Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review

Abstract

Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds.

Negative Pressure Wound Therapy with Instillation and Dwell for the Management of a Complex Burn: A Case Report and Review of the Literature

“…Recent literature has shown that NPWT can be used as an adjunct to treat burn patients. NPWT can reduce the number of dressing changes for patients while improving management and healing time by stimulating the formation of healthy granulation tissue critical for successful grafting [12-13]. Current research has shown negative pressure wound therapy (NPWT) decreases the length of recovery time after burns, with a reported 78% decrease in hospital stay and a 76% decrease in cost [14].…”

Computational modelling of wounded tissue subject to negative pressure wound therapy following trans-femoral amputation

“…The mechanism of the NPWT in wound healing is multifactorial and current results of the NPWT in non-combat-related wounds encouraged military surgeons (Maurya and Bhandari 2016 ). This technique becomes a preferred method in combat trauma management.…”

“…In this study, several model assumptions were made due to the prerequisite for simplification, and these should be considered when interpreting our results. Many of the wounds caused by the combat-related traumatic injuries have complex shapes with an extensive loss of soft tissues and bony materials (Maurya and Bhandari 2016 ). In our simplified version of the scenario, the wound shape was assumed as a cylinder-shaped cavity in order to reduce the complexity of the model.…”

“…Many of the wounds caused by the combat-related traumatic injuries have complex shapes with an extensive loss of soft tissues and bony materials (Maurya and Bhandari 2016 ). In our simplified version of the scenario, the wound shape was assumed as a cylinder-shaped cavity in order to reduce the complexity of the model.…”

Infections in Combat / Terrorist Injuries And Rational Antibiotic Use

“…Yaralı tahliyesinin gecikmesi Savaş yaralanmalarında; dokulara yüksek enerjinin transferi sonucu birçok anatomik yapı etkilenmekte olup, genellikle kompozit doku kaybı görülmektedir. Yaralanmaların erken döneminde yara iyileşmesi hız-lı, enfeksiyon oranı düşüktür (4) . (5) .…”