Negative-pressure wound therapy is where intermittent sub-atmospheric pressure is applied, via a bandage and suction method, to the surface of a wound. It’s a technique designed to speed up healing and is also commonly referred to as assisted wound closure therapy. Over the years it has become an increasingly popular way to treat and manage many acute and chronic wounds.
How does negative pressure wound therapy work?
The optimum pressure for effective wound healing appears to be approximately 125mm Hg, using an alternating pressure cycle of five minutes of suction followed by two minutes of suction. During a range of studies carried out on animals, this technique has been shown to decrease swelling and optimise blood flow to the wound bed. It also helps reduce bacteria and remove excessive fluid that can slow up the healing the process.
Additionally, intermittent low pressure has been shown to change the structure of the cells in the wound bed. In turn this triggers a cascade of intracellular signals that boosts the rate of cell division and the formation of granulation tissue.
When is negative-pressure wound therapy a useful option?
There are many examples of when negative-pressure wound therapy has made a substantial and positive difference to patient outcomes. They include:
- Pressure ulcers
- Acute surgical and traumatic wounds
- Subacute and dehisced wounds
- Chronic and open wounds (for example diabetic foot ulcers and venous stasis ulcers)
- An adjunct to skin grafts/flap procedures
- Meshed grafts, to secure the graft in place and/or to accelerate the epithelialisation of the donor site
When is negative-pressure wound therapy not appropriate?
Some types of wounds are not suitable for negative-pressure wound therapy and it should therefore be avoided. They include:
- Wounds that are the result of skin cancer
- Necrotic (dead) tissue or eschar that has not been debrided (sloughed-off dead tissue, or a scab)
- Fistulas (tunnels) to organs and body cavities (non-enteric and unexplored fistulas)
- Osteomyelitis (inflamed bones)
Silver-containing dressings should also not be used if the patient is sensitive to these.
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