Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Dermatol. Feb 2, 2017; 6(1): 1-16
Published online Feb 2, 2017. doi: 10.5314/wjd.v6.i1.1
Evidence based review of negative pressure wound therapy
Adriana C Panayi, Tripp Leavitt, Dennis P Orgill
Adriana C Panayi, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom
Tripp Leavitt, Boston University School of Medicine, Boston, MA 02115, United States
Dennis P Orgill, Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Panayi AC gathered and analyzed the data, drafted and edited the manuscript; Leavitt T assisted in revision of the manuscript and figures; Orgill DP supervised and assisted in the drafting and provided critical revision of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript. Dr. Orgill is a consultant for KCI and receives research funding through grants to Brigham and Women's Hospital.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Dennis P Orgill, Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, United States.
Telephone: +1-617-5257837 Fax: +1-617-7302855
Received: August 26, 2016
Peer-review started: September 27, 2016
First decision: October 15, 2016
Revised: December 16, 2016
Accepted: January 11, 2017
Article in press: January 12, 2017
Published online: February 2, 2017

Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy (NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms (macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms (including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.

Keywords: Negative pressure wound therapy, Chronic wounds, Microdeformational wound therapy, Vacuum assisted closure, Pressure ulcers

Core tip: Negative pressure wound therapy has been very beneficial in the wound care of many different kinds of wounds, from pressure ulcers to open fractures mostly due to its mechanism of action which we explain in detail. We explain the original purpose of this technology and going into detail about the many different ways it is currently being used in a clinical setting. Our review also explains its advantages and disadvantages and how they could be overcome. The last part of this review discusses the future of this technology and how it will keep impacting the field of wound care.