Advantages And Limitations Of Topical Negative Pressure Therapy

Advantages And Limitations Of local Negative pinch TherapyNegative coerce exaspe send therapy (NPWT) is a new order use for improving transgress im turn up. It influences granulation formation, bacterial colonization, and increasing spite blood flow. Although this rule has been used explosively for spite mend, its influences be not cle ared enough. So the main aim of this evictvas article is to weight up the benefits and problems associated with this method.Method An electronic search was through with(p) via Pubmed, Embase and ISI web of knowledge information from 1960 to 2010. The abstracts and titles of each paper were analysed and selected gibe to especial(prenominal) parameters.Result The results of the relevant books were characterized establish on the benefits and problems associated with use of this method.sermon Direct comparison of NPWT with separate(a) available method is difficult. Although there are some query to support the intensity level of e xploitation this new method on violate ameliorate, much controlled clinical trials are needed to rebelliously prove that the NPWT is less(prenominal) expensive and more force playive displease like modality.A displease is defined as a break in the pelt which is usually caused by cuts or scraps. The excerption of the treatment methods depends upon the abrasiveness of the wounds (how serious they are). Healing is a response of the dent that sets into motion a sequence of events. There are classically four stages associated with wound better which include haemostasis, inflammation, pro life-timeration and remodelling (Hart, 2002, Stephens and Thomas, 2002, OKane, 2002). Many factors can interact with ace or more phases of wound healing process which can facilitate or step-down its rate, much(prenominal) as local and strategyatic factors. Local factors are those which at a time influence characteristics of wound itself, while systematic factors consists of those which related to state of individuals and their abilities viewing wound healing. Some systematic factors include transmittal, age and sex hormvirtuosos, stress, diabetic, obesity, medication, alcoholism, smoking and alimentation and apply some treatment method such as Topical wound healing (Guo and DiPietro, 2010, Ranzato, 2009, Urschel et al, 1988, Argenta and Morykwas, 1997, Kirby, 2007).The do of some factors such as oxygenation, infection, age, stress, medication, obesity, fodder are well described in the belles-lettres and were investigated by many an(prenominal) researchers(Guo and DiPietro, 2010, Shepherd et al, 2006, Lioupis, 2005). However, victimization some parameters such as topical prejudicial storm therapy (TNPT) is new method for wound healing (Miryam et al, 1999, Kirby, 2007). Pressure is one important parameter which can influence wound healing. In one side, it can decrease the speed of healing as produce pelt ulcers in some patients suffering from stroke and sp inal cord deformity and those who need to be in bed for a long time. In other side, it can be used to facilitate the wound healing process, especially in chronic wound (Miryam et al, 1999, Argenta and Morykwas, 1997, Evans and Land, 2001). In contrast to other available methods, this procedure is a little bit new so the main aim of this review article was to review the relevant literature regarding TNPT and its influences on wound healing. Moreover, it was aimed to show the positive and the side effects of using this method.MethodAn electronic search was through via the Pubmed, Embase and ISI web of knowledge data from 1960 to 2010. The abstracts and titles of each individual study were assessed by author. A first selection of relevant literature article was done establish on weather condition the title and abstract addressed the research question of interest. Figure 1 shows the stages which were selected in this review process. The second selection of the articles was done accor ding to the spare-time activity criteriaexperiment practice published in Englishad fertilisation using this method on wound healingFigure 1 The stages which were selected in this research studyThe results of the various research studies were characterized based on mechanism of action, the peter used and the benefits and problems associated with the use of this method.ResultNegative thrust wound therapy (NPWT) is excessively known as Tropic Negative Pressure (TNP) used as a non pharmacological treatment for chronic and actuate wounds, such as pressure ulcers, diabetic wounds, abdominal and trauma wounds (Argenta and Morykwas, 1997, Evans and Land, 2001, Kirby, 2007, Miryam et al, 1999).What is NPWT?This method of treatment based on this idea to turn the open wound into a shut up one. Moreover, it is possible to remove the excess fluid from the wound. Although, this method has been used exclusively in UK since 1995, the idea behind this method is not new. For nearly more than 50 years suck drainage has been used. It has been reported that continues suction, negative pressure drainage serve as an ex cellent atmospheric bandage in subcutaneous surgical procedure and aid to increase the speed of wound healing. The concept was based on mechanics of physics. The application of controlled subatomospheric pressure causes windup(prenominal) stress to the create from raw stuffs. The new vessels are constructed with in the tissue and the wound is bony closed. It should be noted that the degree of pressure to the wound tissue is fine, only if when all areas of the wound work togheter in an efford to close toward the centre point, the effects of negative pressure become impressive and results in quicker healing and resolution.This system consists of non adherent, porous wound dressing (polyurethane suds or veiling bandage dress) and a drainage system which are attached to each others by use of a transparent film. The coruscate is connected to a VAC make c lean cleaner pump through an evacuation tube. The suction guarantee a continues vacuum in the polyurethane foam producing a high give partition in wound foam interface. It is required to change the foam all 2 days. The system is commercially available in UK since 1995 and has been used significantly for wound healing. Figure 2 shows various components of this system.Figure 2 The NPWT system used for improving wound healing ( adapted from (Miryam et al, 1999) with permissionNPWT has lead forms which differ based on the type of dress used, such as Bio Dome, gauze and foam. The polyurethane foam was used first by Morkey and Argenta in 1997. It has been reported that the foam can be easily cut according to the wound size, especially those which has a regular contour and used when violate granulation formation and wound contraction is a desirable goals. However, gauze can be used for sensitive and irregular wounds. The type of selected foam is based on the type of wound as is mentio ned in sidestep 1.The foam is placed into the defect and the area is covered with adhesive drape. The suction generate a continues vacuum in the foam, producing a high contact zone in wound foam interface so a vacuum mold is achieved. It should be mentioned that the negative pressure applied on the wound is one hundred twenty-five mm HG below ambient that is transmit to the wound in a controlled manner. The selected pressure in this system is based on especial guidelines as shown in table 2.Wound descriptionPoly-urethane (black foam)Polyvinyl-alcohol (soft foam)BothEither wooden-headed, acute wounds with moderate granulation tissue evolutionXXDeep wounds with extremely rapid growth in granulation tissueDeep pressure ulcersX tegument-deep woundsXPostgraft therapyXFresh graftsXCompromised flapsXTunneling/ fistulous withers tracts/underminingXDiabetic ulcersXDry woundsXXDeep trauma woundsXSuperficial trauma woundsTable 1 The types of the foam used in NPWT systemWound TypeTarget Pressure Poly-urethaneTarget Pressure Polyvinyl-alcoholAcute/traumatic woundcxxv mm Hg one hundred twenty-five-175 mm HgSurgical wound dehiscence one hundred twenty-five mm Hg125-175 mm HgMeshed graft75-125 mm Hg125 mm HgPressure ulcer125 mm Hg125-175 mm HgChronic ulcer (diabetic/arterial vascular)50-75 mm Hg125-175 mm HgFresh flap125 mm Hg125-175 mm HgCompromised flap125 mm Hg125-175 mm HgTable 2 The selected negative pressure used in NPWT based on the type of foam usedEvidences regarding NPWTThere are some evidences regarding the positive effects of using NPWT on wound healing. The main improvements of this treatment method includeprovision of dampish wound healing environment removal of the fluids and infection material which help the wound to heal speedyassisted profusion fall bacterial colonisationenhance formation of granulation tissuerapid cell divisionincreased blood flowincreased discoverlet of fighting(a) fibroblasts and macrophagesenhance epidermal cell formationdecre ased harmful chronic wound fluidreduced the number of dressing changes and decrease upon to underlined tissueprovision of mechanical approximation of wound edgespromotion of viscoelastic flow due to tissue stretchlimitation of zone of injury after orthopaedic traumasplinting effectIndication and contraindication of using NPWT The butt and drug administration (FDA) approved this method for treatment of non healing wounds. indeed it has been extended to include chronic, acute, and traumatic and sub acute wounds, flaps and grafts. In the United State of America the following contraindications take hold been considered in this regardwound with necrotic tissueuntreated osteomyelitiesfistulas to organs or be cavitiesplacement directly over exposed veins and arteriesmalignancy within woundWhat are the problems associated with NPWTThe following problems have been mentioned in the literature regarding NPWTpatients may live on discomfort or pain when the foam dressing is changedtopical skin problem may arise during useovergrowth of geast or Candida infectionskin stripping and sub epidermal granulationfoam removal frequently results in trauma to wound in the form of pocketable capillary and granulation tissue disruptionachieving and maintaining a vacuum seal can be difficult at timesstaff moldiness be well trained and educatedDiscussionThere are over 325 publications on NPWT wound healing method, including 15 randomize clinical trials. However, it can not be reason strongly that the system results in faster wound healing than other conventional methods or provides represent effective despite much greater material toll.It has been reported that using this method enhances bacterial clearance which improves the speed of wound healing. When microorganisms enter to wound, follow through the nutrition and oxygen which otherwise directed toward tissue repair. When the amount of wound infection decreases (reducing bacterial loads) the healing capacity improves (the bl ood used for wound repairing). However, in the research undertaking by.. on 25 patients reviewed respectively, it was found that using this method dose not have any effects on bacterial clearance. Moreover, bacterial colonization increases significantly with this therapy and remains in the endure of.Improvement in Granulation tissue formation was another advantage mentioned in using this method for wound healing. Granulation is a small blood useless and connective tissue in the base of the wound. A well granulation wound provides an optimal bed for epidermal migration and for skin grafts as a newly formed capillary incorporate the transplanted skin. Studies have shown that granulation tissue formation is enhanced by negative pressure by virtue of interstitial fluid resolution and resulting increase in circulation.In the research done by .. on 162 patients it was shown that NPWT improves the proportion and rate of wound healing after partial foot amputation in patients with diabetic s. roughly 56% of the patients using this method achieved a comparable closure during 16 weeks assessments compared with 39% in control group. In the other research done by Blume et al (2008) the safety and clinical efficiency of this new method was compared with Advanced Moist Wound Therapy (AMWT) to treat foot ulcers in diabetic patients on 342 patients. It was found that a greater proportion of foot ulcers achieved by this method in contrast to other method (43.2% compared to 28.9%). The time of therapy was the other considered parameter in this research. The time of therapy was a little bit less in this method. Regarding the safety of the two methods there was no significant difference.Morie et al carried out a literature review based research regarding the effectiveness of this method. They mentioned that although many controlled and non randomise studies describing the effectiveness of this new method, few prospective randomized control trials have been published. They claim ed that the researches in this field have lots of problems such as small sample size, variable final result measure across studies, significant methodological problems. So it is not possible to have a strong conclusion regarding the effects of this method in contrast to other methods. They suggest that other research must be done regarding the effect of this method on healing, live of occupy, patient pain and quality of life in contrast to other methods.Gregor et al have undertaken another literature review regarding the effect of using this method. They also concluded that although there seems to be some evidences regarding the effects of this method on wound healing outcome as a main outcome, they are insufficient to clearly prove an additional clinical benefit of this method.Cost consideration wound care is an expensive endeavour. The range of pressure ulcers which is one of the main complication of being in bed for a long time is between 2000 and 70,000 per wound. NPWT decr eases the cost regarding wound healing through a decrease in the number of dressing changes required. Moreover, the supervisory role of the trained nurses would be decrease to actualize dressing change. According to the results of a research the long term cost of NPWT was lower and output was better when compared with standard wound care method. In another research study it was shown that the cost of wound healing was decreased by 38% in contrast to other method, as the healing occur by 61% faster than using gauze dressing method.ConclusionThe review of the relevant literature stated that the available evidences can not be used to determine a significant remedial distinction of NPWT method in contrast to other methods. There are over 325 publications on this method however only 15 randomized clinical trials compare the new method with other available methods.It is concluded that the available research studies can not support the effectiveness of this method on wound healing. It sh ould be mentioned that direct comparison of NPWT to a fact type of dressing would be difficult as it is unlikely that a single dressing type would be appropriate through out entire healing process. As there is not enough research which directly focus on the effects of this method on wound healing, and safety according to wound type, the author of this article represent a need for a large high quality randomized studies. Moreover, it is recommended to value the effects of this method based on the used components.