negative pressure wound management by dr ,mohammad abdel ghany

1. intro

2. Dr.
Mohammed Abdel Ghany
Ismail
MD plastic and reconstructive surgery
El-mehala Plastic Surgeons Club

3. Definition
• New theraputic technique using subatmospheric
pressure or vacuum-assisted drainage to remove
fluid from a wound surface
• A sponge or foam
interface is used to
distribute the negative
pressure allover the
wound surface

4. History
• Started 1989 USA California
• Released 1994 in Europe
• Published 1997;Annals of Plastic Surgery
(175 casas)

5. Principles and Mechanism
Exact unknown, but theories:
1. Fluid-based mechanism
2. Mechanical mechanism
3. Reduction of bacterial load

6. 1- Fluid-based mechanism
Removes excess interstitial fluid
• Improves microcirculation and oxygen delivery
• Allows transport of nutrients
• Removal of waste products &local toxins in wounds
• (proteolytic enzymes, acute phase proteins,
metalloproteinases,proinflammatory mediators,
and cytokines)

7. 2- Mechanical mechanism
Cellular response to mechanical tissue stress
• Negative pressure causes the contact wound dressing
to collapse
• the force is transferred to the wound edges, drawing
them closer together
• pieces of tissue are drawn into contact dressing
inducing mechanic alstress, stimulating angiogenesis
and tissue growth.

8. Application
• The wound is cleaned and necrotic tissue debrided
• Nonadherent contact layer, Xeroform , between
prepared wound bed and contact dressing
• A piece of sponge is cut to fit the wound approximately
• The sponge is placed within the wound and a drainage
tube placed over it (if circumferential holes, another piece
of sponge should be put over the top of the tube)

10. Application (cont.)
• Adhesive transparent waterproof dressing
(opsite) overlaps the surrounding skin, and a
seal created with the skin and the drainage
tube.
• Suction tubing is attached to a cannister
(through another tube).
• The cannister slots into the VAC unit.

11. Video Demonstration

12. Variation
• Contact dressing may be foam, sponge or
gauze.
• Transparent dressing is placed directly on the
sponge; a hole is cut in it; and a suction tube
with a flat adhesive end is stuck over the hole.

13. Pressure
• Apply subatmospheric pressure.
• Continuous or intermittent pressure application
• Continuous with early wound+excess exudate
• Intermittent pressure shown to produce more
rapid granulation tissue deposition(5-2,5-1).
• Pressure of 50 to 125 mm Hg applied.
• Maximum increase in blood flow seen at 125 mm
Hg.

15. Frequency of dressing changes
• No less than three times a week for non-
infected wounds
• More frequently for infected wounds
• Twice a week is suitable

16. Indications
• Acute ,chronic, traumatic, and dehisced
wounds.
• Partial-thickness burns, ulcers (diabetic,
pressure, venous stasis)
• Flaps, and grafts

17. Acute wounds
Large soft tissue injuries with compromised tissue,
contaminated wounds, hematomas, gunshot wounds.
1. Debride wound of all nonviable tissue.
2. Remove foreign bodies.
3. Hemostasis.
4. Cover vital structures such as major vessels, viscera, and
nerves with muscle or soft tissue.
5. If significant contamination or patient has signs of sepsis,
change dressings at 24-hour intervals with repeated
debridement .

18. Chronic wounds
Pressure ulcers, long-term dehisced wounds,
venous stasis ulcers, vascular and diabetic ulcers)
• Debride wound of all nonviable tissue.
• Converts a chronic wound into a subacute
wound that responds more rapidly.

19. Contraindications
1. Exposed vessels, nerves, and organs
2. Malignancy in wound
3. Untreated osteomyelitis
4. Nonenteric or unexplored fistulas
5. Fresh anastomotic site
6. Necrotic tissue with eschar present
TIP: Some surgeons may cover vessels, nerves, and organs
temporarily using either a nonadherent contact layer or a white foam
contact dressing on a case-by-case basis.

20. Precautions
• Active bleeding
• Anticoagulant
• Difficult haemostasis
• Near BV,organs; protect with fascia or barrier
• Irradiated

21. Benefits
1. Protect the wound and prevent environmental
contamination, and prevent wound desiccation.
2. Prepare wound bed for surgical closure or allow healing
by secondary intention
3. Improve granulation tissue formation, manage infection
and reduce wound size
4. Improve patient comfort: Decrease pain, decrease
number of dressing changes
5. Reduce costs: Shorten time to closure or next additional
surgery, minimize wound complications, and allow
management of wounds as outpatient

22. Special Clinical Applications
Extremities and Orthopedic Injuries
• NPWT has become a first-line treatment for
allowing definitive reconstruction to be
performed in a stable, clean wound on an
elective basis.(Streubel et al.,2012)
Use of negative-pressure wound therapy in orthopaedic trauma

23. Values in Orthopaedic Trauma
1) Allows serial debridement of only nonviable soft tissue and
bone, minimizing unnecessarily aggressive debridements.
2) Removes edema and increases perfusion.
3) Viable soft tissue is drawn together so that the wound does
not enlarge with edema and retraction.
4) Bone is kept in a moist environment, minimizing
desiccation.!!
5) Can be placed directly over hardware.!!
6) After fasciotomies, reducing edema and allowing primary
closure sooner

24. Special Clinical Applications (cont.)
Grafting Over Bone
• NPWT may be used on surgically exposed
cranial diploe or other bones by drilling at 1
cm intervals to bleeding level to partially
remove the corex;
• accelerates formation of granulation tissue for
skin grafting.

25. Cases

29. 1
Vac therapy is not magic but may be a
suitable solution for some difficult
wounds that are not suitable or ready
for reconstruction immediately

30. 2
Negative pressure wound dressing prepares
the wounds well and changes a hard option
to apply into simple one (free flap graft)

31. 3
It added a revolution in soft tissue rec. of foot
and ankle because it has enabled surgeons to
close wounds by simple technique that usually
needed complex pedicled or microsrgical flap

32. 4
At last we need more cases of application
in our own experience to judge this
method efficiently