How Effective Is Negative Pressure Wound Therapy in Chronic Wound Healing - Essay Example

How effective is negative pressure wound therapy(VAC) in chronic wound healing Although managing and treating wounds of complex nature has always posed challenges for the medical profession, it becomes more difficult when the patients have multiple co-morbidities and complex pathologies. Accordingly, several wound management techniques were studied that could successfully meet such challenges. During 1997, a short study presented by Argenta and Morykwas ( Morris & others, OSTOMY WOUND MANAGEMENT) demonstrated a new wound management technique which involved application of sub-atmospheric pressure to the wounds, at intervals or continuously. During their study, the authors found that application of negative pressure on wounds resulted in positive response from majority of the patients. This process of negative wound pressure therapy (NWPT) was identified as an effective tool to treat patients with wound complications. This therapy is known by different names, which include vacuum-assisted closure (VAC), topical negative pressure (TNP), vacuum sealing technique (VST) and sealed surface wound suction (SSS) .While VAC is currently used on an extensive basis in North America and Europe, its cost effectiveness is yet to be confirmed……( Morris & others, OSTOMY WOUND MANAGEMENT, para 1-5) How VAC works While the technology helps wound to heal faster by pulling the edges together, granulation tissue is used for filling the wound, from bottom-up. However, the engineering in this therapy includes a suction pump, pressure of which can be set by clinicians as per the individual wound sealing requirement. Nevertheless, in most of the cases, the pressure setting varies from 70mmHg to 150mmHg, while in certain cases it could go up to 200mmHg. Apart from the pump, connection tubings and devices would be required for connecting the pump with the wound and its sealing materials, like wound dressings. (NPWT, 2010) The technology involves use of reticulated polyurethane ether foam dressing, while a non-collapsible evacuation tube is attached to this material at one end and the other end of this tube is connected to the pump, called the vacuum source. The foam dressing is cut exactly as per the wound bed size and shape, while it serves the purpose of absorbing wound exudates, as well as, evenly distributing the negative pressure over the total wound surface. To ensure that an air-tight compartment is created over the wound bed, an adhesive drape, being a transparent film, is placed over the tube and the foam dressing. However, the tube must extend around 3 to 5 cms beyond the edges of the wound, for creating better effect. As the VAC therapy activates, the pump creates negative pressure on the wound, pulling the affluent matter from it, while a collecting vessel is used for gathering it. However, the application of negative pressure would depend on the characteristics of the individual wound, and the wound complexities involved……………………..( Morris & others, OSTOMY WOUND MANAGEMENT, The device) Advantages of VAC This therapy is known to provide remarkable help in treating the wounds related to open abdomen, as it is useful for treatment of patients with abdominal compartment syndromes, traumatic injuries, and severe intra-abdominal sepsis. In addition, this therapy helps in controlling the intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure. The application of this therapy becomes necessary in treating the wounds or advanced stage ulcers, where the application or other wound treating technology has not proved to be effective. NPWT is also recommended for treatment of surgically created wound like dehiscence, or any traumatic wound like preoperative flap, as the treatment of such wounds might require accelerated formation of granulation tissue, since other typical wound treatment methods may not be able to achieve this formation. While treating chronic wounds and ulcers of decubitus type, the NPWT is said to be responsible for increasing local vascularity and oxygenation of the wound bed, as it can also remove exudate and bacteria, as well as reduce edema by evacuating the wound fluid. However, apart from the cost factor, which is open to further exploration, for this therapy, in-depth investigation is required to confirm its advantages in comparison to other conventional wound healing treatments, which are currently available. Accordingly, such research studies should cover points like, blinding of wound accessories, reporting of healing data, reporting of randomization methods, among other issues……………….(Negative Wound Pressure Therapy, aetna.com) Comparison of VAC with Advanced Moist Wound Therapy (AMWT) Apart from conducting studies to know the efficacy of negative pressure wound therapy, its results for treating foot ulcers in diabetic patients have been compared with AMWT, as investigated during various research studies. One such research study included 342 patients, with a mean age of 58, in which 78% were male. While the study revealed benefit from VAC to around 43% of the patients, who achieved complete ulcer closure by this treatment, only 28% of patients achieved similar results from AMWT. Accordingly, NPWT is supposed to be more effective in treating diabetic foot ulcers, than other conventional treatment methods, as well as, AMWT. Similarly, while comparing the degree of ulcer area reduction and granulation tissue formation, it was found that VAC is more effective getting the ulcer closure as compared to AMWT. These results were accompanied by the significant reduction in median time to achieve the desired wound healing in patients treated by VAC. Treatment of chronic and complex wound involves the application of different treatment methods by physicians that include treatment modalities like debridement, assessment, and treatment of infection, revascularization if indicated, and sufficient off-loading of the foot, in case of foot ulcer wounds. NPWT has an advantage of working in conjunction with debridement as the foundation upon which the wound healing process can begin. Accordingly, the study suggests, that VAC technology, along with debridement has been responsible for reducing the healing time, while increasing the rate of healing process, as compared to AMWT……(Blume & others, 2007) While other therapies for wound treatment have their own advantages, the principle of granule formation and application of negative pressure to the wound bed, as used in VAC, is gaining popularity among physicians and clinicians, being more effective method, particularly for treating complex wounds, for patients who have complicated pathological conditions. Works –cited ( all accessed on 14/15th May 2010) Blume P A, Walters J, Payne Wyatt, Labtis John and others, 2007, “ Comparison of Negative Wound Pressure Therapy…..” , available at: http://care.diabetesjournals.org/content/31/4/631.full Morris & others, OSTOMY WOUND MANAGEMENT, “Negative Pressure Wound Therapy Achieved by Vacuum-Assisted Closure: Evaluating the Assumptions”, available at: http://www.o-wm.com/article/6655 Negative Wound Pressure Therapy, available at: http://www.aetna.com/cpb/medical/data/300_399/0334.html NPWT, 2010, available at: http://medicaledu.com/NPWT.htm Read More