Topical negative pressure for treating chronic wounds: a systematic review

doi:10.1054/bjps.2001.3547

British Journal of Plastic Surgery

Volume 54, Issue 3, May 2001, Pages 238-242

https://doi.org/10.1054/bjps.2001.3547 Get rights and content

Summary

Some wounds take a long time to heal, fail to heal or recur, causing significant pain and discomfort to thepatient and cost to the National Health Service. This review assesses the effectiveness of topical negative pressure (TNP) in treating chronic wounds. The Cochrane Wounds Group Specialised Trials Register was searched for randomised controlled trials (RCTs) that evaluated the effectiveness of TNP on chronic-wound healing. Eligibility for inclusion, data extraction and details of trial quality were conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials, with different outcome measures, fulfilled the selection criteria. Trial 1 considered any type of chronic wound, trial 2 considered diabetic foot ulcers. Both trials compared TNP with saline-gauze dressings. Trial 1 reported a statistically significant difference in the percentage change in wound volume after 6 weeks, in favour of TNP. Trial 2 reported a difference in the number of days to healing and a difference in the percentage change in wound surface area after 2 weeks, in favour of TNP. These two small trials provide weak evidence to suggest that TNP may be superior to saline-gauze dressings in terms of wound healing. However, due to the small sample sizes and the methodological limitations of the studies, these findings must be interpreted with extreme caution. The effects of TNP on cost, quality of life, pain and comfort were not reported. It was not possible to determine the optimum TNP regimen. Further high-quality RCTs that address these issues are required.

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Cited by (97)

Pressure distribution and flow characteristics during negative pressure wound therapy
2020, Journal of Tissue Viability
Citation Excerpt :
The surgical treatment of chronic and infected wounds remains challenging [2,3]. Transient negative pressure wound therapy (NPWT) has become an integral part of wound conditioning after local debridement [4–9]. Despite undisputed positive effects of its healing potential, varied evidence exists about the underlying mechanism of action [1,10–17].
Negative pressure wound therapy is thought to improve wound healing by altering capillary perfusion. However, despite many theories, the underlying mechanism of action remains controversial. Recent evidence suggests an increased tissue pressure and a temporary decreased microvascular blood flow as the main reasons for the good clinical results [1]. In an attempt to further explain the mechanism of action, we investigated the pressure distribution on the foam interface, and the influence on perfusion in a pre-experimental design.
Pressure distribution was measured using a sensor based on a capacitive dielectric elastomer with flexible electrodes. In vitro flow measurements were done with vessel imitations in a block of 300 bloom ballistic gel to simulate soft tissue.
A peak pressure of up to 187 mmHg (255 g/cm2) within the foam interface, as well as decreased perfusion, were found using a standard negative pressure wound therapy setup. In conclusion, negative pressure wound therapy applies positive pressure to adjacent tissue and decreases local flow. The amount of suction applied is proportional to the pressure on the foam interface and reduction in flow.
In line with previous studies investigating the underlying mechanism of action, these findings may contribute to possible alterations in the use of negative pressure wound therapy, e.g. lowering suction pressure in patients with diminished peripheral blood flow.
Oxygen levels during negative pressure wound therapy
2019, Journal of Tissue Viability
Citation Excerpt :
Although wound-healing complications can sometimes be handled by non-surgical treatments, proper healing of such wounds often requires surgery intervention. Healing can be promoted by the application of transient negative pressure wound therapy, often in combination with tissue debridement [6–11]. Since its introduction by Argenta et al.
Negative pressure wound therapy (NPWT) has become an established treatment modality when dealing with chronic and infected wounds. The underlying mechanism of action is still under discussion and remains controversial. Evidence exists showing rather hypoxic conditions as the main reason for the positive results and bacterial clearance. In an attempt to further explain the mechanism of action, we investigated oxygen levels within the foam interface of a NPWT device.
We used an optical sensor based on the principle of dynamic fluorescence quenching and tested five different commonly available NPWT systems used during our daily clinical routine. All measurements were done in an in vitro experimental design for at least 24 h and multiple vacuum intensities were investigated.
Oxygen levels decreased as much as 22.8% and the amount of vacuum applied inversely correlated with the oxygen reduction. A stepwise increase in vacuum of 25 mmHg showed a linear mean drop of 2.75% per setting. All devices were able to maintain a constant level of negative pressure, and no significant difference between the various dressings was found (p > 0.05).
Therefore, oxygen levels are decreased within the foam of NPWT dressings, likely leading to oxygen deprivation effects in the underlying wound tissue.
Risk factors for prolonged treatment and hospital readmission in 280 cases of negative-pressure wound therapy
2014, Journal of Plastic, Reconstructive and Aesthetic Surgery
There is evidence of certain beneficial effects and increasing understanding of the mechanisms of action of negative-pressure wound therapy (NPWT). However, it is known that prolonged duration of NPWT is associated with increased bacterial growth and efforts should be made to decrease the duration of NPWT. It was the aim of this study to evaluate potential risk factors for the duration, from first application of NPWT to secondary wound closure and to identify factors that increase the rate of hospital readmission.
In a retrospective cohort study, 261 patients (46 ± 19 years, 70 female) who underwent 280 treatments with NPWT were analysed. Patient-specific and demographic characteristics and the presence of several risk factors were documented. The duration of treatment from first application of NPWT to secondary wound closure, the number of interventions, the duration of hospital stay and the incidence of readmissions due to complications of the wound treated by NPWT were recorded and a risk factor analysis was performed.
The median number of NPWT procedures was 2.0 ± 2.0, the duration of NPWT was 6.0 ± 14.7 days and the length of hospital stay was 16.0 ± 27.9 days. Presence of an open fracture (p = .002) and increased age (p = .004) were identified as independent risk factors for a prolonged duration of NPWT. Patients who smoked (p = .001) or patients with alcohol/drug abuse (p = .015) were more likely to return to hospital (smoking: 18 out of 58 cases; alcohol/drug abuse: 7 out of 19 cases). No such association was seen for diabetes (p = .702), peripheral vascular disease (PVD) (p = .052), immunosuppressive medication (p = .187), immunodeficiency (p = .404), trauma (p = .358), infection (p = .298) and open fracture (p = .061).
Patient age and presence of an open fracture are independent predictors of a prolonged duration from first application of NPWT to secondary wound closure. These results should be taken into account for the calculation of average costs and anticipated hospital stay associated with this therapy.
Comparison of the effects of negative pressure wound therapy and negative pressure wound therapy with instillation on wound healing in a porcine model
2023, Frontiers in Surgery
Negative-Pressure Wound Therapy Application in Fingertip Replantations and a Systematic Review
2022, Plastic and Reconstructive Surgery
Treatment of open wounds secondary to trauma using polyurethane foams with boric acid particles
2021, Ulusal Travma ve Acil Cerrahi Dergisi

View all citing articles on Scopus

^*: A more detailed version of this review is available in electronic format on the Cochrane Library and will be continually update with relevant RCTs establishing the effectiveness of TNP in treating chronic wounds. (The Cochrane Library (January 2001/1). Oxford: Update Software.)

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ReviewTopical negative pressure for treating chronic wounds: a systematic review*

Summary

Am J Surg

Br J Plast Surg

J Wound Ostomy Continence Nursing

Vacuum-assisted closure: a new method for wound control and treatment: clinical experience

Ann Plast Surg

Topical negative pressure therapy in wound care: a review of the development and use of sub-atmospheric pressures in the management of patientswith different types of wound

J Wound Care

Vacuum sealing: indication, technique, and results

Eur J Orthop Surg Traumatol

Healing cavity wounds with negative pressure

Elderly Care

Whither subatmospheric pressure dressing

Ann Plast Surg

When wounds won't heal

RN

Drainage systems: their role in wound healing

AORN J

1, 2, 3 s-t-r-e-t-c-h; vacuum enhances wound closure

External application of sub-atmospheric pressure and healing: mechanisms of action

Wound Healing Soc News-letter

Use of negative pressure to increase the rate of granulation tissue formation in chronic open wounds

Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation

Ann Plast Surg

Review
Topical negative pressure for treating chronic wounds: a systematic review*