Topical negative pressure in wound management

Objective: To investigate the role of topical negative pressure (TNP) thera py in the management of difficult wounds. Design: Prospective consecutive patient series. Patients and setting: 30 patients referred to our tertiary plastic and reco nstructive surgical service with wounds deemed unsuitable for reconstructiv e surgery were treated between November 1997 and the end of December 1998. The mean pretreatment duration of the wounds was 418 days (range, 8-1650 da ys). All wounds were at least Grade III pressure sores. Intervention: Topical negative pressure therapy (TNP) using the VAC device (KCI Medical, San Antonio, USA). Suction (75-125 mmHg) was continuous for t he first 48 hours, then intermittent (2 min on, 5 min off). Main outcome measures: Achievement of wound healing endpoints: (1) complete healing of the wound; (2) obliteration of the wound cavity to allow surfac e dressings; or (3) closure of the wound by suture or skin graft. Results: TNP was successful in 26 out of 30 patients with mean therapy time of 35 days (range, 3-124 days). Healing was more rapid in acute (less than six weeks old) wounds. A reduction in the number of bacterial species and colonies was also observed during therapy. Conclusion: TNP can, in some circumstances, promote rapid secondary wound h ealing. A further randomised trial of TNP versus more traditional wound man agement modalities is justified.