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ABSTRACT
Introduction: Negative pressure wound therapy (NPWT) has become a mainstay in the armamentarium for wound care. Since the initial commercial vacuum-assisted closure device became available in 1995, subsequent research has confirmed the positive physiological effects of negative pressure on wound healing. Traditionally, NPWT has been used to improve healing of open nonsurgical wounds by secondary intention. However, the clinical applications of NPWT have significantly broadened, and now also include use in open surgical wounds, closed surgical incisions, and skin graft surgery. In addition, devices have evolved and now include functionality and features such as instillation, antimicrobial sponges, and portability.
Areas covered: This article reviews the history, background, and physiology underlying NPWT, as well as the most commonly used devices. In addition, an evidence-based discussion of the current clinical applications of NPWT is presented, with a focus on those with high levels of evidence.
Expert opinion: Future directions for device development include modifications to increase ease of use by patients and to allow its use in a broader array of anatomic areas. Lastly, more research with high levels of evidence is needed to better define the outcomes associated with NPWT, including in relation to specific clinical applications and cost.
Article highlights
Negative pressure wound therapy (NPWT) entails the application of negative pressure to a wound or incision and includes a system for removal of fluid.
Negative pressure wound therapy improves blood flow and granulation tissue formation as well as reduces tissue edema.
Negative pressure wound therapy devices include those with functionality to cyclically irrigate wounds and remove fluid (NPWTi-d), silver-impregnated sponges and sponges with varying pore sizes, and components designed specifically for use on closed surgical incisions.
NPWT is contraindicated for use directly in contact with exposed blood vessels, anastomotic sites, organs, or nerves. In addition, NPWT is contraindicated in the setting of malignancy, untreated osteomyelitis, necrotic tissue with eschar present, and non-enteric or unexplored fistulas.
When applied to open nonsurgical and surgical wounds, NPWT is used when the objectives are to reduce edema, promote granulation and to remove exudate. Evidence for its efficacy in these settings is greatest for chronic lower extremity ulcers.
When applied to closed surgical wounds, ciNPT aims to reduce the risk of complications such as dehiscence and infection, and has been demonstrated to be most effective in the setting of vascular surgery.
Negative pressure wound therapy dressings may also be beneficial to facilitate healing in skin graft surgery, where it can help minimize the causes of skin graft failure such as fluid collection and shearing.
Reviewer disclosures
A reviewer on this manuscript has disclosed they consult for KCI/3M and they are on the German advisory board. Another reviewer has disclosed they are a speaker at congress for Acelity. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.