RECOMMENDATIONS OF AN EXPERT PANEL
Negative pressure wound therapy (NPWT) is a concept that has been around for over 20 years. There is now more choice, potential and possibilities for the use of the NPWT for different indications. An international group of specialist surgeons with a high level of experience of NPWT in various wound types convened to discuss the use of NPWT today.
Stationary multi-use systems include a canister for fluid collection from the wound. The pressure applied is adjustable, with continuous and intermittent modes of operation possible. Often powered by a main electricity source, stationary multi-use devices are mostly used for inpatients but can also be adjusted for the use in outpatient care. Moreover, stationary multi-use can be adapted and used with a wound cleanser (NPWT instillation).
(sNPWT; or pocket, cannister-free, mechanically powered, disposable, portable)
Some sNPWT devices are canister-free and handle fluid mainly through evaporation from the outer layer of the dressing. Mainly suitable for low to moderate exudate levels. The pressure is applied continuously and is not usually adjustable. sNPWT devices are often battery powered, and tend to be used in outpatient care, although more research is required.
(ciNPWT; or prophylactic, preventative)
Closed incision NPWT (ciNPWT; or prophylactic, preventative) NPWT used on primary closure surgical sites to reduce risk of surgical site complications, such as infection, seroma, haematoma, local skin ischaemia and necrosis, dehiscence and delayed healing. Both traditional and sNPWT can be used as ciNPWT.
Make therapy as simple
as possible
– Turn off suction 5–10 minutes before dressing change to reduce pressure ;
– Use lidocaine irrigation before dressing change;
– Use a medical adhesive remover and avoid pulling the foil too forcefully, which may damage the skin
– Use an intermittent layer (for example silicone with perforations) between polyurethane sponge and the wound, especially on sensitive and granulated wounds
– Ensure surrounding skin of the wound is dry;
– Use smaller parts of adhesive foil in complicated body contours (i.e. groin);
– Use stoma paste as a sealant around the wound dressing ;
– For traditional NPWT with canisters, localise the port of the dressing at lowest part of the wound, where the highest collection of exudate is expected. For sNPWT without canister, localise the port of dressing far from the wound to use all the space of dressing to collect the exudation ;
– In highly exudating wounds, apply the dressing pad as fast as possible and turn on of the pump to avoid fluid collection below the foil .
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