EWMA Document: Negative Pressure Wound Therapy

Abstract

1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care. NPWT has been described as a effective treatment for wounds of many different aetiologies and suggested as a gold standard for treatment of wounds such as open abdominal wounds, dehisced sternal wounds following cardiac surgery and as a valuable agent in complex non-healing wounds. Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care. While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse. The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary ...

Negative Pressure Wound Therapy for Necrotizing Fasciitis and Compartment Syndrome of the Upper Extremity — a case report

“…3, 6,11 Nowadays, negative pressure wound therapy is a widely used method in complex wound care. 1,10 There are not many publications about NPWT in necrotizing fasciitis. Some authors suggest using NPWT only a few days after the primary operation.…”

“…It has positive effects on wound healing, bacterial decontamination, removal of excessive, toxic fluid from the wound, angiogenesis and tissue perfusion. 1,10 In the last decade, the use of NPWT has become the gold standard in the treatment of NF. 1,3,4,6,9 We present a successful negative pressure wound therapy in case of extended necrotizing fasciitis and compartment syndrome of the right upper extremity.…”

Negative pressure wound therapy use in diabetic foot syndrome—from mechanisms of action to clinical practice

“…This list involves acute, chronic and postsurgical wounds, including those localized in the abdomen and sternum, open fractures, foot pressure ulcers (particularly in diabetes), grafts and flaps. 16 Negative pressure wound therapy is a general term that includes all devices firmly sealing the wound and creating a near airtight setting to which a vacuum is connected. This term is sometimes used interchangeably with another name, vacuum-assisted closure (VAC).…”

“…The European Wound Management Association (EWMA) has recently published an extensive summary on the use of NPWT in different clinical situations, including diabetes. 16 It is noteworthy that both important trials, by Amstrong and Blume, were criticized by EWMA for their possible biases. 25,26 In the first study, the option of directing study participants to surgery was up to the investigators.…”

Evaluating complications in below‐knee skin cancer surgery after introduction of preoperative appointments: A 2‐year retrospective cohort study

“…24 Some studies show a positive effect of NPWT on postoperative wound healing, but the evidence is still limited with a need for larger RCT studies. [24][25][26]…”