Negative pressure wound therapy

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Background

  • Also known as a "wound vac"
  • A technique for treating acute and chronic wounds by using a sealed wound dressing attached to a vacuum pump.
  • The vacuum creates a negative pressure gradient that draws out fluid and increases blood flow to the area.
  • Often applied to wounds that are expected to heal poorly, such as diabetic foot ulcers, pressure ulcers, or very large tissue defects.

Efficacy

  • High quality evidence exists for improved outcomes in the treatment of diabetic foot ulcers.
  • Poor quality or insufficient evidence suggests may improve treatment of bedsores, large tissue defects, or other wounds.
  • There is little evidence to suggest an increased risk of complications, so wound vacs are often applied to many other kinds of wounds.

Contraindications

  • Malignancy in the wound
  • Untreated osteomyelitis
  • Non-enteric or unexplored fistulas
  • Presence of an eschar
  • Direct exposure of blood vessels, anastamoses, internal organs, or nerves.

Troubleshooting

  • Most ER visits regarding wound vacs will be due to "the machine beeping". This is often due to loss of negative pressure in the circuit.
  • This can usually be fixed by re-packing the wound and placing a new occlusive dressing over it.
    • May require special supplies not available in the ER. If that is the case, most patients can still be discharged if they have expedited follow up with a home health nurse or PCP that can provide supplies.

References