Negative pressure wound therapy (NPWT) is a form of wound care which utilizes a vacuum to create a suction interface at the site of the injury. It’s being utilized in all sorts of scenarios ranging from pressure sores and post-op wounds to open abdominal wounds and injuries with bone exposure.
NPWT creates a flush interface against an irregularly shaped wound. The suction removes debris and particulate necrotic tissue while promoting blood flow to facilitate the healing process. In addition, it creates a barrier against the outside environment to prevent healing disruption.
A trial done by a group from the Netherlands attempted to assess how effective (healing and cost wise) NPWT is relative to traditional therapy. 1
The trial had patients with any wound type (acute or chronic) undergo surgical debridement of necrotic/infectious tissue and then placed them randomly into either “vacuum-assisted closure” or “conventional therapy.” While NPWT didn’t offer a considerable improvement in healing time for many, it provided an almost statistically significant (p=0.06) improvement for patients with diabetes (DM) and hypertension (HTN).
| Vacuum | Conventional | |
| n | 32 | 33 |
| Median Healing Time | 16 d | 20 d |
| Median Healing Time for DM and HTN | 14 d | 23 d |
So how about the costs? One would think that a vacuum contraption and special dressings cost way more than some special bandages used in regular wound care. The following costs are in euros.
| Vacuum | Conventional | |
| n | 26 | 21 |
| Materials (range) | 259 (86-1297) | 94 (16-431) |
| Direct labor (range) | 81 (21-282) | 176 (16-750) |
| Total costs (range) | 353 (111-1503) | 273 (40-1123) |
So yeah, NPWT costs about 30% more than conventional treatment, but is it worth it? The data suggest that in terms of actual healing, there’s no difference in the two protocols; however, additional patient comfort and less time commitment from the wound care team are in NPWT’s favor. Time will tell if wound care teams will expand the role of NPWT. See the full article in the link below.
1. “The Clinical Efficacy and Cost Effectiveness of the Vacuum-Assisted Closure Technique in the Management of Acute and Chronic Wounds: A Randomized Controlled Trial”
Plast Reconstr Surg. 2006 Aug;118(2):390-7; discussion 398-400.
https://www.ncbi.nlm.nih.gov/pubmed/16874208
Very interesting Rishi! I’m enjoying these last few articles you’ve written taking statistical looks at, what are assumed to be more effective therapies. Now, I’ll have something to discuss next time I shadow a surgeon. Thanks!