Edges are clean with evidence of granulation and even some epithelial migration at the distal edges.ĥ. Drainage is moderate serosanguineous with no active bleeding noted no evidence of pseudomonas in the drainageĤ. Tissue consists grossly of 40% exposed muscle, 30% tendon with paratenon intact, 30% fascia, and subcutaneous tissue with five Penrose drains in placeģ. What wound characteristics would determine if NPWT is indicated?Ģ. What medical information would you need from the patient’s chart to determine if NPWT is indicated?Ģ. There are exposed tendons and muscle, and Penrose drains (at the arrow) have been placed to allow drainage from the deeper tissue.ġ. Most devices offer several options for “tailoring” 21 NPWT to each patient need so that optimal care can usually be achieved regardless of specific vendor.įIGURE 15–2 Case study wound for NPWT Left-hand wound after surgical debridement of infected tissue. 1, 5, 13, 27 Despite differences in size and shape, all NPWT devices basically offer the same benefits, and selection of a device may depend on the patient’s medical coverage. 13, 26 The occlusive covering maintains a moist wound healing environment and an airtight seal that is vital in sustaining negative pressure. Mechanical stimulation at both the tissue (macrostrain) and cellular (microstrain) levels 25 encourages cellular proliferation, granulation tissue formation, and wound contraction. Inflammatory mediators and bacteria are removed along with tissue fluids, thereby reducing wound inflammation and facilitating progression to the proliferative healing phase. As fluid is suctioned from the wound, interstitial edema is reduced. NPWT promotes wound healing primarily through removing wound fluid, mechanical stimulation of cells, and occlusion of the wound from environmental contaminants. Increased healing, portability, and ease of management can result in decreased length of hospital stay, faster return to function, 23 cost savings, 24 and improved quality of life. 3, 15 Over the past few years, an explosion in NPWT interest and development has occurred and now multiple vendors offer relatively silent NPWT devices in various sizes that are reusable, recyclable, or disposable with some units being specially designed for specific types of wounds (see TABLE 15-2 for partial vendor list). 22 A smaller, portable, battery-operated unit was designed a short time later for use in the outpatient setting. device was a somewhat bulky, electrically powered unit designed primarily for inpatient use. (Kinetic Concepts, Inc (KCI), San Antonio, TX). The first commercially available NPWT device marketed in the United States as a wound healing device 22 was the Vacuum Assisted Closure or V.A.C. Although every system has its own unique characteristics, the basic functions of removing interstitial edema, stimulation cell proliferation, and reducing wound size are the same. ![]() TABLE 15-1 further describes NPWT components.įIGURE 15–1 Negative Pressure Wound Therapy The fluids are suctioned from the wound, through the foam, into an attached tube and into an air tight disposable canister. 21 Wound fluids are collected in a disposable container that is attached to the pump ( FIGURE 15-1). NPWT systems consist of a pump unit that provides suction, a wound filler that transfers negative pressure to the wound bed and allows flow of fluids from the wound, a transparent occlusive sheet that covers the wound filler and creates an airtight seal, and flexible tubing that delivers suction and serves as a conduit for removal of drainage and wound debris. 18 Events such as the devastating 2010 earthquake in Haiti 14 and war in the Middle East 14, 19, 20 have also shown how the benefits of NPWT can positively influence limb salvage rates and decrease morbidity and mortality in mass casualty and high-energy injury situations. Since its acceptance into mainstream wound management, NPWT has been utilized in treating a wide variety of acute and chronic wounds 12 including acute traumatic and surgical 2, 13 wounds healing by primary and secondary intention burns 14, 15 and chronic wounds associated with venous insufficiency, 3, 12 diabetes, 3, 10, 16, 17 and pressure. ![]() ![]() Reduction in the frequency of dressing changes 11 Stimulation of granulation tissue formation 9, 10 Reduction of edema and interstitial fluid 1, 4, 5
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