The practice of exposing a wound to sub-atmospheric pressure to promote healing has rather ancient origins. The first clinical use dates back to about a thousand years ago, when it was first used in Chinese medicine in addition to acupuncture techniques.
Subsequently, in 1891, Junod adopted a technically innovative method that uses heated cups applied directly to the patient’s skin. The air inside the cups, cooling down, decreased its volume and therefore created a sub-atmospheric pressure, causing hyperemia. This discovery was a real source of inspiration for the researchers who later carried out numerous studies on the subject.
In particular, it led researchers Michael Marykwas and Louis Argenta to discover the effects and benefits of using vacuum on difficult wounds. Through a series of studies on animals, they discovered the use of polyurethane foam as an interface between the wound surface and the vacuum source. This material has thus proved to be a fundamental tool as it guarantees a uniform distribution of negative pressure over the entire surface of the wound and, thanks to its reduction in volume caused by pressure, causes the stretching of the cells, the contraction of the wound and the elimination of fluids.
In 1993 Fleischmann applied this concept in the clinical setting, on patients with open fractures. Using a system built by them, the authors observed efficient wound cleansing and healing, with marked proliferation of granulation tissue, without cases of osteomyelitis. In subsequent works, the treatment of patients with compartment syndrome of the lower limb and infected, acute or chronic wounds was described. The mean duration of treatment ranged from 4 to 31 days, with an average of 13, in compartment syndromes and wounds were subsequently closed by suturing and/or skin grafts in fewer cases.
In these studies, the negative pressure was achieved using conventional equipment, such as wall-mounted aspirators or portable surgical aspirators, connected to various types of dressings isolated from the environment by means of adhesive sheets used in the operating room. Naturally, the types of dressing, the levels of depression and the duration of the treatments were not homogeneous and did not allow conclusive definitions of the technical aspects of the method.
The first widely used commercial system for sub-atmospheric pressure dressing was introduced to the US market in 1995. Since then, negative pressure has been applied to almost any type of wound or injury, giving rise to a scientific literature vast. In recent years it has also begun to be used in the prevention of infections in wounds at risk of infection or collected, by applying it over the surgical suture directly in the operating room at the end of the operation.
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Armstrong DG, Attinger CE, Frykberg RG, Kirsner RS, Lavery LA, Mills JL (2002) Guidelines Regarding Negative Pressure Wound Therapy (NPWT) in the Diabetic Foot: results of the Tucson Expert Consensus Conference (TECC) on V.A.C. Therapy
Fleischmann W, Strecker W, Bombelli M, et al. (1993) Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg. Vol. 96(9):488-92
European Wound Management Association. Position Paper: Topical Negative Pressure in Wound Management. London: MEP ldt (2007)