The document provides an overview of Closed Cyclic Negative Pressure Wound Therapy (CCNPWT) and its role in wound management, including the mechanism by which it promotes healing, such as tissue decompression and stimulation of granulation tissue formation. It outlines the types of wounds that are suitable for CCNPWT, contraindications, benefits, and the dressing application technique. Additionally, it emphasizes the importance of monitoring, managing co-morbid conditions, and adjusting treatment based on wound assessments.

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INTRODUCTION
OF
CLOSED CYCLIC NEGATIVE
PRESSURE WOUND THERAPY
in management of wounds
By SIDDHARTH MANDAL
CEO
TRIAGE MEDITECH PVT. LTD.
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What is Closed Cyclic Negative
Pressure Wound Therapy(CCNPWT)?
Negative Pressure Wound Therapy also widely
known as NPWT, WOUND VAC or TNP(Tropical
Negative Pressure) is a widely accepted wound
management modality today, i.e.,
A specially designed foam dressing applied on a
wound bed, sealed with a PU/PE drape further
connected with a drainage tubing to regulated /
controlled negative pressure source.
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How does CCNPWT promote wound healing?
•Removing excess fluid (infections and non-infectious),
allowing tissue decompression
•Stimulates granulation tissue formation by increasing
vascular perfusion,
•Encourages mechanical stretching, approximates wound
edges, enhances overall wound contraction
•Protects wound from microbe imbalance
•Maintains a moist wound
healing environment
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CONSUMABL
ES
PORTFOLIO
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ALL PRODUCTS ARE
CERTIFIED
SINGLE USE ONLY
ALL PRODUCTS ARE MANUFACTURED UNDER
STRICT PARAMETERS OF ISO 13485:2003
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5. Stick the drainage tubing
aligning the hole made
1. Rinse the wound thoroughly
& Debride majority of necrotic tissues
4. Make a small hole in the centre
2. Cut the foam dressing
in the shape of the wound
3. Place it on the wound bed
& seal with PU drape
6. INITIATE the Therapy & observe
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CCNPWT creates an Environment
of Wound Healing at the Cellular Level
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10. CCNPWT THERAPY
DRESSING BENEFITS
Flexible foam dressing adapts to the contours of
deep & irregular surface of the wound bed
Specially designed hydrophobic, non-linear
networked foam dressing removes bacteria
colonised wound exudate
The CCNPWT foam dressing aggressively
promotes uniform healthy granulation tissue
throughout the wound bed

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CCNPWT THERAPY DRESSING
BENEFITS
Flexible foam dressing adapts to the contours of
deep & irregular surface of the wound bed
Specially designed hydrophobic, non-linear
networked foam dressing removes bacteria
colonised wound exudate
The CCNPWT foam dressing aggressively
promotes uniform healthy granulation tissue
throughout the wound bed
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CCNPWT provides a closed sterile & moist wound
healing environment
Promotes granulation tissue formation, recent
studies suggest mechanical stretching may result in
increased mitosis (Cell Replication)
 Controlled Negative Pressure Therapy decreases
wound volume approximating wound edges, helps
uniformly draw wounds closed
Promotes continuous wound debridement by
removing wound debris & bacteria colonized wound
output/interstitial fluid allowing tissue decompression
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Contd..
Reduces oedema
Reduces bacterial load
Stimulates cell proliferation
Enchances dermal perfusion
Promotes micro angiogenesis
Protects wound from re-infection, cross
infection or spreading further infection
Promotes Skin Graft/Flap uptake (The
flexible foam dressing gently presses the skin
graft or flap ensuring full contact with the
wound bed
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Increased Perfusion
Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: NPWT: A New Method for Wound
Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997
Peak blood flow recorded at 125 mmHg
 Study helped establish original pressure
protocol with Foam Dressing (400-600
micron pore-size)
Positive effect on perfusion
with 100-125 mmHg
Hypothesized that reduction in oedema
decompresses small blood vessels and
increases flow
Frank Ischaemia and Wound Hypoxia
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Reduction of Inhibitory Factors
Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: NPWT: A New Method for Wound
Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997
Reduction of oedema has positive effect in wound
healing
 Reduction of inhibitory factors contained in
interstitial fluid (chemical)
 Decompression of small blood vessels, which
restores flow (mechanical)
Negative Pressure Wound Therapy increases perfusion and
oxygenation, therapy likely enhances resistance to infection
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WHAT TYPE OF WOUNDS
BENEFIT FROM CCNPWT?
Pressure ulcers
Full thickness and partial thickness burns
Diabetic / Neuropathic ulcers
Venous Insufficiency ulcers
Post-operative and dehisced surgical
Traumatic Wounds
Skin Flaps and Grafts
Explored fistulas
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WHEN IS CCNPWT CONTRAINDICATED?
• Wounds containing malignant tissue
• Untreated osteomyelitis
• Necrotic tissue such as slough or eschar
• Unexplored or non-enteric fistulas
• Exposed or unprotected organs, blood vessels
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WHAT CONDITIONS INDICATE CAUTION?
• Active bleeding or patient on anticoagulant
therapy
• Proximity of blood vessels, organs, muscle, and
fascia requiring protection
• Irradiated vessels and tissue
• Bony fragments
• Untreated malnutrition
• Non-compliant or combative behaviour
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CCNPWT helps in Flaps & Graft uptake
Fixation of skin graft (mesh-grafts) or flap until the
graft has taken (4-6 days). In these special cases,
Topical Negative Presure Therapy is used
for the secure fixation
of a split skin graft to the wound
The soft foam helps gently press the graft/flap onto the wound
bed and thus ensures full contact between the graft and the
underlying wound bed, irrespective of the wound contours and
the formation of pockets, also continuously drains out the
wound output, ensures infection free graft uptake
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DRESSING APPLICATION TECHNIQUE
STEP 1 : DEBRIDE & CLEAN THE WOUND WITH
ISOTONIC SOLUTION
STEP 3: SEAL THE WOUND WITH SEMI-PERMEABLE
DRAPE & MAKE A SMALL HOLE IN THE CENTRE
STEP 2 : CUT THE FOAM DRESSING IN THE SHAPE
OF WOUND AND PLACE IT ON WOUND BED
STEP 4 : STICK THE MAPC TUBING DISTAL END
KEEPING SYMMETRY WITH HOLE IN CENTRE &
CONNECT WITH THE NEGATIVE PRESSURE
SOURCE
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INDICATED for TRAUMA WOUNDS
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INDICATED for
DIABETIC FOOT
ULCERS
Granulation after 3 days of application
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Indicated for all
Grade II, III & IV
Pressure Ulcers
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INDICATED FOR
VENUS/ARTERIAL
LEG ULCERS
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INDICATED FOR
ABDOMINAL
COMPARTMENT
SYNDROME
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Infected Laprotomy
**Please seek advice for special Dressing selection
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Venus Leg ulcer with complications of sickle
cell anaemia
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CCNPWT
application
for 10 days
20 days
post follow-up
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ROAD ACCIDENT LACERATION
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Road Accident case : with no vessels for
primary closure
(results of 13days NPWT Dressing Application)
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INFECTED COMPOUND
FRACTURE
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AFTER Ist DRESSING
CHANGE
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AFTER 2nd DRESSING CHANGE
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FOLLOW-UP
POST FLAP
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Crushed Injury
Amputation
CCNPWT
applied for
4 days
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ROAD
ACCIDENT
LACERATION
Patient :
HBsAg
Positive
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CCNPWT
Applied for 7 days
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PRESSURE ULCER (GRADE IV)
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Result of 8 days / 2 dressing change
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WHAT INTERVENTIONS WILL MAXIMIZE
HEALING?
 Debride wound prior to Negative Pressure
Therapy
 Off load pressure ulcers consistently
 Minimize time off NPWT to < 4 hours in a day
 Manage co-morbid condition
 Increased blood flow
 Reduce oedema
 Minimize infection
 Control blood glucose level
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WHAT ARE THE EXPECTED OUTCOMES?
• May observe increased exudate and wound size during
the first 48-72 hours due to the decompression of interstitial
space and removal of extra-cellular fluid and debris.
• Gradual reduction of fluid and surface area should be
observed with each assessment.
• Colour of wound bed should become a deeper red as
perfusion to the site increases.
• Measurements should decrease weekly.
• If healing is not observed in a week, treatment should be
re-evaluated.
• The average treatment with NPWT is 1-4 weeks. Length of
treatment is determined by goals of therapy.
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HOW DO YOU MANAGE WOUND WITH CCNPWT?
Change dressing two/three times per week.
Monitor frequently
Observe wound and peri-wound area for signs and
symptoms of infection
Remove dressings carefully to protect new tissue
growth.
Bright gush flow red blood in canister requires
immediate evaluation.
Measure and document per facility protocol
Note : To initiate it is recommended to follow CCNPWT protocol, to ensure optimal results, as
ithese are tried and tested protocol designed by various CCNPWT expert wound managers
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WOUND
ASSESMENT
CHART
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WOUND
ASSESMENT
CHART
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WOUND
TREATMENT
PLAN CHART
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Thank you for your patience
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