Negative Pressure Wound Therapy

  • Giulia Davini
  • Marco Romanelli


Non-healing wounds are defined as wounds that do not improve after four weeks of treatment or do not heal in eight weeks. They are characterized by loss of substance involving the deep tissue layers, with a tendency to become chronic and relapse. For these reasons chronic wounds involve a difficult, long and expensive treatment, causing a negative impact on physical and mental health and on the quality of life of patients. The evolution of medical science, the direct experience in the field, and the better understanding of the mechanisms of healing of the lesions have led to the development of advanced methods for the treatment of skin lesions. There is a wide range of advanced treatments, including negative pressure wound therapy (NPWT). When proven efficacious and safe, the use of NPWT for the treatment of hardly healing wounds has a positive impact on the health system, the organization of services, patients and their families.


Negative pressure wound therapy Medical devices Wound healing 


Conflict of Interest

The authors declare no conflict of interest for this chapter.


  1. 1.
    Banwell P, Téot L. Topical negative pressure (TNP) therapy. First international topical negative pressure (TNP) therapy focus group meeting proceedings. London: TXP Communications; 2004.Google Scholar
  2. 2.
    Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg. 1993;96(9):488–92.PubMedGoogle Scholar
  4. 4.
    European Wound Management Association (EWMA). Position Document: Negative pressure wound therapy for the management of chronic wounds. London: MEP Ltd, 2007.Google Scholar
  5. 5.
    Regione Emilia Romagna, Commissione Regionale dei Dispositivi Medici: Le medicazioni avanzate per il trattamento delle ferite acute e croniche. Delibera Regionale n. 1523/2008. 2010.Google Scholar
  6. 6.
    Winter G. Formation of scab and rate of epithelialization of superficial wound in the skin of the young domestic pig. Nature, 1962.Google Scholar
  7. 7.
    Jones J. Winter’s concept of moist wound healing: a review of the evidence and impact on clinical practice. J Wound Care. 2005 Jun;14(6):273–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Timmers MS, Le Cessie S, Banwell P, et al. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg 2005; 55(6): 665–671; discussion 1097-98.Google Scholar
  9. 9.
    European Wound Management Association (EWMA). Position Document: Hard-to-heal wounds: a holistic approach. London: MEP Ltd, 2008.Google Scholar
  10. 10.
    Vowden K. Conservative management of pressure ulcers. In: Banwell PE, Harding K (eds.), Vacuum Assisted Closure TM Therapy: Science and Practice. London: MEP Ltd, 2006. 12.Google Scholar
  11. 11.
    Sumpio BE, Banes AJ, Link WG, et al. Enhanced collagen production by smooth muscle cells during repetitive mechanical stretching. Arch Surg. 1988;123(10):1233–6.CrossRefGoogle Scholar
  12. 12.
    Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res. 1990;250:8–26.Google Scholar
  13. 13.
    Greene AK, Puder M, Roy R, et al. Microdeformational wound therapy: effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg. 2006;56(4):418–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Fabian TS, Kaufman HJ, Lett ED, et al. The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. Am Surg. 2000;66(12):1136–43.PubMedGoogle Scholar
  15. 15.
    Gustafsson RI, Sjögren J, Ingemansson R. Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy. Ann Thorac Surg 2003; 76(6): 2048–2053; discussion 2053.Google Scholar
  16. 16.
    Stechmiller JK, Kilapadi DV, Childress B, et al. Effect of vacuum-assisted closure therapy on the expression of cytokines and proteases in wound fluid of adults with pressure ulcers (letter to editor). Wound Rep Regen. 2006;14:371–4.CrossRefGoogle Scholar
  17. 17.
    Sjögren J, Gustafsson R, Nilsson J, et al. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional therapy. Ann Thorac Surg. 2005;79(6):2049–55.CrossRefPubMedGoogle Scholar
  18. 18.
    Cowan KN, Teague L, Sue SC, et al. Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery. Ann Thorac Surg. 2005;80(6):2205–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Mehbod AA, Ogilvie JW, Pinto MR, et al. Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure. J Spinal Disord Tech. 2005;18(1):14–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Dosluoglu HH, Schimpf DK, Schultz R, et al. Preservation of infected and exposed vascular grafts using vacuum assisted closure without muscle flap coverage. J Vasc Surg. 2005;42(5):989–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Schimp VL, Worley C, Brunello S, et al. Vacuum-assisted closure in the treatment of gynecologic oncology wound failures. Gynecol Oncol. 2004;92(2):586–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Cro C, George KJ, Donnelly J, et al. Vacuum assisted closure system in the management of enterocutaneous fistulae. Postgrad Med J. 2002;78:364–5.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Goverman J, Yelon JA, Platz JJ, et al. The ‘fistula VAC,’ a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases. J Trauma 2006; 60(2): 428–431; discussion 431.Google Scholar
  24. 24.
    McCord SS, Naik-Mathuria BJ, Murphy KM, et al. Negative pressure therapy is effective to manage a variety of wounds in infants and children. Wound Repair Regen. 2007;15(3):296–301.CrossRefPubMedGoogle Scholar
  25. 25.
    Chariker ME, Gerstle TL, Morrison CS. An algorithmic approach to the use of gauzebased negative-pressure wound therapy as a bridge to closure in pediatric extremity trauma. Plast Reconstr Surg. 2009;123(5):1510–20.CrossRefPubMedGoogle Scholar
  26. 26.
    World Union of Wound Healing Societies (WUWHS). Principles of best practice: Vacuum assisted closure: recommendations for use. A consensus document. London: MEP Ltd, 2008.Google Scholar
  27. 27.
    Llanos S, Danilla S, Barraza C, et al. Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double-masked, controlled trial. Ann Surg. 2006;244(5):700–5.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Henderson V, Timmons J, Hurd T, Deroo K, Maloney S, Sabo S. NPWT in everyday practice Made Easy. Wounds International 2010; 1(5).Google Scholar
  29. 29.
    Awad T, Butcher M (2012) Managing diabetic foot ulceration with a new, highly portable NPWT device. Wounds International 3(2): 40–41.Google Scholar
  30. 30.
    Chen SZ, Li J, Li XY, et al. Effects of vacuum-assisted closure on wound microcirculation: an experimental study. Asian J Surg 2005; 28:211–17.Google Scholar
  31. 31.
    Ousey KJ, PhD, MA, PGDE, BA, RN, reader, School of Human and Health Sciences, Centre for Health and Social Care Research, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, United Kingdom.Google Scholar
  32. 32.
    EWMA Document: Negative Pressure Wound Therapy. Overview, challenges and perspectives. 2017.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Giulia Davini
    • 1
  • Marco Romanelli
    • 1
  1. 1.Department of DermatologyUniversity of PisaPisaItaly

Personalised recommendations