Procedure

Negative Pressure Wound Therapy

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Negative Pressure Wound Therapy, NPWT, Negative Pressure Wound Dressing, Vacuum-Assisted Wound Management

  • See Also
  1. Wound Dressing
  • Definitions
  1. Negative Pressure Wound Therapy (NPWT)
    1. Foam Dressing cut to fit wound applied to surface
    2. Vacuum applied to dressing to remove wound exudate and inflammatory mediators to promote Wound Healing
  1. Remove wound exudate and inflammatory mediators
  2. Improves perfusion and circulates nutrients to the tissue
  • Contraindications
  1. Exposed vessels or viscera
    1. Risk of the sponge adhering to critical tissue with risk of injury or Hemorrhage
    2. Vaseline Gauze may be applied to these structures to create a barrier and prevent sponge adherence
  2. Substances that clog the sponge and counter the vacuum
    1. Necrotic wounds
    2. Purulent drainage
    3. Thick exudate over wound surface
  • Precautions
  1. Sponge must be changed regularly
    1. Risk of Toxic Shock Syndrome
    2. Risk of tissue adhering to sponge and resulting in Hemorrhage or injury on removal
  2. Clean the wound with each dressing change
    1. Cleaning with saline, wound cleanser or gentle wiping with gauze
  3. Sponge should be properly fit to wound margins
    1. Too large a sponge will result in maceration of normal skin at wound margins
    2. Too small a sponge will offer less optimal wound management
  • Types
  • Sponge
  1. Black reticulated polyurethane ether foam sponge (most common)
    1. Typical sponge used in most cases
  2. Dense white polyvinyl Alcohol foam
    1. Indicated when tougher sponge material is needed (e.g. tunneled wound)
  3. Silver impregnated sponges
    1. Indicated for increased Bacterial colonization
  • Technique
  • Dressing Change
  1. Prepare materials needed
    1. Sponge (see types above)
    2. Scissors to cut sponge to wound size
    3. Occlusive dressive material
      1. Protect underlying vascular or visceral structures
      2. Protect healthy tissue margin
      3. Apply over surface of wound and wound margin
    4. Saline or wound cleanser
    5. Gauze
    6. Vacuum or suction tubing
  2. Removing dressing
    1. Consider instilling saline through vacuum tubing before removal (may ease sponge removal)
    2. If sponge is adhered to underlying tissue, consider applying saline to surface and waiting 5-10 minutes
  3. Clean the wound
    1. Irrigate the tissue bed and periwound edges with saline or wound cleanser
    2. Gently wipe away remaining debris with saline soaked gauze
    3. Remove any loose sponge pieces with forceps
    4. Dry the periwound edges
  4. Protect healthy tissue margin and underlying sensitive structures (e.g. vessels, viscera)
    1. Apply an adherent Occlusive Dressing to the healthy wound margins (protect from maceration)
    2. Trim Occlusive Dressing to fit only the areas to protect, while leaving exposed remaining wound
  5. Prepare the foam sponge
    1. Trim the foam sponge to fit within the wound
    2. Multiple foam pieces may be needed to fill a deeper defect
    3. In most cases, apply the same number of foam pieces that were removed
    4. The foam surface should be roughly level with the periwound margin
  6. Apply the dressing
    1. Insert properly sized foam sponge into the wound
    2. Apply adherent Occlusive Dressing over the sponge and and wound
      1. Adherent dressing should extend over the normal periwound skin on all sides by 1.25 cm (1/2 inch)
  7. Apply the vacuum
    1. Cut a 1-2 cm (roughly 1/2 inch) hole in the adherent dressing, overlying the center of the foam and wound
    2. Apply the vacuum tubing over the hole
    3. Connect the vacuum tubing to thye vacuum system
    4. Ensure that proper seal is achieved when vacuum is on
  8. Label the dressing
    1. Write on the dressing, the date, time, and number of foam pieces
    2. Document the procedure details
  • Complications
  1. Maceration of periwound margins from overlying sponge
  2. Sponge clogging due to thick drainage material
  • Resources
  1. How to apply a Negative Pressure Wound Therapy Dressing (Youtube)
    1. https://www.youtube.com/watch?v=-0eeoacEw-k
  • References
  1. Warrington (2022) Crit Dec Emerg Med 36(6):16-7
  2. Putnis (2014) Open Orthop J 8:142-7 +PMID: 25067967 [PubMed]
  3. Peinemann (2011) Dtsch Arztebl Int 108(22):381-9 +PMID: 21712971 [PubMed]