Clinical Update TEN TOP TIPS Using negative pressure wound therapy effectively


Ten Top Tips... Using negative pressure wound therapy effectively


Author: Peter Vowden


revolutionised the approach to complex wounds, enabling a breakthrough in wound management.[1,2]


N 1


egative pressure wound therapy (NPWT) has


2 Drawing


on current research-based evidence and expert consensus opinion, the


following tips can be used to aid appropriate use for optimal outcomes.


KNOW WHAT YOU WANT TO ACHIEVE


Select the right patient NPWT can be used to treat full- and partial- thickness acute and chronic wounds, including pressure, diabetic foot and venous leg ulcers, traumatic, postoperative and dehisced surgical wounds, skin flaps and grafts, explored fistulae and partial-thickness burns. Large cavity wounds with high exudate levels are particularly suited to NPWT, although it can also be used on wounds with mild or moderate levels of exudate. Treatment should only be commenced


following a thorough assessment and patients for whom NPWT is contraindicated (e.g. those with untreated osteomyelitis or malignancy) have been excluded. Understand when precautions are needed (e.g. in patients with active bleeding or difficult wound haemostasis) and proceed accordingly. For example, this may include protecting vulnerable structures such as exposed blood vessels, anastomotic site, organs or nerves.


Define the treatment aims When starting NPWT it is important to define what you want to achieve and establish both the timeline for care and the exit dressing or surgical strategy for individual patients. Review aims at every dressing change. If the initial treatment aims have not been met at 2 weeks, stop and re-evaluate the treatment plan.


PREPARE THE WOUND BEFORE STARTING THERAPY


Before starting therapy, ensure underlying and associated causes have been addressed. Debride the wound to remove any devitalised and sloughy tissues, which impede delivery of negative pressure. NPWT may assist with ongoing wound bed preparation by removing body fluids, wound exudate, and infectious materials.[3]


However, NPWT can never replace


debridement and is contraindicated in wounds containing dry, necrotic eschar. Cleanse the wound thoroughly (including


any tunnels or undermined areas) using saline or a suitable antiseptic irrigation solution (e.g. Prontosan [B Braun], Octenilin [Schülke and Mayr] and Dermacyn [Oculus])[4]


prior to NPWT


application. This can help to reduce the bacterial load and remove any debris from the wound surface such as slough. It is important to dry the periwound area thoroughly after cleansing. Consider using a light layer of a skin barrier


product to protect the surrounding skin from repetitive removal of the NPWT dressing. This can also protect intact skin from contact with body fluids.[5] Always read the manufacturer’s instructions


for use, and relevant clinical guidelines, before commencing therapy.


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FILL THE WOUND USING THE RIGHT AMOUNT OF FILLER


Fill the wound with sufficient material – this may be foam or gauze – contouring to fit the dimensions of the wound bed, which may be difficult in irregularly shaped wounds. A pre- cut (spiral) foam dressing can be useful in this situation and can make application easier to perform. Applying negative pressure will remove air from the dressing material and pull the wound edges together by reducing the volume of the cavity. If insufficient material is used, it can lead to sub-optimal delivery of negative pressure. Only fill explored tunnels or undermined areas and fill tunnels using the most appropriate


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com


Author details Peter Vowden is Consultant Vascular Surgeon and Professor of Wound Healing Research, University of Bradford, Bradford, UK.


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Ten Top Tips


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