II. Definitions
- Negative Pressure Wound Therapy (NPWT)
- Foam Dressing cut to fit wound applied to surface
- Vacuum applied to dressing to remove wound exudate and inflammatory mediators to promote Wound Healing
III. Mechanism: Promote Wound Healing
- Remove wound exudate and inflammatory mediators
- Improves perfusion and circulates nutrients to the tissue
IV. Contraindications
- Exposed vessels or viscera
- Risk of the sponge adhering to critical tissue with risk of injury or Hemorrhage
- Vaseline Gauze may be applied to these structures to create a barrier and prevent sponge adherence
- Substances that clog the sponge and counter the vacuum
- Necrotic wounds
- Purulent drainage
- Thick exudate over wound surface
V. Precautions
- Sponge must be changed regularly
- Risk of Toxic Shock Syndrome
- Risk of tissue adhering to sponge and resulting in Hemorrhage or injury on removal
- Clean the wound with each dressing change
- Cleaning with saline, wound cleanser or gentle wiping with gauze
- Sponge should be properly fit to wound margins
- Too large a sponge will result in maceration of normal skin at wound margins
- Too small a sponge will offer less optimal wound management
VI. Types: Sponge
VII. Technique: Dressing Change
- Prepare materials needed
- Sponge (see types above)
- Scissors to cut sponge to wound size
- Occlusive dressive material
- Protect underlying vascular or visceral structures
- Protect healthy tissue margin
- Apply over surface of wound and wound margin
- Saline or wound cleanser
- Gauze
- Vacuum or suction tubing
- Removing dressing
- Consider instilling saline through vacuum tubing before removal (may ease sponge removal)
- If sponge is adhered to underlying tissue, consider applying saline to surface and waiting 5-10 minutes
- Clean the wound
- Irrigate the tissue bed and periwound edges with saline or wound cleanser
- Gently wipe away remaining debris with saline soaked gauze
- Remove any loose sponge pieces with forceps
- Dry the periwound edges
- Protect healthy tissue margin and underlying sensitive structures (e.g. vessels, viscera)
- Apply an adherent Occlusive Dressing to the healthy wound margins (protect from maceration)
- Trim Occlusive Dressing to fit only the areas to protect, while leaving exposed remaining wound
- Prepare the foam sponge
- Trim the foam sponge to fit within the wound
- Multiple foam pieces may be needed to fill a deeper defect
- In most cases, apply the same number of foam pieces that were removed
- The foam surface should be roughly level with the periwound margin
- Apply the dressing
- Insert properly sized foam sponge into the wound
- Apply adherent Occlusive Dressing over the sponge and and wound
- Adherent dressing should extend over the normal periwound skin on all sides by 1.25 cm (1/2 inch)
- Apply the vacuum
- Cut a 1-2 cm (roughly 1/2 inch) hole in the adherent dressing, overlying the center of the foam and wound
- Apply the vacuum tubing over the hole
- Connect the vacuum tubing to thye vacuum system
- Ensure that proper seal is achieved when vacuum is on
- Label the dressing
- Write on the dressing, the date, time, and number of foam pieces
- Document the procedure details
VIII. Complications
- Maceration of periwound margins from overlying sponge
- Sponge clogging due to thick drainage material
IX. Resources
- How to apply a Negative Pressure Wound Therapy Dressing (Youtube)
X. References
- Warrington (2022) Crit Dec Emerg Med 36(6):16-7
- Putnis (2014) Open Orthop J 8:142-7 +PMID: 25067967 [PubMed]
- Peinemann (2011) Dtsch Arztebl Int 108(22):381-9 +PMID: 21712971 [PubMed]