11/19/2023 0 Comments Negative pressure wound therapy ncbiThe tissue damage caused by a bullet is related to its kinetic energy transferred to the tissues, given by the formula of ½ mv 2. 4Ĭombat wound characteristics and wound ballistics NPWT became a preferred method in combat trauma as compared to traditional methods, with saline-soaked dressings. 3, 5 It rapidly gained popularity among the military surgeons worldwide due to its versatility, ease of application, and varied indications in combat-related wounds. The use of NPWT was widely reported during Operation Iraqi Freedom and OEF. 11 Their handbook on Emergency War Surgery describes its role in combat wounds with an improved and accelerated healing. The use of vacuum wound closure systems in war wounds was reported for the first time in 2004 by Burris et al. Subsequently numerous authors have described their experience with NPWT in noncombat wounds. They concluded that application of controlled subatmospheric pressure creates an atmosphere conducive to wound healing. They also reported a decrease in tissue bacterial counts and an increase in random flap survival by 21% as compared to controls. They found an increase in blood flow by fourfold with a negative pressure of 125 mm Hg and a significant increase in granulation tissue formation. Subatmospheric pressure of 125 mm Hg was applied to the covered foam. 6 Using pig model, wound was covered by open cell foam and sealed by adhesive tape. reported their results in animal studies. 5Īlthough the use of negative pressure for medicinal purpose was described in 600 BC, it was only in 1997, when Morykwas et al. 4 Further technical refinements have validated its use during air transport, allowing casualties to receive continuous NPWT during air evacuation, from forward surgical center to a tertiary care center. 2, 3 The popularity of NPWT can be gauged by the fact that during Operation Enduring Freedom (OEF) in March 2003, about 46% of wounds were managed with NPWT and in September 2003 its use had increased to over 90% of admitted wounds. The benefits of NPWT in combat trauma have been reported by various authors. The disadvantages of this form of management were well recognized. Traditionally these wounds have been managed with wound irrigation, debridement, and a delayed closure. In a war scenario, an early wound care may be delayed due to late evacuation to a forward surgical center. Involvement of multiple anatomical sites, make these individuals critical, requiring urgent resuscitation and life support. Due to high energy transfer, multiple tissue planes are opened leading to contamination beyond the zone of trauma. These wounds are heavily contaminated with dust, soil, the patient's clothing, and other foreign bodies, and characterized by extensive loss of soft tissues and bony materials. The wounds are sustained due to gunshots, grenade blasts, landmines, improvised explosive devices (IEDs), and bombs. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds.Ĭombat wounds pose a challenge to a military trauma surgeon. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure.įuture Directions: Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. Early debridement is indicated followed by delayed closure of wounds. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting.Ĭritical Issues: Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. An early wound cover is associated with lower rate of infections and a faster wound healing. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. Significance: Wounds sustained in a combat trauma often result in a composite tissue loss.
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