Negative-Pressure Wound Therapy

Abstract

Negative-pressure wound therapy (NPWT) or vacuum-assisted closure (VAC) is a mode of therapy used to encourage wound healing. In 1997, Morykwas et al. first described applying controlled suction through a foam to create a favorable environment for wound healing, which they defined as NPWT. This therapy has been widely and successfully used over the last 15 years although the physiologic basis of its effects is not yet fully understood. NPWT has dramatically changed the treatment of chronic and complex wounds. It can be also used as an adjunct treatment for temporary closure and wound preparation preceding surgical procedures such as skin grafts and flap surgery. Randomized controlled clinical trials have shown that NPWT increases the wound healing rate. In this chapter, composition of NPWT device, mechanism of action, application method, benefits, indications, contraindications, adverse effects, and innovations are described. However, although NPWT is a useful modality for wound healing, there is a potential problem for the treatment of diabetic foot ulcers. NPWT decreases tissue oxygenation in wound beds by the external compression exerted by the foam and pad of the connecting tube. Moreover, the foot is the most sensitive region in the body to ischemia, and diabetes is often accompanied by atherosclerosis. Therefore, when an NPWT is applied to a diabetic foot ulcer, care should be taken to minimize compression pressure. The author’s applying method of NPWT for diabetic foot ulcers is presented in this chapter.