Inside Insights On Negative Pressure Wound Therapy
All four panelists have had positive experiences with NPWT. For Eric Travis, DPM, negative pressure therapy is “valuable and consistent” when treating lower extremity wounds. As he says, the foot and ankle pose a unique challenge with traditional dressings. Dr. Travis notes that results with such dressings have been “inconsistent and ineffective” due to uneven topography, shear forces, undrained subcutaneous seromas and unique vectors of wound tension. Dr. Travis notes that NPWT seems to decrease the amount of proteases and other lytic enzymes that cause cellular breakdown and delayed healing. He adds that the literature on this subject supports this as well. Negative pressure also decreases bacterial load, increases granulation and increases tissue oxygen perfusion and nutrient uptake, according to Dr. Travis. Calling Vacuum Assisted Closure (VAC) therapy “a wound simplification device,” Lee Rogers, DPM, says the technology makes complicated wounds simple. Within days, he says VAC therapy can convert a wound with exposed structures (e.g. University of Texas (UT) 2A ulcer) into a superficial wound with quality granulation tissue (UT 1A ulcer) ready to accept a skin substitute or a graft. Dr. Rogers says VAC therapy is “extremely effective” at creating or enhancing granulation tissue, and is also effective in preparing the wound bed for advanced closure. Although VAC therapy (KCI) is contraindicated in “untreated osteomyelitis,” Dr. Rogers says he frequently uses NPWT over exposed bone without surrounding signs of soft tissue infection. He will fenestrate the exposed bone with a 2.0-mm drill in the operating room and if intraoperative hemorrhage is controlled, he places the VAC therapy on the wound. As Dr. Rogers notes, fenestrating or decorticating the bone exposes the marrow, containing mesenchymal stem cells, to the wound bed and can enhance granulation tissue. Since 1999, Desmond Bell, DPM, has been using the VAC therapy extensively on foot, heel and lower leg wounds in hospital, office and home care settings. Dr. Bell thinks VAC therapy is “one of the true difference makers” and says the technology of negative pressure therapy has paralleled the advancement of wound care as a specialty. “Negative pressure wound therapy has had a tremendous impact on my patient population as it has been a critical component of many successful outcomes in which the potential for lower extremity amputation was great,” explains Dr. Bell. Robert Frykberg, DPM, has had an “excellent” experience with NPWT. He uses VAC therapy frequently for conditions such as lower extremity ulcers, post-amputations and dehiscence. He also uses the technology to prepare wounds for delayed closure. “Like most successful wound care products, NPWT is consistent, effective and versatile,” says Dr. Travis. “I tend to use VAC therapy on the majority of my patients unless insurance or circumstances dictate otherwise. In those cases, I will use a similar device.” Dr. Travis uses VAC therapy on tunneling wounds, traumatic wounds, amputation wounds that are compromised by inadequate circulation, and for ulcerations associated with diabetes and peripheral vascular disease. “I really find that VAC therapy has given me a great advantage with skin grafting techniques of the foot and ankle,” he notes. “I feel that skin grafting techniques with NPWT have created a more rapid, secure graft take while removing the negative factors that cause graft failure.”
When you are evaluating a wound, what factors facilitate the use of NPWT?