Negative pressure wound therapy

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KCI Acti V.A.C. pump used to create negative pressure and used in conjunction with a variety of KCI dressings.

Negative pressure wound therapy NPWT [1], also known as topical negative pressure (TNP), sub-atmospheric pressure dressings (SPD) or vacuum sealing technique (VST), is a therapeutic technique used to promote healing in acute or chronic wounds, fight infection and enhance healing of burns. A vacuum source is used to create sub-atmospheric pressure in the local wound environment. While the exact method of action is not yet fully understood, NPWT is thought to benefit wound healing by:

1) removing wound fluid and dessicated tissue;
2) decreasing the level of bacteria in the wound;
3) improving blood flow in the wound bed and surrounding tissue;
4) promoting granulation tissue and
5) pulling the wound edges together and stimulating cell growth[1][2]

The dynamic interplay of these methods of action are thought to improve the state of the wound and promote healing.


Contents

[edit] Overview

NPWT seals the wound with a gauze or foam filler dressing, a drape and a vacuum source that and applies negative pressure to the wound bed with a tube threaded through the dressing. The vacuum may be applied continuously or intermittently, depending on the type of wound being treated and the clinical objectives. Intermittent removal of used instillation fluid supports the cleaning and drainage of the wound bed and the removal of infectious material.[3]

[edit] Technique

NPWT has two forms which mainly differ in the type of dressing used to transfer NPWT to the wound surface: gauze or foam.

In 1997, Morykwas & Argenta described an approach using a sealed polyurethane foam dressing.[4] There are earlier reports of clinicians using both foam or gauze. There is little evidence suggesting that either is more effective than the other. Clinicians’ preferences for one dressing type over another depend on the type of wound, clinical objectives, and a particular patient. [5] For pain sensitive patients with shallow or irregular wounds, wounds with undermining or explored tracts or tunnels, and for facilitating epithelialization, gauze may be a better choice for the wound bed. On the other hand, foam may be cut easily to fit a patient’s wound that has a regular contour, such as surgical dehiscence or abdominal wound and perform better when aggressive granulation formation and wound contraction is the desired goal [6]

Application of a vacuum pump using a foam dressing to a wound.

A dressing, containing a drainage tube, is fitted to the contours of a deep or irregularly-shaped wound and sealed with a transparent film. The tube is connected to a vacuum source, turning an open wound into a controlled, closed wound while removing excess fluid from the wound bed to enhance circulation and remove waste from the lymphatic system. The technique is usually used with chronic wounds.[7]). NPWT is also applied to diabetic foot ulcers [8], venous insufficiency ulcers [9], traumatic wounds [10], dehisced surgical wounds [11] as well as a variety of burns [12] and to facilitate graft take.[13]

[edit] Effectiveness

A Cochrane Review updated on December 13, 2007 sought to evaluate the effects of NPWT on chronic wound healing. It reviewed seven studies comparing NPWT with moistened dressings and other topical agents in a total of 205 patients with chronic wounds. The reviewers concluded that the seven studies has methodological flaws and do not demonstrate a beneficial effect of NPWT in chronic wound healing. The reviewers called for better quality research.

In addition to the seven studies reviewed by Cochrane, there have been more than 254 articles published on the use of NPWT in a variety of wound types and clinical environments, Gregor. There is a consensus document in the International Wound Journal on the V.A.C. that lists 16 studies relating to different wound types. (Harding 2008).

[edit] NPWT SUPPLIERS

In 1995 the Food and Drug Administration was presented with and first approved negative pressure equipment that was subsequently marketed as the V.A.C (for vacuum assisted closure), by KCI (Kinetic Concepts, Inc., San Antonio, TX). In medical trials, the treatment was as safe, and more effective, than moist treatment for diabetic ulcers.[14]

Smith & Nephew acquired Blue Sky Medical in 2007 [15] and marketed its NPWT equipment until Smith & Nephew introduced RENASYS [16] EZ and RENASYS GO NPWT systems in February 2009. RENASYS works with both foam and gauze wound dressings.


[edit] Gallery

Diabetic foot ulcer prior to treatment

After treatment

[edit] References

  1. ^ Banwell, Paul and Teot Luc (2006). Topical negative pressure (TMP): the evolution of a novel wound therapy. Tissue Viability Society, Vol 16, No 1, February 2006.
  2. ^ Chariker, Mark (2009). Moisture Balance: Exploring Options in Negative Pressure Wound Therapy. Advances in skin and wound care, Volume 22, Supplement 1, pps 10-12, January 2009.
  3. ^ Moch D, Fleischmann W, Westhauser A (1998). "[Instillation vacuum sealing--report of initial experiences]" (in German). Langenbecks Arch Chir Suppl Kongressbd 115: 1197–9. PMID 9931834. 
  4. ^ Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W (June 1997). "Vacuum- assisted closure: a new method for wound control and treatment: animal studies and basic foundation". Ann Plast Surg 38 (6): 553–62. PMID 9188970.
  5. ^ Arnold-Long Mary and Blevins Anne (2009). Options in Negative Pressure Wound Therapy. Journal of Wound, Ostomy and Continence Nursing, Vol 36, No 2, March/April 2009
  6. ^ Arnold-Long Mary and Blevins Anne (2009). Options in Negative Pressure Wound Therapy. Journal of Wound, Ostomy and Continence Nursing, Vol 36, No 2, March/April 2009.
  7. ^ Armstrong DG, Lavery LA (2005
  8. ^ Vuerstaek , Jeroen D. D. , MD, Tryfon Vainas, MD, PhD, Jan Wuite, MD, Patty Nelemans, MD, PhD, Martino H. A. Neumann, MD, PhD, and Joep C. J. M. Veraart, MD, PhD (2006). State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings. Journal of Vascular Surgery, Volume 44, Issue 5, November 2006, Pages 1029-1037.
  9. ^ Stannard, James P. MD; Robinson, James T. BS; Anderson, E Ratcliffe MD; McGwin, Gerald Jr PhD; Volgas, David A. MD; Alonso, Jorge E. MD, (2006). Negative Pressure Wound Therapy to Treat Hematomas and Surgical Incisions Following High-Energy Trauma. Journal of Trauma-Injury Infection & Critical Care. 60(6):1301-1306, June 2006
  10. ^ Fleck, Tatjana M., Michael Fleck, Reinhard Moidl, Martin Czerny, Rupert Koller, Pietro Giovanoli, Michael J. Hiesmayer, Daniel Zimpfer, Ernst Wolner, and Martin Grabenwoger (2002). The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann. Thorac. Surg., Nov 2002; 74: 1596 – 1600.
  11. ^ Llanos, Sergio, MD, Stefan Danilla, MD, MSc, Cristina Barraza, Eugenia Armijo, RN, Jose L. Pin˜eros, MD, Maria Quintas, MD, Susana Searle, MD, and Wilfredo Calderon, MD, FACS (2006). Effectiveness of Negative Pressure Closure in the Integration of Split Thickness Skin Grafts. A Randomized, Double-Masked, Controlled Trial. Annals of Surgery • Volume 244, Number 5, November 2006.
  12. ^ Harding Keith (2008). Vacuum-assisted closure: Recommendations for use. A consensus Document. International Wound Journal. September 2008, Volume 5, Supplement 4.
  13. ^ Blume PA, Walters J, Payne W, Ayala J, Lantis J (April 2008). "Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial". Diabetes Care 31 (4): 631–6. doi:10.2337/dc07-2196. PMID 18162494
  14. ^ Blume PA, Walters J, Payne W, Ayala J, Lantis J (April 2008). "Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial". Diabetes Care 31 (4): 631–6. doi:10.2337/dc07-2196. PMID 18162494. http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=18162494. 
  15. ^ “Smith &Independent Buys Wound Care Firm Blue Sky for $110M”. 12 May 2007
  16. ^ “Smith & Nephew Introduces RENASYS™ EZ for Negative Pressure Wound Therapy”, Reuters, 24, February 2009
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