In Part 1 of the Negative Pressure Therapy Demonstration, Japa Volchok, DO discusses the indications, contraindications and dressing selection for the wound care therapy. Negative pressure therapy, or “Wound V.A.C. therapy”, is designed to promote faster wound healing. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home.
Understand Wound Care:
Negative Pressure Therapy Demonstration- Part 1
Indications, Contraindications & Dressing Selection
Commentary: Japa Volchok, DO
In this demonstration we will be discussing the indications and contraindications for negative pressure therapy. Negative pressure therapy is also commonly referred to as V.A.C. or V.A.C. therapy. This is a trademark name from K.C.I. For the purposes of this demonstration, negative pressure therapy will be used to indicate any type of negative pressure therapy system where a dressing is applied to a wound and then is connected to a device that generates continuous or intermittent suction and has been approved by the F.D.A. for prescription by physicians or other medical staff for specific indications.
Negative pressure therapy is a treatment option for patients that have wounds that are healing by secondary or tertiary intent. These are wounds that would normally heal slowly and fill in with granulation tissue from the base of the wound and the edges of the wound before the wound would re-epithelialize.
Negative pressure therapy increases the speed at which the wound heals. In addition, negative pressure therapy promotes wound healing by removing edema, removing exudate as well as other factors within the wound.
Negative pressure therapy is indicated for a variety of conditions including pressure ulcers, venous ulcers, post-surgical wounds and other conditions.
There are several contraindications to negative pressure therapy. These include malignancy within the wound, untreated osteomyelitis, a fistula that it non-enteric or has not been explored, necrotic tissue with eschar. As well as other relative contraindications that include sensitivity to the dressing material. The adhesive commonly contains acrylic. Some patients may have an allergy to acrylic. In addition, there are negative pressure therapy dressings that contain silver. If a patient has a silver allergy or a silver sensitivity it may be contraindicated.
There is one area of relative contraindication that involves patients that are at higher risk for bleeding. These include patients that may be on Coumadin or Plavix. In addition, negative pressure therapy is contraindicated when there is exposed blood vessel, nerve or an anastomotic site, either a vascular anastomosis or an enteric anastomosis.
The wound models and dressings that will be demonstrated in this video today are courtesy of K.C.I. These are proprietary products and there a variety of vendors that supply dressings and vacuum devices.
Negative pressure wound dressings come in a variety of designs. The model that we will be using for this demonstration today is a foam-based primary dressing, this is supplied by K.C.I.
This foam dressing as seen here is this black foam. This comes in a variety of sizes and shapes. In addition, this can be cut or molded to the specific sizes and dimensions of the wound.
Also supplied in this sterile packaging is the adhesive dressing that is placed over the primary foam dressing, as well as the tubing that leads to the negative pressure generating unit.
The foam dressings come in a variety of sizes from a medium size, small size as well as larger sizes. In addition, there are pre-cut foam dressings supplied in a variety of shapes and sizes. Foam is also supplied in a variety of thicknesses. These foam dressings can be cut as well as stacked to fill the wound bed.
There are, in addition, gauze-based negative pressure therapy systems and other foam-based negative pressure therapy systems. Some alternatives include shapes that are moldable based on a spiral as well as specific dressings that have been impregnated with silver.
This is a silver impregnated sponge that is supplied by K.C.I. This is one that can be an adjunct for use in a wound that may have an infection that is being treated simultaneously with systemic antibiotics.
One significant note to be made is that the adhesive dressing that is supplied with the primary foam dressing, in the K.C.I. system includes clearly marked “number 1” and “number 2.” These are the order with which this is removed for application to the patient. This will be demonstrated subsequently.