details of npwt aka vac

1. PRESENTOR-Dr MOHAMMED
NAYEEMUDDIN
MODERATOR-Dr SACHIN SHAH

2.  Wound is defined as an interruption in the
continuity of the body surfaces like burns ,
laceration and crushing injuries.
 Inflammation which occurs at the site of wound
causes angiogenesis thus increasing the local
blood supply.
 Factors influencing wound healing are pressure ,
trauma vascular insufficiency , diabetes ,
infection and prolonged immobilisation are some
of them.

3.  Negative pressure wound therapy with reticulated open
cell foam (NPWT-ROCF) also called as vacuum assisted
closure (VAC).
 VAC has evolved as a beneficial adjunctive treatment
modality for soft tissue management after high energy
trauma.
 DEBRIDEMENT – is defined as a process of removing dead
necrotic tissue and foreign materials from and around a
wound to expose healing tissue.
 SURGICAL DEBRIDEMENT : is defined as a process in which
scalpel , scissors or other surgical instruments are used to
cut out the necrotic tissue from the wound. It is also
known as sharp debridement.

4.  Soft tissue trauma with or without underlying fractures is
the best indication of VAC.
 Pressure skin grafts and to improve skin graft incorporation
and also can be applied on donor site to epithelize it.
 VAC can be applied on exposed bones , tendons and
orthopaedic implants.
 Post traumatic ulcers
 Diabetic foot with large wounds.
 Wound after fasciotomy.
 Infected wounds after debridement.
 Post operative infection.
 Chronic osteomyelitis
 Surgical incisions that cannot close without tension.
 Closed surgical incision with continued drainage especially
if the wound have serous drain on post op day 4.
 Necrotizing fasciitis.

5.  As a result of continuous research on the
effect of subatmospheric pressure on open
wounds . kinetic concepts Inc (KCI, San
antonio ,TX) developed the KCI vacuum
assisted closure (VAC) system.

6. Pump
Canister
Sponge
Pump
Canister
Sponge

7. Pump

8. Polyurethane Foam Poly-vinyl-alcohol
0.2 to 1mmPore size: 400-600
microns

9. multi-lumen
For Fluid
For Measurement

10.  Moisten the interface between sponge and
wound.
 Apply cuticle to the wound then NPWT.
 Topical lidocaine on the wound surface.

11.  Standard : -125 mmHg.
 Range : - 125 to – 200 mmHg
 Neonates : - 50 mmHg.
 Children < 2 years : -50 to -75 mmHg
 Children > 2 years : -75 to -125 mmHg
 Adults : -125mmHg

12.  Do not apply on nondebrided dirty wounds.
 May cause bleeding if any cut vessel is in the
vicinity of the wound on where NPWT is to be
applied.
 Pain may occur while removing the adhesive
tape.
 Retained sponge may lead to infection.
 Dehydration in children occurs due to suction
of fluids from the wound.
 Maceration of skin can occur if the foam
overlaps the healthy skin.
 Hematoma in surrounding tissue may occur.
 In immune compressed individuals wound
dehiscence can occur.

13.  Leakage may occur in cases of power loss
resulting in maceration and may cause
infection and wound complications.
 Poor sealing leading to loosening of drainage
system.

14.  Necrotic tissue with eschar.
 Exposed nerves and organs.
 Undernourished patient.
 Severe pain.
 Malignant wound.
 Nonenteric and unexplored fistulas

15.  It is a controversial topic as antibiotic is lost
when fluid.
 But in authors institute it is followed as the 5
minutes interval of VAC exerts a beneficial
effect.

16.  Apply VAC on primary closure.
 Used in high risk surgical closure of wound.
 High energy tibial plateau fracture.
 Calcaneal fractures.
 Pilons fractures.
 Acetabular fracture.
 Amputed limbs in diabetes.
 Previously irradiated tissue.
 Morbidity obese patient.
 Incisions in hip and knee replacement
surgeries.

17.  After traumatic wound or surgical incision , the
tensile forces cause gapping of the wound.
 If wound is kept without coverage becomes
impossible.
 NPWT exerts a contracting effect on the wound
that pulls the edges together and the wound
become slowly smaller and smaller with each
NPWT and it is then possible to do primarily
close the wound.
 Vacuum assisted closure system appears as a
thermal insulation and prevention a loss of heat.
 This is a special important onces in burns ,
physiological unstable and polytraumatized
patients.

18.  Daniel – schlatterer has described instill
irrigation technique is a gravity dependent
filtration of the irrigant into the wound bed for
approximately 30 seconds.
 This is followed by a short time period of no
suction.
 This incubation phase is referred to us the dwell
or hold time period.
 The solution reaches the wound bed after
traversing the pressure foam dressing.
 This movement of irrigant is supported by the
work of Labler and Trantz.
 Further studies are required to give definite
recommendations.

19.  Modern papineau technique : involves
aggressive excisional debridement of
infected or necrotic bone with open bone
grafting with cancellous bone accompained
by VAC.

20. THANK YOU