Abstract
Negative pressure wound therapy (NPWT) is a technique that converts an open wound
into a controlled closed environment by applying intermittent or continuous sub-atmospheric
pressure to a specialized wound dressing in order to stimulate healing. The available
literature which has set the standard for the care of acute and chronic orthopaedic
wounds using this technique, especially for the lower extremities, is reviewed. Original
studies by Morykwas and Argenta are discussed as well as the current basic science
and clinical studies related to care for the orthopaedic patient. Finally, complications
reported in the literature are addressed.
Key words
NPWT - wound VAC - basic science - history
References
- 1
Argenta L C, Morykwas M J.
Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.
Ann Plast Surg.
1997;
38
563-577
- 2
Armstrong D G, Lavery L A.
Diabetic foot study consortium. Negative pressure wound therapy after partial diabetic
foot amputation: a multicenter, randomised controlled trial.
Lancet.
2005;
336 (9498)
1704-1710
- 3
Barringer C B, Gorse S J, Burge T S.
The VAC dressing - cautionary tale.
Br J Plast Surg.
2004;
57
482
- 4
Bonham P A.
Surgical wound case studies with the Versatile 1 wound vacuum system for negative
pressure wound therapy.
J Wound Ostomy Continence Nurs.
2006;
33
185-190
- 5 Burdette-Taylor S R. Use of the Versatile One (V1) for closed suction drainage to
stimulate closure in chronic wounds in home care. Poster supported by Blue Sky Medical
of San Diego, CA and Genesis Medical of Indianapolis, IN
- 6
Clare M P, Fitzgibbons T C, McMullen S T, Stice R C, Hayes D F, Henkel L.
Experience with the vacuum assisted closure negative pressure technique in the treatment
of non-healing diabetic and dysvascular wounds.
Foot and Ankle International.
2002;
23
896-901
- 7
Campbell P E.
Surgical wound case studies with the Versatile 1 wound vacuum system for negative
pressure wound therapy.
J Wound Ostomy Continence Nurs.
2006;
33
176-185
- 8
Davydov Y A, Larichev K G.
The bacteriological and cytological assessment of vacuum therapy of purulent wound.
Vestnik Khirugii.
1988;
10
48-52
, Translation by Blue Sky Medical, 2004
- 9
Davydov Y A, Larichev K G, Abramov A Y.
Concepts for clinical biological management of the wound process in the treatment
of purulent wounds using vacuum therapy.
Vestnik Khirugii.
1991;
2
132-135
, Translation by Blue Sky Medical, 2004
- 10
Davydov Y A, Malafeeva A P, Smirnov A P.
Vacuum therapy in the treatment of purulent lactation mastitis.
Vestnik Khirurgii.
1986;
9
66-70
, Translation by Blue Sky Medical, 2004
- 11
DeFranzo A J, Argenta L C, Marks M W, Molnar J A, David L R, Webb L X, Ward W G, Teasdall R G.
The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds
with exposed bone.
Plast Reconst Surg.
2001;
108
1184-1191
- 12
Eginton M T, Brown K R, Seabrook G R, Towne J B, Cambria R A.
A prospective randomized evaluation of negative-pressure wound dressings for diabetic
foot wounds.
Ann Vasc Surg.
2003;
17
645-649
- 13
Fleischmann W, Lang E, Kinzl L.
Vacuum assisted wound closure after dermatofasciotomy of the lower extremity.
Unfallchirurg.
1996;
99
283-287
, [in German]
- 14
Fleischmann W, Lang E, Russ M.
Treatment of infection by vacuum sealing.
Unfallchirurg.
1997;
100
301-304
, [in German]
- 15
Fleischmann W, Russ M, Marquardt C.
Closure of defect wounds by combined vacuum sealing with instrumental skin expansion.
Unfallchirurg.
1996;
99
970-974
, [in German]
- 16
Fleischmann W, Strecker W, Bombelli M, Kinzl L.
Vacuum sealing as treatment of soft tissue damage in open fractures.
Unfallchirurg.
1993;
96
488-492
, [in German]
- 17
Green A K, Puder M, Roy R, Arsenault D, Kwei S, Moses M A, Orgill D P.
Microdeformational wound therapy: Effects on angiogenesis and matrix metalloproteinases
in chronic wounds of 3 debilitated patients.
Ann Plast Surg.
2006;
56
418-422
- 18
Gwan-Nulla D N, Casal R S.
Toxic shock syndrome associated with the use of the vacuum assisted closure device.
Ann Plast Surg.
2001;
47
552-554
- 19
Herscovici D, Sanders R W, Scaduto J M, Infante A, DiPasquale T.
Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy
soft tissue injuries.
J Orthop Trauma.
2003;
17
683-688
- 20
Ilizarov G A.
The tension-stress effect on the genesis and growth of tissues. Part I. The influence
of stability of fixation and soft tissue preservation.
Clin Orthop Rel Res.
1989;
238
249-281
- 21
Ilizarov G A.
The tension-stress effect on the genesis and growth of tissues. Part II. The influence
of the rate and frequency of distraction.
Clin Orthop Rel Res.
1989;
239
263-285
- 22
Joseph E, Hamori C A, Bergman S, Roaf E, Swann N F, Anastasi G W.
A prospective randomized trial of vacuum-assisted closure versus standard therapy
of chronic nonhealing wounds.
Wounds.
2000;
12
60-67
- 23
Kostiuchenok I I, Kolker V A, Karlov V A.
The vacuum effect in the surgical treatment of purulent wounds.
Vestnik Khirurgii.
1986;
9
18-21
, Translation by Blue Sky Medical, 2004
- 24
Mendonca D A, Cosker T, Makwana N K.
Vacuum-assisted closure to aid wound healing in foot and ankle surgery.
Foot and Ankle International.
2005;
26
761-766
- 25
Miller M S, McDaniel C.
Treating wound dehiscence with an alternative system of delivering topical negative
pressure.
J Wound Care.
2006;
17
321-324
- 26
Morykwas M J, Argenta L C, Shelton-Brown E I, McGuirt W.
Vacuum-assisted closure: a new method for wound control and treatment: animal studies
and basic foundation.
Ann Plast Surg.
1997;
38
553-562
- 27
Morykwas M J, Faler B J, Pearce D J, Argenta L C.
Effects of varying levels of subatmospheric pressure on the rate of granulation tissue
formation in experimental wounds in swine.
Ann Plast Surg.
2001;
47
547-551
- 28
Müllner T, Mrkonjic L, Kwasny O, Vécsei V.
The use of negative pressure to promote healing of tissue defects: a clinical trial
using vacuum sealing technique.
Br J Plast Surg.
1997;
50
194-199
- 29
Parrett B M, Matros E, Pribaz J J, Orgill D P.
Lower extremity trauma: trends in the management of soft-tissue reconstruction of
open tibia-fibula fractures.
Plast Reconstr Surg.
2006;
117
1315-1322
- 30
Saxena V, Hwang C, Huang S, Eichbaum Q, Inber D, Orgill D.
Vacuum-assisted closure: microdeformations of wounds and cell proliferation.
Plast Reconstr Surg.
2004;
114
1086-1096
- 31
Shi B, Chen S Z, Zhang P, Li J Q.
Effects of vacuum assisted closure on the expression of MMP-1, 2, 13 in human granulation
wounds.
Zhongua Sheng Wai Ke Ka Zhi.
2003;
19
279-281
- 32
Sumpio B E, Banes A J, Levin L G. et al .
Mechanical stress stimulates aortic endothelial cells to proliferate.
J Vasc Surg.
1987;
6
252-256
- 33
Thoma R.
Über die Histomechanik des Gefäßsystems und die Pathogenese der Angiosklerose.
Virchows Archiv Path Anat.
1911;
204
1-74
- 34
Usupov Y N, Yepifanov M V.
Active wound drainage.
Vestnik Khirugii.
1987;
4
42-45
, Translation by Blue Sky Medical, 2004
- 35
Wackenfors A, Sjogren J, Gustafsson R, Algotsson L, Ingemansson R, Malmsjo M.
Effects of vacuum-assisted closure therapy on inguinal wound edge microvascular blood
flow.
Wound Repair and Regeneration.
2004;
12
600-606
- 36
Wirtz H RW, Dobbs L G.
Calcium mobilization and exocytosis after one mechanical stretch of lung epithelial
cells.
Science.
1990;
250
1266-1269
- 37
Yang C C, Chang D S, Webb L X.
Vacuum-assisted closure for fasciotomy wounds following compartment syndrome of the
leg.
J Surg Orthop Adv.
2006;
15
19-23
Nicole Arcand
Department of Orthopaedics · RI Hospital/Brown University School of Medicine
2 Dudley Street
Providence, RI 02905
USA
Phone: +1/4 01/8 29 17 50
Fax: +1/4 01/4 44 61 82
Email: narcand@yahoo.com