Negative Pressure Wound Therapy
| Autor: | Zaver V; Manchester University NHS Foundation Trust, Kankanalu P; Rajiv Gandhi University of Health Sciences, India |
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| Jazyk: | angličtina |
| Zdroj: | 2022 Jan. |
| Abstrakt: | Negative pressure wound therapy (NPWT) is a broad term used to describe a unique and versatile system that aids the optimization of wound healing through the application of sub-atmospheric pressure to help reduce inflammatory exudate and promote granulation tissue. It can be utilized to manage acute and chronic wounds, ranging from open fasciotomy wounds and diabetic foot ulcers to closed surgical incisions. NPWT has undergone a significant evolution since the first modern-day recorded application of this concept in the 19 century.[1] The most recent iteration of NPWT is courtesy of Argenta and Morykwas, who demonstrated its efficacy in their paper published in 1997. This type of NPWT system comprises a porous foam dressing upon which continuous or intermittent suction is applied through an electronically powered suction device to achieve a sub-atmospheric pressure of 125mmHg below ambient pressure.[2] The system has seen widespread uptake and is now implemented routinely for open wounds, such as open fractures, fasciotomies, ulcers, and infected wounds. Termed Vacuum-Assisted Closure (often abbreviated to “VAC”), this system is only effective if applied correctly by trained individuals. It is usually performed in the operating room, given the fact that the wounds usually require debridement and a washout in a sterile environment. More modern iterations of this system now offer advanced options to enhance the delivery of the NPWT, such as a range of pressure settings from -40mmHg to -200mmHg, which can be tailored for different types of wounds. The material from which the foam is derived is either polyurethane (PU) (black) or polyvinyl alcohol (PVA) (white).[3] In more recent years, NPWT has also been adapted for the adjunctive treatment of closed wounds, such as closed surgical incisions and skin grafts.[4] This aims to reduce edema and seroma formation and promote granulation to encourage healing. While the available evidence shows equivocal results for wound healing, this wound management system has seen widespread implementation for closed wounds prone to dehiscence or infection secondary to exudate and localized inflammation.[5] An emergent adaptation of NPWT is using fluid instillation in conjunction with NPWT to enhance the therapy delivered. This comprises the direct administration of saline or antibiotic-containing solution into the wound bed, followed by a period of time ranging from ten to twenty minutes to allow for the distribution of the solution throughout the wound. Negative pressure is then applied at 125mmHg below atmospheric pressure for a sustained duration of up to six hours, after which the fluid instillation recurs.[6] Since this is a relatively recent advancement, the efficacy of this treatment modality is yet to be established. NPWT provides an impactful and exciting development in wound care, with different clinical applications. This article explains the mechanism of NWPT along with the indications, contraindications, and practical approaches to this advanced wound care modality. (Copyright © 2022, StatPearls Publishing LLC.) |
| Databáze: | MEDLINE |
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