Pressure distribution and flow characteristics during negative pressure wound therapy

Biermann, Niklas; Geissler, Edward K.; Brix, Eva; Schiltz, Daniel; Muehle, Clemens; Prantl, Lukas; Taeger, Christian D.

doi:10.1016/j.jtv.2019.12.004

Cited by 12 publications

(15 citation statements)

References 29 publications

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“…Although we used a different device in our current study, examined values were comparable to previous investigations in our department ( 8 ). An almost linear increase in surface pressure was found in relation to applied suction, which is also in line with results published earlier ( 10 , 14 ).…”

Section: Discussionsupporting

confidence: 92%

Superior Enhancement of Cutaneous Microcirculation Due to “Cyclic” Application of a Negative Pressure Wound Therapy Device in Humans – Local and Remote Effects

et al. 2022

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ObjectivesDespite a common utilization of “Negative Pressure Wound Therapy” (NPWT) Devices in a wide range of specialties, some of the basic mechanisms of action of the techniques are still on debate. Conflicting results from prior studies demonstrate our lack of understanding how wound-bed perfusion or cutaneous microcirculation is affected by NPWT.MethodsWe conducted a prospective randomized study which included 45 healthy subjects to further investigate the acute effects of NPWT on cutaneous microcirculation underneath the applied dressing. Three modes of application, namely, continuous, intermittent, cyclic, were tested. Amongst others, measurements of elicited surface pressure and a comprehensive microcirculatory analysis were carried out by utilizing an O2C-device. For the detection of (systemic) remote effects, perfusion changes of the contra-lateral thigh were evaluated.ResultsAll three tested modes of application led to a significant (p < 0.05) improvement in local tissue perfusion with an increased blood flow of max +151% and tissue oxygen saturation of +28.2% compared to baseline values. Surface pressure under the dressing significantly increased up to 29.29 mmHg due to the activation of the NPWT device. Continuous, intermittent, and cyclic application of negative pressure were accurately sensed by participants, resulting in reported pain values that mirrored the different levels of applied suction. Although the cyclic application mode showed the most pronounced effects regarding microcirculatory changes, no statistical significance between groups was observed.ConclusionWe could demonstrate a significant improvement of cutaneous microcirculation under an applied NPWT dressing with favorable effects due to cyclic mode of application. An increased surface pressure leads to a better venous drainage of the tissue, which was shown to increase arterial inflow with a consecutive improvement of oxygen supply. Further research is warranted to evaluate our findings regarding wound bed perfusion in the clinical field with respect to formation of granulation tissue and wound healing.

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Section: Discussionsupporting

confidence: 92%

Superior Enhancement of Cutaneous Microcirculation Due to “Cyclic” Application of a Negative Pressure Wound Therapy Device in Humans – Local and Remote Effects

et al. 2022

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“…Results revealed that even if the NPWT device did not sound an alarm and appeared to be working properly, pressure in the chamber was sometimes not of the intended values (Figure 2A). It is known that the pressure exerted on the wound surface during NPWT does not always match the machine settings 32 . In in vitro experiments, ambiguity in parameter settings can cause uncertainty of results and confusion among researchers.…”

Section: Discussionmentioning

confidence: 99%

“…This study focused on microdeformation as part of the major therapeutic mechanisms of NPWT. In NPWT, a sudden pressure difference between inside and outside the dressing occurs as soon as treatment begins, resulting in a compression force on the wound surface 32 and hypoxia in the dressing 35 . This rapid and transient environmental change is thought to induce cellular responses such as the release of angiogenetic factors 36 .…”

Section: Discussionmentioning

confidence: 99%

Novel cell culture system for monitoring cells during continuous and variable negative‐pressure wound therapy

Yamashiro

Kubota

Mayumi

et al. 2022

Skin Research and Technology

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Background Although the clinical efficacy of negative‐pressure wound therapy (NPWT) is well known, many of its molecular biological mechanisms remain unresolved, mainly due to the difficulty and paucity of relevant in vitro studies. We attempted to develop an in vitro cell culture system capable of real‐time monitoring of cells during NPWT treatment. Materials and methods A novel negative‐pressure cell culture system was developed by combining an inverted microscope, a stage‐top incubator, a sealed metal chamber for cell culture, and an NPWT treatment device. Human keratinocytes, PSVK‐1, were divided into ambient pressure (AP), continuous negative‐pressure (NPc), and intermittent negative‐pressure (NPi) groups and cultured for 24 h with scratch assay using our real‐time monitoring system and device. Pressure inside the device, medium evaporation rate, and the residual wound area were compared across the groups. Results Pressure in the device was maintained at almost the same value as set in all groups. Medium evaporation rate was significantly higher in the NPi group than in the other two groups; however, it had negligible effect on cell culture. Residual wound area after 9 h evaluated by the scratch assay was significantly smaller in the NPc and NPi groups than in the AP group. Conclusion We developed a negative‐pressure cell culture device that enables negative‐pressure cell culture under conditions similar to those used in clinical practice and is able to monitor cells under NPWT. Further experiments using this device would provide high‐quality molecular biological evidence for NPWT.

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“…Despite a steadily increasing application of negative pressure wound therapy with instillation (NPWTi) in acute and chronic wound care, a thorough understanding of the underlying physiology, as well as of monitoring tools during the dressing phase, is lacking [1][2][3][4][5][6][7][8]. In NPWTi, the additional fluid instillation is thought to facilitate the removal of microorganisms, dilute inflammatory and cytotoxic molecules, as well as more strongly influence angiogenesis due to intermittent suction intervals [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study

Taeger

Wallner

Martini

et al. 2021

Cells

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Background: During negative pressure wound therapy (NPWT), open wounds are draped with a nontransparent sponge, making daily wound evaluation impossible. Sometimes, late or undetected bacterial infections and postoperative bleeding result in repetitive surgery, thus prolonging inpatient time. With the introduction of additional fluid instillation (NPWTi), the wound surface is rinsed, and bacteria, proteins and biomarkers are flushed into a collecting canister, which is later discarded. Methods: The aim of this pilot study was to analyze rinsing fluid samples (0.9% sodium chloride) from the NPWTi device in patients with acute and chronic wounds. In 31 consecutive patients a standardized laboratory analysis was performed to evaluate cellular composition and potassium, phosphate, lactate dehydrooxygenase, pH and total protein levels. Results: While there was an increase in the total cellular amount and the number of polymorphonuclear cells, the number of red blood cells (RBC) decreased after surgery. Potassium and pH showed no significant changes in the first three postoperative days, whereas total protein showed an undulant and partially significant course. Conclusion: We were able to quantify cellular metabolites by analyzing the rinsing fluid of NPWTi. We propose the analysis of this material as a novel and potentially promising tool to monitor wound status without removal of the dressing. The establishment of reference values might help to improve the NPWTi therapy.

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Pressure distribution and flow characteristics during negative pressure wound therapy

Cited by 12 publications

References 29 publications

Superior Enhancement of Cutaneous Microcirculation Due to “Cyclic” Application of a Negative Pressure Wound Therapy Device in Humans – Local and Remote Effects

Superior Enhancement of Cutaneous Microcirculation Due to “Cyclic” Application of a Negative Pressure Wound Therapy Device in Humans – Local and Remote Effects

Novel cell culture system for monitoring cells during continuous and variable negative‐pressure wound therapy

Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study

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