Negative pressure wound therapy: mechanisms of action and clinical uses

Published on October 7, 2014   32 min
0:00
Hello, I'm Doctor Dennis Orgill, and today I'd like to talk about negative pressure wound therapy, mechanism of action, and clinical uses.
0:11
For financial disclosures, I've had passed research funding and have been a consultant and an expert witness for KCI.
0:20
Today we'll begin by discussing the history and technology transfer of negative pressure wound therapy devices, we'll review the biology of skin stretching, and we'll talk about the four primary mechanisms of negative pressure wound therapy, which include macrodeformation, microdeformation, fluid removal, and a moist wound environment. We'll then discuss secondary mechanisms which include, angiogenesis, inflammation, regulation of matrix metalloproteinases, and their effect on peripheral nerves. Finally, we'll go over some case examples including sternal wounds, open abdomens, groin wounds, and skin grafts following a brief discussion.
1:05
When clinicians started using negative pressure wound therapy devices, they had some amazing results. On the left you see a patient of ours who came into the hospital with necrotizing faciitis. She had peripheral vascular disease and diabetes, and this required a hip disarticulation. We placed the vac device on and changed it over 30 days. Normally we would have put a large flap on this, but she was too sick in the ICU. This could eventually be covered with a skin graft to close the wound. On the right, we commonly use a vac device to cover skin grafts, and this shows how this is applied to a lower leg wound.
1:46
Suction has a long history in the use of medicine and surgery. At the top left is a commonly used chest tube system in our hospital which carefully regulates suction, usually between 20 and 40 millimeters of mercury. Below that is a suction drain which also provides a low suction pressure to evacuate fluid from surgical wounds. On the right is a gomco devise which has the capacity to provide intermittent suction, particularly for the gastrointestinal tract.
Hide

Negative pressure wound therapy: mechanisms of action and clinical uses

Embed in course/own notes