Negative Pressure Wound Therapy in Orthopedic Surgery (Review)
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negative pressure wound therapy, wound healing, traumatology and orthopedics.

How to Cite

Zazirnyi, I., Kravchenko, D., & Andreev, A. (2020). Negative Pressure Wound Therapy in Orthopedic Surgery (Review). Herald of Orthopaedics, Traumatology and Prosthetics, (2(105), 52-60.


Summary. Negative pressure wound therapy (NPWT), in its most used Vacuum Assisted Closure (VAC) variant, consists in applying subatmospheric pressure to a wound that is sealed off by a specially designed dressing and connected by a tube to a suction pump and drainage collection system. Skin defects are extremely common in orthopedic and trauma surgery. VAC is valuable across a range of indications. Proven effects include an increase in blood flow, stimulation of angiogenesis, and a decrease in wound surface area. VAC can be used to treat post-traumatic and surgical wounds, burns, and chronic wounds such as pressure sores and ulcers. The lower frequency of dressing changes with VAC lightens the staff workload. The public health services of Australia, Belgium, Canada, New Zealand, the United States, Germany, and France have issued good practice guidelines for the use of VAC in specific and limited indications. VAC has benefited from the introduction of several technological improvements such as silicone interfaces, foam dressings with various densities and pore sizes, and irrigation systems. The result of using this method is greater adaptability to each specific situation. Nevertheless, VAC is not appropriate in every case and cannot replace a necessary surgical procedure. The aim of this study is to review the principles, practical modalities, and indications of VAC.
ARTICLE PDF (Українська)


Argenta L.C., Morykwas M.J. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast. Surg. 1997; 38: 563–76.

Ubbink D.T., Westerbos S.J., Evans D., Land L., Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001898. doi: 10.1002/14651858.CD001898.pub2.

McNulty A.K., Schmidt M., Feeley T., Kieswetter K. Effects of negative pressure wound therapy on fibroblast viability, chemotactic signaling, and proliferation in a provisional wound (fibrin) matrix. Wound Repair Regen 2007; 15: 838–46. doi: 10.1111/j.1524-475X.2007.00287.x.

McNulty A.K., Schmidt M., Feeley T., Villanueva P., Kieswetter K. Effects of negative pressure wound therapy on cellular energetics in fibroblasts grown in a provisional wound (fibrin) matrix. Wound Repair Regen 2009; 17: 192–9. PMID: 19320887.

Morykwas M.J., Simpson J., Punger K., Argenta A., Kremers L., Argenta J. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 2006; 117 (7 Suppl.): S121–6. PMID: 16799379.

Baharestani M., De Leon J., Mendez-Eastman S., Powell G., Weir D., Niezgoda J. Consensus statement: a practical guide for managing pressure ulcers with negative pressure wound therapy utilizing vacuum-assisted closure- understanding the treatment algorithm. Advance Skin Wound Care 2008; 21 (Suppl. 1): 1–20.

Baharestani M.M., Driver V.R., De Leon J.M., Gabriel A., Kaplan M., Lantis J. Optimizing clinical and cost effectiveness with early intervention of VAC therapy. Ostomy Wound Manage 2008; 54 (11 Suppl.): 1 –15.

Mouës C.M., Heule F., Hovius S.E. A review of topical negative pressure therapy in wound healing: sufficient evidence? Am. J Surg. 2011; 201: 544–56. PMID: 21421104.

Bulla A., Farace F., Uzel A.P., Casoli V. Negative pressure wound therapy and external fixation device: a simple way to seal the dressing. J Orthop. Trauma 2014; 28 (7): e176–7. PMID: 24296597.

Whitney J., Phillips L., Aslam R., Barbul A., Gottrup F., Gould L. Guidelines for the treatment of pressure ulcers. Wound Repair Regen 2006; 14: 663–79.

Krug E., Berg L., Lee C., Hudson D., Birke-Sorensen H., Depoorter M. Evidence-based recommendations for the use of negative pressure wound therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus. Injury 2011; 42: S1–12.

Birke-Sorensen H., Malmsjo M., Rome P., Hudson D., Krug E., Berg L. Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer)-steps towards an international consensus. J Plast. Reconstr. Aesthet. Surg 2011; 64: S1–16.

Gabriel A., Kahn K.M. New advances in instillation therapy in wounds at risk for compromised healing. Surg Technol Int 2014; 24:7 8–81. PMID: 24700215.

Rycerz A.M., Allen D., Lessing M.C. Science supporting negative pressure wound therapy with instillation. Int Wound J 2013; 10: 20–4. PMID: 24251840.

Gabriel A., Rauen B. Simplified negative pressure wound therapy with instillation: advances and recommendations. Plast Surg Nurs 2014; 34: 88–92.

Gupta S., Gabriel A., Lantis J., Téot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J 2016. Apr; 13(2): 159-174. PMID: 26011379.

Scalise A., Calamita R., Tartaglione C., Pierangeli M., Bolletta E., Gioacchini M. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of incisional negative pressure wound therapy. A systematic review of the literature. Int. Wound J 2016 Dec; 13(6):1260-1281. doi: 10.1111/iwj.12492.

Horch R.E. Incisional negative pressure wound therapy for high-risk wounds. J Wound Care 2015; 24 (4 Suppl.): 21–8. PMID: 25853645.

Vikatmaa P., Juutilainen V., Kuukasjarvi P., Malmivaara A. Negative pressure wound therapy: a systematic review on effectiveness and safety. Eur J Vasc Endovasc Surg 2008;36(4):438-48. PMID: 18675559.

Pham C.T., Middleton P.F., Maddern G.J. The safety and efficacy of topical negative pressure in non-healing wounds: a systematic review. J Wound Care 2006;15(6):240-50.

Peinemann F., McGauran N., Sauerland S., Lange S. Disagreement in primary study selection between systematic reviews on negative pressure wound therapy. BMC Med Res Methodol 2008; 8: 41.

Wild T., Stremitzer S., Budzanowski A., Hoelzenbein T., Ludwig C., Ohrenberger G. Definition of efficiency in vacuum therapy--a randomised controlled trial comparing with V.A.C. Therapy. Int Wound J 2008;5(5):641-7.

Llanos S., Danilla S., Barraza C., Armijo E., Pineros J.L., Quintas M. Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double masked, controlled trial. Ann Surg 2006;244(5):700-5.

Armstrong D.G., Lavery L.A. Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 2005;366(9498):1704-10.

Vuerstaek J.D., Vainas T., Wuite J., Nelemans P., Neumann M.H. Veraart J.C. State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings. J Vasc Surg 2006;44(5):1029-37. doi: 10.1016/j.jvs.2006.07.030.

Nam D., Shershon R., Levine B., Della Valle C. The Use of Closed Incision Negative-Pressure Wound Therapy in Orthopaedic Surgery // J Am Acad. Orthop. Surg. 2018, Vol. 26, N 9, pp. 295-302, DOI: 10.5435/JAAOS-D-17-00054.

Petrou S., Parker B., Masters J., Achten J., Bruce J., Lamb S., Parsons N., Costa M.L. Cost-effectiveness of negative-pressure wound therapy in adults with severe open fractures of the lower limb: evidence from the WOLLF randomized controlled trial // Bone Joint J 2019; 101-B: 1392–1401. DOI:10.1302/0301-620X.101B11. BJJ-2018-1228.

Strungala V., Martin R. Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications. Surg Infect (Larchmt) 2017 Oct;18(7):810-819. doi: 10.1089/sur.2017.156.

Agarwal A. Management of Closed Incisions Using Negative-Pressure Wound Therapy in Orthopedic Surgery Plast Reconstr Surg 2019 Jan;143(1S Management of Surgical Incisions Utilizing Closed-Incision Negative-Pressure Therapy):21S-26S. doi: 10.1097/PRS.0000000000005308.

Wang C., Zhang Y., Qu H. Negative Pressure Wound Therapy for Closed Incisions in Orthopedic Trauma Surgery: A Meta-Analysis. Orthop Surg Res 2019 Dec 11;14(1):427. doi: 10.1186/s13018-019-1488-z.

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