Vacuum-assisted Closure System Research Articles

Corrigendum

Vacuum-assisted closure system in treatment of postoperative mediastinitis, by Mohamed Ahmed Elawadi and Farouk Oueida, Asian Cardiovascular and Thoracic Annals December 2013 21: 708-712, DOI: 10.1177/0218492313479353 For the above paper the affiliation details for Mohamed Ahmed Elawadi were incomplete, they should have read: (1)Department of Cardiac Surgery, Saud Al-Babtain Cardiac Center, Dammam, Saudi Arabia (2)Cardiothoracic Surgery Department, Banha Faculty of Medicine, Banha University, Egypt.

Current concepts in the management of necrotizing fasciitis.

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis. NF is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the laboratory risk indicator for necrotizing fasciitis score or Fournier’s gangrene severity index score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites. Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.

Successful open abdomen treatment for multiple ischemic duodenal perforated ulcers in dermatomyositis.

IntroductionDermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute vasculitis is less common but could be a life-threatening condition.MethodsA 21-year-old woman, affected by dermatomyositis, presented to our attention with a three-day story of severe abdominal pain, no bowel movement and biliary vomit. She was diagnosed with acute abdomen. A CT scan with bowel contrast demonstrated the presence of a leakage from the retroperitoneal aspect of duodenum. The surgical and clinical management in the light of literature review is presented.ResultsOur first approach consisted in primary repair of the duodenal perforation with omentopexy. Post-operative course was complicated by hemorrhage. A reintervention showed a new perforation associated with multiple ischemic intestinal areas. We performed a gastroenteric anastomosis with functional exclusion of the damaged duodenum and positioning of drainages to create a biliary fistula. A nutritional enteric tube and an open abdomen vacuum-assisted closure system to monitor the fistula creation and to prevent abdominal contamination and collections were positioned. To reduce the amount of biliary leakage, a percutaneous transhepatic biliary drainage was placed, with progressive fistula flow disappearance in four months.ConclusionsIn patients with dermatomyositis, when clinical findings and symptoms suggest abdominal vasculitis, it is very important to be aware of the risk of bowel and particularly duodenal perforations. Open abdomen treatment favors control of contamination by gastrointestinal contents, offers temporary abdominal closure, helps ICU care and delays definitive surgery.

Use of a vacuum-assisted closure system for the management of enteroatmospheric fistulae.

The aim of this study was to analyze the management of enteroatmospheric fistulae (EAF) in an open abdomen using vacuum-assisted closure (VAC) therapy. Eighteen patients (ten male/eight female) were treated in our surgical department for the management of EAF. VAC therapy was used to manage both complex and open abdominal wounds and for effluent control in all patients except one until definitive surgery could be performed or spontaneous closure of the EAF occurred. The median age of the patients was 61.1 years (range 29-84 years). Their average hospital stay was 88.89 days (range 22-129 days). The median number of VAC applications was 22.5, and the median duration of VAC applications was 43.6 days (range 14-114 days). Non-surgical spontaneous closure of the fistulae with negative pressure wound therapy could be achieved in four patients. In the other six patients, after the EAF were controlled with VAC therapy, definitive surgery was performed. Primary fascial repair was performed in two patients, and the component separation technique was synchronously performed in another two patients. Ventral hernia repair using polypropylene mesh was performed in a patient 1 year after discharge from the hospital. One patient was discharged with skin grafting plus ileostomy after the EAF was managed with VAC therapy. Eight patients (44.4%) died due to intraabdominal infections and sepsis, which could not be controlled despite all precautions. No VAC-related complications were observed in this study. A VAC system can be successfully used for wound management in the control of fistula effluent in patients with an EAF in an open abdomen until spontaneous fistula closure occurs or definitive fistula surgery can be performed.

The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts.

In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5-10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement.

The Influence Manufacturers Have on Negative-Pressure Wound Therapy Research

Studies investigating the effects of negative-pressure wound therapy using the Chariker-Jeter system (gauze-based interface) and the vacuum-assisted closure system often have outcomes that favor one particular system. This study attempts to examine whether manufacturer involvement could be related to the outcomes of these scientific studies. A literature review was undertaken to identify a cohort of studies that compared these two forms of negative-pressure wound therapy. Clinical outcomes studies, basic research studies, and published conference abstracts were included. Allthe articles' abstracts and conclusions were given to five surgeons, who were blinded to the titles and authors. They were individually asked to record what they would consider to be the take-home message of each article (in terms of which system is superior). After categorizing each study according to the system that it appears to favor, the level of manufacturer involvement in each study was evaluated. The relationship between the outcome of a study and the level of manufacturer involvement in that study was then investigated. Of the total of 24 studies found to match the inclusion criteria, 22 were considered to favor a particular system (the other two were categorized as impartial). Of the 24 studies, 19 had some form of manufacturer involvement. Of the 19 that had some form of manufacturer involvement, 18 had outcomes that were deemed beneficial to the involved manufacturer, whereas one was deemed to have an impartial outcome. This study suggests that manufacturer involvement in these studies (regardless of level) correlates with the outcomes being beneficial to the involved manufacturer in almost all cases. Potential reasons for this and the implications thereof are discussed.

Management of Hidradenitis Suppurativa Wounds with an Internal Vacuum-Assisted Closure Device

Hidradenitis suppurativa is a chronic, debilitating disease that is difficult to treat. Once medical management fails, wide local excision offers the best chance for cure. However, the resultant wound often proves too large or contaminated for immediate closure. The authors performed a retrospective chart review of hidradenitis cases managed surgically between 2005 and 2010. Data collected included patient characteristics, management method, and outcomes. Approximately half of the patients received internal vacuum-assisted closure therapy using the vacuum-assisted closure system and delayed closure and half of the patients received immediate primary closure at the time of their excision. Delayed closure consisted of closing the majority of the wound in a linear fashion following internal vacuum-assisted closure while accepting healing by means of secondary intention for small wound areas. Patients managed with internal vacuum-assisted closure had wounds on average four times larger in area than patients managed without internal vacuum-assisted closure. In both groups, all wounds were eventually closed primarily. Healing times averaged 2.2 months with internal vacuum-assisted closure and 2.7 months without. At an average follow-up time of 2.3 months, all patients with internal vacuum-assisted closure had no recurrence of their local disease. Severe hidradenitis presents a treatment challenge, as surgical excisions are often complicated by difficult closures and unsatisfactory recurrence rates. This study demonstrates that wide local excision with reasonable outcomes can be achieved using accelerated delayed primary closure. This method uses internal vacuum-assisted closure as a bridge between excision and delayed primary closure, facilitating closure without recurrence in large, heavily contaminated wounds. Therapeutic, III.

Double perforation digestive et fasciite nécrosante après bandelette sous-urétrale rétropubienne

A 60-year-old woman without medical history developed after a Tension-free Vaginal Tape (TVT) procedure a necrotizing fasciitis and an abscess. After unadapted initial treatment, surgical procedure revealed 2 bowel perforations caused by the sling. Treatment was achieved by total mesh removal, bowel repair, necrosis excision and vacuum-assisted closure system. This is the first case report about the association of necrotizing fasciitis and double bowel perforations after TVT procedure. Any critical sepsis or with unsatisfactory evolution after retropubic sub-urethral sling has to make look for a digestive wound.

Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC)

BackgroundEsophageal perforations and postoperative leakage of esophagogastrostomy are considered to be life-threatening conditions due to the development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC), a well-established treatment method for superficial infected wounds, is based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy is a novel method, and experience with its esophageal application is limited.MethodsThis retrospective study summarizes the experience of a center with a high volume of upper gastrointestinal surgery using E-VAC therapy for patients with leakages of the esophagus. The study investigated 14 patients who had esophageal defects treated with E-VAC. Three patients had a spontaneous defect; two patients had an iatrogenic defect; and nine patients had a postoperative esophageal defect.ResultsThe average duration of application was 12.1 days, and an average of 3.9 E-VAC systems were used. For 6 of the 14 patients, E-VAC therapy was combined with the placement of self-expanding metal stents. Complete restoration of the esophageal defect was achieved in 12 (86 %) of the 14 patients. Two patients died due to prolonged sepsis.ConclusionThis report demonstrates that E-VAC therapy adds an additional treatment option for partial esophageal wall defects. The combination of E-VAC treatment and endoscopic stenting is a successful novel procedure for achieving a high closure rate.

EComment. Post-sternotomy mediastinitis management: negative pressure is the key

I read with great interest the paper by Yu et al. in which they compare outcomes of vacuum-assisted closure (VAC) therapy with conventional management in patients with post-sternotomy mediastinitis (PSM) [1]. There is no general consensus concerning the appropriate surgical approach to PSM and multiple wound healing strategies have been proposed [2]. The treatment of PSM has changed radically with the advances made in VAC systems since the concept of negative wound pressure therapy was first described in the mid 1990s. VAC therapy was introduced to clinical practice in 1995 in North America and two years later it was available in Europe. Since the introduction of VAC techniques in the management of sternal wound infection, there has been a paradigm shift toward the use of this less invasive strategy as a first-line therapy in the management of PSM [2]. Although I recognize the efforts of Yu et al. in reviewing the literature to find the best strategy for patients with PSM, I would like to mention one important point that they failed to include in their report. Closed drainage with Redon catheters is another alternative technique for PSM first used by Durandy et al. [3]. The high negative pressure (-700 mmHg) induced by the bottles fulfils exactly the role of VAC in a different fashion. Vos et al. [4] were the first to perform a prospective study comparing clinical outcomes of VAC with primary closure using Redon catheter in the setting of PSM. They included in their study 161 patients with PSM; there were 89 patients in the VAC group and 43 patients in the Redon group. Both groups were similar in risk factors and severity of mediastinitis. Hospital stay was significantly shorter in the Redon group (45 + /-38 days) compared with the VAC group (74 + /-61 days). The in-hospital mortality rate was similar in both groups, however re-infection rate was higher in the VAC group probably due to the increased risk of wound contamination during dressing changes. The authors of the present study concluded that this treatment modality using Redon drains provides sternal wound healing without repeat intervention while significantly reducing the hospital stay without compromising mortality. By applying negative pressure to a sternal wound either by VAC or Redon drain connected to bottles several advantages are combined: removing exudate from the infected area and increasing blood flow into the wound. None of these studies is a randomized trial; therefore a prospective clinical trial is required to address this issue at a higher level of evidence. Conflict of interest: none declared

Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.

Management of orocutaneous fistulas using a vacuum-assisted closure system

The vacuum-assisted closure (VAC) system has been used to manage complicated wounds. The purpose of this study was to describe a novel technique in using the VAC system for orocutaneous fistulas. A retrospective study was performed on 10 patients treated at the National Cancer Centre, Singapore, who developed postoperative orocutaneous fistulas. Hydrogum dental paste was used as a sealant together with the VAC system to close the fistulas. We used either the RENASYS or VAC ATS system with 50 mm Hg to 125 mm Hg continuous suction. The 10 patients developed 11 fistulas. The median age of this cohort was 67 years (range, 33-80 years). Nine patients had successful closure of their fistulas with VAC therapy whereas 1 patient had unsuccessful VAC therapy and required flap reconstruction. The median time to fistula closure was 19 days (range, 6-36 days). The median time to radiotherapy after surgery was 46 days (range, 26-62 days). VAC therapy is an effective treatment option for orocutaneous fistulas.

Vacuum-assisted closure system in treatment of postoperative mediastinitis

Post-cardiac surgery mediastinitis is a serious complication with high morbidity and high financial costs. Using a vacuum-assisted closure system is the established line of treatment for mediastinitis, which improves outcome, especially in the high-risk group of patients. From January 2007 to April 2011, a retrospective study was carried out to evaluate the outcome of vacuum-assisted closure in the treatment of postoperative mediastinitis. There were 34 patients; 27 were male and 7 female. Mean time from infection to vacuum-assisted closure was 3.34 ± 1.10 days. The duration of vacuum-assisted closure was 6.51 ± 1.85 days (3-9 days). The mean amount of discharge was 759.60 ± 175.28 mL (range, 354-990 mL). Of the 34 patients, 21 (61.76%) had direct surgical wound closure and 13 (41.16%) had re-wiring. Two patients had bilateral pectoral flaps. One patient had chronic fistula formation, and one had a tear in the right ventricle. Mean hospital stay was 11.28 ± 2.09 days (range, 6-16 days). Vacuum-assisted closure therapy is a safe, reliable, and cost-effective modality of treatment for postoperative mediastinitis. It improves the outcome and can be combined with other modalities of conventional treatment, especially in high-risk groups such as the elderly or patients with diabetes.

Management of Avulsion Injuries

The optimal management sequence to treat avulsion injuries in children is particularly difficult because of the following problems: (1) Assessment of these rare but frequently massive injuries can be very difficult and treacherous, as the extent of the injury is often underestimated and treatment therefore considered inappropriate; (2) Avulsion injuries have a high risk of infection: lesions are always contaminated due to the mechanism of injury (mostly vehicle accidents) and subsequent long-term hospitalization adds an additional risk for nosocomial infections; (3) Children with avulsion injuries have an increased risk to develop functional deficits: although the body grows, scars and reconstructed tissues may not adapt sufficiently and this may lead to serious constraints. Because of these problems, avulsion injuries may lead to a high morbidity and even mortality, especially if the injury is mismanaged. Reviewing the most recent data regarding the management of avulsion injuries yields the following key points: (1) A scoring system may help to assess the primary dimension of the defect; (2) Innovative techniques such as the use of a Vacuum Assisted Closure system may lower the risk of infection; (3) Choosing a comprehensive, reconstructive approach taking the growth of the child into consideration, may reduce the development of serious functional deficits and improve cosmetic outcome.

Vacuum-assisted closure for complicated wounds in head and neck region after reconstruction

The aim of this study is to suggest that negative pressure wound therapy (NPWT) is an excellent alternative for managing complicated wounds after head and neck reconstruction. Management of complicated wounds such as wound infection or persistent saliva leakage from poor wound healing with dead space is challenging in head and neck reconstruction. The NPWT is a useful device widely used in treating many complicated wounds. In this study, we applied this device on complicated wounds after head and neck reconstruction and share our experience and modifications. From January 2004 to December 2009, 13 male patients (mean age: 50.0 years) were included. Eleven patients were reconstructed with free flap transfer and the other two patients received a local flap for repair immediately after tumour ablation. Among them, 12 patients (92%) had complicated wounds with infection and one patient (8%) with partial loss of the free flap. Eight of these 13 patients (62%) had saliva leakage and fistula formation. For those who had a free flap transfer, the vacuum-assisted closure (VAC) system was applied with modifications to the complicated wound 2 weeks later, after better neo-vascularisation around the free flap. Watertight suturing on the mucosal side is needed to ensure air sealing and enhance wound healing acquired by the VAC system. All wounds demonstrated adequate control of wound infection, quick obliteration of dead space and rapid growth of granulation tissue under the NPWT. Eleven patients (85%) had wound healing with secondary intention; one (8%) needed a further skin grafting; and one patient (8%) needed a free flap transfer due to partial flap loss in a severe wound infection even after the NPWT application. The average duration of the NPWT usage was 10.8 days (4-24 days); most of the wounds healed within 1 week after the NPWT application. The NPWT is an excellent alternative for managing complicated wounds after head and neck reconstruction. It is safe and comfortable for the patient and provides good results in infection control, dead space obliteration and improvement of wound healing.

The use of vacuum assisted closure system (vac) in the treatment of postoperative mediastinitis, a single center experience. INT

Introduction Post cardiac surgery mediastinitis is a serious complication, associated with high morbidity and high financial costs. VAC therapy is well established line of treatment in mediastinitis which improves outcome in those patients. Methods Retrospective study to evaluate the outcome of VAC therapy in 34 patients with post-sternotomy mediastinitis. All preoperative, operative and postoperative data are collected and analyzed. Results 34 patients treated with VAC, 27 patients were re-admitted after discharge home, mean time from infection to VAC therapy was 3.34 ± 1.10 days. The duration of VAC therapy was 6.51 ± 1.85 days minimum 3 days and maximum 9 days. The mean amount of discharge was 759.60 ± 175.28 with minimum 354 ml and maximum 990 ml. 21 patients (61.76%) received direct surgical wound closure of the wound, de-wiring or just tighten the sternal wires. 13 patients (41.16%) need debridement of the sternum and re-wiring. 2 patients need bilateral pectoral flap to close the defect of soft tissue. one patient had chronic fistula formation 4 months after discharge home and need de-wiring and curettage of the fistula. One patient had tear in right ventricle controlled surgically. Mean hospital stay 11.28 ± 2.09 days, minimum 6 days and maximum 16 days. One patient died due to postoperative cerebral infarction and multiple organs failure. Conclusion VAC therapy is safe, reliable and cost-effective adjacent to conventional treatment of postoperative mediastinitis especially in high risk patients like old age and diabetics.

Minimally invasive vacuum-assisted closure therapy in the management of complex pleural empyema

The pool of potential candidates for pleural empyema is expanding. In a previous technical report, we tested the feasibility of the minimally invasive insertion of a vacuum-assisted closure (Mini-VAC) system without the insertion of an open-window thoracostomy (OWT). In this study, we describe a consecutive case series of complex pleural empyemas that were managed by this Mini-VAC therapy. In this retrospective study, we investigated 6 patients with multimorbidity (Karnofsky index ≤ 50%) who were consecutively treated with Mini-VAC for a primary, postoperative or recurrent pleural empyema between January 2011 and February 2012. Local control of the infection and control of sepsis were satisfactory in all 6 of the patients treated by Mini-VAC therapy. The suction used did not create any air leaks or bleeding from the lung or mediastinal structures. Mini-VAC therapy allowed a reduction of the empyema cavity and improved the re-expansion of the residual lung. Mini-VAC therapy resulted in a rapid eradication of the empyema. The chest wall was closed in all patients during the first hospital stay. All patients left the hospital in good health (Karnofsky index >70%) and with a non-infected pleural cavity at a mean of 22 ± 11 days after Mini-VAC installation. Pleural empyema was not detected in any of the 6 patients at the 3-month follow-up appointment. The Mini-VAC procedure with the abdication of an OWT offers a rapid treatment for complex pleural empyema with minimal surgical effort and the opportunity for a primary closure of the empyema cavity.

Combination of omentoplasty, trans-abdominal biological mesh, and vacuum-assisted closure system for complex pelvic floor reconstruction. An alternative to current standards?

Combination of omentoplasty, trans-abdominal biological mesh, and vacuum-assisted closure system for complex pelvic floor reconstruction. An alternative to current standards?

Dermatofibrosarcoma Protuberans in Childhood Treated with Slow Mohs Micrographic Surgery

Dermatofibrosarcoma protuberans (DFSP) in childhood is a rare tumor with high recurrence rates. Wide local excision can result in disfiguring mutilation, whereas Mohs micrographic surgery (MMS) reduces surgical margins. MMS in children is not performed routinely, as the required infrastructures such as a histopathology lab in close proximity to the operating room is often lacking. We retrospectively reviewed children diagnosed with DFSP treated at our hospital over 2 years. We recorded surgical treatment details, including margins, duration of inpatient stay, outcome, follow-up, and molecular genetic tumor tissue analysis. Four children with a median age of 6.8 years (range 6.0-8.8 years) were identified who had a diagnostic delay of a median of 2.5 years (range 0.5-4.0 years); all underwent complete tumor excision using the slow MMS technique using vacuum-assisted closure systems between repeated excisions and before wound closure. The median maximal safety margins were 1.5 cm (range 1.0-3.0 cm). By using vacuum-assisted closure systems, no dressing changes were needed, pain was limited, and full mobility was maintained in all children. The median total time in the hospital was 11 days (range 10-14 days). No relapses occurred during a median follow-up of 25.8 months (range 11.3-32.6 months). Collagen 1A1/platelet-derived growth factor B (COL1A1/PDGFB) translocation on chromosomes 17 and 22 was detected in all three analyzable specimens. Lesions suspected of being DFSP warrant prompt histologic evaluation; interdisciplinary management is mandatory in particular for children. Micrographic surgery allows smaller surgical margins than wide excision and should be considered as the treatment of choice in children with DFSP. The interim usage of vacuum-assisted closure systems increases patient comfort. Translocations in the COL1A1/PDGFB gene imply susceptibility to targeted treatment modalities for therapy-resistant cases.

Zor İyileşen Alt Ekstremite Yaralarının Tedavisinde Negatif Basınçlı Yara Tedavi Yönteminin Etkinliği ve Sonuçları

Aim: The chronic infected wounds are commonly encountered in the orthopedic practice and occur due to several etiological factors. They are responsible for serious morbidity and mortality. Regardless of the etiology, the underlying factors at these wounds are healing problems and predisposition to infection due to microvascular insufficiency. There are several methods for the treatment of these wounds. One of them is vacuum assisted closure systems (VAC) or negative pressure wound therapy (NPWT). The aim of present study is to evaluate the NPWT methods’ efficacy in the treatment of chronic lower extremity wounds with insufficient microvascular blood supply.Material-method: The data and results of a case series of five patients with several etiologies who had been treated by NPWT are analyzed and the results are evaluated retrospectively in this study.Findings and results: Five patients with chronic wound in their lower extremities due to microvascular circulation insufficiency were treated with NPWT for a period ranging from 11 to 51 days (average 31 days). The chronicity time was average 53,3 days in patients. NPWT was applied in -75 mmHg with -150 mmHg pressures. According to findings of this study, the NPWT was found influent as a method for the treatment of chronic wounds with insufficient blood circulation in lower extremities.