NEGATIVE PRESSURE THERAPY FOR WOUND MANAGEMENT

1. Dr.Kapil Ashoka
DNB, General Surgery Resident
Saifee Hospital.

2. INTRODUCTION
Is a therapeutic technique using a specially designed customised vacuum
dressing to promote wound healing in Acute or Chronic wound.
First described by Fleischmann et al in 1993.
Consist of placing an open cell wound interface (sponge/guaze) directly
on wound surface and covering it with occlusive film. Negative pressure
is then applied to entire wound surface.

4. HOW IT WORKS
Provide a closed and moist wound healing environment.
Decrease wound volume—Macrostrain- draws wound edges together.
Remove excess fluids that can inhibit wound healing.—Removes Infectious material.
Helps remove Interstitial fluids-Reduces oedema.
Promote granulations.—Tissue Microstrain.
Promote Perfusions—Neovascularization.
Cell migration and Proliferation.

6. INDICATION
For almost any open wound where surgical closure is not feasible.
Full thickness pressure ulcer—Bed sore.
Dehisced surgical wound.
Diabetic/Neuropathic ulcer.
Venous Leg Ulcer.
Post surgical wound.
Traumatic Wound.
Pre/Post op Flap and grafts.

7. CONTRAINDICATIONS
Necrotic tissue/eschar
Unexplored fistulas
Malignant wound.
Exposed vasculature.
Exposed anastomosis.
Exposed nerves.
Exposed organ.

8. APPLICATION PRESSURE ON VAC
Neonates—- 50 mmHg.
Children <2 years—-50 — 75 mmHg.
Children >2 years—-75- 125 mmHg.
Adults- - 125 mmHg.

9. ADVANTAGES.
Maintenance of moist.
Removal of excess interstitial fluid.
Increase local vascularity.
Decrease bacterial colonization.
Quantification of wound drainage.
Increased rate of granulation tissue formation.
Increased rate of contraction.
Increased rate of epithelisation.
Protect wound.
Prevent cross infection.
Reduce frequent wound dressing.

11. MONITORING
Pressure should be adequate or not.
Functioning of vacumm.
Proper tubing—without leak.
Wound surface—should be contracted .
Pain control.

13. SIDE EFFECT OF NPWT
Ingrowth of granulation tissue into foam.
Pain associated with suction and dressing change.
Maceration and pressure damage to adjucent skin areas.
Reduction in perfusion caused by pressure on small vessels.

15. CONCLUSION
Revolutionised wound management.
Easy/ safe/ and can be achieved using cheap and conventional material
in resource constrain setting.
Adjunct to management of chronic/Acute or difficult wound and not the
ultimate solution.
Prepare wound bed for greater chances of successful closure.

19. ADDRESSING POPULATION
WITH SPECIAL NEEDS.
Obese
Geriatric
Paediatrics
Others.

20. OBESE PATIENTS
Growing and significant healthcare issue.
Clinical definition of obesity— BMI>30Kg/m2
In order to effectively managed and deliver care for this vulnerable
group of patients there is an urgent need to evaluate the strategies for
preventing, treating and caring their chronic and acute wound.

21. OBESITY
Immobility.—long standing same position
Pressure sore.—heavy weight.
Inactivity leads to dependent oedema and venous stasis—risk of venous
ulcer.
Greater risk of wound dehiscence, hematoma, infection.

22. ASSOCIATED RISK
Hypertension
Diabetes mellitus
Dyslipidemia / hyperlipidemia.
Congestive cardiac failure.
Cerebrovascular conditions—plegia.

24. CARE
Skin assessment and pressure
relief
skin and pressure area assessment on
initial admission or transfer.
Regular evaluation of turning/pressure
relief regimen.
Checking of areas prone to pressure ulcer
such as buttock and between skin fold.
Listening to patients regarding any areas
of the skin where they are experiencing
pain.
Moisture management.
Use of barrier cream.
Personal hygiene- keeping
skin dry and clean.
Use of incontinence aid-pads
.

25. Specialist equipment
• Beds and mattresses designed for the obese
patient .
• Lifting aids.
• Reduction of shear and friction through
low friction slides and covers.
• Mobility aids.
• Pressure-relieving seat cushions.
Training for staff
• Physical and emotional care.
• Use of equipments.
• Identification of at-risk patients.
• Assessment of wound to identify issue such
as wound infection and dehiscence.

26. GERIATRIC POPULATION
Age >60years
Physical decline
Delayed rehabilitation.
Infection
Depression
Senile debility
Financial burden.
Chronic disease.— DM, PVD, HTN, CVA.
70% pressure ulcers.
Vascular ulcers.
Neuropathic ulcer.

27. skin—decrease in water content., tensile strength, loss of subcutaneous
tissue, vascularity, diminission stability of small blood vessels.

28. TREATMENT
Pressure relief management.
Moisture balance.
Remove excess exudates and toxins.
Make skin and wound dry.
Mobility.
Listen to patient

29. THANK YOU