Negative-pressure wound devices and placement Removes excessive fluid that can slow cell growth and proliferation in the wound bedĪdditionally, intermittent low pressure alters the structure of the cells in the wound bed, triggering a cascade of intracellular signals that increase the rate of cell division and the formation of granulation tissue.The best pressure for wound healing appears to be approximately 125 mm Hg, using an alternating pressure cycle of 5 minutes of suction followed by 2 minutes off suction.Īnimal studies have demonstrated that this technique: ![]() How does negative pressure wound therapy work? Negative-pressure wound therapy is also called vacuum-assisted wound closure therapy, It has become a popular treatment modality for the management of many acute and chronic wounds. Negative pressure wound therapy refers to wound dressing systems that continuously or intermittently apply subatmospheric pressure to the surface of a wound to assist healing. Wounds treated with NPWTi (in this case with quarter strength bleach instillation solution) had a statistically significant reduction in bioburden, while wounds treated with NPWT had an increase in bioburden over the 7 days.īioburden Chronic lower extremity wounds Instillation Negative pressure wound therapy.What is ne gative pressure wound therapy? Other work has demonstrated that debridement alone does not reduce wound bioburden by more than 1 Log. It has long been realized that NPWT does not make its greatest impact by bioburden reduction. The mean absolute reduction in bacteria for the NPWTi group was 10.6 × 10(6) bacteria per gram of tissue while there was a mean absolute increase in bacteria for the NPWT group of 28.7 × 10(6) bacteria per gram of tissue, therefore there was a statistically significant reduction in the absolute bioburden in those wounds treated with NPWTi (p = 0.016). Wounds treated with NPWTi had a mean of 2.6 × 10(5) (☓ × 10(5)) CFU/gram of tissue culture while wounds treated with NPWT had a mean of 2.79 × 10(6) (☓.18 × 10(6)) CFU/gram of tissue culture (p = 0.43). The mean CFU/gram tissue culture was statistically greater - 3.7 × 10(6) (±4 × 10(6)) in the NPWTi group, while in the standard group (NPWT) the mean was 1.8 × 10(6) (☒.36 × 10(6)) CFU/gram tissue culture (p = 0.016) at the end of therapy there was no statistical difference between the two groups (p = 0.44). Quantitative cultures were taken pre-operatively after sterile preparation and draping of the wound site (POD # 0, pre-op), post-operatively once debridement was completed (POD # 0, post-op), and on post-operative day 7 after operative debridement (POD # 7, post-op).Īfter operative debridement (post-operative day 0) there was a mean of 3 (☑) types of bacteria per wound. The patients were sequentially enrolled in 2 treatment groups: the first receiving treatment with operative debridement followed by 1 week of NPWT with the instillation of quarter strength bleach solution the other receiving a standard algorithm consisting of operative debridement and 1 week of NPWT. Thirteen patients, corresponding to 16 chronic lower leg and foot wounds were taken to the operating room for debridement. We undertook a prospective pilot study to assess the efficacy of wound bed preparation for a standard algorithm (sharp surgical debridement followed by NPWT) versus one employing sharp surgical debridement followed by Negative Pressure Wound Therapy with Instillation (NPWTi). One means of decreasing the bioburden in a wound is to operatively debride the wound for wound bed optimization prior to application of other therapy, such as Negative Pressure Wound Therapy (NPWT). An overabundance of bacteria in the chronic wound plays a significant role in the decreased ability for primary closure.
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