Vacuum therapy
The vacuum therapy (also vacuum seal , negative pressure wound therapy ( NPWT ) and others) is a form of wound treatment . The wound healing is to be achieved here by a wound closure (occlusion) in combination with a drainage for wound secretion and blood, whereby a negative pressure is maintained by suction.
The naming in the German language was unfortunate because no vacuum in the actual sense, but reduced atmospheric pressure is used. A better name for the procedure is negative pressure wound therapy .
Active principle of action
A pump is used to generate a controlled, localized negative pressure in a wound, thereby possibly accelerating the healing process in chronic as well as acute wounds, in any case simplified. This is done by sucking off wound exudate and the associated sucking off of proteolytic enzymes, especially the matrix metalloproteases , as well as mechanical cleaning of the wound. The blood circulation in the wound is improved by inducing the sprouting of new vessels ( angiogenesis ). As a result, granulation tissue is formed and a moist wound treatment without accumulation of wound exudate and proteolytic enzymes is given. The negative pressure can be continuous, intermittent or constant. Depending on the blood flow situation in the affected area (e.g. if PAD is present ), the negative pressure can be varied in a range from 25 mmHg to 125 mmHg.
Areas of application
- Acute wounds: soft tissue defects, seromas , infected wounds after surgical debridement , fixation of skin grafts .
- Acute - subchronic wounds: wound conditioning, lymph fistulas , sternal wound infection, chest wall windows.
- Chronic wounds: decubitus , ulcus cruris , chronic wound healing disorders, radiation ulcer , etc. (cf. Willy 2005, p. 18f).
Other special areas of application are the abdominal compartment syndrome , septic abdomen and the care of enteral fistulas .
Contraindications
As part of the consensus conference on vacuum therapy, the representatives of the wound healing societies from Austria and Germany agreed on the following contraindications:
- Severe bleeding disorders with an increased risk of bleeding,
- exposed blood vessels, which are at risk of being damaged by vacuum therapy.
- necrotic wound bed,
- untreated osteomyelitis ,
- malignant wound base (Willy 2005)
- The close of the wounds, vagus nerve are
In this context, the FDA issued a warning in 2009 and again in March 2011 after a series of 12 deaths and 174 injuries from bleeding through to circulatory shock within 4 years. The FDA does not recommend therapy
- Children
- People with vascular grafts
- Blood vessel infections
- Patients receiving anticoagulant drugs
- Wounds with necrotic tissue or a scab pad
- untreated osteomyelitis,
- with non-enteric or unexplored fistula
- Malignancies in the wound area
- Wounds in which blood vessels, nerves, anastomoses, or organs are visible
- if the bone is exposed, the bone must be covered.
rating
Since the system is closed, the dressing can stay on the wound for several days; at least in theory, no daily dressing changes are necessary. The suction in the system reduces the wound volume, removes excess fluid and obstructing exudate and promotes granulation. In addition, there is increased comfort for the patient (no odor, no annoying exudate, less frequent dressing changes, etc.).
The less frequent dressing changes (depending on the wound condition) are offset by the leasing costs of the therapy system and the price of the consumables. The individual dressing change is significantly more complex, on the other hand less common. The pumps basically require mains power. However, mobile systems with battery operation are also available, so that the patient can move freely according to the battery capacity, but has to carry the pump with him.
A systematic review of randomized, controlled studies comes to the conclusion that vacuum therapy may have a positive effect on wound healing, but ultimately there is still no evidence of advantages or disadvantages compared to conventional wound therapy. In particular, the published studies were heterogeneous and the statements were distorted as a result. It is also noticeable that a large number of studies have apparently been discontinued. A Cochrane review (2008) and two IQWiG assessments (2006 and 2018) also came to a similar conclusion .
supporting documents
- ^ A b Frank Peinemann, Stefan Sauerland: Vacuum therapy of wounds: Systematic overview of randomized controlled studies. In: Dtsch Arztebl Int. 108 (22), 2011, pp. 381-389.
- ↑ Negative pressure wound therapy: FDA warns of fatal risks. In: Deutsches Ärzteblatt. March 1, 2011.
- ↑ DT Ubbink, SJ Westerbos, D. Evans, L. Land, H. Vermeulen: Topical negative pressure for treating chronic wounds. In: Cochrane Database Syst Rev. (3), July 16, 2008, p. CD001898. Review. PMID 18646080
- ↑ IQWiG report N04-03: Vacuum sealing therapy of wounds , 2006.
- ↑ IQWiG report vacuum therapy for wounds: Violation of ethical and scientific standards. Manufacturers and scientists therefore keep study results under lock and key / benefit and harm unclear. , August 28, 2018, accessed September 3, 2018
literature
- Ch. Willy: The vacuum therapy: basics, indications, case studies, practical tips. Anne Lindqvist Verlag, Ulm 2005, ISBN 3-00-016219-4 .
- A. Vasel-Biergans, W. Probst: Wound pads . Wissenschaftliche Verlagsgesellschaft, Stuttgart 2003, ISBN 3-8047-2003-X .
- D. Furniss, PE Banwell, W. Fleischmann: Surgical Wound Infection: The Role of Topical Negative Pressure Therapy. Oxford Wound Healing Society, 2005.
