The first step in wound healing is to remove or correct factors that impair healing. Most wounds will heal with good wound care that includes proper nutrition and an environment that promotes healing, maintaining moisture, removal of necrotic tissue, and controllinginfection. Some chronic wounds will benefit further from adjunctive therapies.

As evidenced in the literature, negative pressure vacuum therapy has proven successful in healing a variety of wounds. NPWT has been used for the treatment of open wounds for nearly a century. Beginning in 1908 with Bier’s Hyperemic Treatment, clinicians applied vacuum suction to infections and all types of chronic, traumatic, and post-surgical wounds. Over the last decade, NPWT has been established as a well-defined wound care option in treating complex acute and chronic wounds and, in many instances, has become the standard of care.

NPWT is currently approved for use in preparing the wound bed for closure, reducing edema, promoting granulation tissue formation and perfusion, and removing exudate and infectious material within the wound. In theory, a dressing containing a drainage tube is fitted to the contours of a deep or irregularly-shaped wound and sealed to the healthy skin.. The tube is connected to a vacuum source, turning an open wound into a controlled, closed wound while removing excess fluid from the wound bed to enhance circulation and remove waste. The vacuum may be applied continuously or intermittently, depending on the type of wound being treated and the clinical objectives. The technique is often  used with chronic wounds or wounds that present difficulties while healing, such as those associated with diabetes, pressure ulcers, or venous insufficiency limits circulation to the affected area.

The benefits of NPWT go well beyond drainage management. NPWT studies have shown improvements in granulation tissue formation, decrease in bacterial burden, protection from the outside environment, promotion of moisture balance within the wound bed, and decreased frequency of dressing changes.

NPWT is appropriate for use on the following wounds:

• Pressure ulcers
• Diabetic / Neuropathic ulcers
• Venous insufficiency ulcers
• Traumatic wounds
• Post-operative and dehisced surgical wounds
• Explored fistulas
• Skin flaps and grafts

Morbidity associated with difficult-to-heal, chronic wounds negatively impacts the patient’s quality of life and may result in exorbitant healthcare costs. A variety of studies have sought to determine if pressure ulcers and other chronic wounds treated at home with NPWT close faster and result in reduced treatment and costs compared to conventional therapies (e.g., therapeutic support surface and saline-soaked gauze).

A comprehensive review of Stage III and Stage IV wounds that failed to respond to previous interventions and were subsequently treated with NPWT found that such wounds averaged 22.2cm in size and closed at an average of 0.23cm per day. This type of wound would take 247 days to heal and cost $23,465 using conventional therapies. Using NPWT, the same wound would heal in 97 days at a cost of $14,546. Studies concluded that NPWT is an efficacious and economical treatment modality for a variety of chronic wounds.

How does one choose the appropriate NPWT device?

Clinicians choosing to use NPWT appreciate the differences among devices, including a variety of indications and appropriate wound types for use. Differing negative pressure pumps incorporate a variety of wound interface materials and employ different suction and safety features; therefore accommodating a variety of applications. Choosing the right NPWT device is based on careful consideration of the specific FDA indications for use, the amount of clinical evidence, and availability of clinical support. 

By necessity, patients often must transfer out of the acute care setting while continuing on advanced wound care therapy, resulting in changes in caregivers and, therefore, often changes in wound treatment. Insurance reimbursement and facility protocols may also affect treatment modalities. Our expert staff works with your physician and home care provider to employ the most appropriate equipment for your situation, including:

• Appropriate wound bed preparation
• Wound type and patient condition
• Careful oversight of patients’ care as they transition to outpatient settings
• Monitor the wound consistently to assess wound progression toward goal of therapy

River City HealthCare & Pharmacy has partnered with two leading wound care companies, ConvaTec and Kalypto Medical, to offer a full range of application accommodating a wide variety of wound types and other patient diversities. 

When should NPWT be discontinued?

When the treatment goal is met, NPWT should be stopped. It has been recommended that a 50% improvement in wound size over four weeks is a good indication that the therapy is working and that the wound will heal. In addition, careful attention should be paid to the development of worsening infection, necrotic tissue, and uncontrolled bleeding with the use of NPWT. In some cases, NPWT can be used until wound closure, although in most cases, it is used until the wound is filled with good granulation tissue and ready for standard wound therapy, skin graft, or flap.