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Topical Negative-Pressure Therapy in Wound Management

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Abstract

Topical negative pressure therapy (TNP) is the application of a local sub-atmospheric pressure across a wound [1]. It is a novel non-pharmacological physical method of promoting wound healing.TNP has found a routine role in acute wound management, the down-staging and temporisation of complex trauma prior to surgery, in chronic wound treatment and in the management of patients with a poor operative risk [2]. The evidence base for TNP is rapidly expanding, although it has been considered controversial in some quarters [2, 3].

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References

  1. Banwell PE (1999) Topical negative pressure therapy in wound care. J Wound Care 8: 79–84

    PubMed  CAS  Google Scholar 

  2. Banwell PE, Teot L (2003) Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care 12: 22–28

    PubMed  CAS  Google Scholar 

  3. Greer SE (2000) Whither subatmospheric pressure therapy? Ann Plas Surg 453: 332–334

    Article  Google Scholar 

  4. Fox JW 4th, Golden GT (1976) The use of drains in subcutaneous surgical procedures. AM J Surg 132: 673–674

    Article  PubMed  Google Scholar 

  5. Fay MF (1987) Drainage systems: their role in wound healing. AORN J 46: 442–455

    Article  PubMed  CAS  Google Scholar 

  6. Brock WB, Barker DE, Burns RP (1995) Temporary of open abdominal wound: the vacuum pack. Am Surg 61: 30–35

    PubMed  CAS  Google Scholar 

  7. Shaer WD (2001) Inexpensive vacuum-assisted closure employing a conventional disposable closed suction drainage. Plas Recon Surg 107: 292–293

    Article  CAS  Google Scholar 

  8. Masters J (1998) Reliable, inexpensive and simple suction dressings. Br J Plas Surg 51: 267

    Article  CAS  Google Scholar 

  9. Strover AE, Thorpe R (1997) Suction dressings: a new surgical dressing technique. J R Coll Surg Edin 42: 119–121

    CAS  Google Scholar 

  10. Morykwas MJ, Argenta LC, Shelton-Brown EI,McGuirt W (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plas Surg 38: 553–562

    Article  CAS  Google Scholar 

  11. Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plas Surg 38: 563–576

    Article  CAS  Google Scholar 

  12. Fleischmann W, Becker U, Bischoff M, Hoekstra H (1995) Vacuum sealing: indication technique and results. Eur J Orthop Surg Trauma 5: 37–40

    Article  Google Scholar 

  13. Smith LA, Barker DE, Chase CW, Somberg LB, Brock WB, Burns RP (1997) Vacuum pack technique of temporary abdominal closure: a four-year experience. Am Surg 63: 1102–1107

    PubMed  CAS  Google Scholar 

  14. Evans D, Land L (2001) Topical negative pressure for treating chronic wounds: a systemic review. Br J Plas Surg 54: 238–242

    Article  CAS  Google Scholar 

  15. Short B, Claxton M, Armstrong DG (2002) How to use VAC therapy on chronic wounds. Podiatry Today, July 2002

    Google Scholar 

  16. Mullner T, Mrkonjic L, Kwasny O, Vecsei V (1997) The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. B J Plas Surg 50: 194–199

    Article  CAS  Google Scholar 

  17. Mendez-Eastman S (2001) Guidelines for using negative pressure wound therapy. Adv Skin Wound Care 14: 314–322

    Article  PubMed  CAS  Google Scholar 

  18. Morykwas MJ, Faler BJ, Pearce DJ, Argenta LC (2001) Subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Ann Plast Surg 47: 547–551

    Article  PubMed  CAS  Google Scholar 

  19. Genecov DG, Schneider AM, Morykwas MJ et al. (1998) A controlled subatmospheric pressure dressing increases the rate of skin graft donor site re-epithelialisation. Ann Plas Surg 40: 219–225

    Article  CAS  Google Scholar 

  20. Schneider AM, Morkywas M J, Argenta LC (1998) A new and reliable method of securing skin grafts to the difficult recipient bed. Plast Recon Surg 1024: 1195–1198

    Google Scholar 

  21. Banwell PE (1998) Skin graft fixation. Br J Oral Maxillofac Surg 36: 480–481

    Article  PubMed  CAS  Google Scholar 

  22. Clare MP, Fitzgibbons TC, McMullen ST, Stice RC, Hayes DF, Henkel L (2002) Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. Foot Ankle Int 23: 896–901

    PubMed  Google Scholar 

  23. Banwell PE (1998) Negative pressure therapy: a new concept in wound healing. Association of Surgeons in Training Book 1998/9. Rowan Group, London

    Google Scholar 

  24. Cooper SM (2000) Topical negative pressure. Int J Derm 39: 892–898

    Article  Google Scholar 

  25. Skagen K, Henriksen O (1983) Changes in subcutaneous blood flow during locally applied negative pressure to the skin. Acta Physiol Scand 117: 411–414

    Article  PubMed  CAS  Google Scholar 

  26. Fentem PH, Matthews JA (1970) The duration of the increase in arterial inflow during exposure of the forearm to sub-atmospheric pressure. J Physiol Lond 2102: 65–66

    Google Scholar 

  27. Banwell PE, Jones S, Evison D et al. (2002) Topical negative pressure modulates dermal microvascular blood flow dynamics and temperature profiles at the wound-dressing interface. J Wound Care (submitted)

    Google Scholar 

  28. Banwell PE,Morkywas MJ, Jennings DA et al. (2000) Dermal microvascular blood flow in experimental partial thickness burns: the effect of topical sub-atmospheric pressure. J Burn Care Rehabil 21: 161

    Google Scholar 

  29. Morykwas MJ, David LR, Schneider AM, Whang C, Jennings DA, Canty C, Parker D, White WL, Argenta LC (1999) Use of subatmospheric pressure to prevent progression of partial-thickness burns in a swine model. J Burn Care Rehabil 201: 15–21

    Google Scholar 

  30. Lund T, Wiig H, Reed DK (1986) Acute post burn edema: role of strongly negative interstitial fluid pressure. Am J Physiol 255: 1069–1074

    Google Scholar 

  31. Wysocki AB, Staiano-Coico L, Grinnell F (1993) Wound fluid from chronic leg ulcers contains elevated levels of metalloproteinases MMP-2 and MMP-9. J Invest Derm 101: 64–68

    Article  PubMed  CAS  Google Scholar 

  32. Yager DR, Nwomeh BC (1999) The proteolytic enviroment of chronic wounds. Wound Rep Regen 76: 433–441

    Article  Google Scholar 

  33. Bucalo B, Eaglstein WH Falanga V (1993) Inhibition of cell proliferation by chronic wound fluid. Wound Rep Regen 1: 181–186

    Article  CAS  Google Scholar 

  34. Falanga V (1992) Growth factors and chronic wounds: the need to understand the microenviroment. J Derm 19: 667–672

    CAS  Google Scholar 

  35. Banwell PE (2002) Novel perspectives in wound care: Topical negative pressure therapy. Eur Tiss Rep Soc Bull 92: 49–50

    Google Scholar 

  36. Buttenschoen K, Fleischmann W, Haupt U, Kinzl L, Buttenschoen DC (2001) The influence of vacuum assisted closure on inflammatory tissue reactions in the postoperative course of ankle fractures. Foot Ankle Surg 7: 165–173

    Article  Google Scholar 

  37. Gustafsson R, Johnsson P, Algotsson L et al. (2002) Vacuum-assisted closure therapy guided by C-reactive protein level in patients with deep sternal wound infection. J Thorac Cardiovasc Surg 1235: 895–900

    Article  Google Scholar 

  38. Urschel JD, Scott PG, HTG Williams (1988) The effect of mechanical stress on soft and hard tissue repair; a review. Br J Plas Surg 41: 182–186

    Article  CAS  Google Scholar 

  39. Ryan TJ, Barnhill RL (1983) Physical factors and angiogenesis in development of the vascular system. Ciba Foundation Symposium 100. Pitman Books, London

    Google Scholar 

  40. Ichioka S, Shibata M, Kosaki I et al. (1997) Effects of shear stress on wound healing in the rabbit ear chamber. J Surg Res 721: 29–35

    Article  Google Scholar 

  41. Sumpio BE, Banes AJ, Levin LJ et al. (1987) Mechanical stress stimulates aortic endothelial cells to proliferate. J Vase Surg 6: 252–256

    CAS  Google Scholar 

  42. Olenius M, Dalsgaard, CJ, Wickmann M (1993) Mitotic activity in expanded human skin. Plas Reconstr Surg 91: 213–216

    Article  CAS  Google Scholar 

  43. Cherry GW, Austad E, Pasyk K et al. (1983) Increased survival and vascularity of random pattern flaps elevated in controlled expanded skin. Plas Reconstr Surg 72: 680–687

    Article  CAS  Google Scholar 

  44. Fabian TS, Kaufman H J, Lett ED, Thomas JB, Rawl DK, Lewis PL, Summitt JB, Merryman JI, Schaeffer D, Sargent LA, Burns RP (2000) The evaluation of subatmospheric pressure and hyperbaric oxygen in ischaemic full thickness wound healing. Am Surg 66: 1136–1143.

    PubMed  CAS  Google Scholar 

  45. Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW (2000) A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic non-healing wounds. Wounds 12: 60–67

    Google Scholar 

  46. Fleischmann W, Lang E, Russ M (1997) Treatment of infection by vaccum sealing. Unfallchirurg 1004: 301–304

    Article  Google Scholar 

  47. Giovanni UM, Demaria R, Teot L (2001) Benefits of negative pressure therapy in infected surgical wounds after cardiovascular surgery. Wounds 132: 82–87

    Google Scholar 

  48. Obdeijn MC, de Lange MY, Lichtendahl DH, de Boer WJ (1999) Vacuum-assisted closure in the treatment of poststernotomy mediastinitis. Ann Thorac Surg 686: 2358–2360

    Article  Google Scholar 

  49. Avery CM, Harrop C (2002) Rapid healing of MRSA infection at the suprafascial radial donor site. Int J Oral Maxillofac Surg 31: 318–321

    Article  PubMed  CAS  Google Scholar 

  50. Morykwas MJ, Kennedy A, Argenta JP, Argenta LC (1999) Use of subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model. J Surg Oncol 72: 14–17

    Article  PubMed  CAS  Google Scholar 

  51. Avery C, Pereira J, Moody A, Whitworth I (2000) Clinical experience with the negative pressure wound dressing. Br J Oral Maxillofac Surg 38: 343–345

    Article  PubMed  CAS  Google Scholar 

  52. Wanner MB, Schwarzl F, Strub B, Zaech GA, Pierer G (2003) Vacuum-assisted wound closure for cheaper and more comfortable healing of pressure sores: a prospective study. Scand J Plast Reconstr Surg Hand Surg 37: 28–33

    PubMed  Google Scholar 

  53. McCallon SK, Knight CA, Valiums JP, Cunningham MW, McCulloch JM, Farinas LP (2000) Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage 46: 28–32

    PubMed  CAS  Google Scholar 

  54. DeFranzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX, Ward WG, Teasdall RG (2001) The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 108: 1184–1191

    Article  PubMed  CAS  Google Scholar 

  55. Labler L, Oehy K (2002) [Vacuum sealing of problem wounds] Swiss Surg 8: 266–272.

    Article  PubMed  Google Scholar 

  56. Herscovici Jr D, Sanders RW, Scaduto JM, Infante A, DiPasquale T (2003) Vacuum-assisted wound closure (VAC Therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma 17: 683–688

    Article  PubMed  Google Scholar 

  57. Meara JG, Guo L, Smith JD, Pribaz JJ, Breuing KH, Orgill DP (1999) Vacuum-assisted closure in the treatment of degloving injuries. Ann Plast Surg 42: 589–594

    Article  PubMed  CAS  Google Scholar 

  58. DeFranzo AJ, Marks MW, Argenta LC, Genecov DG (1999) Vacuum-assisted closure for the treatment of degloving injuries. Plast Reconstr Surg 104: 2145–2148

    Article  PubMed  CAS  Google Scholar 

  59. Josty IC, Ramaswamy R, Laing JH (2001) Vacuum-assisted closure: an alternative strategy in the management of degloving injuries of the foot. Br J Plast Surg 54: 363–365

    Article  PubMed  CAS  Google Scholar 

  60. Banwell PE, Evison D, Whitworth IM (2002) Vacuum therapy in degloving injuries of the foot: technical refinements. Br J Plast Surg 55: 264–366

    Article  PubMed  CAS  Google Scholar 

  61. Jackson DM (1953) The diagnosis of the depth of burning. Br J Surg 40: 588–596

    Article  PubMed  CAS  Google Scholar 

  62. Cro C, George KJ, Donnelly J, Irwin ST, Gardiner KR (2002) Vacuum-assisted closure system in the management of enterocutaneous fistulae. Postgrad Med J 78: 364–365

    Article  PubMed  CAS  Google Scholar 

  63. Garner GB, Ware DN, Cocanour CS, Duke JH, McKinley BA, Kozar RA, Moore FA (2001) Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg 182: 630–638

    Article  PubMed  CAS  Google Scholar 

  64. Erdmann D, Drye C, Heller L, Wong MS, Levin SL (2001) Abdominal wall defect and enterocutaneous fistula treatment with the vacuum-assisted closure (VAC) system. Plast Reconstr Surg 108: 2066–2068

    Article  PubMed  CAS  Google Scholar 

  65. Bonnamy C, Hamel F, Leporrier J, Fouques Y, Viquesnel G, Le Roux Y (2000) Use of the vacuum-assisted closure system for the treatment of perineal gangrene involving the abdominal wall. Ann Chir 125: 982–984

    Article  PubMed  CAS  Google Scholar 

  66. Alvarez AA, Maxwell GL, Rodriguez GC (2001) Vacuum-assisted closure for cutaneous gastrointestinal fistula management. Gynecol Oncol 80: 413–416

    Article  PubMed  CAS  Google Scholar 

  67. Kercher KW, Sing RF, Matthews BD, Heniford BT (2002) Successful salvage of infected PTFE mesh after ventral hernia repair. Ostomy Wound Manage 48: 40–42

    PubMed  Google Scholar 

  68. Domkowski PW, Smith ML, Gonyon DL Jr, Drye C, Wooten MK, Levin LS, Wolfe WG (2003) Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis. J Thorac Cardiovasc Surg 126: 386–390

    Article  PubMed  Google Scholar 

  69. Luckraz H, Murphy F, Bryant S, Charman SC, Ritchie AJ (2003) Vacuum-assisted closure as a treatment modality for infections after cardiac surgery. J Thorac Cardiovasc Surg 125: 301–305

    Article  PubMed  Google Scholar 

  70. Fleck TM, Fleck M, Moidl R, Czerny M, Koller R, Giovanoli P, Hiesmayer M J, Zimpfer D, Wolner E, Grabenwoger M (2002) The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg 74: 1596–1600

    Article  PubMed  Google Scholar 

  71. Doss M, Martens S, Wood JP, Wolff JD, Baier C, Moritz A (2002) Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis. Eur J Cardiothorac Surg 22: 934–938

    Article  PubMed  Google Scholar 

  72. Song DH, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M (2003) Vacuum assisted closure for the treatment of sternal wounds: the bridge between debridement and definitive closure. Plast Reconstr Surg 111: 92–97

    Article  PubMed  Google Scholar 

  73. Blackburn JH 2nd, Boemi L, Hall WW, Jeffords K, Hauck RM, Banducci DR, Graham WP 3rd (1998) Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 40: 453–457

    Article  PubMed  Google Scholar 

  74. Scherer LA, Shiver S, Chang M, Meredith JW, Owings JT (2002) The vacuum assisted closure device: a method of securing skin grafts and improving graft survival. Arch Surg 137: 930–933

    Article  PubMed  Google Scholar 

  75. Chang KP, Tsai CC, Lin TM, Lai CS, Lin SD (2001) An alternative dressing for skin graft immobilization: negative pressure dressing. Burns 27: 839–842

    Article  PubMed  CAS  Google Scholar 

  76. Avery C, Pereira J, Moody A, Gargiulo M, Whitworth I (2000) Negative pressure wound dressing of the radial forearm donor site. Int J Oral Maxillofac Surg 29: 198–200

    Article  PubMed  CAS  Google Scholar 

  77. Greer SE, Longaker MT, Margiotta M, Mathews AJ, Kasabian A (1999) The use of subatmospheric pressure dressing for the coverage of radial forearm free flap donor-site exposed tendon complications. Ann Plast Surg 43: 551–554

    Article  PubMed  CAS  Google Scholar 

  78. Baynham SA, Kohlman P, Katner HP (1999) Treating stage IV pressure ulcers with negative pressure therapy: a case report. Ostomy Wound Manage 45: 28–32, 34–35

    PubMed  CAS  Google Scholar 

  79. Azad S, Nishikawa H (2002) Topical negative pressure may help chronic wound healing. BMJ 4: 1100

    Article  Google Scholar 

  80. Philbeck TE Jr, Whittington KT, Millsap MH, Briones RB, Wight DG, Schroeder WJ (1999) The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage 45: 41–50

    PubMed  Google Scholar 

  81. Ford CN, Reinhard ER, Yeh D, Syrek D, De Las Morenas A, Bergman SB, Williams S, Hamori CA (2002) Interim analysis of a prospective, randomized trial of vacuum-assisted closure versus the healthpoint system in the management of pressure ulcers. Ann Plast Surg 49: 55–61

    Article  PubMed  Google Scholar 

  82. Coggrave M, West H, Leonard B (2002) Topical negative pressure for pressure ulcer management. Br J Nurs 11 [Suppl 6]: S29–36

    PubMed  Google Scholar 

  83. Clare MP, Fitzgibbons TC, McMullen ST, Stice RC, Hayes DF, Henkel L (2002) Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. Foot Ankle Int 23: 896–901

    PubMed  Google Scholar 

  84. Armstrong DG, Lavery LA, Abu-Rumman P, Espensen EH, Vazquez JR, Nixon BP, Boulton AJ (2002) Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage 48: 64–68

    PubMed  Google Scholar 

  85. Armstrong DG, Boulton AJ, Banwell PE (2004) The management of complex diabetic wounds: the role of topical negative pressure. In: Banwell PE (ed) z. Spires Publishing, Oxford

    Google Scholar 

  86. Ubbink DT, van der Oord BM, Sobotka MR, Jacobs MJ (2000) Effects of vacuum compression therapy on skin microcirculation in patients suffering from lower limb ischaemia. Vasa 29: 53–57

    Article  PubMed  CAS  Google Scholar 

  87. Moch D, Fleischmann W, Westhauser A (1998) [Instillation vacuum sealing — report of initial experiences] Langenbecks Arch Chir Suppl Kongressbd 115: 1197–1199

    PubMed  Google Scholar 

  88. Fleischmann W, Russ M, Westhauser A, Stampehl M (1998) [Vacuum sealing as carrier system for controlled local drug administration in wound infection] Unfallchirurg 101: 649–654

    Article  PubMed  Google Scholar 

  89. Chester DL, Waters R (2002) Adverse alteration of wound flora with topical negative-pressure therapy: a case report. Br J Plast Surg 55: 510–511

    Article  PubMed  CAS  Google Scholar 

  90. Weinberg Group Inc (1999) Technology assessment of the V.A.C. for in-home treatment of chronic wounds. Weinberg Group, Washington, DC, p 61

    Google Scholar 

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Thomas, G.P.L., Banwell, P.E. (2004). Topical Negative-Pressure Therapy in Wound Management. In: Téot, L., Banwell, P.E., Ziegler, U.E. (eds) Surgery in Wounds. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59307-9_12

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  • DOI: https://doi.org/10.1007/978-3-642-59307-9_12

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