Negative pressure wound therapy (NPWT), also called vacuum-assisted wound closure, refers to wound dressing systems that continuously or intermittently apply subatmospheric pressure to the surface of a wound. NPWT has become a popular treatment modality for the management of many acute and chronic wounds .
Subatmospheric pressure has multiple beneficial effects on wound healing in animal models. However, clinical evidence of its superiority over conventional wound dressing techniques for all wound types has not been proven. The available randomized trials have significant heterogeneity in the nature of wounds treated and in primary and secondary end points, making rigorous comparisons difficult and limiting the ability to generalize their results.
The general mechanism of action of NPWT, its clinical uses and contraindications, placement and management of the device, and efficacy in specific clinical applications will be reviewed here.
DEVICE AND PLACEMENT
Commercially-available systems for negative pressure wound therapy (NPWT) include the vacuum-assisted closure (V.A.C.™ therapy) device (KCI, San Antonio, Texas) and the Chariker-Jeter™ wound sealing kit (Smith and Nephew PLC, London, UK). V.A.C.™ therapy is the most widely-studied system in randomized trials.
NPWT systems consist of an open-pore polyurethane ether foam sponge, semiocclusive adhesive cover, fluid collection system, and suction pump . The following steps are involved in placing the device (figure 1):