Summary
Background
Negative pressure wound therapy (NPWT) is a technique that has gained such rapid acceptance
for such a diversity of wound management problems that the evidence for optimal use
has struggled to keep up. While clinical studies have sought to evaluate its effectiveness
for a variety of acute and chronic wounds, preclinical studies have suggested that
features such as the magnitude and periodicity of negative pressure, the wound filler
and interface materials and the drainage conduit might introduce key pathophysiological
variations at the wound bed influencing healing. Optimising the methodological approach
is the key to achieving the best outcomes with NPWT. The aim of the present study
was to evaluate and summarise the clinical and experimental evidence for how these
methodological variations influence wound healing when using NPWT.
Methods
A literature review was conducted to evaluate each component of NPWT inciting methodological
variation with reference to clinical and preclinical variables including wound volume
reduction, blood flow, granulation and growth factor stimulation.
Results
Fourteen commercially available NPWT systems are currently available. Both foam and
gauze transmit NP efficiently. While some preclinical evidence suggests foam may preferentially
promote cell proliferation, there is no clear evidence to favour one wound filler.
Most wound contraction occurs within the first −50 mmHg and physiological optimisation
may be achieved within −80 mmHg. Cyclical NP-mediated cell mechanotransduction may
alter the healing characteristics of the wound bed but no definitive clinical protocol
has been established. There is insufficient evidence to credit NPWT with reduced bacterial
wound colonisation.
Conclusion
There is an urgent need to develop evidence-based NPWT regimes, tailoring the methodological
aspects of therapy to the clinical need. An individualised strategy may yield improved
outcomes and realise the potential of this powerful therapeutic intervention.
Keywords
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Article info
Publication history
Published online: January 12, 2012
Accepted:
December 20,
2011
Received:
April 30,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
