Expanding The Use Of NPWT Beyond DFUs: What The Literature Reveals

Recently, the use of NPWT has expanded beyond the treatment of diabetic foot ulcers. Negative pressure wound therapy improves the take of split-thickness skin grafts by acting as a bolster and preventing an accumulation of fluid beneath the graft site.1 In 2004, Moisidis and co-workers found that the quality of take for split-thickness skin grafts subjected to NPWT was qualitatively improved in 50 percent of the cases they studied.2

Researchers have also studied the benefits of NPWT with respect to the healing of wounds secondary to traumatic, open fractures. In 2009, Stannard and colleagues reported on the results of a prospective, randomized study in which 58 patients with 62 open fractures were treated with either standard wet-to-dry dressings or NPWT.3 The authors found that the group treated with NPWT was one-fifth as likely to develop an infection as the control group, suggesting that NPWT may be an effective adjunct in the treatment of severe, open fractures.

Another trend which has been gaining popularity in recent years is the use of NPWT over closed incision sites. NPWT reportedly increases local tissue perfusion, reduces edema, increases the rate of granulation tissue formation and promotes cellular proliferation through micromechanical forces. When one applies NPWT over a clean, closed incision, the modality acts to protect the wound bed and creates a splinting effect on the surrounding soft tissue.4 Furthermore, the need for frequent dressing changes on high-risk incision sites is eliminated and authors have shown that the incidence of dehiscence and infection is decreased.5,6

Various authors have reported the use of NPWT over closed incision sites in cases of coronary artery bypass grafting (CABG), abdominal hysterectomy, revisional hip arthroplasty, transmetatarsal amputation and high-risk fractures of the lower extremity.4-6

References

1. Andros G, Armstrong DG, Attinger CE, Boulton AJ, Frykberg RG, Joseph WS, Lavery LA, Morbach S, Niezgoda JA, Toursarkissian B; Tucson Expert Consensus Conference. Consensus statement on negative pressure wound therapy (V.A.C. Therapy) for the management of diabetic foot wounds. Ostomy Wound Manage. 2006 Jun;Suppl:1-32.
2. Moisidis E, Heath T, Boorer C, Ho K, Deva AK. A prospective, blinded, randomized, controlled clinical trial of topical negative pressure use in skin grafting. Plast Reconstr Surg. 2004;114(4):917-22.
3. Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE. Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma. 2009;23(8):552-7.
4. Stannard JP, Atkins BZ, O'Malley D, Singh H, Bernstein B, Fahey M, Masden D, Attinger CE. Use of negative pressure therapy on closed surgical incisions: a case series. Ostomy Wound Manage. 2009;1;55(8):58-66.
5. Gomoll AH, Lin A, Harris MB. Incisional vacuum-assisted closure therapy. J Orthop Trauma. 2006;20(10):705-9.
6. Stannard JP, Volgas DA, McGwin G 3rd, Stewart RL, Obremskey W, Moore T, Anglen JO. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma. 2012;26(1):37-42.

Editor’s note: This blog was co-authored by Adam Issac, DPM, and excerpted from the forthcoming article, “A Guide To Current And Emerging NPWT Therapies,” which will be published in the July issue of Podiatry Today.



Dennis Timkosays: May 22, 2012 at 10:49 am

I like the idea of using the NPWT over closed incisions. Which type/product of NPWT would you use on a closed incision site? Kalypto?

Also, do insurances cover that type of treatment for a closed wound or is it an out-of-pocket expense?

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