Negative pressure wound therapy

1. Evolving role of negative pressure
wound therapy with instillation
abd dwell time (NPWTi-d-) in
management of trauma and
orthopaedics wounds
Saini et al, IJO,2023
Presenter - Dr. Shubhanshu
Guide – Dr. John Mukhopadhaya

2. Introduction
• Environment for wound healing
• Topical solution into wound bed
• Wound cleaning, removal of debris, delivery of
drug locally

3. • Fleischmann 1998 proposed this
• Three stages – irrigation, dwell, drainage
• NPWT – Normandin et al 2021
– Local blood flow
– Tissue edema
– Bacterial contamination
– granulation
• NPWTi-d additional benefit –
– Wound cleaning, exudate necrosis removal

4. Mechanism
1. Negative pressure setting – 125-150 psi
2. Installation mode
1. Intermittent – two phase
• Instillation and dwell phase – 2-3 hr negative pressure
& dwell time 10 min Faust E et al 2021
– Suitable solution – amount of solution for proper wound
absorbtion
3. NPWTi duration time - 3-14 days acute non
infectious wound 1 week to 9 weeks for
weeks

5. Installation Solution
• NS
• Antimicrobial solution – Silver ion/ Na
Hypoclorite sol/PHMB-
0.1%(polyhexamethyleneBiguanide)/ acetic
acid 0.25-0.1%/ betaine 0.1%
• Antibiotics – vancomycin/ polymyxomycin B,
gentamycin

6. Advantages
• Wound closure rate increases De Pellegrin et al,2023
• Granulation formation rate increases
• Hospital stay reduced kim et al, 2015
• Duration of surgical operation reduced
• Healing of wound increses
• Cost effectivegupta et al,2016

7. Disadvantages
• Does not complement surgery and
debridement
• Time frame not defined
• Not for STSG, dermal replacement, vein artery
exposed region, untreated abscess , critical
ischemic wound
• Tension pneumocephalous reported after post
surgical spine infection

8. Application
• Acute wounds – open #, Necrotizing fascitis
and soft tissue injury
• Chronic wound – OM, Wound with bone
tendon or fixation exposure , infected wound
• Salvage Orthopaedic fixation hardware – post
fixation SSI
Gabriel et al, 2012
Reider et al, 2018
Anghel et al, 2016
Novak et al, 2014

9. Advances
• Reticulated open cell foam dressing with
through holes (RCOF-CC)- better oxygenation
drainage Shimbo et al, 2022
• Smart NPWTi-d- material changes response to
environment Khuswaha et al, 2022
• 3-D printed NPWTi-d- Uchida et al, 2023

10. Efficacy and safety
• Wound closure achieved 65% cases Elhessey at al 2021
• NPWTi-d- with Saline solution better
outcomes Pellegrin et al 2023
• Wound granulation tissue recovers quickly
Enodien et al, 2021
• Goss et al, 2016 showed decreases CFU of
tissue culture treated with NPWTi-d-

11. Take home message
• Choosing right patient
• Create environment
• Provides wound hydration, irrigation and
facilitating local antibiotics.
• Cost-benefit assessment