Expert Pointers On Negative Pressure Wound Therapy

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Lee C. Rogers, DPM, used VAC therapy until the wound bed was completely prepared and granular as shown in the above photo.
Here one can see a meshed graft on the dorsum of the foot covering a chronic wound. Note that one can minimize the meshed area, giving greater coverage and still avoiding seroma collection when using VAC therapy. (Photo courtesy of Eric Travis, DPM)
Expert Pointers On Negative Pressure Wound Therapy
Expert Pointers On Negative Pressure Wound Therapy
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Author(s): 
Clinical Editor: Lawrence Karlock, DPM

Given the increasing use of negative pressure wound therapy (NPWT) to spur wound healing, our expert panelists return for the second part of this Q&A discussion on NPWT (see “Inside Insights On Negative Pressure Wound Therapy,” page 24, May issue). They offer specific pearls on the use of NPWT, how to combine the modality with skin grafts and silver dressings, and tips for avoiding wound maceration.

Q: Do you have any pearls for using negative pressure wound therapy (NPWT)?
A:
Eric Travis, DPM, utilizes VAC therapy (KCI) mostly at 125 mmHg of continuous suction. For a fragile wound or one with heavy exudation, he lowers the amount of suction. Dr. Travis advises caution with wounds that have significant periwound maceration and necrosis. He notes that he uses VAC open sponge technology to treat tunneling wounds.
To prepare wounds prior to grafting, he applies growth factor technology, namely Regranex (Johnson & Johnson), and Panafil (Healthpoint) with VAC technology. In such cases, Dr. Travis recommends daily dressing changes. He uses silver dressings like Silverlon (Argentum Medical) with VAC therapy as he says they essentially maintain a lower bacterial burden and promote wound healing. Dr. Travis says such a combination is most effective with grafting techniques.

Desmond Bell, DPM, incorporates VAC therapy with compression dressings. He says this is effective in helping prevent accidental disruption of the VAC seal. Compression via an Unna boot can also help reduce inherent edema in the lower extremity and can expedite the removal of exudates, according to Dr. Bell. In addition, Dr. Bell says wrapping a self-adhering bandage around the VAC tubing and subsequently securing it to the self-adhering outer wrap of the Unna boot can help prevent accidental pulling or catching of the tubing.
For Lee Rogers, DPM, the most important pearl is knowing the proper wound in which to use NPWT. As he says, NPWT is best suited for deep, complicated wounds that require granulation tissue formation or enhancement of this tissue. Negative pressure wound therapy is not going to improve a wound that is shallow and granular, asserts Dr. Rogers, as such a wound is already at the desired endpoint. He notes the importance of thoroughly debriding the wound of necrotic and fibrotic tissue prior to using NPWT. Dr. Rogers suggests that one can also use NPWT in difficult locations such as interspaces between toes or around external fixation devices.
Robert Frykberg, DPM, uses NPWT therapy frequently. He includes a TRAC Pad (KCI) on the top of the foot for plantar wounds and also uses NPWT in conjunction with tissue substitutes.

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