[Negative pressure therapy for surgical wounds]

Abstract

In surgery, negative pressure wound therapy (NPWT) is applied for thoracic, abdominal, and extremity wounds, particularly if there is traumatic tissue loss, if primary wound closure is not possible or if the wound has to be left open or reopened because of an infection. The NPWT applications are, however, running ahead of scientific evidence to support their use. Although there is plenty of literature available, very little convincing evidence exists based on well-conducted, randomised trials. NPWT can be applied to thoracic wounds (usually due to deep sternal wound infections) to reduce treatment duration. NPWT also appears useful if primary closure of the abdomen is not possible. For traumatic extremity wounds, NPWT can be helpful as a practical temporary wound cover. Possible disadvantages of NPWT are skin irritation, painful dressing changes, entero-atmospheric fistulae, and the risk of bleeding in patients using anticoagulants. The effect of NPWT on wound healing, infection, mortality, and costs remains unclear. To obtain convincing evidence, we call for greater NPWT application in a research context.