Inside Insights On Negative Pressure Wound Therapy
“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?
In evaluating the potential for wound healing with NPWT, Dr. Bell cites the importance of checking the patient’s vascular status and perfusion to the wound. He adds that clinicians should also consider any sign of viable tissue in a deep wound as a favorable indication of the wound’s potential to heal. Dr. Bell says he has seen numerous wounds that presented initially with a majority of fibrin, slough or other debris but gave way to healthy granulation after consistent use of VAC therapy.
Dr. Bell says one must also address the infectious process. He notes that underlying osteomyelitis is not a contraindication if intravenous antibiotics or surgical treatment of the infection are ongoing. He notes that another benefit of NPWT is fluid/drainage management, especially considering the potential for reduction of matrix metalloproteinsases, which are a deleterious component of wound exudate.
Negative pressure wound therapy would be contraindicated in lower extremity wounds with the presence of malignancy or heavy bleeding, according to Dr. Bell. Dr. Travis also does not use NPWT on malignant wounds and emphasizes that one resolve active wound bleeding before instituting NPWT.
In Dr. Rogers’ center, NPWT fits into the spectrum of ulcer treatments in a narrow window. After excluding or treating ischemia and infection, and after mitigating plantar pressure through offloading, Dr. Rogers says one can address the purely neuropathic wound. He follows a spectrum of treatment for these wounds: debridement, promotion of granulation and wound closure. Dr. Rogers and his colleagues use NPWT as a very effective means of promoting granulation.
“It is not the alpha and the omega, and cannot be used throughout the treatment of a wound,” he says of NPWT. “Having a better understanding of when VAC therapy should be used will make it less likely to fail in wounds in which other modalities may be better suited.”
Dr. Rogers uses NPWT on a deep wound with or without exposed subcutaneous structures, and after it has been debrided of any nonviable tissue. He often combines VAC therapy with bioengineered tissue, collagen or silver products. After the wound becomes completely granular, Dr. Rogers discontinues VAC therapy and closes the wound by any number of means. During wound closure, he says one may continue NPWT briefly if it is intended as a bolster dressing for skin substitutes or skin grafts.
Dr. Travis agrees it is important to debride the wound prior to using NPWT and he utilizes sharp, mechanical or chemical debridement. He does not use VAC therapy on suspicious lesions or vasculitic ulcers.
Dr. Frykberg considers the depth and size of the wound as well as vascularity. He says NPWT is frequently used for management of open post-amputation wounds or post-I&D of infected wounds.
How do you compare VAC therapy (KCI) with other products that provide negative pressure?
Most of Dr. Travis’ experience is with VAC therapy. He feels the system’s dressings can fit the majority of the wounds he faces and it is a “universal system” that he can adjust according to his needs. Dr. Travis has used the Invia (Medela) and the Versatile 1 (Blue Sky Medical) devices as well, noting they were also effective. However, he says his comfort with VAC therapy and the ability to tailor his treatment make the device preferable.
“In my opinion, the comparison between VAC therapy and other systems is like comparing an automobile to a bicycle,” opines Dr. Bell.