had left and were in need of follow-up care. Of the hundreds of patients assessed, the researchers chose eight people suffering from a variety of injuries– amputations, open tissue wounds, open fractures, crushing injuries (where the skin had to be opened to give the muscle room to expand), infected surgical wounds, and bedsores from being paralyzed–appropriate for negative-pressure therapy. “Because this was a disaster setting, we didn’t feel it was an appropriate place for rolling out a randomized controlled trial,” says Riviello. (They cared for other patients with typical dressings.)
The surgeon would first apply a sponge over the cleaned wound and then cover it with a plastic seal. A tube fed through a small hole in the plastic connected to the pump, which was manually compressed to create negative pressure. The team trained patients’ families, who often took on typical nursing duties, to charge, or pump, the device. “We learned that family members are interested in being trained and motivated to keep the device charged because they saw the benefits for their loved ones,” says Riviello. “They were tremendously reliable. We saw patients twice a day, but it became clear that we could come back days later and the device would still be charged.”
Because the researchers were in Haiti for just 10 days, they weren’t able to determine if the device helped patients heal faster. But it did seem to keep the wounds cleaner, says Riviello, and reduced the need to change bandages, which is painful for the patient. In fact, one patient requested the treatment after observing how a neighbor in the next bed was subjected to fewer painful dressing changes, says Zurovcik. Now back in Cambridge, she is tinkering with the prototype, trying to further improve the pressure seal and the amount of negative pressure the device can deliver.
The team plans a larger test in Rwanda, where it will likely put the device to broader use. People in poor countries are much less likely to survive severe burns, for example, which can be helped with negative-pressure therapy. And the rate of complications from diabetes, such as foot ulcers, is skyrocketing in these countries as well, says Olson.