Negative Pressure Wound Therapy

  I would give a lot to have a picture of the first “portable” negative pressure wound therapy (NPWT) device used by one of my patients. It was 1977, and a resourceful woman who had experienced an abdominal wound had used bungee cord to attach one of the original NPWT devices that existed (about the size of a carry-on suitcase) to a skateboard. That orange, 50-foot, industrial-strength cord allowed her to ambulate from room to room, her skateboard trailing the NPWT device behind her.   I had been running a wound center for seven years at that time, and I will never forget the first time I changed an NPWT dressing and saw a field of beautiful granulation tissue — where only days before there had been none. I remember thinking, “This will revolutionize the way we care for patients.” I wasn’t wrong.   In this issue of Today’s Wound Clinic, we cover the spectrum of what NPWT means to wound care today. Lee Goldstein, MD, FACS, CWS, provides an historical perspective on negative pressure that will help readers compare mechanical and electronic forms of NPWT. My co-editor and fellow TWC board member Dot Weir, RN, CWON, CWS, discusses evidence-based benefits of the mechanical variety, which represents the next step forward for the innovation of NPWT. The impact of negative pressure utilization is further showcased in the article “Pairing Advanced Wound Care Therapy With NPWT” by Christina Le, LVN, WCC, who details the effects of NPWT when used in conjunction with other therapeutic options to expedite the healing of complex wounds in ways we could not have imagined 20 years ago. Also in this issue, Carol Price, MSN, RN, CWS, DAPWCA, details the delicate use of NPWT to gain closure of a giant omphalocele in newborns, another cutting-edge development in the field.

Strolling Down NPWT Memory Lane

  I remember the first time we used NPWT in the clinic on a patient living with abdominal compartment syndrome. To cover the viscera, we used an empty plastic IV bag with holes poked through it and applied foam on top. Despite the crudeness of the NPWT dressing, the process was wildly successful and forever changed the management of abdominal compartment syndrome at my institution.   For many years, one of the most difficult aspects of NPWT surrounded the paperwork associated with ordering it for our patients. As always, when it comes to financial issues in the wound center, you can’t afford to miss “Business Briefs” by fellow TWC board member Kathleen D. Schaum, MS, who covers reimbursement considerations for surgical dressings as well as traditional and disposable NPWT devices in this issue.   It was inevitable that the novel concept of negative pressure would lead to innovative equipment with which to deliver it. Devices have gotten smaller, materials being used at the wound interface have evolved, new ways have been developed to manage tunnels, and novel technology becomes available to control bioburden each day. Originally, NPWT devices actually needed batteries. Eventually, battery life lasted longer; and now it seems electricity can be considered entirely optional for NPWT devices. I wish I could go back in time and show one of today’s tiny NPWT devices to my patient with the skateboard and the 50-foot extension cord, but the future seems just as inspiring. Caroline Fife, MD, FAAFP, CWS, co-editor of TWC, chief medical officer at Intellicure Inc.