Reviewed and updated by Myrna Buiser Schnur, MSN, RN: January 25, 2024

Since I began working in a reconstructive surgery clinic several years ago, I have been exposed to a myriad of complex acute and chronic wounds that require advanced treatment modalities to heal, such as Negative Pressure Wound Therapy (NPWT). These devices were new to me, and I quickly realized that they can be a source of great anxiety for both patients and clinicians. I decided I needed more information and education on the topic. In Part 1 of this blog series, I will discuss the basics of NPWT, what it is, how it works, as well as risks and benefits. 

What is Negative Pressure Wound Therapy (NPWT)? (Gestring, 2023)

Also known as vacuum-assisted wound closure (VAC), NPWT distributes negative pressure across the surface of a wound continuously or intermittently. The therapy, which emerged in the early 1980’s, includes the placement of a dressing (foam or gauze) onto the wound and is connected to a vacuum pump via tubing. A clear occlusive dressing is placed on top, forming an airtight closed system. Gentle, controlled suction is applied pulling wound debris into a collection chamber. The Food and Drug Administration (FDA) approved the first device for NPWT in 1997. There are a variety of FDA-approved devices now available on the market, many of which are small and lightweight, allowing patients full mobility. Due to varying designs, it is important that you become familiar with the manufacturer instructions for the specific device in use.

NPWT can ssist in wound healing by (Lippincott Procedures, 2023):

• Providing a moist wound healing environment
• Improving nutrient and oxygen delivery to the wound
• Reducing swelling
• Assisting with wound contracture
• Removing exudate and bacteria that can impede cell growth
• Limiting inflammtory agents
• Promoting blood vessel growth and tissue granulation

Which types of wounds benefit most from NPWT? (Lippincott Procedures, 2023; Wound Care Centers, n.d.)

• Surgical wounds, especially those which need to heal by secondary intention
• Following surgical debridement of acute or chronic wounds (i.e., orthopedic, necrotizing infection, post-sternotomy mediastinitis)
• Open abdominal incisions, dehisced surgical wounds
• Burns
• Skin flaps and preparation for skin graft sites in reconstructive surgery 
• Traumatic wounds
• Chronic wounds, such as venous insufficiency ulcers, arterial ulcers, diabetic foot ulcers, and pressure injuries
• Wounds at high risk for infection
• Wounds with copious drainage
• Meshed grafts, to either secure the graft in place or improve epithelialization
• Prophylactic therapy to prevent surgical wound infections

How effective is NPWT? (Gestring, 2023)

Compared to traditional forms of wound therapy, advantages of NPWT include: ​

• Improved wound healing and decreased time to wound closure in diabetic patients, improving quality of life.
• Less frequent dressing changes (every two to five days)
• Dressings that can be individualized to all types of wounds

What are the risks involved with NPWT?

NPWT devices, if used improperly, could cause harm to patietns including:

• Pain 
• Bleeding
• Infection
• Enterocutaneous fistula
• Damage to adjacent skin
• Dehydration

What are the factors that increase a patient’s risk for adverse events with NPWT?

• Increased risk for bleeding and hemorrhage
• Anticoagulant or platelet aggregation inhibitor therapy
• Friable or infected blood vessels
• Vascular anastomosis
• Infected wounds
• Osteomyelitis
• Spinal cord injury
• Enteric fistulas
• Exposed organs, vessels, nerves, tendons, and ligaments

Are there any contraindications for NPWT? (Gestring, 2023)

• Exposed blood vessels, vascular grafts, or vital organs
• Untreated malignancy 
• Relative contraindications include:
  • Ischemic wounds, necrotic tissue with eschar
  • Ongoing infection
  • Fragile skin
  • Adhesive allergy

While great strides have been made to improve the safety of NPWT devices, serious adverse events may still occur. Clinicians should take time to review specific device instructions for use, indications, and contraindications and adequate staff training should be provided. Healthcare providers that understand the principles of NPWT can then collaborate to ensure that each patient is selected appropriately for therapy based on wound type, risk profile and care setting. In Part 2 of this series, I will review the procedure for applying a NPWT dressing, general patient care, and tips to trouble-shoot the device.
 

References:
Gestring, M. (2023, November 17). Negative pressure wound therapy. UpToDate. https://www.uptodate.com/contents/negative- pressure-wound-therapy

Lippincott Solutions (2023, February 20). Negative pressure wound therapy. Lippincott Solutions. https://procedures.lww.com/lnp/view.do?pId=858844&hits=therapy,negative,wound,wounds,pressure  

Tamir, E., Finestone, A.S., Wiser, I., Anekstein, Y. and Agar, G. (2018). Outpatient negative-pressure wound therapy following surgical debridement: Results and complications. Advances in Skin & Wound Care: The Journal for Prevention and Healing, 31(8), 365-369. https://doi.org/10.1097/01.ASW.0000531352.93490.24  

Wound Care Centers. (n.d.) Negative Pressure Wound Therapy. Retrieved January 18, 2024 from http://www.woundcarecenters.org/article/wound-therapies/negative-pressure-wound-therapy

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