Negative Pressure Wound Therapy (NPWT)
Negative pressure wound therapy (NPWT) is a method of soft-tissue injury treatment in which an impervious dressing is applied to skin or soft tissue, and then connected to a vacuum-generating device. Research has demonstrated decreased rates of infection, increased rates of healing, and fewer subsequent surgeries when NPWT is used in the setting of open fractures, infection, or extensive soft-tissue loss. Traditionally, NPWT required the use of large, immobile vacuum-generating devices, which often could not leave the hospital. This leads to increased cost to patients, and often served as a barrier to discharge or de-escalation of care-level.
Amputation sites following necrotizing soft tissue infections are often left open, or loosely closed, for eventual definitive closure. Uncertainty of extent of infection, profound local edema and soft tissue swelling, and impaired patient healing factors are all factors which often lead surgeons to delay primary closure. Negative pressure wound therapy (NPWT) has become the mainstay of treatment when delayed primary closure is utilized. Research has demonstrated a proven effect on NPWT’s ability to decrease local swelling and edema, decrease spread of infection, and promote healing factor migration to local areas. Owing to the fact that most patients with NSTIs spend prolonged periods of time in the hospital, portability of NPWT is not of paramount important. Rather, strength of suction and dressing availably moves to the forefront as the most important variables.
Irrigation and Debridement
Operative irrigation and debridement is the gold standard surgical procedure by which open fractures are initially managed. While timing for definitive osseous fixation varies depending on fracture severity and location, it is widely accepted that time to operative debridement should be no more than 6-8 hours. Effective operative debridement includes removal of foreign bodies, copious irrigation of the injury site, extension of soft tissue injury to fully visualize the field of injury, possible local infiltration of antibiotic, and primary or delayed soft-tissue closure.
The KCI Prevena™ is the first-ever home NPWT system. Prevena™ utilizes a portable vacuum-generating device and canister that can be easily transported by the patient while healing from their injuries. It removes fluid from the site of injury, serves as an impermeable barrier to infection, increases healing rates, and allows for personal hygiene. It is single use, and can be disposed of at home when therapy is complete.