NEGATIVE PRESSURE WOUND THERAPY

SQN LDR AMAR VARSHNEY

First reported in 1993 for the treatment of open or
infected wounds (Fleischmann et al. 1993)

Successfully used this technique in 15 patients with open

fractures

Reported that this treatment resulted in "efficient

cleaning and conditioning of the wound, with marked
proliferation of granulation tissue"
 MECHANISM OF ACTION
Not completely understood.

Macrodeformation - induced wound shrinkage caused by collapse of

the pores and centripetal forces exerted onto the wound surface by
the foam

Microdeformation - undulated wound surface (“tissue mushrooms”)

induced by the porous interface material when exposed to suction
Changes in cellular functions can be initiated by these dynamic physical
inputs
Stimulates angiogenesis, cellular proliferation & matrix molecule
synthesis 
 MECHANISM OF ACTION
Fluid removal
Removal of exudates thereby removing bacteria from the
wound
Removal of edema fluid containing suspended cellular debris,
osmotic ally active molecules and biochemical mediators

Alteration of the wound environment

Helping to maintain a stable, moist wound environment
Act as thermal insulators to maintain wound warmth
Increases blood flow
ADVANTAGES OVER OTHER TREATMENTS
Greatly reduce the length of hospital stay by enhancing
wound closure in chronic wounds

Faster wound healing results in less discomfort and pain

for the patient.

Change of dressing after every 48 hrs. This leads to lower

risk of infection and reduces the need of material and
qualified personnel.
 PRESSURE
90 – 125 mmHg - increase in blood flow equivalent to
four times, with negative pressure values of 125 mmHg

Intermittent cycling
rhythmic perfusion of the tissue is maintained
cells which are undergoing mitosis must go through a cycle
of rest
 ADJUSTING VAC PRESSURE
May turn down (minimum 75 mmHg) when:
Unrelieved pain

Bruising in wound bed

Excessive bleeding

Compromised circulation (PVD)

Excessive granulation tissue growth

May turn pressure up when:

Excessive drainage

Large wound volume

Difficulties maintaining a seal

CONTINUOUS VS. INTERMITTENT
Continuous therapy:
Always for at least first 48 hours
Significant discomfort in intermittent mode
High amounts of exudate
Wound requires constant contraction (sternal wounds, tunnels)

Intermittent therapy
Use to stimulate granulation tissue faster
 INDICATIONS
Pressure ulcers
Venous ulcers
Diabetic foot ulcers
Dehisced surgical incisions
Partial thickness burns
Grafts & flaps
Acute wounds
Fasciotomy
Temporary closure for abdominal compartment syndrome
 CONTRAINDICATIONS
• Exposed arteries or veins

• Malignancy in the wound bed

• Active bleeding or coagulopathic patients

• Untreated osteomyelitis

• Fistulas to body cavities/organs

• Eschar/ necrotic slough

 WOUND HEALING : PROGRESSION
Decrease in overall wound volume should be noted from
week to week

Wound should become “beefy red” initially

Wound may look larger at beginning because of removal of

edema

May be oozing of blood from disruption of capillary buds

as granulation tissue develops
WOUND HEALING : PROGRESSION
Wound should become redder as granulation tissue increases

Color of wound may then become paler as amount of collagen

in wound increases

Likely gradual decrease in exudates levels

New epithelial growth should be evident at viable wound

edges(Granulation tissue should increase around 3-5% per
day.)
WHEN TO DISCONTINUE THERAPY
When goal of therapy has been met
Most of the time VAC used to prepare wound for
surgery
Sometimes VAC will take wound to full closure

When wound shows no progress for 1-2 weeks

If there is increased inflammation consider

discontinuing treatment.
FACTORS THAT MAY INCREASE SUCCESS
OF THERAPY
Wound factors Patient factors
 Wound has good blood  Patient has been maximally
supply medically stabilised (eg
 Wound has healthy, granular nutrition, blood pressure,
bed blood glucose, fluid balance,
 Wound as been freshly infection)
 Patient has few or well-
debrided
 Wound produces high levels controlled co-morbidities
 Patient is comfortable (eg not
of exudate
in pain)
 Wound is greater than 2cm
 Patient is adherent with
wide
therapy
VAC THERAPY AND WOUND INFECTION
In presence of persistent infection or deterioration or
in wounds exhibiting no clinical progress towards
healing, discontinue VAC therapy and change
treatment.
If infection develops during therapy, consider systemic
antibiotic therapy and discontinue VAC therapy to
allow monitoring of wound.
 IMPACT OF VAC THERAPY
Quality of life
Advantages Disadvantages
 Control of odour and exudates  Noise of the VAC therapy unit
 less frequent dressing changes
(can be intrusive and difficult
 Able to participate in daily living
to tolerate)
activities, physical therapy and
rehabilitation
 Weight of the VAC therapy
 Faster return to reduced unit (mobility can be a
dependency and normal living problem, especially in older
 Improvement in adherence (eg people)
with offloading)
 Improvement in anxiety and
depression
 Cost-effectiveness

Reduction in use of resources and labour

Reduction in complexity and number of surgical
procedure/adverse events
Reduction in length of treatment and hospital
stay/number of hospitalisations
Improvement in clinical outcome
 FUTURE DEVELOPMENTS
Further research is needed to:
 increase understanding of the therapeutic effects of VAC
therapy to give clinicians stronger arguments to support its
use.
type of foam dressing and pressure settings to be used in
paediatric patients.
establish the relationship between negative pressure and
blood flow and the optimal pressure for wound healing.
justify the increased cost of treatment against the overall
benefit of shorter healing times.
need to compare the effectiveness of different devices with
each other.
THANK YOU