Negative pressure therapy vs. moist wound healing in chronic wounds: A systematic review (original) (raw)
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A systematic review of topical negative pressure therapy for acute and chronic wounds
British Journal of Surgery, 2008
Background Topical negative pressure (TNP) therapy is becoming increasingly popular for all kinds of wounds. Its clinical and cost effectiveness is unclear. Methods A search of randomized controlled trials (RCTs) on TNP in adult patients with all kinds of wounds in all settings was undertaken in Medline, Embase, Cinahl (to October 2007) and the Cochrane Library (to issue 4, 2007). Information was also sought from manufacturer of the VAC® device. Selection of trials for analysis, quality assessment, data abstraction and data synthesis were conducted by two authors independently. The primary endpoint was any measure of wound healing. Secondary endpoints were infection, pain, quality of life, oedema, microcirculation, bacterial load, adverse events, duration of hospital stay and cost. Results The search identified 15 publications on 13 RCTs. These reported on patients with chronic wounds, diabetic wounds, pressure ulcers, skin grafts and acute wounds. In chronic and diabetic wounds, TN...
A Study of Wound Healing with Modified Topical Negative Pressure Therapy in Chronic Wounds
2021
Background: Wounds are a major source of morbidity even lead to considerable disability and are associated with increased mortality; hence it implies a significant impact on public health and the expenditure of healthcare resources. Negative pressure wound therapy (NPWT) has transformed the management completely for chronic wounds. However, it's availability at every center and high cost of a conventional NPWT system still an enigmatic challenge. We carried out this study to assess whether we can replicate the conventional NPWT system using resources which are easily available in most hospitals and determine its clinical efficacy and cost effectiveness. Material and Method: A total of 30 cases clinically presenting as ulcer between August 2019 and February 2021 were taken for study. Each patient was examined clinically in systematic manner for study presenting with wound. Modified VAC dressing was done and outcome was measured by recording wound scores on days 3, 7 and 10. Result: The study group included 20 males and 10 females. Duration of stay in hospital ranged from 5 to 34 days, with average duration of 11.93 days. Wound closure was achieved by secondary suturing in 12 (40%) of the cases and split thickness skin grafting in 14 (46.66%) of the cases while 4 patients lost to follow up. Wound assessment was done using the wound scoring system which revealed most of the wounds attaining granulation tissue 66% of patients by day 5 post vac therapy. Wound healing was better in the non-diabetic group compared to diabetic and in non-smokers compared to smokers.
Negative Pressure Wound Therapy
Archives of Surgery, 2008
To systematically examine the clinical effectiveness and safety of negative pressure wound therapy (NPWT) compared with conventional wound therapy. MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched. Manufacturers were contacted, and trial registries were screened. Randomized controlled trials (RCTs) and non-RCTs comparing NPWT and conventional therapy for acute or chronic wounds were included in this review. The main outcomes of interest were wound-healing variables. After screening 255 full-text articles, 17 studies remained. In addition, 19 unpublished trials were found, of which 5 had been prematurely terminated. Two reviewers independently extracted data and assessed methodologic quality in a standardized manner. Seven RCTs (n = 324) and 10 non-RCTs (n = 278) met the inclusion criteria. The overall methodologic quality of the trials was poor. Significant differences in favor of NPWT for time to wound closure or incidence of wound closure were shown in 2 of 5 RCTs and 2 of 4 non-RCTs. A meta-analysis of changes in wound size that included 4 RCTs and 2 non-RCTs favored NPWT (standardized mean difference: RCTs, -0.57; non-RCTs, -1.30). Although there is some indication that NPWT may improve wound healing, the body of evidence available is insufficient to clearly prove an additional clinical benefit of NPWT. The large number of prematurely terminated and unpublished trials is reason for concern.
A review of topical negative pressure therapy in wound healing: sufficient evidence?
The American Journal of Surgery, 2011
BACKGROUND: Topical negative pressure (TNP) therapy has become a useful adjunct in the management of various types of wounds. However, the TNP system still has characteristics of a "black box" with uncertain efficacy for many users. We extensively examined the effectiveness of TNP therapy reported in research studies.
Wounds-a Compendium of Clinical Research and Practice, 2022
Both experimental and epidemiological study designs, including randomized controlled trials, pseudo-randomized trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies, and analytical cross sectional studies were sought. Types of outcomes The primary outcome was the occurrence of post-surgical wound infection or dehiscence as measured by the following: surgical site infectionssuperficial and deep; surgical wound dehiscence; wound pain; wound seroma; wound hematoma. Search strategy Published and unpublished studies in English from 1990 to 2013 were identified by searching a variety of electronic databases. Reference lists of all papers selected for retrieval were then searched for additional studies. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Data collection Data were extracted from the included papers using a standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. In addition to study results, the data extracted included details of the study population, setting, intervention and author's conclusion. Data synthesis Where appropriate, data were pooled using Comprehensive Meta-Analysis software. Metaanalyses were performed for three outcomes. In cases of heterogeneity between studies a narrative summary of results was undertaken. Results Eight studies were included in the review. Meta-analyses revealed a statistically significant difference in favor of the use of negative pressure wound therapy as compared to standard surgical dressings was found for surgical site infections. Conflicting results were found for wound dehiscence and seroma. Conclusions Given the small number of studies, mostly retrospective comparative cohort in design, no definitive conclusions can be reached as to the effectiveness of the use of negative pressure wound therapy in the prevention of surgical wound complications. However, there was a demonstrated association between the use of negative pressure wound therapy and reduction in surgical site infection.
Faster Wound Healing With Topical Negative Pressure Therapy in Difficult-to-Heal Wounds
Annals of Plastic Surgery, 2011
Objective: A randomized clinical trial was conducted to determine the effectiveness and safety of topical negative pressure therapy in patients with difficult-to-heal wounds. Methods: A total of 24 patients were randomly assigned to either treatment with topical negative pressure therapy or treatment with conventional dressing therapy with sodium hypochlorite. The study end point was 50% reduction in wound volume. The maximum follow-up time was 6 weeks. Results: The median treatment time to 50% reduction of wound volume in the topical negative pressure group was 2.0 weeks (interquartile range ϭ 1) versus 3.5 weeks (interquartile range ϭ 1.5) in the sodium hypochlorite group (P Ͻ 0.001). The unadjusted hazard rate ratio for the time until 50% wound volume reduction was 0.123 (P Ͻ 0.001). After adjustment for relevant baseline characteristics in a Cox proportional hazards model treatment group, membership was found as the only and statistically significant indicator for the time to 50% wound volume reduction (hazard rate ratio of 0.117 ͓P Ͻ 0.001͔). Subgroup analysis of spinal cord injured patients with severe pressure ulcers showed similar statistically significant results as in the total wound group. Conclusion: Topical negative pressure resulted in almost 2 times faster wound healing than treatment with sodium hypochlorite, and is safe to use in patients with difficult-to-heal wounds.
Efficacy of Negative Pressure Therapy (NPWT) in the Management of Wounds of Different Etiologies
Revista de Chimie, 2018
The objective was to assess the role of negative pressure wound therapy (NPWT) in the management of wounds of various etiologies, infected or not, acute or chronic. The study was conducted in a group of 37 patients (24 men and 13 women) aged 26 to 86 years with acute or chronic wounds, posttraumatic or due to chronic diseases located on the lower limbs or following oncological abdominal surgery. In all cases a Vacuum Assisted Closure (VAC) system was continuously applied using a subatmospheric pressure ranging from 90 to 120 mmHg. Beside sex, age and etiology of soft tissue defect the following parameters were studied: surgical treatment performed prior to NPWT application, frequency of dressing changes, duration of NPWT, level of subatmospheric pressure used in each case, number of hospital days, complications arising from NPWT use. The outcome was favorable in all cases without such complications as infection or bleeding, a perilesional erythema (contact dermatitis caused by the u...
Effectiveness of negative pressure wound therapy is still unproven
Journal of wound care, 2011
Both experimental and epidemiological study designs, including randomized controlled trials, pseudo-randomized trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies, and analytical cross sectional studies were sought. Types of outcomes The primary outcome was the occurrence of post-surgical wound infection or dehiscence as measured by the following: surgical site infectionssuperficial and deep; surgical wound dehiscence; wound pain; wound seroma; wound hematoma. Search strategy Published and unpublished studies in English from 1990 to 2013 were identified by searching a variety of electronic databases. Reference lists of all papers selected for retrieval were then searched for additional studies. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Data collection Data were extracted from the included papers using a standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. In addition to study results, the data extracted included details of the study population, setting, intervention and author's conclusion. Data synthesis Where appropriate, data were pooled using Comprehensive Meta-Analysis software. Metaanalyses were performed for three outcomes. In cases of heterogeneity between studies a narrative summary of results was undertaken. Results Eight studies were included in the review. Meta-analyses revealed a statistically significant difference in favor of the use of negative pressure wound therapy as compared to standard surgical dressings was found for surgical site infections. Conflicting results were found for wound dehiscence and seroma. Conclusions Given the small number of studies, mostly retrospective comparative cohort in design, no definitive conclusions can be reached as to the effectiveness of the use of negative pressure wound therapy in the prevention of surgical wound complications. However, there was a demonstrated association between the use of negative pressure wound therapy and reduction in surgical site infection.
EWMA Document: Negative Pressure Wound Therapy
Journal of Wound Care, 2017
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4–6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12–14 The ongoing controversy regarding high-level evidence in wound care in general is w...