Negative Pressure Wound Therapy in Surgical Wound Management: Mechanisms, Clinical Outcomes, and Comparative Analysis of Modern NPWT Systems
DOI:
https://doi.org/10.12775/QS.2025.40.59833Keywords
Negative Pressure Wound Therapy (NPWT), Vacuum-assisted closure (VAC), wounds healing, surgical woundsAbstract
Introduction: Surgical wounds that fail to heal or that develop complications such as infection or dehiscence are challenging problem that health care has to deal with everyday. Negative Pressure Wound Therapy (NPWT) has emerged as an important tool for managing complex wounds. This review aims to summarize the mechanisms by which NPWT supports wound healing, estimate the clinical efficacy of NPWT in surgical wounds and compare available NPWT systems.
Materials and methods: A literature review was conducted using the databases such as Pubmed and Google Scholar.
State of Knowledge: NPWT involves a sealed dressing attached to a suction pump that applies subatmospheric pressure to the wound. There are four major mechanisms that lead straight to the effect: microdeformation [14]; macrodeformation [13], fluid removal [15]; stabilization of wound environment [11]. Clinically, NPWT has demonstrated improved healing rates in chronic wounds (e.g., diabetic foot ulcers) [5, 6] and decreased surgical site infection and seroma in high-risk surgical incisions [7, 8].
Conclusions: NPWT upgrades healing by stabilizing environment of wound, enhancing granulation and closing wound faster. Evidence confirms its efficacy in reducing wound complications in both open and closed surgical wounds. NPWT has become an invaluable tool in surgical wound management, however it is still important to use it in selected group of patients.
References
1. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing for soft tissue damage in open fractures. Unfallchirurg. 1993;96(9):488-492. PMID: 8235687
2. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563-576. PMID: 9188971
3. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553-562. DOI: 10.1097/00000637-199706000-00001
4. Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM, Davison PG. Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications. Semin Plast Surg. 2021;35(3):164-170. DOI: 10.1055/s-0041-1731792
5. Armstrong DG, Lavery LA; Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet. 2005;366(9498):1704-1710. DOI: 10.1016/S0140-6736(05)67695-7
6. Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631-636. DOI: 10.2337/dc07-2196
7. Hyldig N, Birke-Sørensen H, Kruse M, et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg. 2016;103(5):477-486. DOI: 10.1002/bjs.10084
8. Groenen H, Jalalzadeh H, Buis DR, et al. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine. 2023;62:102105. DOI: 10.1016/j.eclinm.2023.102105
9. Dumville JC, Webster J, Evans D, Land L. Negative pressure wound therapy for treating pressure ulcers. Cochrane Database Syst Rev. 2015;(5):CD011334. DOI: 10.1002/14651858.CD011334.pub2
10. Hurd T, Rossington A, Trueman P, Smith J, et al. A retrospective comparison of the performance of two NPWT systems in the management of wounds of mixed etiology in the community. Adv Wound Care (New Rochelle). 2017;6(1):33-37. DOI: 10.1089/wound.2015.0679
11. Venturi ML, Attinger CE, Mesbahi A, Hess CL, Graw KS. Mechanisms and clinical applications of the VAC device: a review. Am J Clin Dermatol. 2005;6(3):185-194. DOI: 10.2165/00128071-200506030-00005
12. Orgill DP, Manders EK, Sumpio BE. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146(1):40-51. DOI: 10.1016/j.surg.2009.02.002
13. Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber DE, Orgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg. 2004;114(5):1086-1096. DOI: 10.1097/01.prs.0000135330.51408.97
14. Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg. 2008;122(3):786-797. DOI: 10.1097/PRS.0b013e31818237ac
15. Stechmiller JK, Kilpadi DV, Childress B, Schultz GS. Effect of vacuum-assisted closure therapy on the expression of cytokines and proteases in wound fluid of adults with pressure ulcers. Wound Repair Regen. 2006;14(3):371-374. DOI: 10.1111/j.1743-6109.2006.00134.x
16. Agarwal P, Kukrele R, Sharma D. Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: A review. J Clin Orthop Trauma. 2019;10(5):845-848. DOI: 10.1016/j.jcot.2019.06.015
17. Kim PJ, Attinger CE, Steinberg JS, et al. The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg. 2014;133(3):709-716. DOI: 10.1097/01.prs.0000438060.46290.7a
18. Fong KD, Marston WA. SNaP Wound Care System: ultraportable mechanically powered NPWT. Adv Wound Care. 2012;1(1):41-43. DOI: 10.1089/wound.2011.0281
19. Gwan-Nulla DN, Casal RS. Toxic shock syndrome associated with the use of the vacuum-assisted closure device. Ann Plast Surg. 2001;47(5):552-554. DOI: 10.1097/00000637-200111000-00014
20. White RA, Miki RA, Kazmier P, Anglen JO. Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery. J Orthop Trauma. 2005;19(1):56-59. DOI: 10.1097/00005131-200501000-00011
21. Eginton MR, Brown KR, Seabrook GR, Towne JB, Cambria RA. A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. Ann Vasc Surg. 2003;17(6):645-649. DOI: 10.1007/s10016-003-0065-3
22. McCallon SK, Knight CA, Valiulus JP, Cunningham MW, McCulloch JM, Farinas LP. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage. 2000;46(8):28-32, 34. PMID: 11189545
23. Ford CN, Reinhard ER, Yeh D, et al. Interim analysis of a prospective, randomized trial of vacuum-assisted closure versus the Healthpoint system in the management of pressure ulcers. Ann Plast Surg. 2002;49(1):55-61. DOI: 10.1097/00000637-200207000-00009
24. Stannard JP, Volgas DA, McGwin G Jr, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma. 2012;26(1):37-42. DOI: 10.1097/BOT.0b013e318216b1e5
25. Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2019;3:CD009261. DOI: 10.1002/14651858.CD009261.pub4
26. Norman G, Shi C, Goh EL, et al. Negative pressure wound therapy for surgical wounds healing by primary closure (Update). Cochrane Database Syst Rev. 2020;5:CD009261. DOI: 10.1002/14651858.CD009261.pub7
27. Gupta S, Gabriel A, Lantis J, Téot L. Clinical recommendations and practical guide for negative pressure wound therapy with installation. Int Wound J. 2016 Apr;13(2):159-74. DOI: 10.1111/iwj.12452
28. Willy C, Agarwal A, Andersen CA, et al. Closed incision negative pressure therapy: international multidisciplinary consensus recommendations. Int Wound J. 2017;14(2):385-398. DOI: 10.1111/iwj.12612
29. Stannard JP, Atkins BZ, O’Malley D, et al. Use of negative pressure therapy on closed surgical incisions: a case series. Ostomy Wound Manage. 2009 Aug 1;55(8):58-66. PMID: 19717857
30. Bruhin A, Ferreira F, Chariker M, Smith J, et al. Systematic review and evidence based recommendations for the use of Negative Pressure Wound Therapy in the open abdomen. International Journal of Surgery.2014 Oct;12(10):1105-14. DOI: 10.1016/j.ijsu.2014.08.396
31. J G Ondieki, S O Khainga, F Owilla, F W Nangole. Outcome od foam versus gauze dressings in negative pressure wound therapy for the management of acute traumatic wounds with soft tissue loss at Kenyatta National Hospital. East Afr Med J. 2012 Jul;89(7):230-40. PMID: 26845802
32. Putnis S, Khan WS, Wong JM-L. Negative Pressure Wound Therapy – A Review of its Uses in Orthopaedic Trauma. Open Orthop J. 2014;8:142–147. DOI:10.2174/1874325001408010142
33. Iheozor-Ejiofor Z, Newton K, Dumville JC, Costa ML, Norman G, Bruce J. Negative pressure wound therapy for open traumatic wounds. Cochrane Database Syst Rev. 2018;7(7):CD012522. DOI:10.1002/14651858.CD012522.pub2
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