The application of pressure applies forces to the wound, exerting effects macroscopically, through macrodeformation, as well as microscopically, through microdeformation. It has been postulated that NPWT draws antibiotics into the wound, but evidence is lacking. īy drawing f luid out of the wound, negative pressure increases blood f low, decreases the bacterial burden, cleans the wound, reduces local edema, and removes soluble inf lammatory mediators that may delay wound healing. The third type is a longer-lasting battery-powered NPWT that can be purchased over the counter and is designed to last 7 days and subsequently discarded, while altered models designed for inpatient use that include additional functions, such as negative pressure wound therapy with instillation-dwelling (NPWTi-d) and incisional negative pressure wound therapy (iNPWT), are the last. The first is a large, battery-powered NPWT in the acute inpatient setting, while the second is a portable, battery-powered NPWT designed for outpatient use, but cannot be purchased over the counter and tends to be noisy. The cover creates an airtight seal over an open wound, and the pump applies the negative pressure. Wound dressing aids in transferring pressure from the pump to the wound itself, and modern NPWT typically utilizes reticulated open-pore polyurethane foam, intended to equalize the negative pressure across the entire wound surface. NPWT refers to wound healing technology consisting of three major parts: a wound dressing, covers, and a pump. The rudimentary NPWT led to increased blood f low, granulation tissue, and f lap survival, with decreased bacterial growth.
Morykwas’ initial methodology involved packing the wound with foam, covering and sealing with an adhesive drape, and applying 125 mm Hg of negative pressure either continuously or intermittently. The concept of negative pressure wound therapy (NPWT) was pioneered in 1997 by Morykwas, applying vacuum-assisted closure (VAC) on a pig wound model. Further clinical studies and cost-benefit analysis are needed to recommend routine postoperative use of incisional NPWT in high-risk and low-risk patient population. Improved outcomes of incisional NPWT are reported from various surgical procedures on abdominal, breast, orthopedic, vascular, cardiac, and plastic surgeries. Recent literature supports enhanced wound healing and superior scar appearance as well as improved wound maturity, evidenced by 50% more force required to pull apart a sutured incision. The improved perfusion and oxygenation facilitate quicker wound healing as well as minimize ischemic complications like f lap necrosis. The negative pressure reduces wound edema and improves local perfusion and lymphatic f low, thereby minimizing hematoma and seroma rates. The application of NPWT, in the immediate postoperative period, reduces surgical site infections (SSIs) and wound dehiscence by 50% in high-risk patients. Improved outcomes on open wounds prompted the application of NPWT on closed surgical incisions. Negative pressure wound therapy (NPWT) is widely used for chronic and acute open wounds, with clinically proven benefits of faster wound healing by promoting granulation tissue growth and increased perfusion and facilitating epithelialization and contraction.
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