Negative Pressure Wound Therapy (NPWT) Devices

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In this demonstration video, Dr. Michael Desvigne walks the audience through the process of applying various negative pressure wound therapy (NPWT) devices as well as highlights a newly released, easy-to-use NPWT dressing. This demonstration video was captured at the Symposium on Advanced Wound Care (SAWC) Fall 2024 in Las Vegas, Nevada.

Transcript:

Hi there. My name is Michael Desvigne. I'm a plastic and reconstructive surgeon. I come from Phoenix, Arizona. I work at the Arrowhead, Abrazo Wound Clinic and Hospital. I have joined with me today my assistant, Jody Wolf, who is an RN and CWOCN, who is director of our wound program at Abrazo, and we also have our assistant and now patient who are going to demonstrate today some use of negative pressure wound therapy. So, a little bit about negative pressure wound therapy. It's now evolved over the last 30 years and it's something that we utilize to help treat wounds. It is negative pressure that is applied through a foam dressing and a machine, which then allows negative pressure to be delivered. What we've learned is that the use of negative pressure wound therapy can help with wound bed preparation. Today we are going to demonstrate several different dressings that are available.

Firstly, we have a negative pressure wound therapy dressing that is designed to deliver instillation and dwell, and what we mean by that is fluid will be instilled into the foam and then delivered to the wound bed to allow for an instillation and dwell time. The second dressing we're going to demonstrate today is a newer form of a traditional negative pressure wound therapy dressing that is designed to be a one-step dressing called the Peel and Place [Solventum Corporation]. This is a very new technology that we're very excited about because it will also allow for a longer wear time up to 7 days. So, today, again, we're going to demonstrate all of the above. And again, we're going to start first with the instillation and dwell dressing. What we have now is a reticulated open cell foam as Jody is turning on the machine to allow it to warm up. What she is demonstrating is cutting the foam to size to fit the wound bed. This waffle-type dressing and foam will allow for cleansing of the wound bed as we instill fluid and allow it to drain.

As she's carefully cutting the dressing to size, she is then going to cut the hybrid drape, which is also a specialized drape to allow for protection of the periwound. This kind of cut-and-paste technique is unique to this more traditional type of negative pressure dressing and also with the instillation and dwell dressing. As she prepares the hybrid drape, she uses the 2 ends almost like a handlebar, and the reason that's so important is some of the other more classic dressings we've needed to cut further prior to placement. She is carefully placing the foam onto the wound bed, again with the waffle side, with the reticulated open cell foam onto the wound bed, and then placing the hybrid drape to allow for coverage so she can maintain a seal. As you saw her do, this dressing is special in that it's allowed to reposition up to 20 minutes; and so if there is a small wrinkle that can be taken care of by repositioning the dressing.

Again, she's using what might appear to be an excessive amount of the drape, but because the drape has this hybrid technology, it is very protective of the periwound, so there's no fear of causing any tissue damage of the periwound. The tabs are easily removed, and again, she's smoothing out that drape to make sure that she can maintain a seal. She's now cutting an area for the track pad. Once again, there's a fair amount of cutting and sort of customizing of this particular dressing and as we'll see in comparison to the newer dressing available is slightly different and takes a little bit more time.

As she's taking out the track pad, I want to note that there are sets of tubing. One is for the instillation of fluid and then the other is for the negative pressure. As she places the track pad over the area of the foam, she's carefully once again removing the tabs and allowing for the dressing to create a seal. As she's doing that, she's also considering how the patient will be lying in bed or sitting so that she can basically appropriately place the tubing so that it's not in the way of ambulation. Again, she's now hooking up the tubing to the system, again, which will allow instillation of fluid as well as a dwell time. As we are starting to get a drawdown to make sure that we have an adequate seal, Jody is now pointing out the areas where she can now choose the type of therapy. There are several therapies available with this particular unit, which is available in the acute care setting.

She chooses the appropriate instillation and dwell therapy, which is what is designed for this particular dressing. You can hear the machine as it starts and ramps up. We have a nice seal and you see the drawdown of the dressing itself. The options of this dressing will allow for several different volumes of fluid and you can basically customize based on the size of the wound bed and the amount of fluid that you would like to instill and then allow for dwell. The benefit of this dressing once again is to allow for removal of exudate and this particular dressing with the reticulated open foam will also, because of the ability to fracture any debris, can actually allow for a hydro-mechanical debridement as well.

So again, we've noted that we have a nice seal. We have instillation of fluid with dwell, and now we're going to move on to our next dressing, which is called the Peel and Place dressing. As Jody turns off the machine prior to removal of the dressing, this is a very small but very important point because that will allow for easier removal because the negative pressure is now off. As she removes the hybrid drape, you can see that it's because of the silicone layer. It's very easily removed, although it has a nice seal because of the adhesive component, you can see there's no periwound irritation.

Now, in preparation for the next Peel and Place dressing, I want to point out that this dressing comes as one unit. As Jody holds up the dressing that you can see there is already a cut hole for what we call the track pad. This is a big benefit as it allows for one less step. Additionally, you can see that the drape itself is very similar to the drape that we just used. The holes are slightly larger, which allows for an even better seal, but you still get that periwound protection. But as you can see with the one-step dressing, it's applied as one unit. There is no cut and paste necessary, and the tabs are easily removed just as was seen in the previous dressing.

Because the hole is precut, it is the perfect size for the track pad, and once again, Jody is considering the direction of the tubing so that it makes it easier for the patient to ambulate. Once again, because of this hybrid dressing or hybrid drape, you also can reposition it if needed in about a 20-minute timeframe. So because this dressing does not allow for instillation and dwell, this is going to be placed at a different setting just to allow for negative pressure therapy. Again, you can see that Jody has obtained an adequate seal. The patient appears to be comfortable, and again, the ease of the dressing is very important because it appears to be much faster in comparison to the more traditional negative pressure therapy dressing.

The other benefit of this dressing is that it does allow for a longer wear time, up to 7 days. The traditional negative pressure wound therapy dressings typically are changed every 2 to 3 days, and this allows for a more extended period of time of use, so less dressing changes. And if a patient needs to come to clinic each time, it's only once a week.

So, now that we have a seal, we'll move on to our last dressing, which is called the Prevena, which is an incisional management negative pressure dressing. Again, as Jody removes the drape., again, no periwound irritation, and the patient appears quite comfortable.

Incisional management with negative pressure therapy is particularly valuable for surgeons because it allows for reduction of postoperative complications such as infection or dehiscence. The difference however, in this dressing is that the negative pressure is delivered, but it's being delivered over a closed incision, not to a wound bed. There is a nonadherent layer that is incorporated into this particular dressing, as Jody will show, and this nonadherent layer also has silver, which has that antimicrobial protection. This particular version of this dressing is able to be placed as one unit. The drape is applied and again with care to get a seal.

The similarity of this drape is more similar to a Tegaderm if you're used to that in terms of use on an IV site or for skin tears. As Jody smooths the drape and gets ready to connect, once again, the setting for this particular dressing is typically at 125 mm Hg. And this can be utilized as a disposable unit, but it also can be utilized in the acute care setting unit, which was the pump that we showed earlier. The advantage of the disposable pump is that this dressing will stay in place. The patient will go home with a disposable pump and then the disposable pump will then be discarded at 7 days.

There is a pump with a slightly larger timeframe that can be a 14-day pump, and that is the added advantage. If in fact it is needed or felt necessary to have additional negative pressure, that can be utilized as well. So again, Jody has had an excellent seal. The patient appears comfortable, this disposable unit patient will be discharged on, and then a different dressing can be applied in clinic.

So, what we have showcased today are 3 dressings for negative pressure therapy. Negative pressure can be utilized for wound therapy, but as we have shown, it can also be used for incisional management. The negative pressure wound therapy dressings are available in different sizes and depending on the goal of therapy, they can be utilized for wound bed preparation as well as utilized to help for wound bed progression towards healing. The benefit of negative pressure wound therapy is to allow for both use in the acute care setting as well as the post-acute care setting, which can then allow transitioning to care.

So, on behalf of my assistants, both Jody and Jaclyn, I want to thank you, and I appreciate your time today.