Negative pressure therapy for the treatment of complex wounds

Abstract

The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment

“…NPWT is a system that usually consists of reticulated foam covered with an adhesive drape. Evidence suggests that wound healing is achieved by several mechanisms, which include: facilitating fluid efflux removal, reducing peripheral oedema, improving blood supply, approximating the edges of the wound, eliminating necrotic tissue, stimulating the formation of granulation tissue, and stimulating the expression of healing‐related factors, and it is proposed that bacterial clearance may occur …”

“…Evidence suggests that wound healing is achieved by several mechanisms, which include: facilitating fluid efflux removal, reducing peripheral oedema, improving blood supply, approximating the edges of the wound, eliminating necrotic tissue, stimulating the formation of granulation tissue, and stimulating the FIGURE 2 Left: Wound bed preparation after negative pressure wound therapy (NPWT) treatment; right: split-thickness skin graft over scalping lesion FIGURE 3 Six months' postoperatively, with stable coverage of the scalping lesion expression of healing-related factors, and it is proposed that bacterial clearance may occur. 5,14,15 Significant complications of NPWT are infrequent and have already been described. These include mainly bleeding, infection, and pain.…”

“…One technique of temporary coverage is negative pressure wound therapy (NPWT) . It is a method of injury treatment that applies subatmospheric pressure to the surface of a wound …”

“…4 It is a method of injury treatment that applies subatmospheric pressure to the surface of a wound. 5 Complications of NPWT have been described, mainly represented by bleeding, infection, and pain. 6 However, there is no report of acute otitis externa (AOE) because of NPWT.…”

Dressings Indicated in the Treatment of Mediastinitis After Cardiac Surgery: Integrative Review

“…The mechanism of action of NPWT consists of cellular proliferation and angiogenesis, favoring the appearance of granulation tissue, reduction of the local inflammatory response, through the reduction of edema and exudate, and consequent contraction of the wound margins. 21 Professionals of the European Association of Cardiothoracic Surgery published in 2016 a guideline on prevention and management of mediastinitis, in which treatment with negative pressure therapy is classified as grade of recommendation I, level of evidence B, that is, there is a general consensus that the procedure is safe and effective. 5 However, it is important to emphasize that despite the benefits described, NPWT can also present complications and, therefore, safety measures should be adopted during treatment.…”