04. tbl. 100. árg. 2014

Negative pressure wound therapy – review

Sárasogsmeðferð - yfirlitsgrein

Negative pressure wound therapy (NPWT) is a new therapeutic option in wound healing and was first described in its present form in 1997. A vacuum source is used to create sub-atmospheric pressure in the local wound environment to promote healing. This is achieved by connecting a vacuum pump to a tube that is threaded into a wound gauze or foam filler dressing covered with a drape. This concept in wound treatment has been shown to be useful in treating different wound infections, including diabetic wounds as well as complex infections of the abdomen and thorax. NPWT has been used in Iceland for over a decade and its use is steadily increasing. This review describes the indications and outcome of NPWT and is aimed at a broad group of doctors and nurses where recent Icelandic studies on the subject are covered.

Key words: Negative pressure wound therapy (NPWT), vacuum assisted closure, wound infection, treatment, outcome, review.

Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is

Ingibjorg Gudmundsdottir1, Steinn Steingrimsson1, Elsa Valsdottir1,2, Tomas Gudbjartsson1,2

1Department of Surgery, Landspitali University Hospital, 2Faculty of Medicine, University of Iceland.

Fig. 1.
 A schematic drawing showing the effects of negative pressure wound therapy. Further explanation in the text . Published with permission from KCI®  Medical.

Fig. 2. A NPWT-device and dressing for large and exudating wounds.

Fig 3. A NPWT-device and wound dressings for small wounds that can be treated in outpatient clinics or at the patient's home.

Fig. 4. A NPWT-device and dressing for small wounds. The device can fit into a pocket.

Fig. 5. Deep sternal wound infection following open heart surgery treated with NPWT. The wound is shown before treatment fig 5a, during treatment with NPWT fig. 5b and after two weeks treatment fig. 5c.

Fig. 6. The application of NPWT for a major shot gun injury to the left chest and abdomen. Parts of the chest wall, left lower lung and diaphragm were severly injured with rupture of the pericardium and colon fecal contamination. The figures in the first row show how a vaseline gauze was used to cover the heart and diaphragm. Then several layers of polyfoam-dressings were laid into the wound, covered with a transparent adhesive film that was connected to a suction device with 125mmHg negative pressure. The figures in the middle row show the wound and the large defect of the chest wall after 2 and 7 weeks of treatment, but also after transpositionalflap and split skingraft reconstruction. The last two figures show the wound 18 months from injury.

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