Key principles of  NPWT  

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• Before starting NPWT, you need a plan. What do you hope to achieve with the Negative Pressure Wound Therapy (NPWT) treatment? Do you want to " kick-start" a wound that seems to have stalled? Do you want to form granulation tissue as quickly as possible? Do you want 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 do you plan to change the NPWT dressings, and who will perform the dressing changes? What should the patient do when a blockage or leakage alarm sounds while they are at home? Who will check the pump several times daily to ensure it is working correctly and that the pump's batteries 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 are the only one with 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 it, then apply suction. If you try that, it will likely end in disaster, most likely a severe infection.  

• It is essential to understand that the medium (gauze or foam) is in direct 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, particularly important in deep ulcerations, such as extensive pressure ulcers. You need to be vigilant and ensure that the medium is in contact with the entire wound cavity to prevent infection. 

• It is essential that the NPWT dressing is as airtight as possible. Some caregivers believe that a small leakage is insignificant, which is incorrect. When the dressing is 100% airtight, we see the best results, and there is usually less smell coming from the wound. We hypothesize 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, this can lead to a severe infection, including 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 to three hours. 

• As technology advances, some negative pressure wound therapy (NPWT) pumps have become compact and user-friendly. However, be aware that the small pumps have limitations regarding the types of wounds for which they can be used. They are less forgiving regarding leaks and may be more challenging to apply to difficult anatomical areas, such as the groin area, for example. 

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