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CHAPTER OBJECTIVES

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At the end of this chapter, the learner will be able to:

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  1. Explain the effect of negative pressure wound therapy on wound healing.

  2. Explain the cellular and tissue effects of negative pressure wound therapy and link these effects to wound healing.

  3. Describe the indications for negative pressure wound therapy in wound management.

  4. Describe continuous and intermittent modes of negative pressure wound therapy and the advantages/disadvantages of both.

  5. Identify precautions and contraindications for the use of negative pressure wound therapy and develop adaptation strategies.

  6. Describe the basic steps involved in negative pressure wound therapy application.

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INTRODUCTION

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Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy (TNP),1,2 and negative pressure wound care (NPWC),3 was first documented as an adjunct treatment for open wounds in the early 1990s.2 By 2004 this active therapy was reported as standard of care for a variety of diagnoses in modern wound management.1 Through the application of a closed wound dressing and attached suction, NPWT applies controlled, subatmospheric pressure to open wounds and has been shown to provide the following benefits for wound healing:

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  • ▪ Promotion of moist wound healing4

  • ▪ Reduction of edema and interstitial fluid 1,4,5

  • ▪ Increased local perfusion6-8

  • ▪ Approximation of wound edges4,9

  • ▪ Stimulation of granulation tissue formation9,10

  • ▪ Reduction in bacterial load9

  • ▪ Reduction in the frequency of dressing changes11

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Since its acceptance into mainstream wound management, NPWT has been utilized in treating a wide variety of acute and chronic wounds12 including acute traumatic and surgical2,13 wounds healing by primary and secondary intention; burns14,15; and chronic wounds associated with venous insufficiency,3,12 diabetes,3,10,16,17 and pressure.18 Events such as the devastating 2010 earthquake in Haiti14 and war in the Middle East14,19,20 have also shown how the benefits of NPWT can positively influence limb salvage rates and decrease morbidity and mortality in mass casualty and high-energy injury situations.

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NPWT systems consist of a pump unit that provides suction, a wound filler that transfers negative pressure to the wound bed and allows flow of fluids from the wound, a transparent occlusive sheet that covers the wound filler and creates an airtight seal, and flexible tubing that delivers suction and serves as a conduit for removal of drainage and wound debris.21 Wound fluids are collected in a disposable container that is attached to the pump (FIGURE 15-1). TABLE 15-1 further describes NPWT components.

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Figure 15-1

Negative Pressure Wound Therapy The fluids are suctioned from the wound, through the foam, into an attached tube and into an air tight disposable canister. Although every system has its own ...

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