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Mechanism of Action
Continuous or intermittent sub-atmospheric pressure
Leads to:
↓ Interstitial oedema
↑ Blood flow
Mechanical stimulation of tissue (“microdeformation”)
↓ Bacterial load
Indications
Open fractures
Soft tissue defects
Post-debridement wounds
Temporary coverage before flap or graft
Chronic wounds (selected cases)
Orthoplastic Role
Used between debridement and definitive coverage
Helps:
Maintain wound environment
Prepare wound bed
Control exudate
Bridge therapy—not definitive treatment
Application Technique
Foam dressing placed in wound
Covered with occlusive film
Connected to suction device
Typical Settings
−75 to −125 mmHg
Continuous or intermittent
Benefits
Reduces wound oedema
Promotes granulation tissue
Protects exposed structures temporarily
Improves wound bed quality
Limitations
Does NOT replace:
Adequate debridement
Early flap coverage
Overuse may delay definitive treatment
Contraindications
Untreated necrotic tissue
Active infection without debridement
Malignancy in wound (relative)
Exposed vital structures without protection
Complications
Delayed definitive coverage
Bleeding
Pain during dressing changes
Foam retention (rare)
Timing Considerations
Should be used short-term only
Ideal:
As a bridge to coverage (<5–7 days)
Prolonged use → increased infection risk
Comparison with Standard Dressings
NPWT:
Better exudate control
Improved wound bed preparation
but; No proven superiority over early flap coverage
Pits & Pearls
NPWT is a bridge, not a destination
Always combine with proper debridement
Plan definitive coverage before applying NPWT
Useful in staged orthoplastic protocols
Pitfalls
Using NPWT as a long-term solution
Applying over necrotic tissue
Delaying flap unnecessarily
Ignoring need for repeat debridement