The application of incisional negative pressure wound therapy for perineal wounds: A systematic review

Impaired perineal wound healing is a major source of morbidity after abdominoperineal resection. Incisional negative pressure wound therapy can improve healing, prevent infections, and decrease the frequency of dehiscence. Our objective was to summarise existing evidence on the use of incisional negative pressure wound therapy on perineal wounds after abdominoperineal resection and to determine the effect on perineal wound complications. Electronic databases were searched in January 2017. Studies describing the use of incisional negative pressure wound therapy on primarily closed perineal wounds after abdominoperineal resection were included. Of the 278 identified articles, 5 were retrieved for inclusion in the systematic review (n = 169 patients). A significant decrease in perineal wound complications when using incisional negative pressure wound therapy was demonstrated, with surgical site infection rates as low as 9% (vs 41% in control groups). The major limitation of this systematic review was a small number of retrieved studies with small patient populations, high heterogeneity, and methodological issues. This review suggests that incisional negative pressure wound therapy decreases perineal wound complications after abdominoperineal resection. Further prospective trials with larger patient populations would be needed to confirm this association and delineate which patients might benefit most from the intervention.     

The impact of incisional negative pressure wound therapy on the wound healing process after midline sternotomy

Previous studies have reported that the use of incisional negative pressure wound therapy (INPWT) might reduce the incidence of wound infections, although its mechanism remains unknown. We designed a prospective study to explore the effects of INPWT on different stages of the wound healing process. After meeting the inclusion criteria, 108 patients were enrolled. Based on exclusion criteria four patients were excluded and 104 patients were randomised into two groups. INPWT was applied after primary closure of the midline sternotomy in the study group (n = 52), while conventional wound dressing was applied in the control group (n = 52). We documented the incidence of deep sternal wound infections and analysed the pre‐ and postoperative inflammatory biomarkers and scar size in both groups. No wound infections were observed in the study group compared with six cases (11.1%) in the control group, (P = .026). No significant differences were observed in the inflammatory biomarkers between the groups. Scar size was significantly smaller in the study group. We concluded that INPWT has less effect on the inflammatory phase and appears to have more effect on the proliferation phase through pronounced scar formation.     

Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta-analysis of randomised controlled trials

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.     

TIME伤口床准备联合封闭式负压引流用于慢性伤口护理

目的探讨基于TIME原则的伤口床准备联合封闭式负压引流治疗慢性伤口的效果。方法将80例患者随机分为观察组和对照组各40例。观察组采用TIME原则进行伤口床准备,并应用封闭式负压引流,对照组在TIME原则指导下采用传统清创联合无菌敷料换药方法进行伤口护理。比较两组干预前和干预后7d、14d、21d的伤口面积缩小率、深度缩小率、局部症状体征以及观察期内伤口愈合率及所有愈合伤口的愈合时间、伤口换药时数、伤口换药费用。结果观察组伤口面积、深度缩小率和局部症状体征改善显著优于对照组(均P0.01);观察组90d内伤口愈合率显著高于对照组,伤口愈合时间、护理时数和换药费用显著低于对照组(均P0.01)。结论基于TIME原则的伤口床准备联合封闭式负压引流能够显著促进慢性伤口愈合,减少护理工作量及患者经济负担。     

Effects of negative pressure wound therapy on wound infection and healing in patients with open fracture wounds: A meta-analysis

A meta-analysis was conducted to comprehensively evaluate the impact of negative pressure wound therapy (NPWT) on wound infection and healing in patients with open fracture wounds. Computer searches were performed in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the application of NPWT in open fracture wounds, with the search period covering the databases inception to September 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1814 patients with open fracture wounds were included. The analysis revealed that compared with other treatment methods, NPWT significantly shortened the wound healing time (standardized mean difference [SMD] = −2.86, 95% confidence intervals [CI]: −3.51 to −2.20, p < 0.001) and fracture healing time (SMD = −3.14, 95% CI: −4.49 to −1.79, p < 0.001) in patients with open fracture wounds. It also significantly reduced the incidence of wound infection (odds ratio [OR] = 0.36, 95% CI: 0.23–0.56, p < 0.001) and complications (OR = 0.29, 95% CI: 0.20–0.40, p < 0.001). This study indicates that in the treatment of open fracture wounds, NPWT, compared with conventional treatment methods, can accelerate the healing of wounds and fractures, effectively control infections and reduce the occurrence of complications, demonstrating high safety.     

Research progress on negative pressure wound therapy with instillation in the treatment of orthopaedic wounds

Negative pressure wound therapy with instillation (NPWTi) has the dual function of negative pressure sealing drainage and irrigation, which overcomes the disadvantages of NPWT, such as tube obstruction, inability to apply topical medicine, and poor anti‐infection ability. NPWTi has been researched extensively and widely used in various types of wounds, and certain effects have been achieved. A series of parameters for NPWTi have not been unified at present, including the flushing fluid option, flushing mode, and treatment period. This paper reviews the research progress of these parameters for NPWTi and their application in the treatment of orthopaedic wounds.     

An inexpensive method of negative pressure wound therapy for extremities

Negative pressure wound therapy (NPWT) is an established method for the faster wound healing of chronic non‐healing wounds. It is also used for laparostomy wounds and healing of split skin grafts. The commercially available machine and the consumables for NPWT are very expensive and economically not feasible in developing and underdeveloped countries. So, we devised a NPWT system for wounds of the extremity using inexpensive, readily available materials in any hospital. The materials used are sterile glove, autoclaved sponge, Foley catheter, and a wall suction unit. The sponge was placed over the wound, and a sterile glove was pulled over it. A Foley catheter was placed over the sponge and taken out through one of the fingers of the glove. Adhesive plaster was used to air‐seal the glove. The Foley catheter was fixed with silk ties and connected to wall suction. Granulation and wound healing was faster in this system. This system was safe and inexpensive for the treatment of wounds of the extremity.     

Topical negative pressure wound therapy: a review of its role and guidelines for its use in the management of acute wounds

Over the past two decades, topical negative pressure (TNP) wound therapy has gained wide acceptance as a genuine strategy in the treatment algorithm for a wide variety of acute and chronic wounds. Although extensive experimental and clinical evidence exists to support its use and despite the recent emergence of randomised control trials, its role and indications have yet to be fully determined. This article provides a qualitative overview of the published literature appertaining to the use of TNP therapy in the management of acute wounds by an international panel of experts using standard methods of appraisal. Particular focus is applied to the use of TNP for the open abdomen, sternal wounds, lower limb trauma, burns and tissue coverage with grafts and dermal substitutes. We provide evidence-based recommendations for indications and techniques in TNP wound therapy and, where studies are insufficient, consensus on best practice.     

负压封闭结合局部氧疗用于创伤性慢性伤口的效果研究

目的评价负压封闭结合局部氧疗用于创伤性慢性伤口除菌抑菌和改善伤口微环境的效果。方法将64例创伤性慢性伤口患者随机分为两组,每组32例。对照组给予负压封闭伤口治疗;观察组在负压封闭伤口治疗基础上24h局部给氧,持续12d。12d后两组继续按湿性疗法处理伤口或手术治疗,直至愈合或3个月止。两组干预3、6、9、12d评估测量伤口渗液pH、伤口温度,干预前和12d分泌液细菌培养监测伤口细菌阳性率;3个月内的治愈率和愈合时间。结果干预后12d观察组细菌阳性率显著低于对照组(P0.01),两组渗液pH随治疗时间延长而下降,观察组下降更明显(P0.01)。伤口温度随治疗时间增加而升高,观察组升高更明显(P0.01)。观察组治愈率显著高于对照组(P0.05),愈合时间显著短于对照组(P0.01)。结论负压封闭结合局部氧疗治疗优化了伤口微环境,强化了除菌抑菌作用,有助于提高伤口治愈率和缩短愈合时间。     

Treatment of anticoagulated patients with negative pressure wound therapy

There is a paucity of evidence surrounding the use of negative pressure wound therapy (NPWT) in patients receiving anticoagulant medication. Guidelines generally recommend caution regarding the use of NPWT in anticoagulated patients in general, but areas of particular risk are frequently not highlighted. The US Food and Drug Authority (FDA) reported six mortalities between 2009 and 2011 in patients receiving NPWT. These mortalities were associated with the use of NPWT over vascular graft sites. The coagulation status of these patients was not reported. It is the authors' recommendation that guidelines regarding the use of NPWT in anticoagulated patients highlight specific clinical situations of risk, although there is insufficient evidence to support the avoidance of NPWT in anticoagulated patients in general.     

Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies

Wound complications are an important cause of postoperative morbidity among patients with gynaecologic malignancies. We evaluated whether the placement of closed‐incisional negative pressure therapy (ciNPT) at the time of laparotomy for gynaecologic cancer surgery reduced wound complication rates. A retrospective cohort study with primary wound closure performed by a gynaecologic oncologist was carried out. We evaluated two cohorts of patients who underwent surgery in 2017 with standard closure and patients who underwent surgery in 2019 with the placement of prophylactic ciNPT. Postoperative outcomes were examined. A total of 143 patients were included, 85 (59.4%) vs 58 (40.6%) with standard closure and ciNPT, respectively. The total complication rate in our sample was 38.71%. The rate of surgical complications in patients treated with ciNPT was 6.9% compared with 31.8% (P = .000) in patients treated with standard closure. In the analysis of complications, a significant reduction in infections (17.1%), seromas (15.4%), and wound dehiscence (17.1%) were observed when ciNPT was applied. The median hospital stay was 8 vs 6 days in the standard closure vs ciNPT groups (P = .048). The use of the prophylactic ciNPT following a laparotomy may decrease wound complications and hospital stays in oncological patients. ciNPT could be considered as part of clinical practice in patients at high risk of wound complications, such as patients with gynaecological malignancies.     

肝移植术后脂肪液化伤口采用水胶体拉合免缝法联合负压治疗效果观察

目的 探讨水胶体拉合免缝法联合负压治疗肝移植术后脂肪液化伤口的效果.方法 47例肝移植术后脂肪液化患者按照入院时间分组,2017年2月至2018年7月的患者分为对照组(26例),2018年8月至2019年12月的患者分为观察组(21例).两组均行伤口评估及常规伤口床准备,对照组采用常规方法行伤口换药,观察组采用水胶体拉合免缝法联合负压治疗.结果 两组伤口总愈合时间、总愈合速度、总换药时间、换药总次数、换药费用、单位时间伤口缩小面积、单位时间伤口深度改变、单位时间伤口愈合速度等指标比较,差异有统计学意义(均P＜0.01).结论 水胶体拉合免缝法联合负压治疗能促进肝移植术后脂肪液化伤口愈合,且不增加经济负担,同时减轻护理工作量.     

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection.     

Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications

Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: “negative pressure wound therapy,” “head and neck,” and “fistula.” We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow‐up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of −125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high‐quality trials are warranted to corroborate the findings of this systematic review.     

Use of a novel silicone‐acrylic drape with negative pressure wound therapy in anatomically challenging wounds

Negative pressure wound therapy (NPWT) utilises a polyurethane drape with acrylic adhesive over foam dressings to create a seal. In anatomically challenging areas, ancillary products are frequently used. Additionally, health care providers are unable to reposition the drape once placed. A novel hybrid drape consisting of polyurethane film with acrylic adhesive and silicone perforated layer has been developed to allow for repositioning after initial placement and easy removal. This six‐patient case series evaluates the use of NPWT with hybrid drape over anatomically challenging wounds. Three males and three females were treated. Dressing changes occurred every 2 to 3 days. Drape application, repositioning, and ability to maintain a seal were evaluated. During application, the drape was repositioned 1 to 2 times without periwound skin irritation in 4/6 wounds. Prior to initial application, ancillary products were applied to help create a seal. However, by the second or third application, ancillary products were no longer used in 4/6 wounds. None of the dressing applications resulted in negative pressure seal leaks. In these patients, health care providers could reposition the hybrid drape after initial placement without periwound skin irritation and successfully create a negative pressure seal without ancillary products in anatomically challenging wound locations.     

自体组织移植联合负压创面治疗技术在创伤性创面治疗中的应用

目的：探讨自体组织移植联合负压创面治疗技术在治疗创伤性创面中的临床分析。方法：选择2010年4月-2012年4月笔者所在医院收治的创伤性创面患者64例,所有患者早期均采取负压创面治疗技术治疗,根据创面情况选择皮瓣移植手术或者皮片移植手术。结果：64例患者创面分泌物进行细菌培养,培养阳性患者37例,阳性率为57.81%;64例患者采取皮瓣移植手术患者30例、采取皮片移植手术患者34例,皮瓣移植手术优良率为96.67%,皮片移植优良率为88.24%,两者比较差异不具有统计学意义（P＞0.05）。结论：自体组织移植联合负压创面治疗技术能够促进创伤性创面的愈合,提高自体组织移植的成活率,值得临床推广运用。     

The impact of negative‐pressure wound therapy with instillation on wounds requiring operative debridement: Pilot randomised,controlled trial

Presence of bacteria in wounds can delay healing. Addition of a regularly instilled topical solution over the wound during negative‐pressure wound therapy (NPWT) may reduce bioburden levels compared with standard NPWT alone. We performed a prospective, randomised, multi‐centre, post‐market trial to compare effects of NPWT with instillation and dwell of polyhexamethylene biguanide solution vs NPWT without instillation therapy in wounds requiring operative debridement. Results showed a significantly greater mean decrease in total bacterial counts from time of initial surgical debridement to first dressing change in NPWT plus instillation (n = 69) subjects compared with standard NPWT (n = 63) subjects (?0.18 vs 0.6 log₁₀ CFU/g, respectively). There was no significant difference between the groups in the primary endpoint of required inpatient operating room debridements after initial debridement. Time to readiness for wound closure/coverage, proportion of wounds closed, and incidence of wound complications were similar. NPWT subjects had 3.1 times the risk of re‐hospitalisation compared with NPWT plus instillation subjects. This study provides a basis for exploring research options to understand the impact of NPWT with instillation on wound healing.     

The wound adjuncts effect of closed incision negative pressure wound therapy on stopping groin surgical site wound infection in arterial surgery: A meta-analysis

A meta-analysis study was conducted to assess the influence of the wound adjuncts therapy of closed incision negative pressure wound therapy (ciNPWT) on stopping groin site wound infection (SWSI) in arterial surgery. A comprehensive literature examination till January 2023 was implemented and 2186 linked studies were appraised. The picked studies contained 2133 subjects with groin surgical wounds of arterial surgery in the picked studies' baseline, 1043 of them were using ciNPWT, and 1090 were using standard care. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the wound adjuncts therapy of ciNPWT on stopping groin SWSI in arterial surgery by the dichotomous and continuous styles and a fixed or random model. The ciNPWT had a significantly lower SWSI (OR, 0.42; 95% CI, 0.33–0.55, P < .001), superficial SWSI (OR, 0.46; 95% CI, 0.33–0.66, P < .001), and deep SWSI (OR, 0.39; 95% CI, 0.25–0.63, P < .001) compared with the standard care in groin surgical wound of arterial surgery. The ciNPWT had a significantly, lower SWSI, superficial SWSI, and deep SWSI compared with the standard care in groin surgical wounds of arterial surgery. Although precautions should be taken when commerce with the consequences because some of the picked studies for this meta-analysis was with low sample sizes.     

The effect of negative wound pressure therapy on haemodynamics in a laparostomy wound model

We have recently shown that negative pressure wound therapy (NPWT) induces a decrease in microvascular blood flow in the small intestinal loop close to the dressing. The effect of NPWT is thus thought to be local. In this study, we investigate whether the application of NPWT in laparostomy affects the haemodynamics. Midline incisions were made in six pigs followed by NPWT at ?120 mmHg for 20 minutes. The cardiac output, mean systemic arterial pressure, mean pulmonary artery pressu re, central venous pressure, left atrial pressure and superior mesenteric artery blood flow were recorded. The blood flow in a small branch of the superior mesenteric artery was then recorded under NPWT between ?50 and ?175 mmHg. Cardiac output was not affected by NPWT [P = not significant (n.s.)]. Neither the mean arterial pressure nor the mean pulmonary artery pressure was affected by NPWT (P = n.s.). Negative pressures of ?50, ?75, ?100 and ?125 mmHg did not alter the blood flow in the small branch of the superior mesenteric artery (P = n.s.). After application of ?150 mmHg, a significant decrease in blood flow was seen (P < 0·01), while the application of ?175 mmHg resulted in only a slight decrease in blood flow (P = n.s.). The effect of NPWT in laparotomy seems to be local and to have no influence on central haemodynamics or the blood flow to the superior mesenteric artery.     

Use of disposable negative pressure wound therapy on split‐thickness skin graft recipient sites for peripheral arterial disease foot wounds: A case report

Split‐thickness skin graft (STSG) helps to promote healing of wounds by providing a viable soft tissue cover. However, the success of which is influenced by how well it takes to the recipient site. Studies have demonstrated that negative pressure wound therapy (NPWT) is an excellent modality to promote graft survival. Technological advancements have made possible the invention of disposable, ultraportable, and mechanically operated versions for improved user experience. Alas, little has been discussed about their benefits on STSG. Therefore, the purpose of this case report is to highlight the effective use of disposable NPWT on freshly applied STSG. We report here a novel use of the disposable NPWT (SNAP therapy system) for STSG recipient sites in two patients with peripheral arterial disease (PAD) foot wounds. In both patients, there was 100% STSG uptake, and the lightweight disposable NPWT system makes for a more cost‐effective and comfortable experience for patients. Disposable NPWT may be a feasible alternative to conventional NPWT to aid with STSG uptake for PAD foot wound recipient sites.