Managing the open wound: indications for topical negative pressure therapy

Surgeons frequently encounter open wounds. These include wounds which have failed to close by primary means, wounds which are left open at the outset and wounds which fail to heal by secondary intention in a timely manner. Wound healing is a complex process involving tissue repair and remodelling at the same time as removal of necrotic tissue and foreign material. Topical negative pressure (TNP) is a wound management technique which applies subatmospheric pressure to a healing wound in an attempt to facilitate healing. The potential mechanisms of action of TNP are poorly understood and may involve mechanical and biochemical effects. TNP has been suggested to be of value in a variety of settings, ranging from management of acute wounds to ischaemic and diabetic ulcers. There has been inadequate scientific evaluation of TNP, which has rarely been subjected to rigorous clinical trials or adequate effective economic evaluation. Although in general TNP does appear to be largely safe and acceptable to patients, the risk of fistulation associated with its use in the open abdomen remains to be determined and is currently being evaluated by a national audit.