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Introduction

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The use of negative-pressure wound therapy (NPWT) has increased dramatically in recent years in the United States and Europe, due in part to case studies and controlled trials demonstrating the effectiveness of the therapy. The process of applying negative pressure to wounds has been referred to by many names in the literature, including vacuum-assisted closure (V.A.C.®), topical negative pressure (TNP), vacuum-sealing technique (VST), subatmospheric pressure dressing (SPD), and sealed surface wound suction (SSS). The current NPWT nomenclature generally describes the controlled application of subatmospheric pressure to a wound using an electrical pump to intermittently or continuously convey pressure through connecting tubing to a specialized wound dressing to promote healing.

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History

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Subatmospheric pressure has been used in wound care for centuries through the use of drains from body cavities. However, the use of suction drainage was practiced more routinely beginning in the middle of the 20th century for the postsurgical removal of blood, bile, and other exudates.1 Early studies reported the use of closed wound suction for prophylactic drainage, which appeared to greatly improve wound healing, minimize postoperative complications, and reduce the duration of hospitalization following surgery.1

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Fleck and Frizzell reported that by the early 1980s, the principle of applying constant suction to promote healing gained renewed interest with surgeons. It was thought that a key factor in facilitating wound healing was the ability to contain, control, and remove excess fluid, air, or material that may disrupt the healing process.2

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Several studies can be found in the Russian medical literature that analyze the benefits of vacuum treatment for purulent wounds following surgical débridement.3,4,5,6,7 Kostiuchenok et al reported that the use of vacuum treatment in combination with surgical débridement significantly reduced the bacterial burden in the subject wounds and improved healing.3 Davydov et al similarly found that the use of vacuum treatment in conjunction with surgical treatment in patients with purulent lactation mastitis reduced the bacterial load in the wound and reduced wound healing time as well as boosted immune system function.4 In 1987 Usopov and Yeplifanov used a rabbit model to study the effects of vacuum treatment in the clinical setting in an effort to evaluate beneficial settings for negative pressure and duration of treatment.5 Davydov et al published another study in 1988 evaluating the bacteriological and cytological properties of purulent wounds following vacuum treatment.6 Over 200 patients had perforated drains placed in the depths of their purulent wounds following surgical incision and drainage. The drains were connected to a hemispherical chamber to cover the wound and connected to a vacuum source 1 hour a day for 6 days. A comparative group received the surgical intervention alone. Subsequently, tissues were obtained for biopsy from both groups. The authors concluded that vacuum treatment and surgical débridement in conjunction shortened the inflammatory process and ...

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