The use of negative pressure wound therapy in veterinary wound care
Abstract
Negative pressure wound therapy (NPWT) or vacuum-assisted closure (VAC) of wounds is a treatment modality that consists of applying sub-atmospheric, or negative, pressure to a wound resulting in wound protection, drainage and accelerated wound healing. NPWT systems are constructed by the use of commercial or improvised systems; the wound is packed with open cell polyurethane foam or gauze, covered with adhesive drape and connected with tubing to an adjustable suction device. Recently, more portable, single-use systems have been developed, that make them more versatile for use, particularly in veterinary patients.
Negative-pressure wound therapy (NPWT) is a noninvasive, active, closed, wound management system that exposes the wound bed to local subatmospheric pressure. Also referred to as vacuum-assisted closure (VAC), NPWT is used to stimulate granulation tissue formation, reduce interstitial oedema and inflammatory cytokines, and improve circulation while maintaining a moist wound-healing environment. In humans, NPWT therapy is used extensively to treat non-healing wounds (e.g. diabetic ulcers), burns, open fractures, and median sternotomy wounds (Argenta and Morykwas, 1997; Runkel et al, 2011; Demaria, 2011).
Indications for NPWT in animals include: treatment of large, open, contaminated wounds; dehisced surgical wounds, (with or without exposed orthopaedic implants or bones), degloving injuries and skin avulsions; chronic non healing wounds; and compartment syndrome (e.g. abdominal/myofascial) (Stanley, 2012).
NPWT wound care has also been used to prevent post-operative seroma or oedema formation and enhance skin graft re-epithelialisation (Perry and Witte, 2013a and 2013b). With this therapy, wound size and volume are reduced, skin graft acceptance enhanced, response to antibiotic therapy improved, and duration of open wound management reduced (ultimately reducing hospitalisation time and number of bandage changes) (Labler et al, 2004; DeFranzo et al, 2001).
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