NEGATIVE PRESSURE WOUND

THERAPY IN COMPLEX CRANIO-

MAXILLOFACIAL AND CERVICAL
WOUNDS
Novelli G, Daleffe F, Birra G, Canzi G, Mazzoleni F, Boni P, Maino C, Giussani C, Sozzi D, Bozzetti A.
International Wound Journal ISSN 1742-4801(2017)

GUIDED BY: PRESENTED BY:

DR K.V. ARUN KUMAR DR NASIM
 INTRODUCTION

‘Time heals all wounds’ is a sentence-serving but quite true assertion

due to the abilities of the human body.
Negative pressure wound therapy (NPWT) could be used to achieve
better and faster recovery.
The main aim of this study is to describe and discuss the usefulness of
NPWT in the cranial-facial-cervical region.
 • The practice of
In the 1960s that Von exposing a wound to
Silvis and Moloney Leden and Kaplan as sub atmospheric
developed a method well as McLean, pressure for an
for the removal of described the use of a extended period to
excess liquid during portable suction promote debridement
head and neck surgery drainage system (the and healing was first
in 1930s. Hemo Vac System). described by
Fleischmann et al.
 In 2006, Schuster
• Negative pressure • In the early 1990s, and Adrews
within the wound Morykwas and In 1995, a published the
was achieved Argenta stimulated commercial system
through the use of the development of for promoting VAC
first clinical trials
conventional vacuum-assisted was introduced into related to V.A.C.
methods, such as a closure (V.A.C. the United States application to
wall suction Advanced Therapy market.
apparatus or System) by Kinetic
both complicated
surgical vacuum Concepts Inc. of San cranial-facial
bottles as discussed Antonio, TX. lesions and in
by Banwell cervical infected
wounds.
Removal of excessive exudate, catabolic products and necrotic debris

Stimulating the wound bed to produce granulation tissue

Improving local vascularisation

Mechanically stabilises the wound

Eliminates most of the oedema and interstitial exudate

Increases local tissue perfusion and reduces the bacterial load

Rapid and efficient healing of complex wounds

MATERIALS AND METHODS

Healing complications
Cervicofacial in oncological-
infectious disease reconstructive
surgery

Healing complications Healing complications

of injury with bone in traumatic injury
and/or internal with loss of substance
fixations exposed
 Evaluation criteria:
1. Complete or incomplete wound
healing,
2. Application time, related also to
hospitalisation time,
3. Days of intensive care unit (ICU)
stay and management of the
upper airways,
4. Timing of medication renewal,
5. Patient comfort and compliance
(on a scale of (1–5)
ActiVAC Therapy Unit, derived from a V.A.C System (Kinetic Concepts
Inc.)
Hydrophobic polyurethane black open pore (400–600 microns) foam.
Depression values: -75 and -125 mmHg in a continuous aspiration
pattern.
 Medication renewals: 48–72 hours
 RESULTS
Study group: 11 males and 5 females (9 month and 78 years)
12 (75%) achieved a full recovery.
In cases where NPWT could not achieve complete recovery, it was
useful to reduce wound area and prepare the wound bed for further
treatments.
 Four patients underwent local advanced dressing over the residual
defect, whereas a cutaneous graft was necessary in only two cases.
V.A.C. Therapy application time: 4 to 22 days (mean of 11⋅57 day)
Hospitalisation period: 5 and 56 days (average of 28⋅0.19 days)
V.A.C. Therapy application time: 42% of time of hospital stay
Infectious disease or necrotising fasciitis: 5 to 22 days
Oncological patients with complex wounds: 7–17 days (mean of
10.75)
 DISCUSSION
Physiological wounds healing passes through:
• Haemostasis,
• Inflammation,
• Cell proliferation
• Differentiation
Complex wounds are lesions whose healing is made difficult by several
factors:
• Patient health status,
• Local injury conditions
• Anatomical area of the wound
 Reduced peripheral blood
flow in diabetic, vasculopatic
or radiotherapic patients
constitutes a concrete
worsening of the healing
course
Infection jeopardises the
recovery process a high
bacterial load prolongs
inflammatory phase,
hindering the formation of
granulation tissue

Temperature or humidity
and wound edges strain,
resulting in ischaemia,
hematomas or seromas
compromising anatomical
planes adhesion
NEGATIVE PRESSURE
WOUND THERAPY
The study proposed to assess an advanced medication system on the
healing of complex wounds.
They reviewed the benefits of NPWT in traumatic, oncological,
malformative and, above all, infectious complex wounds.
Complete healing was achieved in most cases, whereas remaining
patients reached a more-than-adequate clinical improvement,
reduced technique’s cost with less hospitalisation days.
NPWT together with medical and surgical therapy, a treatment
mainstay for those affected by cervical infectious disease.
ICU stay was necessary for continuous monitoring.
Dressing changes were carried out at more deferred time ranges with
painfulness decreased, and symptoms resolution occurred earlier.
Analysing dressing costs, frequency of dressing changes, nursing
time, healing rates and impact on hospitalisation are far more
relevant and must be considered.
CROSS REFERENCES
CASE 1
CASE 2
CASE 3
 TAKE HOME MESSAGE !!!!
NPWT accelerates wound healing by enhancing the inflammation,
proliferation, and remodeling phases of wound healing.
The pressure differential facilitates movement of fluid and reduces
edema while increasing blood flow, which aids in lymphatic drainage
and clearing of the wound to reduce inflammation.
NPWT has been shown to be safely and effectively used in
complicated maxillofacial wounds.
NPWT is under utilized in this due to the limitations in maintaining a
negative pressure seal when TNPDs are applied to the head and neck.