Basics of negative pressure wound therapy (NPWT): Part 1

Since I started working in a reconstructive surgery clinic several years ago, I even have been exposed to a myriad of complex acute and chronic wounds that require advanced treatments resembling negative pressure wound therapy (NPWT). These devices were latest to me and I quickly realized that they may cause great anxiety for each patients and doctors. I made a decision I needed more information and education on this topic. In the primary a part of this blog series, I’ll cover the fundamentals of NPWT, what it’s, how it really works, and the risks and advantages.

What is negative pressure wound therapy (NPWT)? (Gestring, 2023)

NPWT, also referred to as vacuum wound closure (VAC), distributes negative pressure over the wound surface repeatedly or intermittently. The therapy, which emerged within the early Nineteen Eighties, involves placing a dressing (foam or gauze) over the wound and connecting it to a vacuum pump via a tube. A transparent occlusive dressing is placed on top, creating an airtight, closed system. Gentle, controlled suction is used, drawing the wound remnants into the collecting chamber. The Food and Drug Administration (FDA) approved the primary NPWT therapy device in 1997. Today, there are lots of FDA-approved devices available on the market, lots of that are small and light-weight, allowing patients full mobility. Due to the various designs, it is crucial to confer with the manufacturer’s instructions for the precise device you might be using.

NPWT may support wound healing by (Lippincott Procedures, 2023):

• Providing a moist wound healing environment
• Improving the delivery of nutrients and oxygen to the wound
• Reduction of swelling
• Help with wound contracture
• Removal of exudate and bacteria that will impede cell growth
• Reducing inflammatory aspects
• Promoting blood vessel growth and tissue granulation

What sorts of wounds profit most from NPWT? (Lippincott Procedures, 2023; Wound Care Centers, n.d.)

• Surgical wounds, especially people who require healing as a result of secondary intention
• After surgical debridement of acute or chronic wounds (i.e. after orthopedic injuries, necrotic infections, mediastinitis after sternotomy)
• Open abdominal incisions, stripped surgical wounds
• Burns
• Skin flaps and preparation of web sites for skin grafts in reconstructive surgery
• Traumatic wounds
• Chronic wounds resembling venous insufficiency ulcers, arterial ulcers, diabetic foot ulcers and pressure injuries
• Wounds at high risk of infection
• Wounds with abundant drainage
• Mesh grafts, used to secure the graft in place or improve the epithelium
• Prophylactic therapy to stop surgical wound infections

How effective is NPWT? (Gestring, 2023)

Compared to traditional types of wound treatment, the benefits of NPWT include:

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• Improving wound healing and reducing wound closure time in diabetic patients, improving quality of life.
• Less frequent dressing changes (every two to 5 days)
• Dressings that might be adapted to any sort of wound

What are the risks of NPWT?

NPWT devices, if used improperly, may cause harm to patients, including:

• Pain
• Bleeding
• Infection
• Enterocutaneous fistula
• Damage to adjoining skin
• Dehydration

What aspects increase a patient’s risk of hostile events while using NPWT?

• Increased risk of bleeding and hemorrhage
• Anticoagulant therapy or platelet aggregation inhibitor
• Fragile or infected blood vessels
• Vascular anastomosis
• Infected wounds
• Osteomyelitis
• Spinal cord injury
• Intestinal fistulas
• Exposed organs, vessels, nerves, tendons and ligaments

Are there any contraindications to NPWT? (Gestring, 2023)

• Exposed blood vessels, vascular grafts or vital organs
• Untreated cancer
• Relative contraindications include:
  • Ischemic wounds, necrotic tissue with crust
  • Constant infection
  • Delicate skin
  • Glue allergy

Although great progress has been made to enhance the protection of NPWT devices, serious hostile events can still occur. Physicians should take the time to read the precise device manual, indications and contraindications, and ensure appropriate staff training. Providers who understand the principles of NPWT can then work together to be sure that each patient is appropriately chosen for treatment based on wound type, risk profile, and care setting. In the second a part of this series, I’ll discuss the NPWT dressing procedure, general patient care, and suggestions for troubleshooting the device.

Bibliography:
Gestring, M. (2023, November 17). Negative pressure wound therapy. . https://www.uptodate.com/contents/negative- pressure wound therapy

Lippincott Solutions (2023, February 20). Negative pressure wound therapy. . https://procedures.lww.com/lnp/view.do?pId=858844&hits=terapia,negative,wound,wounds,pressure

Tamir, E., Finestone, A. S., Wiser, I., Anekstein, Y., and Agar, G. (2018). Outpatient negative pressure therapy of wounds after surgical debridement: results and complications. , 31(8), 365-369. https://doi.org/10.1097/01.ASW.0000531352.93490.24

Wound care centers. (n.d.) Negative pressure wound therapy. Retrieved January 18, 2024 from http://www.woundcarecenters.org/article/wound-therapies/negative-pressure-wound-therapy