Key principles of  NPWT  

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• Before you start with NPWT you need a plan. What do you want to achieve with the NPWT treatment? Do you want to " kick-start" a wound that seems to have stalled? Do you want to get the granulation tissue forming as quickly as possible? Do you want to use NPWT to control the amount of exudate that comes from a wound? 

• Before you embark on the NPWT, you will also need a solid plan for the logistics. How often are you planning on changing the NPWT dressings, and who will do the dressing changes? What should the patient do when a blockage or leakage alarm goes off when the patient is at home? Who will check several times daily that the pump is working correctly and that the batteries of the pump are charged? Does the patient have access to electricity to charge the pump? If the dressing changes are to occur at your clinic: who will perform the NPWT treatments if you have a few days off work and you are the only one who has some knowledge about NPWT? 

• NPWT will only help to promote granulation tissue. It will not help skin cells to migrate over the wound! 

• NPWT should not be used in wounds with much necrotic tissue, have a high bacterial burden, or are infected, smelly wounds, in cases with untreated osteomyelitis, close to major blood vessels, wounds with fistulas to internal organs, or malignant wounds.

• To make NPWT work, you have to place a medium into the wound; this can be a gauze material or a foam. You cannot simply put a plastic film over a wound and attach a tube to this and apply suction. If you try that, it will end in a disaster ( most likely a severe infection).  

• It is essential to understand that the medium ( gauze or foam) is in contact with the entire wound cavity. If there are pockets where the medium is not in contact, exudate will not be sucked out of these pockets. This can lead to bacteria thriving in these areas and cause infection. This is a fundamental principle of NPWT. This is, for example, important in deep ulcerations like extensive pressure ulcers. You need to be vigilant and ensure that the medium is in contact with the whole wound cavity to avoid an infection. 

• It is essential that the NPWT dressing is as airtight as possible. Some caregivers think that a small leakage does not matter, which is wrong. When the dressing is 100% airtight we see the best results, and there is usually less smell coming from the wound. Our hypothesis is that leakages give rise to a higher bacterial burden developing under the NPWT dressing. We also see more peri-wound skin maceration when the dressing is not entirely airtight. 

• If an NPWT pump is switched off for several hours or is malfunctioning otherwise, this can lead to a severe infection, even septicemia. An NPWT dressing without active suction attached to it behaves like a greenhouse for bacteria. We have witnessed life-threatening septicemia in patients where a pump had been switched off for a whole day. Most producers, therefore, advise changing the entire dressing if the pump has been switched off for more than two-three hours. 

• As technology advances some NPWT pumps have become tiny and user-friendly. However, be aware that the small pumps have limitations concerning what kind of wounds you can use them on. They are less forgiving with respect to leakages and may be more challenging to apply to difficult anatomical areas like the groin area, for example. 

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• We consistently see the best results when we use NPWT with simultaneous irrigation. This type of NPWT involves rinsing the wound bed with saline or antibacterial solutions at regular intervals. NPWT with irrigation allows us to use NPWT in wounds that are less clean or in wounds where we may be worried about infection. The pumps with this capability are significantly more expensive than regular NPWT pumps. We will discuss this technology later on in the chapter.