Negative Pressure Wound Therapy

Open wound management is frequently used for treatment of wounds with extensive tissue injury or infection or those that are chronic and nonhealing. Early in the course of a wound’s treatment, open techniques require daily bandage changes, which result in pain, increased cost, time investment, and loss in nutritional opportunities because of the need for heavy sedation or anesthesia. An alternative is negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC). Negative pressure wound therapy stimulates wound healing by a variety of mechanisms, including removal of fluid and application of mechanical pressure. Removal of the excess interstitial fluid decreases interstitial pressure and wound edema, allowing capillaries to reopen and blood flow within the wound to increase. Cells within and around the wound are mechanically deformed by the negative pressure, and fibroblast mitotic rate and granulation tissue formation subsequently increase. Wounds that undergo NPWT have increased pro-angiogenic growth factor production and improved collagen deposition. One major advantage of NPWT is the ability to acutely stimulate inflammation and granulation tissue formation while delaying bandage changes to every 2 to 3 days. NPWT has also been used to enhance skin graft attachment, decrease seroma formation after primary wound closure, and treat peritonitis and myofascial compartment syndrome. NPWT should not be used in sites that have neoplasia, active bleeding, or exposed vessels or in patients with coagulopathies.  [...]