When wound care sucks

It is no surprise that I — the Hoover/Oreck queen of my family — have more than an abiding interest in anything with the word vacuum in its name. Plus, the concept vacuum-assisted therapy was just beginning to really take off when I took the reins of Ostomy Wound Management.

Through the years, OWM has provided numerous articles and supplements on negative pressure wound therapy (NPWT). Morykwas and Argenta published their groundbreaking article on the use of subatmospheric pressure in wound care in 1997, but according to Miller’s¹ aggressive search, their concept is predated in Russian medical literature by 11 years. However, despite NPWT's 20-plus year history, and although the visual makes sense, no one is completely sure why sucking backwards on a tightly adhered dressing helps heal a wound. Current thinking is that NPWT promotes wound healing by 1) removing exudate from wounds to help establish fluid balance, 2) providing a moist wound environment, and 3) removing slough — this to potentially decrease wound bacterial burden, edema, and third-space fluids; increase blood flow and growth factors; and promote white cells and fibroblasts.^1,2 But NPWT research mostly involves one specific company’s product, and randomized, controlled trials are somewhat lacking. Plus, the 411 from patients isn’t always positive: NPWT treatment, as well as the post-treatment process of extracting the foam dressing of the manufacturer most associated with the wound vac,³ is painful.⁴

Which makes me wonder if this is why the brouhaha surrounding NPWT 5 to 10 years ago is diminished. Or maybe wound vac-ing has become an established part of wound care, lessening the din. After all, KCI was touted for providing its negative pressure prowess in the post-earthquake relief efforts in Haiti. Various studies show different products and dressings (for example, medicinal honey⁵) are used concomitantly to enhance treatment and counter negative side effects. Clinicians are rethinking the amount of pressure needed.⁶ What do Morykwas and Argenta think about the product size, mobility, and dressing options now available? What do you think?  

Great articles from OWM on NPWT include:

1.     Negative Pressure Wound Therapy: "A Rose by Any Other Name"

2. Negative Pressure Wound Therapy Achieved by Vacuum-Assisted Closure: Evaluating the Assumptions

3. Can You Help?: Making the Dressing Changing Process Less Painful

4. Managing Wound Pain in Patients with Vacuum-Assisted Closure Devices

5. Active Leptospermum Honey and Negative Pressure Wound Therapy for Nonhealing Postsurgical Wounds

6. The Effect of Intermittent and Variable Negative Pressure Wound Therapy on Wound Edge Microvascula