Kennedy Institute of Rheumatology, University of Oxford, ARC Building, 65 Aspenlea Road, Hammersmith, London W6 8LH, UK.
J Plast Reconstr Aesthet Surg. 2012 Aug;65(8):989-1001. doi: 10.1016/j.bjps.2011.12.012. Epub 2012 Jan 10.
Negative pressure wound therapy (NPWT) is a technique that has gained such rapid acceptance for such a diversity of wound management problems that the evidence for optimal use has struggled to keep up. While clinical studies have sought to evaluate its effectiveness for a variety of acute and chronic wounds, preclinical studies have suggested that features such as the magnitude and periodicity of negative pressure, the wound filler and interface materials and the drainage conduit might introduce key pathophysiological variations at the wound bed influencing healing. Optimising the methodological approach is the key to achieving the best outcomes with NPWT. The aim of the present study was to evaluate and summarise the clinical and experimental evidence for how these methodological variations influence wound healing when using NPWT.
A literature review was conducted to evaluate each component of NPWT inciting methodological variation with reference to clinical and preclinical variables including wound volume reduction, blood flow, granulation and growth factor stimulation.
Fourteen commercially available NPWT systems are currently available. Both foam and gauze transmit NP efficiently. While some preclinical evidence suggests foam may preferentially promote cell proliferation, there is no clear evidence to favour one wound filler. Most wound contraction occurs within the first -50 mmHg and physiological optimisation may be achieved within -80 mmHg. Cyclical NP-mediated cell mechanotransduction may alter the healing characteristics of the wound bed but no definitive clinical protocol has been established. There is insufficient evidence to credit NPWT with reduced bacterial wound colonisation.
There is an urgent need to develop evidence-based NPWT regimes, tailoring the methodological aspects of therapy to the clinical need. An individualised strategy may yield improved outcomes and realise the potential of this powerful therapeutic intervention.
负压伤口治疗（NPWT）是一种技术，由于其在各种伤口管理问题上的快速应用，使得最佳使用的证据难以跟上。虽然临床研究已经试图评估其对各种急性和慢性伤口的有效性，但临床前研究表明，负压的幅度和周期性、伤口填充物和界面材料以及引流管等特征可能会在伤口床上引入关键的病理生理变化，影响愈合。优化方法学方法是实现 NPWT 最佳效果的关键。本研究旨在评估和总结这些方法学变化如何影响使用 NPWT 时的伤口愈合的临床和实验证据。
进行了文献回顾，评估了 NPWT 的每个组成部分，参考了临床和临床前变量，包括伤口体积减少、血流、肉芽形成和生长因子刺激，以评估引起方法学变化的因素。
目前有 14 种商业上可用的 NPWT 系统。泡沫和纱布都能有效地传递 NP。虽然一些临床前证据表明泡沫可能优先促进细胞增殖，但没有明确的证据支持一种伤口填充物。大多数伤口收缩发生在最初的 -50mmHg 内，生理优化可能在 -80mmHg 内实现。周期性 NP 介导的细胞机械转导可能改变伤口床的愈合特征，但尚未建立明确的临床方案。没有足够的证据表明 NPWT 可以减少细菌对伤口的定植。
迫切需要制定基于证据的 NPWT 治疗方案，根据临床需要调整治疗的方法学方面。个体化策略可能会产生更好的结果，并实现这种强大治疗干预的潜力。
