Facilitating Wound Closure Using Reapproximation Techniques and Negative Pressure Wound Therapy

Wound healing by secondary intention is a complex and prolonged process. Granulation tissue forms to help close the wound by contraction; the volume of tissue needed to fill the wound defect results in more scar tissue formation. As the scar tissue matures, it will only reach 80% of the original tensile strength (Forrester, Zederfeldt, and Hunt, 1970). Negative outcomes can occur as a result of the significantly reduced loading capacity putting a higher burden on the patient and various health-care resources (Leijnen, Steenvoorde, Vandoorn, Da Costa, and Oskam, 2007).

The technique of wound reapproximation performed by the Wound Ostomy and Continence Department utilizes a systematic approach that includes identifying appropriate candidates, applying the negative pressure wound therapy (NPWT), and advanced assessment skills to evaluate wound progression. The gradual reapproximation of the epithelium is accomplished by using skin closure strips or sutures in conjunction with NPWT to pull the wound together, thereby preserving the original architecture of the tissue and protecting the underlying organs. This ultimately reduces the size of the defect and amount of scar tissue formed.

The NPWT stimulates granulation, reduces bacterial load, perfuses the wound bed, reduces wound edema and leads to earlier wound closure. The resulting decrease in scar tissue leads to many positive outcomes, including decreasing the rates of hernia formation, wound erosion, recurrence of fistulas, and postoperative edema (Perez et al., 2007). In addition, patients report greater satisfaction with aesthetic appearance and increased quality of life and emotional well-being (Perez et al., 2007).