Presentation on theme: "INDICATION FOR TOPICAL NEGATIVE PRESSURE THERAPY"— Presentation transcript:
1INDICATION FOR TOPICAL NEGATIVE PRESSURE THERAPY MANAGING THEOPEN WOUND:INDICATION FOR TOPICAL NEGATIVE PRESSURE THERAPYDR. K. SUTHARSHANREGISTRAR IN SURGERY
2INTRODUCTION Open wounds encountered in surgical practice Primarily closed wounds fail to heal- dehisceintentionally left open at the onsetChronic wounds fails to heal by 2ry intentionChronicity > 12 weeks
3TYPE OF WOUND AND AETIOLOGY Wounds closed primarily which has brokendownWound infectionTissue ischaemiaMalnutritionExcessive wound tensionForeign bodyDrugs: corticosteroidsMedical illness: DM, RAWound intentionally left openAbdominal compartment syndromeExtensive wound debridement: Necrotizing fascitisTherapeutic packingChronic woundsDiabetic foot ulcersVenous ulcersMalignant ulcersTrophic ulcers
4PRINCIPLES OF TOPICAL NEGATIVE PRESSURE WOUND THERAPY( TNP) Several other names: Sub atmospheric pressure therapy/ Vacuum- sealing technique/ Sealed surface wound suction/ Vacuum assisted closure/ Negative pressure wound therapy( NPWT).Applying sub atmospheric pressure to a healing wound.Wound healing enhanced by removal of fluid collecting within it.Tissue growth associated with wound healing might respond positively to forces of distraction.
5Principles……System contains foam or porous dressing- placed in contact with woundsVacuum deviceConnected by drain.
6SYSTEM……Wound made air- tight by placing a polyurethane foam over it and 2 cm beyond the wound edge.Vacuum pressure: - 50mmHg to -125 mmHgPressure applied constantly or intermittently to wound.Porous nature enables equal distribution of pressure to all parts of the wound.Dressing changed initially every 48 hours.Portable/ stationary pump.Portable pump more benefit.
7MECHANISM OF ACTION Increasing wound ( dermal) perfusion Reducing oedemaStimulating the formation of granulation tissueImproving the removal of wound exudatereducing the bacterial loadSealed dressing produce requied moist environment which promote re – epithelialization 30-40% more effectively.recent evidence , mechanical stress increase the expression of genes which promote wound healing. Eg: GF, TGF- B, genes for angiogenesis
9SOFT TISSUE TRAUMA One of the best established treatment 2. specially with extensive tissue lossAs a bridge to skin grafting or flap coverage of open extremity wounds with exposed bones or tendons4. It reduces the size of the defect that needs to be covered and ensuring that local conditions for definitive wound healing are optimized.
10BURNS Improve dermal blood flow Reduce the degree of secondary tissue injuryEvidance not yet well established
11SURGICAL WOUNDS Open abdominal and sternal wounds Open wounds following fasciotomyWounds following extensive surgical debridementWounds needs plastic surgical flaps
12OPEN ABDOMINAL WOUNDSDefined as ‘wound in which all the layers of the abdominal wall are open.LAPROSTOMY wounds are created if a planned second look laparotomy is required or if abdominal compartment syndrome is expected.TNP proven benefit especially in severe abdominal trauma and sepsis.Catastrophic complication of TNP- intestinal fistula, incidence is higher if the mx of open wound takes longer time.
14BENEFITS CLAIMED FOR MANAGING THE OPEN ABDOMEN WITH TNP Reduction in abdominal compartment pressureAvoidance of trauma to internal viscera with repeated dressingsBetter removal of peritoneal exudateReduction in intestinal odema- improved perfusion, motilityBetter protection of skin edges
15OPEN STERNAL WOUNDS SKIN FLAP WOUNDS Deep sternal wound infections Poststernotomy mediastinitisSKIN FLAP WOUNDSOne of the first reported uses of TNPIncrease the rapidity of re- epithelialization and decrease the rate of graft loss.
16CHRONIC WOUNDS Diabetic foot wound Venous leg ulcers Ulcers present a significant health burden and a medical challenge causing increased disability .TNP proved to be benefit.Venous leg ulcersSuccessful indicationNo trials yet that have assessed TNP as a primary therapy for healing venous ulcers without subsequent skin grafting.Helps to reduce the time for healing and prepare the ulcer bed for skin grafting.
19SUMMARY…..Enormous progress in the commercial development of system that allows clinician to deliver TNPUndoubtedly become a key part of clinical management ranging from open abdomen to diabetic leg ulcers.Expensive therapyWhether TNP will continue to be supported in a healthcare system under closer financial scrutiny that increasingly focuses on evidence of cost- effectiveness remains to be seen.