Introduction

Managing chronic wounds can be difficult and often includes multiple treatment strategies. Management techniques can vary depending on the size of the wound, comorbidities of the patient, and the underlying etiology. However, many chronic wounds benefit from the application of negative pressure wound therapy (NPWT). This treatment is known for improving healing conditions across a wide range of acute and chronic wounds.¹

Applications and Benefits of Negative Pressure Wound Therapy

NPWT has increasingly been applied to many types of wounds, including chronic wounds, burns, diabetic foot ulcers, pressure injuries, venous leg ulcers, and many others. The benefits of NPWT are well documented and include the following²:

• Reduction in wound size
• Promotion of wound healing
• Reduced need for and complexity of surgical therapy in some situations
• Improved clinical outcomes
• Expediting patients' transition to outpatient settings more quickly
• Quality of life improvement resulting from fewer dressing changes, faster healing times, and an earlier return to normal function

Mechanism of Action of Negative Pressure Wound Therapy

NPWT has multiple mechanisms of action that illustrate why it can promote better wound healing. NPWT is thought to cause changes in the cytoskeletal conformation of cells, stimulate granulation tissue formation, and reduce the local inflammatory response. It also increases blood flow to the wound, reduces the amount of exudate and edema present, and may also decrease the bacterial load on wounds. The combination of all these benefits often contributes to reduced healing time and better patient outcomes.³

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Although it is generally accepted that NPWT promotes healing, there are few data on the treatment's cellular mechanisms.⁴ In fact, there is much we are still learning related to best practices when applying NPWT to wounds. One aspect that has been explored is the impact of early versus late initiation of NPWT.

Negative Pressure Wound Therapy in Chronic Wound Care

With early initiation of NPWT, patients with chronic wounds receive therapy within the first 30 days of wound care. Late initiation f NPWT occurs after 30 days. Early and fast initiation of NPWT can provide many clinical benefits to chronic wounds. Early initiation of NPWT can reduce the length of inpatient days in acute, intensive, and long-term acute care settings. It can also decrease the total costs associated with treating chronic wounds by up to 25%.⁵

However, perhaps the most clinically significant aspect of early initiation of NPWT is its ability to reduce wound surface area quickly. In one report, when NPWT was initiated early, the median time for chronic wounds to achieve a 75% reduction in wound surface area was 96.4 days; for patients with late initiation of NPWT, the median time to the same reduction was 274.6 days. These data indicate that early initiation of NPWT can result in a 75% wound surface area reduction in approximately one-third of the time compared with NPWT initiated later for chronic wounds.⁶

Conclusion

NPWT has demonstrated efficacy in treating chronic wounds by impacting both the macroenvironment and the microenvironment of the wound. NPWT provides a moist, closed wound healing environment, draws the wound edges together, removes infectious material and fluids, reduces edema, and promotes tissue perfusion and granulation tissue formation. All of these factors prepare the wound bed for closure and optimize the wound healing environment. In chronic wounds, NPWT can stabilize the conditions that impede wound healing related to multiple comorbidities. Although the application of NPWT may be beneficial at any time in the treatment process, there is strong evidence that early application of the therapy greatly reduces the wound surface area faster than can otherwise be achieved using the same therapy. This early intervention can help patients achieve better outcomes before switching to other modalities.

References

1. Abdelmoez A. The use of economic negative-pressure wound therapy (NPWT) therapy machine and supplies in management of acute and chronic wounds: a report of 3 cases. Surg Case Rep. 2018;2(2):39-41.
2. Kim JJ, Franczyk M, Gottlieb LJ, Song DH. Cost-effective alternative for negative-pressure wound therapy. Plast Reconstr Surg Glob Open. 2017;5(2):e1211.
3. Carney BC, Moffatte LT, Travis TE, et al. A pilot study of negative pressure therapy with autologous skin cell suspensions in a porcine model. J Surg Res. 2021;267:182-196.
4. Kantak NA, Mistr, R, Varon DE, Halvorson EG. Negative pressure wound therapy for burns. Clin Plast Surg. 2017;44:671-677.
5. Law A. Economic value with V.A.C. therapy: effect of early versus late initiation of negative pressure wound therapy on total treatment and wound-related costs. Analysis conducted on insurance claims data by Axia Ltd. 2015.
6. Miller-Mikolajczky C. Real world use: comparing early versus late initiation of negative pressure wound therapy on wound surface area reduction inpatients at wound care clinics. Poster presented at the Wound, Ostomy and Continence Nurses Society Annual Conference, Seattle, Washington, 2013.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.