From the Editor: Negative Pressure Wound Therapy

  I have unbelievably just entered my 30th year in wound care. When I think back to what we had at our disposal to use for managing wounds back in my early beginnings, it was rudimentary at best; lots of gauze packing, a nifty product called Bard Absorption Dressing, and transparent films that were just entering the market. As I grew up in the specialty, I was fortunate enough to experience the early entry of other moist wound healing products and new products to manage exudate. Now 30 years later, the list has grown exponentially. There are so many options that we take for granted. It is only when I reminisce like this that I remember that negative pressure wound therapy (NPWT) has not always been around! In 1995 when it entered the market, I wasn’t even in clinical practice; I was in my 2nd of 7 years in industry. But in 2001, as I reentered practice in the world of outpatient wound clinics, there were three modalities I couldn’t wait to experience; topical growth factors, bioengineered tissues, and NPWT.

  Now jump ahead 15 years: I don’t think most wound professionals could imagine practice without these products, which have become extremely commonplace and used on virtually all types of wounds. The utilization of these products has risen to that level because of the positive outcomes that we have seen; and that we can confidently recommend to our patients. Now we are in the era of having NPWT choices to offer our patients and our healthcare systems. As individuals, we have our favorite NPWT device or interface dressing, and know the little application tricks that we have learned and shared with each other. Having choices and differences in the NPWT devices is good for our industry and good for our patients. There are those that are now smaller and more discreet. If you attended the spring SAWC, you saw at least two (I saw 2 but maybe there were more?) that are disposable! This is all very exciting. To that end, the primary focus of this issue of Today’s Wound Clinic is Negative Pressure Wound Therapy.

  But as with anything in life, we can take a lot for granted and get a bit blasé about things. That is when the potential for negative outcomes can enter the picture. Take another real life example: driving your car. There is no question that big piece of metal filled with gasoline has the potential to cause injury. Yet daily we get into our cars and drive them because we’re good at driving. Have you ever sat behind the wheel of your car, arrived at your destination, and were amazed that you had driven there without realizing it because your mind may have been other places? Although you arrived safely, you were scared when you thought about what could have happened while you were day dreaming instead of paying careful attention to the task at hand. You may be wondering how driving a car compares to ordering NPWT for our patients. Unfortunately, we sometimes order/use this modality a bit habitually, with perhaps our own unique techniques because we’re good at it. We do need, however, to continuously think about our processes, so we don’t arrive at a potentially negative outcome, and not know how it happened. To that end, Caroline Fife and I have included a feature article that reviews some of the important considerations to keep in mind as we strive to provide our patients with the care that they need.

  Last fall, at the “Save a Leg, Save a Life” conference that was held in Orlando, my dear friend Carolyn Cuttino gave an excellent presentation on just this topic. Carolyn, like many of us, is an avid user and advocate of NPWT. In fact, when I do dinner presentations or inservices on the topic, a favorite title of mine includes “There’s Nothing Negative About It.” The point of her presentation was responsible use and that includes responsibility to the patient, our facilities and wound professionals. She emphasized knowing the indications for use, including any safety concerns and the importance of close monitoring of the patient. Carolyn reminded the audience to write a comprehensive NPWT policy and procedure, to make sure we have a physician’s order (including the type of interface dressing to be used, a protective barrier if appropriate, the level of negative pressure to be applied, and the frequency of change) before we begin NPWT.

  We must also consider coordinating the continuation of other supportive modalities such as compression, offloading of the foot, and pressure redistribution surfaces. Importantly, wound care professionals must not only know when to start NPWT, but also when it’s time to stop NPWT!

  Education of the patient and the caregiver is another critical component of correctly ordering and applying NPWT. Because most patients under our care are receiving NPWT at home, that education must come from us. It should include, but not be limited to: 1) charging the unit, 2) handling a break in the dressing seal, 3) responding and contacting the appropriate person if the device alarms, 4) troubleshooting the equipment, and most importantly 5) handling unexpected bleeding.

  We’re in a great time in wound management with all of the options that we have to offer our patients. For most of our readers, I would not be surprised to hear that NPWT is high on our list of options. Enjoy this issue with a comprehensive look at NPWT and how we should order and use it appropriately in our wound clinics today, enabling wound professionals to help our patients to arrive at the end of their journey with a healed wound, and know exactly how they got there!