Chapter 47 – Negative Pressure Therapy for Soft Tissue Wounds




Abstract






  • Negative pressure wound therapy (NPWT) provides a closed, moist environment with a regulated level of negative pressure to the wound bed, stimulating perfusion and granulation tissue formation, reduction of local edema, removal of infected fluid, and wound volume contraction.
  • NPWT can be used in a variety of wounds, including large traumatic wounds, fasciotomy sites, skin grafted wounds or burns, necrotizing soft tissue infections, infected orthopedic hardware or joints, and wounds with exposed or infected bone or tendon.
  • The recommended optimal negative pressure is 125 mmHg.
  • Veraflo therapy is a specialized wound dressing that combines negative pressure therapy with automated intermittent wound irrigation. The system instills irrigation fluid into the wound, allows soaking of the wound for determined period of time (usually 10–20 minutes), followed by negative pressure for a defined period of time (usually 3–4 hours). The settings and instillation volume can be customized as needed.
  • The principles of soft tissue wound management differ significantly based on whether or not infection is present.

    • For noninfected soft tissue defects, such as large traumatic wounds, operative management is guided by debridement of dead or ischemic tissues and wound approximation, where possible. Negative pressure therapy may be applied as an adjunct to stimulate granulation tissue formation and wound shrinkage.
    • For infected wounds, operative management is guided by debridement of all infected and necrotic tissue. Systemic antibiotics are often necessary for invasive infections. NPWT with intermittent irrigation (VAC Veraflo System) may be locally applied to enhance wound granulation and closure and decrease bacterial burden as well as frequency of debridements.

  • Appropriate surgical debridement and wound hemostasis are imperative prior to application of NPWT.
  • NPWT reduces the number of surgical debridements, is more comfortable than the traditional dressings, shortens the time to wound closure and hospital stay, and lowers costs.





Chapter 47 Negative Pressure Therapy for Soft Tissue Wounds


Elizabeth R. Benjamin and Demetrios Demetriades



General Principles




  • Negative pressure wound therapy (NPWT) provides a closed, moist environment with a regulated level of negative pressure to the wound bed, stimulating perfusion and granulation tissue formation, reduction of local edema, removal of infected fluid, and wound volume contraction.



  • NPWT can be used in a variety of wounds, including large traumatic wounds, fasciotomy sites, skin grafted wounds or burns, necrotizing soft tissue infections, infected orthopedic hardware or joints, and wounds with exposed or infected bone or tendon.



  • The recommended optimal negative pressure is 125 mmHg.



  • Veraflo therapy is a specialized wound dressing that combines negative pressure therapy with automated intermittent wound irrigation. The system instills irrigation fluid into the wound, allows soaking of the wound for determined period of time (usually 10–20 minutes), followed by negative pressure for a defined period of time (usually 3–4 hours). The settings and instillation volume can be customized as needed.



  • The principles of soft tissue wound management differ significantly based on whether or not infection is present.




    • For noninfected soft tissue defects, such as large traumatic wounds, operative management is guided by debridement of dead or ischemic tissues and wound approximation, where possible. Negative pressure therapy may be applied as an adjunct to stimulate granulation tissue formation and wound shrinkage.



    • For infected wounds, operative management is guided by debridement of all infected and necrotic tissue. Systemic antibiotics are often necessary for invasive infections. NPWT with intermittent irrigation (VAC Veraflo System) may be locally applied to enhance wound granulation and closure and decrease bacterial burden as well as frequency of debridements.




  • Appropriate surgical debridement and wound hemostasis are imperative prior to application of NPWT.



  • NPWT reduces the number of surgical debridements, is more comfortable than the traditional dressings, shortens the time to wound closure and hospital stay, and lowers costs.



Equipment




  • Commercially available NPWT systems include a pump and disposables specific for the wound needs (Figure 47.1).




    • Foam: the wound is filled with a custom cut sponge. Wound needs dictate the type of sponge used




      • Granufoam: standard black foam



      • Granufoam silver: silver impregnated foam




        • Not recommended for use in combination with irrigation system




      • White foam: polyvinyl alcohol-based foam designed to reduce tissue adherence and the sponge of choice over vessels, nerves, or granulating viscera



      • Cleanse Choice: waffle-cut foam designed to mechanically debride wounds during suction and irrigation therapy.




    • Irrigation Fluid




      • Saline, Dakin’s solution, sulfamylon, acetic acid, or antibiotic solution, are some of the solutions used for wound irrigation. No solution is superior to another, and solution type is based on provider discretion and the type of organism cultured from the wound.




Sep 4, 2020 | Posted by in EMERGENCY MEDICINE | Comments Off on Chapter 47 – Negative Pressure Therapy for Soft Tissue Wounds
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