Negative Pressure Wound Therapy

*Wound Healing*

1966;**38**(3):209-218

[70] Friedman SJ, Butler DR, Dittelkov MR. Perilesional linear atrophy and hypopigmentation after intralesional corticosteroid therapy. Journal of the American Academy of Dermatology. 1988;**19**:537-541

[71] Juckett G, Hartman-Adams H. Management of keloids and

Physician. 2009;**80**:253e60

1996;**22**:569e74

hypertrophic scars. American Family

[72] Sclafani AP, Gordon L, Chadha M, Romo T III. Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: A randomized, prospective study and review of the literature. Dermatologic Surgery.

[73] Patel PA, Bailey JK, Yakuboff KP. Treatment outcomes for keloid scar management in the pediatric burn population. Burns. 2012;**38**:767e71

[74] Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clinical and Experimental Dermatology. 2009;**34**:219e23

[75] Khalid F, Mehrose M, Saleem M, Yousaf M, Mujahid A, Rehman S, et al. Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: Randomised control trial. Burns.

[76] Margaret Shanthi FX, Ernest K, Dhanraj P. Comparison of intralesional

verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian Journal of Dermatology, Venereology

and Leprology. 2008;**74**:343e8

contracture by triamcinoloneacetonide. Plastic and Reconstructive Surgery.

[77] Abedini R, Sasani P, Mahmoudi H, Nasimi M, Teymourpour A, Shadlou Z. Comparison of intralesional verapamil versus intralesional corticosteroids in treatment of keloids and hypertrophic scars: A randomized controlled trial.

Burns. 2018;**44**:1482-1488

[78] Jung SI, Seo CH, Jang K, et al. Efficacy of naltrexone in the treatment of chronic refractory itching in burn patients: Preliminary report of an open trial. Journal of Burn Care & Research. 2009;**30**(2):257-260. [discussion: 61]

[79] Hudson DA, Renshaw A. An algorithm for the release of burn contractures of the extremities. Burns.

2006;**32**(6):663-668

**102**

2019;**45**:69-75

**105**

**Chapter 7**

**Abstract**

patient population.

**1. Introduction**

growth [1].

Incisions

*and Robert D. Galiano*

Application of Negative Pressure

Negative pressure wound therapy (NPWT) is widely used for chronic and acute open wounds, with clinically proven benefits of faster wound healing by promoting granulation tissue growth and increased perfusion and facilitating epithelialization and contraction. Improved outcomes on open wounds prompted the application of NPWT on closed surgical incisions. The application of NPWT, in the immediate postoperative period, reduces surgical site infections (SSIs) and wound dehiscence by 50% in high-risk patients. The negative pressure reduces wound edema and improves local perfusion and lymphatic f low, thereby minimizing hematoma and seroma rates. The improved perfusion and oxygenation facilitate quicker wound healing as well as minimize ischemic complications like f lap necrosis. Recent literature supports enhanced wound healing and superior scar appearance as well as improved wound maturity, evidenced by 50% more force required to pull apart a sutured incision. Improved outcomes of incisional NPWT are reported from various surgical procedures on abdominal, breast, orthopedic, vascular, cardiac, and plastic surgeries. Further clinical studies and cost-benefit analysis are needed to recommend routine postoperative use of incisional NPWT in high-risk and low-risk

**Keywords:** negative pressure wound therapy, incisional NPWT, closed incision

The concept of negative pressure wound therapy (NPWT) was pioneered in 1997 by Morykwas, applying vacuum-assisted closure (VAC) on a pig wound model. Morykwas' initial methodology involved packing the wound with foam, covering and sealing with an adhesive drape, and applying 125 mm Hg of negative pressure either continuously or intermittently [1]. The rudimentary NPWT led to increased blood f low, granulation tissue, and f lap survival, with decreased bacterial

NPWT refers to wound healing technology consisting of three major parts: a wound dressing, covers, and a pump [2]. Wound dressing aids in transferring pressure from the pump to the wound itself, and modern NPWT typically utilizes reticulated open-pore polyurethane foam, intended to equalize the negative

NPWT, wound healing, wound dehiscence, surgical site infections

Wound Therapy on Closed

*Chitang J. Joshi, Ji-Cheng Hsieh, Abbas Hassan* 

### **Chapter 7**
