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Synergy Life Solutions9/29/2014


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Negative Pressure

Wound Therapy

(NPWT)In the management of

Woundsby

Randika PereraSynergy Life Solutions9/29/2014


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Basic woundmanagement

debride

Surgical Chemical Enzymat ic



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Basic woundmanagement

dress

Healing

promoting

substance

Absorption

of

discharge

Dirty wound sketch Clean wound sketch

Maitain a

mois t and

cleanenvi ronment



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A Dirty Wound



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Debridement



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A traditional dressing



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the way it works



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A change of dressing



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With the VAC on



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Principle



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History of NPWT. Therapy

Research started in 1989 byDr. Louis Argenta& Prof. Michael Morykwasof Wake ForestUniversity School of Medicine in North Carolina, USA

NPWT. originally designed to treat chronic wounds

NPWT. system released in Europe in 1994

Annals of Plastic Surgery June 1997- 175 cases



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Removes interstitial fluid

allowing Tissue decompression

Reduces local ized edema

Helps remove infectious

materials Reduces bacterial colonization

Enhances dermal perfusion

Provides a closed, moist wound

healing environment

How

VACWOUNDTherapy Works



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Encourages mechanical

stretching and approximation

of the wound edges

Applies negative pressure to

uniformly draw wound closed

(wound contraction)

Promotes wound healing via

stimulation of granulation

tissue Promotes flap survival and

graft uptake

Enhances epithelial migration

Impact of

VACWOUNDTherapy on

wound bed



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Vacuum Assisted Closure.

NPWT. is a non invasive, act ive wound -closuresystem that uses contro l led, local ized negat ive

pressure to prom ote heal ing in acute and ch ronicwounds.



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Granulation Tissue Formation

Ilizarov Method- use of tissue expanders to apply mechanical

stress to soft tissues to increase mitotic rates, (Ilizarov G A, 1989)

Thoma,1911 - first postulation of the effects of mechanical stress to

encourage angiogenesis & tissue growth



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Tension Stress Effect

Morykwas hypothesis: mechanicalstress (contraction of wound) helpscause granulation tissue formation(tissue growth)

Tissue stress effect similar to usingIlizarov techniqueand soft-tissueexpanders to increase mitotic rates

Intermittent applicationresults inrepetive release of second messengers,

further enhancing gran tissueformation

The tension-stress effect on the genesis and growth of tissues. Part 1 Ilizarov GA Clin

Orthop Rel Res 1989;238:249-281



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Reverse Tissue Expansionas dressing collapses in

wound cavity, it exerts a centripetal force on wound

edges

Swan Marc, Banwel l Paul, Advanced Management of the Open Abd omen: Oxford Wo und Heal ing Society, 2003


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Increased Perfusion

Peak blood flow recorded at 125 mmHg

Study helped establish original pressure protocol with Foam Dressing

(400-600 micron pore-size)

Hypothesized that reduction in oedema decompresses small

blood vessels and increases flow

Frank Ischaemia and Wound Hypoxia

Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman:Vacuum-

Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and

Basic Foundation. Annals of Plastic Surgery, 1997; 38 (6)

Positive effect on

perfusion with 125

mmHg


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Effects of Varying Levels of Pressure

Wounds treated at 125 mmHg exhibited a

significant increase (p


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Reduction of Bacteria

All pigs (control and NPWT) were infected with 108organisms /g tissue

VACWOUNDs exhibited significant decrease in number of micro-organisms

(


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At 125 mmHg, VACWOUND

Therapy significantly increased

granulation tissue formation

over wet-to-moist gauze

63.3% with continuous pressure

103.4% with intermittent pressure

0

20

40

60

80

100

120

Continuous Intermittent

Fig 2. Percent increase (mean + standard deviation) in the

rate of granulation tissue formation of acute wounds in

pigs compared to conventional wet-to-moist saline gauze

dressing changes (control).

Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman:Vacuum-

Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies andBasic Foundation. Annals of Plastic Surgery, 1997; 38 (6)


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Reduction of Inhibitory Factors

Reduction of oedema has positive effect

in wound healing

Reduction of inhibitory factors contained

in interstitial fluid (chemical)

Decompression of small blood vessels,

which restores flow (mechanical)

Inhibition of Cell Proliferation by Chronic Wound Fluid

Brian Bucalo MD, William H Eaglestein, MD, Vincent Falanga, MD 1993 WoundRepair and Regeneration



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VACWOUND Therapyis indicated for

Acute Wounds(caused by trauma or surgery)Sub-acute Wounds

Flaps & GraftsFull-thickness surgical wounds

Chronic wounds -Venous stasis ulcersDehisced wounds

Acute Surgical Wounds

Pressure Ulcers

Ortho Trauma Wounds

Diabetic WoundsOpen Abdominal Wounds

Partial Thickness Burns



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INDICATED for

TRAUMA WOUNDS

an application of 13 days

application of 9 days

Follow up after 20 days

Ideal wounds for Negative Pressure Wound Therapy



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INDICATED for

DIABETIC FOOTULCERS

Result in 3 days



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VENUS/ARTERIAL

LEG ULCERS



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Acute Surgical Wounds

Pressure Ulcers

Diabetic Wounds



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Open Abdominal Wounds



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Skin Grafts

Partial Thickness

Burns



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Pump

Dressing Installation



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M.A.P.C.MicroprocessorAss is tedPressure Con trol

ubing

Continuous feedback system that constantly

monitors the negative pressure at the wound site,

compares it with the target pressure, and adjusts

accordingly, so that the wound site pressure is equal

to the target pressure.



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dvantages

Provides more effective therapybecause target sub atmospheric pressureis monitored and maintainedat Maximizes accuracy and effectiveness of

NPWT.Therapy

Ensures controlled, consistent and safeNPWT.the wound site, even

during patient movement

Enables the User to adjust the rate of negative pressureonce the foam is

compressed in the wound to meet individual patients needsand increase

patient comfort

MAPC. System alerts the User of tubing blockagesand pressure leakages

to maximize patient safety



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How to put on a V C

Aggressivelyclean wound

Debride necrotic tissueor eschar if possible

Achieve hemostasis

Shave hair around borderif needed

Irrigate wound with normal saline

Dry and prep skinas appropriate

Cut foamto size of wound

Gently lay foamin wound, including tunnels,undermining, and all surfaces



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How to put on a V C

Materials needed:

Scissors (sterile or clean)

Gloves (sterile or clean)

Dressing kitCanister

NPWT. Unit

Optional:

Skin prep Tincture Benzoin

Non-adherent dressing,



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Clean Wound Thoroughly

Aggressive cleaning of the wound at each dressing change is imperative to

decrease bacterial load and minimize odor



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Cut Foam

Cut the foam to fit the size and shape of the wound, including tunnels and undermined areas



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Lay Foam in Wound

Gently place the foam into the wound cavity, covering the entire wound base and

sides, tunneling and underminingSynergy Life Solutions9/29/2014


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Cut the Drape

Cut the drape large enough to cover the foam and 3-5 cm of surrounding healthy tissue with drape.Synergy Life Solutions9/29/2014


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Applying the Drape

Apply the drape beginning on one side of the foam, toward the tubing. Do not stretch the

drape and do not compress the foam into the wound with drape. This helps minimize

tension or shearing forces on periwound tissue.



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Foam and Drape

Important: Foam should not overlap on to intact skin.



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Applying the suction tubing

Cut hole in drape about 1.5 cm and apply tubingSynergy Life Solutions9/29/2014


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Applying the suction tubing



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Connect to Canister

Connect dressing tubing to canister tubing, making sure clamps are open



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Y Connecting

A Y-connector is available to connect 2 or more wounds to one NPWT. pump



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NPWT. Canister

Canister has graduated marks to measure exudate. Change at least once per week or

when full.Synergy Life Solutions9/29/2014

C i i h I l


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Canister with Isolyser

Canister comes with Isolyser gel that gels fluid on contact and helps eliminate odor



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Dressing in Place with Therapy OFF



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Dressing with Therapy

ON

Therapy is turned on and foam is pulled down into wound



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Adjusting NPWT. Pressure

Standard is 125 mmHg

May turn down (minimum 75 mmHg) when:

Unrelieved pain

Bruising in wound bed

Elderly and nutritionally compromised patient

Excessive bleeding

Compromised circulation (PVD)

Excessive granulation tissue growth



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Adjusting NPWT Pressure

May turn pressure up when:

Excessive drainage

Large wound volume

Using NPWT. Soft-Foam (White Form)

Difficulties maintaining a seal



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Continuous vs. Intermittent

Continuous therapy:

Always for at least first 48 hours

Maintain for length of treatment when:

Significant discomfort in intermittent mode

High amounts of exudate

Wound requires constant contraction (sternal

wounds, tunnels)

Intermittent therapy

Use to stimulate granulation tissuefaster



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NPWT. Alarms

Low pressure (leak) alarm(delayed)-Excessive Leakage

Therapy NOT ON alarm (delayed 15 minutes)

Canister full alarm

Canister out alarm

Consumable Block

Alarm delay button will temporarily delay audible alarm

If cause of alarm is not resolved within 5 minutes, unitautomatically shuts off



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Battery Back Up

NPWT. can run off an internal battery. Clips to the end of bed or IV pole.



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Infected Wounds

NPWT. can be used on infected wounds

Change dressings more often until clinical

signs of infection go away (usually 3-5 days)

Be sure to keep therapy ON

Be sure to clean wound aggressively at

dressing change



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Wound Healing : Progression

Decrease in overall wound volumeshould be noted from

week to week

Wound should become beefy red initially

Wound may look largerat beginning because of removal of

edema

May be oozing of bloodfrom disruption of capillary buds as

granulation tissue develops

Wound should become redder as granulation tissueincreases



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Wound Healing : Progression

Color of wound may then becomepaleras amount

of collagen in wound increases

Likely gradual decrease in exudatelevels

New epithelial growthshould be evident at viablewound edges



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Bridging

Practical Tips:



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Wound Wont eal

Leaks generally make whistling sounds; listen

closely for them

Check around connector and tubing first

Gentlypat around perimeterof wound to seal

off air leaks

May need to seal over drain holes

If you cant hear it, sometimes listening with

stethoscopecan pinpoint leak

Practical Tips:



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bdomen



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Exposed metal



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In Burns



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Orthopedic Trauma



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P Fl


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Post Flap

Result of

2 VAC

dressingapplication



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Case of

Trauma

Amputationwith complication

of diabetesSynergy Life Solutions9/29/2014

C h d I j


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Crushed Injury

Amputation

VACWOUNDTherapy applied

for 4 daysSynergy Life Solutions9/29/2014

Case of ROAD ACCIDENT


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Case of ROAD ACCIDENTHBsAg Positive



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Result of VAC application for 12 days

Initiation of VAC Post Graft



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d A id i h


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Road Accident case : with no

vessels for primary closure(results of 13days VAC application)



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A Result of 4-5

days VACapplication

StumpAmputation


Stit h li I f ti


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Stitch line Infection


Wound ready for secondary closure


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after 4 days VAC application



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Result of 3 days VAC application


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y pp



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Helps to stimulate granulation tissue

formationHigh drainage capacity, therefore

particularly suitable for heavy

exudating and infectious wounds

VACWOUND Black PU Foamis made of open cell, polyurethane(PU) material



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Physical characteristics prevent tissue in-growth

High tensile strength makes it easier to handle

when placing and removing from tunnels

and smaller spaces

Non-adherent

VACWOUND VersaFoamis made of a micro-porous, polyvinyl alcohol(PVA) material


How VAC helps in Flaps & Graft


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How VAC helps in Flaps & Graft

Fixation of skin grafts (mesh-grafts)untilthe graft has taken (4-6 days). In thesespecial cases, VACWOUND Therapy is

used for the secure fixation of a split skingraft to the wound.The soft foam helpsgently press the graft onto the wound

bed and thus ensures full contactbetween the graft and the underlyingwound bed, irrespective of the woundcontours and the formation of pockets


CONTRAINDICATIONS


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CONTRAINDICATIONS

Necrotic tissue with eschar present

Wound should be debrided to remove

majority of necrotic tissue and escharUntreated Osteomyelitis

Exposed blood vessels or organs

Ensure all vessels or underlying organs areprotected with overlying fascia, tissue or otherprotective barrier


PRECAUTIONS


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PRECAUTIONS

Active bleeding

Difficult wound haemostasis

Patients who are on anticoagulants



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Questions?

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