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Wound Management

Theory

Authors: Christian Kaare Paaskesen Stud. Med., Magnus Balslev Avnstorp, MD, & Hasan Gökcer Tekin MD.

Delayed wound healing is a major concern for patient and socioeconomic burden burden.

Conventional NPWT

NPWT removes excess wound exudate through the foam dressing into the tube and attached canister, avoiding maceration and keeping a moist healing environment. This reduces oedema, infection and increases local blood flow to the wound bed, which greatly accelerates wound healing, induces granulation tissue and contraction of the wound. NPWT is especially useful in deep wounds to promote granulation tissue before applying a split skin graft. Using NPWT is effective and widely used in most surgical specialties such as Orthopedic-, Abdominal-, Plastic and Reconstructive surgery. (1, 2, 3).

NPWT with instillation

NPWT with instillation is a type of NPWT that have been widely adopted over the last decade. It consists of a combination between NPWT, instillation and dwell time (NPWTi-d) of a topical solution. The concept of NPWTi-d is a cycle of topical solution instilled into the wound bed and left to dwell over a set period of time. Instillation and dwell time is followed by NPWT that absorbs the topical solution back into the canister, before the cycle restarts. This promotes wound cleansing and wound bed preparation. Saline or hypotonic antiseptics like Microdacyn can be used as topical solution. NPWTi-d is mostly used in cases with complex wounds, but international guidelines from 2019 suggest that NPWTi-d can be used in most wound cases. (4)

References

  1. J Am Coll Clin Wound Spec. 2012 Sep; 4(3): 61–62. Published online 2013 Nov 28. doi:  [10.1016/j.jccw.2013.11.002]
  2. (4. Price J. Dominique anel and the small lachyrmal syringe. Med History 1969;13:340-354. [PMC free article] [PubMed]).
  3. Agarwal P, Kukrele R, Sharma D. Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: A review. J Clin Orthop Trauma. 2019 Sep-Oct;10(5):845-848. doi: 10.1016/j.jcot.2019.06.015. Epub 2019 Jun 20. PMID: 31528055; PMCID: PMC6739293.
  4. Kim PJ, Attinger CE, Constantine T, Crist BD, Faust E, Hirche CR, Lavery LA, Messina VJ, Ohura N, Punch LJ, Wirth GA, Younis I, Téot L. Negative pressure wound therapy with instillation: International consensus guidelines update. Int Wound J. 2020 Feb;17(1):174-186. doi: 10.1111/iwj.13254. Epub 2019 Oct 30. PMID: 31667978; PMCID: PMC7003930.

Procedures

Procedures