The paradox of negative pressure wound therapy - in vitro studies

Negative-pressure wound therapy (NPWT) has revolutionised wound care. Yet, it is still not understood how hypobaric tissue pressure accelerates wound healing. There is very little reported on the relevant physics of any substance subjected to suction in this manner. The common assumption is that applying suction to a substance is likely to result in a reduction of pressure in that substance. Although more than 250 research articles have been published on NPWT, there are little data verifying whether suction increases or decreases the pressure of the substance it is applied to. Clarifying this basic question of physics is the first step in understanding the mechanism of action of these dressings. In this study, pressure changes were recorded in soft plasticene and processed meat, using an intracranial tissue pressure microsensor. Circumferential, non-circumferential and cavity NPWT dressings were applied, and pressure changes within the underlying substance were recorded at different suction pressures. Pressures were also measured at 1 cm, 2 cm and 3 cm from the NPWT placed in a cavity. In all three types of NPWT dressings, the underlying substance pressure was increased (hyperbaric) as suction pressure increased. Although there was a substantial pressure increase at 1 cm, the rise in pressure at the 2-cm and 3-cm intervals was minimal. Substance pressure beneath all types of NPWT dressing is hyperbaric in inanimate substances. Higher suction pressures generate greater substance pressures; however, the increased pressure rapidly dissipates as the distance from the dressing is increased. The findings of this study on inanimate objects suggest that we may need to review our current perception of the physics underlying NPWT dressings. Further research of this type on living tissues is warranted. © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons.