![]() ![]() A continuous pressure of -80 mmHg to -125 mmHg is therefore most commonly used in traumatic orthopaedic wounds. Wounds with high drainage require continuous suction and lower pressure settings tend to be indicated when wound edges are fragile, have low perfusion, are painful, or where a skin graft is being used. Multiple large wounds caused by a suicide bombing treated with NPWT dressings.īase unit pumps can be set to various pressures and usually have two settings: continuous and intermittent. An example of multiple large wounds being treated with foam NPWT dressings can be seen in Fig. Foam has been shown to provide rapid granulation, but this can be offset by in-growth with potential to disturb the epithelialisation process and also be painful when the foam is changed. Both foam and gauze have been shown to be equally effective at wound contraction and stimulation of blood flow at the wound edge. The NPWT device works by providing and distributing negative pressure evenly across the wound bed either through the application of an open cell foam or a gauze dressing. They all share a similar design with a base unit pump to provide negative pressure, a canister to collect wound drainage, and a segment of tubing connecting this to the sealed wound. There are a number of systems now available on the market. NPWT dressings can bring wound edges closer together and promote the production of granulation tissue in large wounds. A warm and moist environment that prevents desiccation of the wound and enhances formation of granulation tissue (see Fig.This can lead to further tissue necrosis frequently seen at further debridement. Extraction of oedematous fluid and exudate from the extracellular space, removing inflammatory mediators and cytokines whose prolonged effect can hinder the ability of the microcirculation to support damaged tissue.Finite element computer models have shown that NPWT produces 5-20% strain across the healing tissues, that promotes cell division and proliferation, growth factor production and angiogenesis. Microdeformation of the wound surface at the microscopic level.This reduces the space required to be healed by primary closure or secondary granulation (see Fig. Macrodeformation of the wound when, depending on the deformability of the surrounding tissues, the wound edges are brought closer together by the suction distributed through the foam sponge.The primary mechanisms of action include: NPWT facilitates wound healing through multiple mechanisms of action both at the macroscopic and microscopic level. ![]() They developed a system, whereby, an open-pore polyurethane foam sponge was placed within a wound, covered by a semi-occlusive dressing and then connected to a device producing suction. The advent of modern NPWT systems is attributed to Argentas and Morykwas, who developed several prototypes to facilitate wound healing by distributing suction across wounds to help draw the skin edges together. ![]()
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