Introduction:
Advanced therapeutic approaches are frequently employed to enhance wound healing. Negative pressure wound therapy is a specific approach that helps manage severe wounds. It is more effective than the body's natural healing process since it speeds up the healing of wounds and reduces the chance of infection in later years. Health professionals are educated to handle technological problems and complete necessary procedures without difficulty, even though they may occur.
What Is Negative Pressure Wound Therapy?
Vacuum-assisted wound closure is another name for negative pressure wound therapy (NPWT), a widely used wound dressing technique. It helps heal large and complex wounds. It helps by taking out the infection and fluid by using negative pressure (vacuum) and also helps in wound closure by bringing the edges of the wound together. Then, a special bandage (dressing) is applied over the wound to connect the vacuum, and the process is carried out.
Why Is NPWT Indicated?
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It is recommended for burns, diabetic ulcers, pressure ulcers, persistent wounds, and injuries where a prolonged healing process is possible.
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It maintains a tight seal, preventing contamination.
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The number of dressing changes decreases.
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It also reduces the rate of infection.
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Though NPWT is a popular therapy, regular wound debridement, irrigation, and re-evaluation are carried out along with it.
What Are the Components of NPWT?
Vacuum-assisted closure is one of the commercially available devices used in negative pressure wound therapy (NPWT). This device comes with the following components:
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A pump (negative pressure device).
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A special dressing (bandage or a film with attachment to tube).
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A tube.
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Canister (a box to collect the fluids).
The pump is connected to the special bandage with the help of the provided tube. Then, controlled pressure is delivered by the device, drawing the fluid and infection from the wound site, which is collected in the canister.
How Does NPWT Work?
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To apply negative pressure to the wound, a specific dressing is properly fitted over it and sealed with a film covering the entire wound and its margins.
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The dressing type can be gauze dressing or open-cell foam.
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The film's opening is attached to the tube connected to the pump and canister.
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After setting the necessary pressure settings, the pump is turned.
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It provides two pressure settings.
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Continuous Pressure - Large wounds with heavy drainage require continuous pressure.
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Intermittent Pressure - Wounds with delicate edges, skin grafts, and other painful wounds require intermittent pressure.
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The pump helps draw the fluid and infection from the wound by bringing the wound edges closer.
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It promotes blood flow at the margins of the wound and aids in wound contraction, both of which are necessary for wound healing.
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Antibiotics and saline may be administered to the wound if it is needed.
The device is set up to work continuously and can be taken off for only two hours a day. Precautions should be taken to reduce any contamination with water as it can loosen the film.
The device sounds an alarm if there is a poor seal or any leakage of the contents.
How Is the Dressing Changed?
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A trained nurse generally changes the dressing.
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Depending on the extent of the illness, it needs to be changed at least twice or thrice weekly.
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Any dressing change can be painful, and pain can be relieved when addressed by the health care professional.
When Is NPWT Indicated?
NPWT is not indicated for managing every wound. Numerous considerations need to be considered, including the patient's overall health, ability to maintain the device, type of wound, clinical status, size of the wound site, and infection. Depending on these factors, the physician may or may not advise NPWT. NPWT is indicated in the following conditions:
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Open Fractures With Soft Tissue Defects - Infection and non-union are associated with open fractures. At first, the bony defect is managed, and the soft tissue defects are addressed later with the help of NPWT. The NPWT seals the wound, preventing any hospital-induced infections.
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Contaminated Wounds - Wounds exposed to external factors like water, dust. Chances of re-infection of contaminated wounds are reduced with the help of NPWT.
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Incisions With a Risk of Wound Breakdown (Re-Opening of a Closed Wound) - This procedure helps with wound closure. The wound appeared significantly healthier with NPWT.
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Wounds With Skin Grafts - Graft incorporation was improved by using NPWT.
When Is NPWT Contraindicated?
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When the wound cannot be managed by NPWT alone, the physician may not advise the therapy.
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The patient is unable to maintain the device.
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When the patient is prone to infections.
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It is contraindicated in certain conditions like fistula (an unusual path that joins two organs or cavities), dead or necrotic tissue, bone disorders like osteomyelitis, and wounds that are caused by skin cancer.
What Are the Complications of NPWT?
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Failure of the vacuum pump, such as technical failures, can occur anytime and be resolved if noticed on time.
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Unrecognized interruption in the process due to technical issues.
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Higher rate of wound infection upon negligence due to poor sealing or contamination with water.
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Loss of graft (the graft is sometimes not taken up by the body, leading to graft loss).
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Excessive bleeding during the process.
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Excessive bleeding during the dressing changes.
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Infection due to remnants of dressing materials left behind in the wound.
How to Prevent Complications?
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Appropriate training on the usage of the device.
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Operate the device cautiously and safely.
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Do not neglect the audio and visual alarms from the device.
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Recognize early symptoms of complications.
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Respond to the changes during the procedure and immediately halt the process.
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Prevent any infection by maintaining the cleanliness of the site.
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Refrain from taking drugs like Aspirin as they may affect bleeding or blood clotting.
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If one feels unable to handle the apparatus at home, the physician may recommend a caregiver who can help one get through the process.
When to Call a Doctor?
If individuals experience any of the following, contact the physician immediately.
Conclusion:
In summary, negative pressure wound therapy (NPWT) is a well-liked substitute for conventional dressings that promote faster healing of wounds. The technically operated device should be carefully used. All the instructions on how to use the device should be carefully followed. When the patient cannot be managed at home, a caretaker can be appointed after consulting the physician, and the process can be carried out safely
