Negative Pressure Wound Therapy

We now commonly use Negative Pressure Therapy (NPWT) as an adjunct to care in a variety of circumstances. In the management of wounds, ulcers or sores of varying size and with such a degree of secretions, exudate, oozing that the correct use of common dressing devices is not possible. Over time, this therapeutic choice has seen an important evolution in clinical indications and technology aimed at achieving an effective and consistent result.


Introduction
Negative Pressure Wound Therapy (NPWT) has ancient origins.The historical summary of the NPWT use to improve wound care is brie y outlined below in Table n. 1 and its e ects on the wound bed in Figure n.1.
The use of NPWT has been constantly increasing due to the improvement of surgical techniques, the growth of technological potential, and the increased knowledge of the mechanisms of action induced by the mechanical forces of macro-and micro-deformation.

Negative Pressure Wound Therapy in the clinical practice
Currently, there are many areas in which wound care professionals use NPWT to manage wounds whose complexity is linked to factors that o en cannot be managed.
Exudate, size, rooting and other elements are the reasons for choosing a tool that has now become a ordable for everyone.
Technological evolution has allowed the introduction on the market of ever smaller, stationary and disposable devices, available in advanced care centres as well as at the patient's own home.We can consider this element as the real breakthrough that has made the di erence in NPWT treatment.However, this breakthrough was achieved thanks to the steps taken by the clinical practice combined with research.We need just to think about how much the application times have evolved, and the evaluation of the e ects on the tissues has reduced the need for extremely lengthy treatments, favouring

NPWT History
• Primitive\Ancient Civilized people • Romane empire • Abu All Ibn Sina author of early medical encyclopedia • Cupping Technique mentioned in 1580-1588 • End of 18 th Century "Suction Syringe" developed • Also in 18 th Rubber Ball used to produce negative pressure

Negative Pressure Therapy in the Guidelines
As NPWT technologies evolved and clinical applications has grown, the scienti c community has increased its work to produce new and solid evidences to convey into clinical practice guidelines.
NPWT has showed to be e ective NPWT is in reconstructive surgery, abdominal surgery in the presence of hypertension, dehiscence surgery, orthopaedic trauma surgery, cardiology, and the management of chronic wounds.
In table 2 are reported some good clinical practice recommendations to follow when using NPWT Tab.n.2 Examples of good practice recommendations to follow when using NPWT NPWT in Plastic and Reconstructive Surgery enhances the quality of tissue, as well as facilitating stabilisation of the tissue 1 .
The combined regular cleansing and application of NPWTi-d are likely of greatest bene t in critically colonised or infected wounds 2 .
Dressing selection for NPWTi-d therapy is dependent on wound characteristics of size, depth, tunnelling and underminin 2 .
NPWTi-d does not replace debridement of the acutely infected, chronically infected or contaminated wound, and appropriate antibiotic therapy 3 Some important outcomes for NPWT are: reduction of exudate from the open abdomen, early fascial closure, shorter length of hospital stay, lower mortality, lower rate of secondary procedures to reconstruct the abdominal wall and improvement in patients' quality of life 4 .
Open fracture-induced so tissue wounds and the closure of the dermatofasciotomy wound were the rst reported indications for NPWT 5 All complicated wounds, especially those larger than 50 cm2, with proven or high risk of infection, with so tissue defect and exposed neuro-vascular elements, bony structures (including fractures and osteotomies) and osteosynthesis, a er hemostasis, surgical treatment and debridement wounds 6 Legend: NPWTi-d -Negative pressure wound therapy with instillation and dwell time

Conclusions
NPWT will certainly continue to be an undisputed therapeutic choice.The future will certainly hold surprises in terms of technology, supply and demand, Healthcare professional have the responsability to maintain their knowledge well updated to deliver the best care for patients needing to recover from wounds as soon as possible, reducing the rate of potential complications.

Fig
Fig.n.1 NPWT mechanisms of action