(PI-032) Analyzing the Science of Negative Pressure Wound Therapy (NPWT)
Co-Author(s):
Austin Price, BS, CCRC – Lead Clinical Research Coordinator, Burn Research, Joseph M. Still Research Foundation, Inc.
Introduction: In the lifespan of Negative Pressure Wound Therapy (NPWT), clinicians in nearly every care setting have perfected the use of NPWT. In fact, it is accepted as a standard of care in many settings for advanced wound care management. How to apply the dressing and maintain the therapy is understood in a broad, general sense by most clinicians. However, not many can describe the fundamentals of what makes these devices perform as they do. Having this understanding elevates practice and knowledge.
Methods: This is a review of the literature and discussion of the physics and dynamics of fluid and pressure in relation to NPWT.
Results: Understanding the fluctuations in atmospheric pressure, how pressure is applied, and its purpose in the medical field helps to define negative pressure. The development of a pressure gradient, movement of fluid, and fluid dynamics will be described. Understanding this helps to understand negative pressure in a more intricate manner which in turn, allows clinicians to monitor and master the application of negative pressure in a more precise way. Finally, understanding how negative pressure affects local tissues contributes to an overall better understanding of the mechanisms of actions with NPWT.
Discussion: There are fundamental requirements of a negative pressure wound therapy system that are important in driving the full mode of action. Understanding these requirements and how they related to negative pressure ensures that the full mode of action can be delivered consistently .
Trademarked Items:
References: • Abbadi OS. The Use of Negative Pressure in Medicine. Int J Clin Exp Physiol. 2020;7(3):91-5. • Birke-Sorenson et al 2011. Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) Steps towards an international consensus J Plast Reconstr Aesthet Surg. 2011 Sep;64 Suppl:S1-16. • Borgquist O, Ingemansson R, Malmsjö M. The influence of low and high pressure levels during negative-pressure wound therapy on wound contraction and fluid evacuation. Plast Reconstr Surg 2011; 127:551-559 • Centers for Medicare and Medicaid Services. Negative Pressure Wound Therapy Interpretive Guidelines. Effective October 2016. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1222.pdf. Accessed Nov, 2020. • Daigle et al 2013. How mechanical deformations contribute to the effectiveness of negative-pressure wound therapy. Wound Rep Reg (2013) 21 498–502 • Flello et al. (Eds) 2016. Physics, the complete course for AQA. GCP, 2016. ISBN:978 1 78294 597 0; Chapter 5. • Guyton and Hall. Medical Physiology, 9th Edition. Chapter 16, The microcirculation and the Lymphatic System. Page 187. • Lalezari et al 2017. Deconstructing negative pressure wound therapy: Deconstructing NPWT. Int Wound J. 2017 Aug;14(4):649-657 • Mojallal et al. Influence of negative pressure when harvesting adipose tissue on cell yield of the stromal-vascular fraction. Biomed Mater Eng 2008;18(4-5):193-7 • Orgil and Bayer. Negative pressure wound therapy: past, present and future. 2013. Int Wound J. 2013 Dec;10 Suppl 1:15-9 • Saxena et al. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plastic Reconstructive Surgery 2004;114:1086-96 • Scherer et al. The mechanism of action of the Vacuum-Assisted Closure device. Plast. Reconstr. Surg. 122: 786, 2008 • Wikipedia. Effects of high altitude on humans. Accessed Nov 2020. https://en.wikipedia.org/wiki/Effects_of_high_altitude_on_humans • Wikipedia. Milimetre of mercury. Accessed Nov 2020. https://en.wikipedia.org/wiki/Millimetre_of_mercury#:~:text=In%20medicine%2C%20pressure%20is%20still,mmHg%20relative%20to%20perfect%20vacuum • Wikipedia. Vacuum. https://en.wikipedia.org/wiki/Vacuum • Wong et al. Pushing Back: Wound Mechanotransduction in Repair and Regeneration. J, Invest. Dermatol 2011; 131:2186-2196.
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