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negative pressure wound therapy

Indications: - pressure ulcer (stage III or IV) not responding to conventional therapy [1] - severe traumatic wounds - diabetic foot infections - wounds complicated by invasive infection or extensive biofilm Contraindications: - simple wounds or wounds in patients without comorbidities - of no benefit for patients with severe open fracture of the lower limb [4] Procedure: - consists of nonadherent, reticulated foam* placed placed into the wound bed & covered with an occlusive transparent film - an evacuation tube is connected to the film & negative pressure is applied with an adjustable vacuum pump [1] - dressing is changed every 48 hours * some systems use gauze packing Clinical significance: - reduces frequency of dressing changes - may decrease cost of nursing time - may decrease cost of supplies - may improve patient's quality of life [1] Mechanism of action: - stimulates formation of granulation tissue & wound retraction - reduces edema at the wound site - pulls fluid from the wound - improves blood flow to the wound

General

wound care

References

  1. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Gupta S, Ichioka S. Optimal use of negative pressure wound therapy in treating pressure ulcers. Int Wound J. 2012 Aug;9 Suppl 1:8-16. Review. PMID: 22727135
  3. Kim PJ, Attinger CE, Olawoye O et al Negative Pressure Wound Therapy With Instillation: Review of Evidence and Recommendations. Wounds. 2015 Dec;27(12):S2-S19. PMID: 26966814 Free Article
  4. Costa ML, Achten J, Bruce J et al Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial. JAMA. 2018; 319(22):2280-2288 PMID: 29896626 https://jamanetwork.com/journals/jama/fullarticle/2684606
  5. Apelqvist J, Willy C, Fagerdahl AM et al. EWMA document: negative pressure wound therapy. J Wound Care. 2017;26(Sup 3):S1-S152 PMID: 28345371 https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2017.26.Sup3.S1
  6. Dumville JC, Webster J, Evans D et al. Negative pressure wound therapy for treating pressure ulcers. Cochrane Database Syst Rev. 2015 May 20;20(5):CD011334 PMID: 25992684 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011334.pub2/full