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Introduction to Noninvasive Therapies
Published in Robert B. Northrop, Non-Invasive Instrumentation and Measurement in Medical Diagnosis, 2017
Negative-pressure wound therapy (NPWT) is an NI therapeutic means of expediting wound healing by applying a vacuum through a special, sterile, dressing sealed to the skin around the wound. A continuously or intermittently applied partial vacuum of ∼−75–125 mmHg is used to draw out fluid (serum, pus) from the wound to prevent its accumulation and possible infection; the vacuum also increases blood flow under the dressing. NPWT devices may also support the delivery of fluids to the wound, for example, saline, antibiotics, etc.; intermittent removal of the used fluid supports cleaning and drainage of the wound bed. An example of an improved NPWT dressing is found in the US Patent Application EP1758837 B1 filed 6/20/05 by P.W. Watt et al. for Systagenix Wound Management IP Co. BV. The first company to have an NPWT product cleared by the US FDA was Kinetic Concepts, in 1995. Worldwide Innovative Health Care (WiCare) offers a mechanically operated Wound-Pump™ NPWT device (2013) (Domings 2016). Their Wound-Pump does not require line electric power (or batteries).
Negative pressure wound therapy: device design, indications, and the evidence supporting its use
Published in Expert Review of Medical Devices, 2021
Stephen J. Poteet, Steven A. Schulz, Stephen P. Povoski, Albert H. Chao
Another aspect of NPWT that could benefit from further delineation are its contraindications. In the presence of critical structures such as blood vessels or nerves, or the possible presence of cancer, NPWT is typically considered contraindicated. Anecdotally, however, surgeons have successfully utilized NPWT to temporize certain types of defects. One example is sternal wounds after coronary artery bypass surgery that still require further surgical debridement prior to definitive closure. In these cases, vital structures are present, and a NPWT dressing provides a closed system that may also reduce the potential for loss of domain while awaiting further surgery. NPWT possesses similar potential advantages for large defects following tumor extirpation where a waiting period for final pathology results to determine on margin status is needed prior to definitive closure. Further study is needed to determine the safety, efficacy, and limitations of the use of NPWT in these settings.
Topical negative-pressure wound therapy: emerging devices and techniques
Published in Expert Review of Medical Devices, 2020
Raymund E. Horch, Ingo Ludolph, Wibke Müller-Seubert, Katharina Zetzmann, Theresa Hauck, Andreas Arkudas, Alexander Geierlehner
NPWT was initially invented to treat complex chronic wounds defined as usually heavily colonized wounds that do not heal within 3 months. However, from personal experience, it is often a matter of years rather than months during which people suffer from chronic wounds. The normal wound healing process can be seen as a complex interplay between certain molecular, cellular, and humoral processes. If disruption of those processes takes place wounds are prone to chronification [79]. The milieu of chronic wounds is markedly different from wounds undergoing a normal healing process. Chronic wounds are usually stuck in the inflammatory phase and highly susceptible to infection. Its underlying causes are manifold including but not limited to venous stasis, pressure necrosis, peripheral arterial disease, radiation, pyoderma gangrenosum, and diabetes (Figure 3) [25,60]. Up to 2% of the population suffers at least once from a chronic wound in the course of a lifetime [66]. Chronic wounds are usually accompanied with long hospital stays and emotional distress [80]. In addition, the patients’ disability and intensive medical care constitute a massive financial burden for the patient and health-care systems [81]. NPWT can also be applied to chronic wounds as temporary closure before definitive surgical closure such as skin grafting or tissue transfer. The rationale behind the bridging strategy in chronic wounds is to prepare the wound bed by reducing its bacterial load, removing harmful substances and debris, as well as stimulating delivery and production of various growth factors. Those effects can be of paramount importance especially in multimorbid patients potentially determining their overall long-term outcome. Lower leg ulcers are often accompanied by soft-tissue infection and severe peripheral vascular disorders. Poor vascularization of the lower limb can limit wound coverage to free tissue transfer in combination with vascular procedures. If a patient's general medical condition does not allow any complex reconstructive procedure under general anesthesia, lower limb amputation is often considered the only way to prevent systemic infection and save a patient’s life. However, NPWT combined with surgical debridement can reduce the complexity of the required surgical procedure such as skin grafting instead of pedicled or free tissue transfer [82,83]. This leads to the reduction of anesthesia time and increases the limb preservation rates in critically ill patients with lower leg defects [84].