Negative pressure wound therapy: Unusual and Innovative Applications

Negative pressure wound therapy (NPWT), based on application of subatmospheric pressure, has revolutionized the management of wounds. It has been successfully used in the setting of wounds complicated by the presence of burn, infection, poor circulation, exposed bone or artificial implants, or previous wound dehiscence. Negative pressure wound therapy facilitates healing by reportedly improving the rate of angiogenesis, endothelial proliferation, the integrity of the capillary basement membrane, capillary blood flow, capillary caliber, and by decreasing interstitial edema and bacterial burden within the wound. It is undisputable that the NPWT paradigm is here to stay. This review summarizes the unusual and innovative applications of NPWT, focusing on the practical aspects relevant to daily clinical practice. The authors present two illustrative cases, followed by a detailed discussion of novel applications of NPWT. Topics included in this manuscript encompass NPWT use in the settings of orthopedic and vascular implant infections, complex abdominal wounds, enterocutaneous and enteroatmospheric fistulae, skin grafting, challenging anatomic locations (i.e., face, neck, and distal extremities), sternal wounds, and ascites. A section on special issues in NPWT then follows. Cite as: Cipolla J, Baillie DR, Steinberg SM, Martin ND, Jaik NP, Lukaszczyk JJ, Stawicki SP. OPUS 12 Scientist 2008;2(3):15-29. Correspondence to: S. P. Stawicki, MD. OPUS 12 Foundation, 1011 Rutherglen Drive, Columbus, OH 43235 USA.