Jwc ewma final indd

J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3

recent times. Technical limitations related to the 

difficulties with producing reliable and affordable 

devices that can safely be applied to the patients 

have been the primary challenge.

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Due to impressive technological upgrading, 

ultrasound equipment now populate the clinical 

environment with a variety of instruments that 

have been applied to almost all the clinical models 

of chronic ulceration with satisfying results.

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A positive feature of the US approach is that this 

technology may be used for many different types 

of tissue, from loose connective tissue to tendon 

and even bones, with a high level of effectiveness.

Limitations

Similar to hydrosurgery, US technology can 

modulate the debriding activity and can be strictly 

controlled by the clinician, whose expertise and 

confidence with the technique is essential to 

guarantee the effectiveness of the procedure and 

avoid the possible complications, such as bleeding 

and disruption of heathy structures.

This is a positive aspect as well as a limitation; 

the indications for the use of US vary according 

to skills of the clinician and may range from 

very simple to complex procedures, based on the 

frequency of usage, the power of the instrument 

available and the type of patients treated.

Another aspect that is relevant for some 

US devices, as well as hydrosurgery, is the 

nebulisation of material from the wound bed. If 

not properly managed, this can be substantial 

and, due to this aspect, the setting in which the 

procedures are carried out is of crucial importance 

for the safety of patients and clinicians.

Barriers and cuffs are indicated, as for jet lavage 

systems, to counteract this negative feature of US, 

which limits use in outpatient settings.

Costeffectiveness

Based on our experience, the total costs related 

to the use of US devices are higher than the 

direct costs related to purchase of the instrument, 

but lower when one consider that most of the 

devices use sterilisable probes and not disposable 

consumables. This may be interpreted as a saving, 

but also as a limitation, since only a limited 

number of patients can be treated in each session, 

depending on the number of probes available.

Indirectdebridement

technologies

Negative pressure

Background

In wound management, negative pressure wound 

therapy (NPWT) is probably the most important 

technological achievement of the last 20 years. It 

arose as the result of the scientific development 

of an empiric observation made, in this case, by 

plastic surgeons, who noted how negative pressure 

dramatically improved the course of both acute 

and chronic wounds.

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NPWT has also been claimed to have certain indirect 

debridement properties.

Mechanismofaction

Negative pressure interacts with the wound 

environment on a number of different levels. It acts 

on the macro-structure as well as on the micro-

structure of the lesion, integrating all these effects  

in a complex activity that promotes wound healing 

in all the phases of the wound development.

On a macro level, NPWT removes secretion and 

fluids from the lesion, reduces peri-wound oedema, 

increases local blood flow and reduces the dimension 

of the ulcer, as well as the risk of contamination of 

the wound from external sources.

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