Negative pressure wound therapy

The availability and use of negative pressure wound therapy (NPWT) systems grew throughout the 1990s in both the management of chronic wounds and the highly specialised management of abdominal wounds and lacerated trauma wounds to the limbs. These different systems allow continuous or intermittent negative pressure of between 50 and 200 mmHg to be applied to the wound. In France, NPWT devices can be used both in hospital and for patients being treated at home, but not on an outpatient basis (this is not reimbursed by health insurance). When used in a healthcare establishment, they are funded based on a payment by results basis (the French programme is known as tarification à l’activité or T2A). Several independent assessments have been carried out in order to determine the circumstances in which this technique is indicated and how it should be used, one of which was a recent Cochrane review that looked at skin grafts and surgical wounds. There have been others conducted by the health authorities in a number of different countries, including in the United States and in France in 2010 [1-4]. These various systematic literature views all come to the same conclusions.

They find this expensive technique is being increasingly used, sometimes for very long durations, and for “borderline” indications in which there are no supporting studies or only poor quality ones. The use of NPWT for chronic wounds in dermatology has become incorporated into some treatment approaches, and these would seem to merit a more in-depth assessment.