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  

S 2 9

On a micro-level, the stimulation that negative 

pressure exerts on the cell surfaces and on many of 

the cellular elements present in the lesion (paralleled 

by a change in nuclear transcription activity) 

induces positive modifications in both the shape and 

function of the cells. It has been demonstrated that 

NPWT promotes angiogenesis, fibrogenesis and the 

activity of macrophages and leucocytes.

108

A number of studies on NPWT have been carried 

out on virtually all clinical conditions related to 

wounds and the management of wounds; acute as 

well as chronic, from cardiosurgery to the diabetic 

foot, and from venous leg ulcers to pressure 

ulceration. Its activity has been confirmed for most 

of the conditions in which it has been tested.

109–112

An interesting option with NPWT is that it can be 

integrated with antiseptic application. This is the 

case if the antiseptics are instilled in the system, 

with the objective to rinse the areas of the wound 

periodically (as has been done with osteomyelitis), 

or if they are absorbed on the material used to 

fill the lesion (such as with PHMB on the gauzes 

used, as is done with many of the devices currently 

on the market). This adds an antimicrobial effect 

to the indirect debridement of NPWT, as the 

new antiseptics have a better profile in terms of 

effectiveness and safety, and have been successfully 

tested in a number of conditions.

113

Limitations

A primary contraindication for the use of NPWT 

in relation to debridement is the fact that this 

technology cannot be used in an uncontrolled 

infection, or when necrotic tissue is present in  

the wound.

In addition, NPWT should not be applied when 

local ischaemia is present, when there is active 

bleeding, or when deep structures, such as vessels, 

tendons, muscles, joints or bones are exposed in 

the lesion.

However, in cases where one or more of the contra-

indications to NPWT are present, it is possible to 

remove these by additional treatment efforts and 

then proceed to apply NPWT.

114

When applying NPWT on a poorly debrided 

wound, the dressing changes must be altered 

accordingly, so that they are more frequent, as the 

foam or gauze will be more saturated with slough 

and the NPWT-machine will malfunction, causing 

problems when the patient is at home.

Costeffectiveness

Many different, and sometimes portable or 

even disposable, NPWT devices are available. A 

potential cost saving is related to the possibility of 

discharging the patient with a portable device until 

debridement is complete, and then prescribing 

a disposable NPWT device in case further 

debridement is needed.

115

 However, when using a 

portable system at home, the health professional 

needs to make sure that the patient can manage 

the treatment and machine by themselves. 

Otherwise there complications may occur, in the 

form of negative impact on the patients quality of 

life and a non-successful treatment result.

The possibility of shortening the hospital stay and 

prolonging debridement activity in an outpatient 

setting supports an improved cost-effectiveness 

profile for NPWT.

116

low-frequency ultrasound

Background

Low-frequency ultrasound is claimed to provide a 

debridement alternative to, for example, surgical 

debridement.

105

 However, it is more commonly 

used for therapeutic purposes.

Ultrasonic waves are also claimed to lead 

to destruction of bacteria and disruption of 

biofilms.

117,118

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