Book Description

Negative pressure wound therapy (NPWT) involves applying a controlled sub-atmospheric pressure environment across the surface of a wound in an airtight dressing. A pump is used to maintain negative pressure, usually between 75 and 125 mmHg, in a consistent or intermittent manner. The mechanism by which NPWT is thought to promote wound healing is through increasing local perfusion, eliminating tissue edema, drawing wound edges together, removing exudates and proinflammatory cytokines, inhibiting bacterial growth, and promoting cell hyperplasia. NPWT systems have been widely adopted for a broad range of wound indications including diabetic foot ulcers (DFUs). In 2011, the FDA published a warning regarding contraindications and risk factors to consider before NPWT use. Application of NPWT on exposed organs, exposed vasculature, necrotic tissue with eschar present, untreated osteomylelitis, malignancy in the wound, or anastomotic sites is contraindicated. Risk factors for NPWT use include patients at high risk for bleeding and hemorrhage, patients with infected wounds, sharp edges in the wound, patient size and weight, and circumferential dressing application. This FDA update on serious complications was prompted by reports on 12 deaths and 174 injuries associated with NPWT use since 2007. NPWT is in widespread use, however, it is expensive and presents possible serious adverse events. The purpose of this report is to retrieve and review existing evidence of clinical effectiveness and cost-effectiveness, and to retrieve and review the existing guidelines for NPWT treatment of DFUs.