For the third in our series on adjunctive therapies, we will examine the role of negative-pressure wound therapy in wound management.

Treatment Overview

Negative-pressure wound therapy (NPWT) is a topical intervention widely used to treat problematic acute and chronic wounds that do not respond to conventional moist wound healing techniques. A negative pressure, typically -125 mmHg, is applied to the wound bed, removing excess exudate and helping to establish fluid balance. In addition, NPWT is thought to stimulate granulation tissue formation, reduce interstitial edema and improve microvascular blood flow.

The negative pressure in NPWT is applied via a tube from a vacuum device, threaded through a gauze or foam dressing that has been sealed with a transparent film. The negative pressure may be applied continuously or intermittently, depending on the wound type and the treatment objectives.

Indications

• Chronic, acute, and traumatic wounds
• Partial-thickness burns
• Dehisced wounds
• Pressure ulcers
• Neuropathic ulcers
• Muscle flaps
• Skin grafts
• Wounds due to arterial or venous insufficiency
• Wounds with exposed bone or tendons
• Orthopedic and degloving injuries
• Wounds with exposed hardware

Contraindications

• Dry wounds
• Necrotic wounds
• Wounds in body cavities
• Wounds over malignancies
• Presence of exposed blood vessels or untreated osteomyelitis

In addition, caution should be used with patients on anticoagulants or wounds with active bleeding, and NWPT should not be applied immediately after an incision and drainage procedure

Advantages

• Provides a closed moist wound healing environment
• Helps reduce contamination from outside bacteria
• Removes excess fluid from the wound and surrounding tissues
• Reduces cell death caused by dehydration
• May facilitate wound contraction
• If used for more than a few days, it may be more cost effective than standard wound care

Disadvantages

• Some patients report pain on treatment
• The bulkiness of the unit makes mobility difficult
• Because of the suction effect, some patients may develop pressure ulcers in the areas treated
• Obtaining an airtight seal can be difficult to achieve in some wound locations
• Cannot be used on necrotic wounds
• Can be expensive, especially over a short time frame

Interested in becoming certified in wound care management? Woundeducators.com is your online resource for the most comprehensive wound care information available, and can help you take the next step in your career. Contact us today for more information.

References:

Ahearn C. (2009). Intermittent NPWT and Lower Negative Pressures - Exploring the Disparity between Science and Current Practice: A Review; Ostomy Wound Management; 55(6), p.22

Sibbald RG, Mahoney J, VAC Therapy Canadian Consensus Group. (2003). A Consensus Report on the Use of Vacuum-Assisted Closure in Chronic, Difficult-to-Heal Wounds; Ostomy Wound Management; 49(11), p.52

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