1. INDICATION FOR TOPICAL NEGATIVE PRESSURE THERAPY
MANAGING THE
OPEN WOUND:
INDICATION FOR TOPICAL NEGATIVE PRESSURE THERAPY
DR. K. SUTHARSHAN
REGISTRAR IN SURGERY

2. INTRODUCTION Open wounds encountered in surgical practice
Primarily closed wounds fail to heal- dehisce
intentionally left open at the onset
Chronic wounds fails to heal by 2ry intention
Chronicity > 12 weeks

3. TYPE OF WOUND AND AETIOLOGY
Wounds closed primarily which has brokendown
Wound infection
Tissue ischaemia
Malnutrition
Excessive wound tension
Foreign body
Drugs: corticosteroids
Medical illness: DM, RA
Wound intentionally left open
Abdominal compartment syndrome
Extensive wound debridement: Necrotizing fascitis
Therapeutic packing
Chronic wounds
Diabetic foot ulcers
Venous ulcers
Malignant ulcers
Trophic ulcers

4. PRINCIPLES OF TOPICAL NEGATIVE PRESSURE WOUND THERAPY( TNP)
Several other names: Sub atmospheric pressure therapy/ Vacuum- sealing technique/ Sealed surface wound suction/ Vacuum assisted closure/ Negative pressure wound therapy( NPWT).
Applying sub atmospheric pressure to a healing wound.
Wound healing enhanced by removal of fluid collecting within it.
Tissue growth associated with wound healing might respond positively to forces of distraction.

5. Principles……
System contains foam or porous dressing- placed in contact with wounds
Vacuum device
Connected by drain.

6. SYSTEM……
Wound made air- tight by placing a polyurethane foam over it and 2 cm beyond the wound edge.
Vacuum pressure: - 50mmHg to -125 mmHg
Pressure applied constantly or intermittently to wound.
Porous nature enables equal distribution of pressure to all parts of the wound.
Dressing changed initially every 48 hours.
Portable/ stationary pump.
Portable pump more benefit.

7. MECHANISM OF ACTION Increasing wound ( dermal) perfusion
Reducing oedema
Stimulating the formation of granulation tissue
Improving the removal of wound exudate
reducing the bacterial load
Sealed dressing produce requied moist environment which promote re – epithelialization 30-40% more effectively.
recent evidence , mechanical stress increase the expression of genes which promote wound healing. Eg: GF, TGF- B, genes for angiogenesis

8. INDICATIONS FOR TNP Acute wounds: Chronic wounds: Soft tissue trauma
Burns
Surgical wounds
Open abdomen
Open sternal wounds
Chronic wounds:
Pressure ulcers
Diabetic foot wounds
venous leg ulcers

9. SOFT TISSUE TRAUMA One of the best established treatment
2. specially with extensive tissue loss
As a bridge to skin grafting or flap coverage of open extremity wounds with exposed bones or tendons
4. It reduces the size of the defect that needs to be covered and ensuring that local conditions for definitive wound healing are optimized.

10. BURNS Improve dermal blood flow
Reduce the degree of secondary tissue injury
Evidance not yet well established

11. SURGICAL WOUNDS Open abdominal and sternal wounds
Open wounds following fasciotomy
Wounds following extensive surgical debridement
Wounds needs plastic surgical flaps

12. OPEN ABDOMINAL WOUNDS
Defined as ‘wound in which all the layers of the abdominal wall are open.
LAPROSTOMY wounds are created if a planned second look laparotomy is required or if abdominal compartment syndrome is expected.
TNP proven benefit especially in severe abdominal trauma and sepsis.
Catastrophic complication of TNP- intestinal fistula, incidence is higher if the mx of open wound takes longer time.

14. BENEFITS CLAIMED FOR MANAGING THE OPEN ABDOMEN WITH TNP
Reduction in abdominal compartment pressure
Avoidance of trauma to internal viscera with repeated dressings
Better removal of peritoneal exudate
Reduction in intestinal odema- improved perfusion, motility
Better protection of skin edges

15. OPEN STERNAL WOUNDS SKIN FLAP WOUNDS Deep sternal wound infections
Poststernotomy mediastinitis
SKIN FLAP WOUNDS
One of the first reported uses of TNP
Increase the rapidity of re- epithelialization and decrease the rate of graft loss.

16. CHRONIC WOUNDS Diabetic foot wound Venous leg ulcers
Ulcers present a significant health burden and a medical challenge causing increased disability .
TNP proved to be benefit.
Venous leg ulcers
Successful indication
No trials yet that have assessed TNP as a primary therapy for healing venous ulcers without subsequent skin grafting.
Helps to reduce the time for healing and prepare the ulcer bed for skin grafting.

19. SUMMARY…..
Enormous progress in the commercial development of system that allows clinician to deliver TNP
Undoubtedly become a key part of clinical management ranging from open abdomen to diabetic leg ulcers.
Expensive therapy
Whether TNP will continue to be supported in a healthcare system under closer financial scrutiny that increasingly focuses on evidence of cost- effectiveness remains to be seen.

20. Thank you