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Plast Aesthet Res 2019;6:32.10.20517/2347-9264.2019.72© The Author(s) 2019.
Open AccessLetter to Editor

Classification of negative pressure wound therapy

Department of Plastic Surgery, King Fahad Central Hospital, Jazan 82666, Saudi Arabia.

Correspondence Address: Dr. Pramod Kumar, Department of Plastic surgery, King Fahad Central Hospital, Jazan, Saudi Arabia. E-mail: pkumar86@hotmail.com

    Science Editor: Raúl González-García | Copy Editor: Jing-Wen Zhang | Production Editor: Tian Zhang
    ...

    © The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

    Since relatively new negative pressure wound therapy (NPWT) has become an integral part of simple to complex wound management, effective price transparency of NPWT should include the release of clear, accurate, and actionable information for patients to determine their cost of treatment and remove the guesswork. The amount and type of material used, number of hours of negative pressure application, cost of maintaining negative pressure for a definite period, etc., usually determine the cost of NPWT. With this idea of price transparency, the author attempted to classify NPWT in different ways. The author believes that, with similar attempts by various authors in the future, a better classification would evolve.

    A. Depending on the schedule of negative pressure and type of environment produced under the NPWT device, it may be classified as:

    1. Continuous NPWT [Vacuum Assisted Closure (VAC)][1] (KCI Medical, San Antonio, Texas) and Versatile-1 Wound Vacuum System (Versatile-1 WVS) (Blue Sky Medical, La Costa Calif)[2].

    2. Intermittent NPWT [Limited access dressing (LAD)][3,4].

    B. Depending on the interface material used between the tissue and device, NPWT may be classified as:

    1. NPWT with interface such as foam, gauze, or other porous material that helps to distribute the negative pressure uniformly over wound surface. Examples include VAC[1] and Suction Assisted Sressing (SAD)[4]. In this type of NPWT devices, granulation grows in the pores of interface material and does not provide favorable environment for epithelialization.

    2. NPWT without interface material. An example is LAD. This type of NPWT is better for epithelialization. The single use portable NPWT dressing used for outdoor (OPD) patients is PICO (Smith and Nephew Healthcare, Hull, United Kingdom) that requires fewer dressing changes and is an adjuvant therapy to hasten wound healing. PICO is better accepted by OPD patient with reduced financial burden[5].

    C. Depending on sealing of the device, NPWT may be classified as:

    1. NPWT with occlusive dressing: such dressings provide moist healing environment with enormous capacity to remove soakage. Examples include VAC and LAD. Moist healing becomes more effective in intermittent negative pressure regimen, such as in LAD[3,4].

    2. NPWT with semi-occlusive dressing. Such dressings, apart from negative pressure, provide wet to dry environment, and are effective in wounds with relatively small amount of soakage. An example is SAD[4].

    D. Depending on area of dressing, NPWT may be classified as:

    1. Small area dressing.

    2. NPWT over a part of a region of the body, e.g., foot.

    3. NPWT over a region of the body, e.g., inferior or superior extremity.

    4. Separate NPWT over multiple regions of the body, e.g., both limbs separately, one upper limb and one lower limb, etc.

    5. Extra large and complex NPWT, e.g., upper limb and adjacent chest.

    6. Whole body dressing, e.g., in extensive burn areas.

    7. Special area NPWT, e.g., perineum, face and scalp, or over area with external fixator.

    Declarations

    Authors’ contributions

    The author contributed solely to the article.

    Availability of data and materials

    Not applicable.

    Financial support and sponsorship

    None.

    Conflicts of interest

    The author declared that there are no conflicts of interest.

    Ethical approval and consent to participate

    Not applicable.

    Consent for publication

    Not applicable.

    Copyright

    © The Author(s) 2019.

    References

    • 1. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997;38:553-62.

      DOIPubMed
    • 2. Campbell PE. Surgical wound closure case studies with the versatile 1 wound vacuum system for negative pressure wound therapy. J Wound Ostomy Continence Nurs 2006;33:176-85. discussion 185-90

      PubMed
    • 3. Kumar P. Limited access dressing. Wounds 2008;20:49-59.

      PubMed
    • 4. Kumar P. Exploiting potency of negative pressure in wound dressing using limited access dressing and suction-assisted dressing. Indian J Plast Surg 2012;45:302-15.

      DOIPubMedPMC
    • 5. Payne C, Edwards D. Application of the single use negative pressure wound therapy device (PICO) on a heterogeneous group of surgical and traumatic wounds. Eplasty 2014;14:e20.

      PubMedPMC

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