The practice of exposing a wound to sub-atmospheric pressure to promote healing was initially described in the orthopedic setting in the early 1990s in patients with exposed fractures. The authors, who used a system built by them, observed efficient wound cleansing and healing, with marked proliferation of granulation tissue, without cases of osteomyelitis. In subsequent work the treatment of patients with compartmental syndrome of the lower limb and of infected, acute or chronic wounds has been described. The average duration of treatment ranged from 4 to 31 days, with an average of 13 days, in compartmental syndromes and the wounds were subsequently closed by suturing and / or skin grafts in a smaller number of cases.
In the infected wounds, the negative pressure treatment lasted for 17 days and on an average for 3.1 dressings were required over the entire period. Most wounds with acute infections were finally treated by suture, while the remainder recovered by secondary intention or were treated with skin grafts in a few cases. Reinfections and failures represented a small percentage of cases.
Many of the initial experiences in topical treatment with negative pressure were carried out in patients with infected wounds of all kinds, and also in post-actinic chronic ulcers such as in soft tissue injuries, including sacral decubitus, post-traumatic lesions, consequent tissue losses to fractures of the lower limbs. In most cases the rapid reduction of the initial size of the wound was observed, with a shortening of the healing time and healing of the pre-existing infection.
In these studies, the negative pressure was achieved by means of conventional equipment, such as wall-mounted vacuum cleaners and the classic “suction bottles”, connected to various types of dressings isolated from the environment by adhesive sheets used in the operating room. This demonstrates that the system can be implemented in a very simple way, while achieving brilliant results. Naturally the types of medication, the depression levels and the duration of the treatments were not homogeneous and did not allow conclusive definitions of the technical aspects of the method.
The first commercial system of wide diffusion for the realization of the sub-atmospheric pressure dressing was introduced in the US market in 1995. Since then the negative pressure has been applied almost to every type of wound or injury, giving life to a wide scientific literature. In recent years it has also been used in the prevention of infections of wounds that were at risk, applying it over surgical suture directly in the operating room at the end of the operation.