#ccnpwt

The use of Negative Pressure Wound Therapy system in Chronic Wounds, Venous Ulcers, Diabetic Ulcers, Traumatic Wounds, Post-Operative and Dehisced Surgical Wounds provides a moist wound environment at the wound site thus:

The use of negative pressure wound therapy (NPWT) is well established in the treatment of chronic wounds. NPWT with instillation (NPWTi) combines traditional NPWT with the application of a topical irrigation solution within the wound bed. The addition of instillation feature with NPWT adds several potential benefits in dealing with complex wounds.

NPWT WITH IRRIGATION -MECHANISM OF ACTION

Potential mechanisms of action include the removal of microorganisms from the wound surface, dilution of cytotoxic molecules, up-regulation of angiogenesis path ways, and maintenance of a moist wound environment. As we have extended our use of these devices to more complex wounds, we have taken advantage of and observed potential mechanisms of action, including facilitated removal of microorganisms, dilution of inflammatory and cytotoxic macromolecules, additional wound hydration, and enhanced angiogenesis through an intermittent application of NPWT.

 Fig 2. NPWTi MECHANISM OF ACTION

INDICATIONS

Several different types of wounds can benefit from negative pressure wound therapy such as:

●        Trauma wounds

●        Dehisced wounds

●        Chronic wounds

●        Abdominal compartment syndrome

●        Pre & post-op flaps/grafts

●        Diabetic ulcers

●        Venous ulcers

●        Arterial ulcers

●        Pressure ulcers

●        Burn wounds

●        Wounds with large amounts of drainage

●        Surgical and acute wounds at high risk for infection

 CONTRAINDICATIONS

 CCNPWT is contraindicated for below:

●        Malignancy in wound

●        Necrotic tissue with eschar

●        Untreated osteomyelitis

●        Fistulas to organs or body cavities

●        Do not place NPWT dressing over exposed arteries or veins

  CCNPWT ADVANTAGES

The use of Negative Pressure Wound Therapy system in Chronic Wounds, Venous Ulcers, Diabetic Ulcers, Traumatic Wounds, Post-Operative and Dehisced Surgical Wounds provides a moist wound environment at the wound site thus:

1.       Enhances dermal perfusion, decompresses blood vessels.

2.       Reduces bacterial colonization.

3.       Promotes micro angiogenesis.

4.       Promotes uniform granulation tissue formation.

5.       Enhances blood circulation in pressure ulcers.

6.       Reduces communicable infection rate.

7.       Improves bed hygiene as it is a closed system.

8.       Less pain full than the daily dressing change for the patient.

9.       Early usage of NPWT may save limbs in case of diabetic foot and other chronic wounds.

10.    Requires lesser nursing time as dressing needs to be changed only after 4 – 5 days and saves man hours.

11.    Early usage of NPWT may save limbs in case of diabetic foot and other chronic wounds.

12.    Lesser antibiotic usage enhances patient immunity and also cost to the hospital and to the society.

13.    Enhances faster bed rotation in Govt. Hospitals where queue of the hospital bed is huge as patients can be discharged early.

14.    Reduces overall treatment cost and time for the patient & Govt. as the hospitalization time decreases by 2/3rd with the use of NPWT

15.    Improves quality of life of the patient.

16.    It prevents spread of infection to the patient family/ visitors as well as to the neighbouring patients

With all the above advantages Negative Pressure Wound Therapy system would definitively help the patients & staff of your prestigious institutions.

CONCLUSION

The low-income countries like INDIA are having a number of issues related to public health. The use of NPWT in the Indian studies has not been reported extensively. Only few Indian studies have provided insights into the NPWT use in Indian setting. The use of CCNPWT is definitely having an advantage in countries like India, where the patient load on the health centres is very high and where more than 40% of the population earns less than one US dollar per day and where only a small portion of government budget goes to health there is an urgent need of faster and cheaper wound healing techniques.

The health care information about the newer and cheaper techniques will help a great deal in the exponentially growing population. In such a scenario any wound healing technique that will work faster than the conventional techniques and deliver at par or at times better results is definitely a boon. As discussed above in the document CCNPWT has certain advantages like it is easy to handle, hospital admission is not essential, good patient compliance and satisfaction, require minimal training to maintain vacuum at home, can be applied to multiple cases at the same time and give adequate mobility to the patient.

The relatively newer technique negative pressure wound therapy (NPWT) is very promising and also useful in the management of difficult to heal wounds.

The management of difficult to heal wounds has always been a cause of concern for the treating clinicians. There has been a tremendous increase in the number of patients presenting with difficult to heal wounds. The conventional techniques have been in use since a long time for the management of these wounds, yet desired results are not achieved always. Thus a newer novel technique which might be useful in the difficult to heal wounds and delivering at par or better results as compared to the conventional techniques is the need of the hour. Despite numerous advances, chronic and other difficult to manage wounds continue to be a challenge for the clinicians. The relatively newer technique negative pressure wound therapy (NPWT) is very promising and also useful in the management of difficult to heal wounds. 

The use of controlled levels of negative pressure application has been shown to accelerate debridement and promote healing in various types of wounds. This optimum level of negative pressure appears to be around -125 mmHg below ambient and there is evidence that this is most effective if applied in a cyclical fashion. Earlier studies used more conventional methods such as a wall suction apparatus or surgical vacuum bottles for creating the negative pressure. However, there were multiple problems present in the use of these conventional methods such as non-regulated pressure, high protein loss, cross contamination from infected patients, also the mobility of the patient was restricted. 

Hence we introduced the commercial system for promoting negative pressure wound therapy also known as vacuum therapy, vacuum sealing or topical negative pressure therapy. This equipment called CCNPWT Wound Management system was designed to overcome the problems associated with conventional methods for the creation of negative pressure. The heart of the system is a microprocessor-controlled vacuum unit that is capable of providing controlled levels of continuous or intermittent sub-atmospheric pressure ranging from 

-20mmHg to -220 mmHg. 

NPWT is an efficacious & cost-effective management approach for almost all wound etiology such as pressure ulcers, trauma wounds, acute & chronic wounds, diabetic foot ulcers, venous leg ulcers, burns, post-surgical wounds, pre & post-op flaps/grafts. 

 MECHANISM OF ACTION

The principle of NPWT involves extending the usually narrowly defined suction effect of drainage across the entire area of the wound cavity or surface using an open-pore filler that has been fitted to the contours of the wound. To prevent air from being sucked in from the external environment, the wound and the filler that rests inside or upon the wound are hermetically sealed with an airtight adhesive polyurethane drape that is permeable to water vapour, transparent, and bacteria proof. A connection pad is then applied over a small hole that has been made in the drape and connected to a vacuum source by means of a tube (Fig 1). 

Fig 1. Mechanism of action of Negative pressure Wound Therapy

 Two main theories prevail regarding the mechanism of action of NPWT used in conjunction with reticulated open cell foam: 

The     first is based on the theory that tissue strain caused by NPWT has a     stimulatory effect on cellular proliferation. 

This     theory is supported by the fact that tissues have been shown to undergo a     5-20% strain when subjected to NPWT. 

This     level of strain is assumed to proactively cause cell division and     angiogenesis. 

The     second theory is focused on the effects of NPWT on the mechanical removal of     extracellular fluid and oedema. 

By actively removing fluid at the wound bed it is felt     that the local micro-circulation is improved and secondary necrosis is     reduced. 

This hypothesis is supported by studies which have shown reduced need for debridement at the time of ‘second look’ for wounds treated with NPWT. It is also supported by in vivo studies using a porcine model which have demonstrated acceleration in capillary formation and increase in luminal area in wounds treated with NPWT

 Fig 2. Dressing application technique

NPWT acts in different ways to promote wound healing. The wound is subject to suction pressure that is propagated through the wound filler to the wound bed. This suction drains exudate from the wound and creates a mechanical force in the wound edges that result in an altered tissue perfusion, angiogenesis and the formation of granulation tissue. Some of the mechanisms of action have been demonstrated experimentally and clinically. 

The effects of NPWT on open wound can be summarised as follows:

Reduction     of the wound area due to negative pressure acting on the foam, pulls     together the edges of the wound (wound retraction)

Stimulation     of granulation tissue formation in an optimally moist wound environment; in     several situations even over brady trophic tissue such as tendons and bone     NPWT was able to stimulate granulation tissue formation

Continuation     of effective mechanical wound cleansing (removal of small tissue debris by     suction)

Effective     biochemical reduction of the fluid concentration of wound     healing-impairing proteases (such as elastase)—in the first days

Reliable,     continuous removal of wound exudate (and, consequently, fewer dressing     changes) within a closed system

Pressure-related     reduction of interstitial oedema with consecutive improvement of     microcirculation, stimulation of blood flow and oxygenation

Hygienic     wound closure—bacteria proof wound dressing for sealing the wound so no     external bacteria can enter the wound and the patient’s own wound bacteria     are not spread.

This     is particularly important in the event of contamination with problematic     bacteria, as in patients with meticillin-resistant Staphylococcus     aureus (MRSA)-infected     wounds. Thus, it

also     reduces the risk of cross-infections and development of resistance within     the hospital

Transparent     dressing permits continuous clinical monitoring of the surrounding skin     through the film with which the wound has been sealed

Odourless     and hygienic dressing technique; constant seeping through the dressing     onto the patient’s clothing and bedding can be avoided, reducing demands     on the nursing staff

Reduction in the number of     required dressing changes (only necessary every two to three days), which     reduces nursing time requirements, particularly in patients with exudating     wounds.

Patient comfort

• Easy and early patient mobilisation