Tuesday, October 12, 2010

Wound Vacs in Haiti

Photo by John Carroll

Student-made device helped wounded in Haiti
Reuters, Fri, Oct 8 2010, By Nancy Lapid

WASHINGTON (Reuters Health) - When surgeons from Harvard Medical School went
to Haiti soon after last January's earthquake, they took along some
experimental three-dollar devices they hoped would help victims' wounds heal
faster. The devices had never been tested in patients before, but they
didn't need electricity, and they could be operated by the average person --
exactly what was needed in the post-earthquake devastation.

Designed by engineering students at the Massachusetts Institute of
Technology, each device involved an accordion-like plastic pump (in reality
an industrial-size toilet plunger) and some tubing. The tubing goes under an
air-tight seal over the wound, and the pump is squeezed to create suction.
The resulting vacuum provides what's known as "negative wound pressure

Negative wound pressure therapy is used in hospitals worldwide to help
serious wounds heal faster -- especially wounds that aren't healing well on
their own. It works in part by drawing excess fluid and dead cells from the
wound, by improving blood flow, and by pulling the tissues together. It also
reduces pain, and helps keep wounds clean in a dirty environment. With
negative wound pressure therapy, patients can have bandages changed every
three days instead of every day. All of these advantages are particularly
important in a disaster zone.

In Haiti, the medical team couldn't actually compare results with their new
pumps to results with standard commercial pumps, so they can't say their
devices are just as good.

But "regular" negative wound pressure pumps need electricity -- which was in
short supply in Haiti -- and they're expensive. The average pumps cost
Medicare more than $17,000 apiece in 2007 (although suppliers paid $3600
apiece), according to a report from the Office of the Inspector General.

Earlier this week at the annual meeting of the American College of Surgeons,
the Harvard surgeons told the story of how they tested their three-dollar
hand-operated pumps in the early chaos of the Haiti earthquake.

As Dr. Alexi Matousek, a second-year surgery resident at Brigham and Women's
Hospital in Boston and a member of the Harvard team in Haiti, told Reuters
Health, doctors from wealthy countries don't like to use one standard of
care for patients at home and another, lower standard for patients who
happen to be in places where resources are in short supply. A few years ago,
according to Matousek, a Harvard doctor visited MIT and asked a class of
engineering students to tackle the problem of making an inexpensive negative
pressure pump that could be taken to war zones and disaster areas. The
doctor had traveled on humanitarian missions and he knew the regular pumps
were in short supply.

One of the MIT students, Danielle Zurovcik, continued to work on the pump
and made it the focus of her master's thesis. In January, a surgeon who was
traveling to Haiti with the non-profit organization Partners in Health
remembered the project and asked Zurovcik to come along and bring her

The 700-bed National Teaching Hospital of Haiti was in ruins when the
Harvard team arrived. Nearly all the buildings were damaged, few staff
members were coming to work, patients were housed in tents, at night there
was no water or pharmacy service, and only four operating rooms were usable.

The doctors treated eight patients with Zurovcik's plastic wound pumps.
Because the pumps had never been tried on patients before, this emergency
use doubled as a feasibility test. The doctors used the pumps in patients
whose wounds were clean to begin with, and not infected. In all cases,
however, the wounds were very serious.

In three of the eight cases, the pumps couldn't function. (In one instance,
the wound was in the groin, where it was difficult to maintain an air-tight
seal; in the other two, the wound stayed too wet.) But by the time the
Harvard team left, roughly 10 days after they'd arrived, the five patients
who'd used the pumps continuously had signs of healthy healing in their

"Patients' families were instrumental in the success of the negative
pressure wound therapy, as they easily learned to compress the bellows
periodically," the Harvard team said in a presentation at this week's
meeting. "Patients readily accepted negative wound pressure therapy and even
requested it."

Overall, the hardest problem was finding a way to maintain the seal over the
wound. (The medical dressing used to create the seal is not included in the
three-dollar price of the pump and tubing, Matousek said.)

A few months after the team returned from Haiti, an article about the
negative wound pressure device appeared in an MIT publication, and "we got
three thousand e-mails in two days," Matousek said. Requests came from
everywhere -- doctors, patients, the military, "even Sea World," he said.
The doctors and Zurovcik had to explain they'd just been testing the
devices, which weren't ready for widespread use.

The presentation at the ACS included medical data about the device's
performance, and it won a prize for "Exceptional Merit." Soon Zurovcik and
the Harvard team will be conducting larger scale tests of the devices in
Rwanda and in Boston.

A poster displaying the medical data closed with a guiding principle: "Care
should be provided with the most simple, inexpensive, and widely applicable
method that can be effective."

Matousek said he and his colleagues want to make this principle the focus of
their careers. The contrast between wealthy and poor countries bothers them,
he said. They want to come up with additional ways to make modern medicine
less expensive.

"In our minds, we have to stop looking to make money," he said. "For one
hundred years we've been trying to make money off of taking care of people."

"We haven't been doing a good job of providing access to care here, and
certainly not worldwide," he added. "We need similar solutions to other
problems worldwide."

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