Healing Wounds Faster in Resource-Limited Settings
The BWH surgeons who traveled to Haiti in the aftermath of the Jan. 12 earthquake performed hundreds of surgeries that required them to leave wounds open and patients to undergo frequent dressing changes to keep them clean.
“If you can just get negative pressure on some of these wounds, they would heal faster,” said Robert Riviello, MD, MPH, a trauma surgeon who spends three months of the year caring for patients in Africa. “But the problem in some settings is that there isn’t electricity to run the pumps.”
Riviello has been working with Danielle Zurovcik, a graduate student at MIT, on a prototype for a negative pressure pump that would cost about $3 to manufacture and could run without electricity in resource-limited settings. Riviello and Zurovcik, who received a CIMIT Young Clinician Researcher Award to continue developing the prototype, were asked by their colleagues in Haiti to bring it to University Hospital in Port-au-Prince to help the hundreds of patients with open wounds heal more quickly.
“We traveled to Haiti with a wound care team and saw about 200 patients,” Riviello said. “Of those, we identified eight who could use the device with no risk of harm.”
To use the pump, physicians cover the patient’s wound with a sponge and then a plastic seal. A tube is fed through a small hole in the plastic and connected to the pump, which is manually compressed to create negative pressure. Riviello and his team worked with patients’ families, who were active participants in their care, to ensure the pumps were kept charged.
“One patient who didn’t have the pump requested it when he noticed the patient next to him underwent fewer dressing changes,” Riviello said. “The dressing changes could be quite painful.”
While 10 days in Haiti was not enough time to determine if the wounds healed faster with pumps, Riviello noted that the wounds did remain very clean. “If we could decrease pain and comfort and increase cleanliness of an open wound, we as clinicians feel we’ve done the right thing,” he said.
Riviello and Zurovcik continue to develop their prototype and are applying for IRB approval through Partners and in Rwanda, where they hope to pilot the device at Partners In Health’s Rwinkwavu Hospital. While working at Rwinkwavu in recent years, Riviello noticed that wounds took a long time to heal, which created longer lengths of stay and affected the number of surgeries that could be performed, since there weren’t enough open beds in the wards.
Zurovcik and Riviello also hope to arrange to have the pumps locally produced in Rwanda and other sites to help provide jobs for residents of those areas.