Negative pressure wound therapy

Background

• Also known as a "wound vac"
• A technique for treating acute and chronic wounds by using a sealed wound dressing attached to a vacuum pump.
• The vacuum creates a negative pressure gradient that draws out fluid and increases blood flow to the area.
• Often applied to wounds that are expected to heal poorly, such as diabetic foot ulcers, pressure ulcers, or very large tissue defects.

Efficacy

• High quality evidence exists for improved outcomes in the treatment of diabetic foot ulcers.
• Poor quality or insufficient evidence suggests may improve treatment of bedsores, large tissue defects, or other wounds.
• There is little evidence to suggest an increased risk of complications, so wound vacs are often applied to many other kinds of wounds.

Contraindications

• Malignancy in the wound
• Untreated osteomyelitis
• Non-enteric or unexplored fistulas
• Presence of an eschar
• Direct exposure of blood vessels, anastamoses, internal organs, or nerves.

Troubleshooting

• Most ER visits regarding wound vacs will be due to "the machine beeping". This is often due to loss of negative pressure in the circuit.
• This can usually be fixed by re-packing the wound and placing a new occlusive dressing over it.
  • May require special supplies not available in the ER. If that is the case, most patients can still be discharged if they have expedited follow up with a home health nurse or PCP that can provide supplies.