Topical negative pressure therapy for treating chronic wounds

Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H

Published Online:

February 16, 2011

Topical negative pressure (TNP) therapy is the application of negative pressure across a wound to aid wound healing. The pressure is thought to aid the drainage of excess fluid, reduce infection rates and increase localised blood flow. TNP is also known as vacuum assisted closure (VAC) and sealed surface wound suction. Seven trials compared TNP with either moistened gauze dressings or other topical agents and found no difference in effects. One very small, poor quality trial (7 wounds) showed a reduction in wound volume and depth in favour of TNP. There is no valid or reliable evidence that topical negative pressure increases chronic wound healing.

Abstract (click to read)

Background:

Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure (TNP) is used to promote healing of surgical wounds by using suction to drain excess fluid from wounds.

Objectives:

To assess the effects of TNP on chronic wound healing.

Search strategy:

For this second update of this review we searched the Cochrane Wounds Group Specialised Register (December 2007), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4, 2007, Ovid MEDLINE - 1950 to November Week 2 2007, Ovid EMBASE - 1982 to 2007 Week 50 and Ovid CINAHL - 1980 to December Week 1 2007. In addition, we contacted authors, companies, manufacturers, and distributors to identify relevant trials and information.

Selection criteria:

All randomised controlled trials which evaluated the effects of TNP on people with chronic wounds.

Data collection and analysis:

Selection of the trials, quality assessment, data abstraction, and data synthesis were done by two authors independently. Disagreements were solved by discussion.

Main results:

Two trials were included in the original review. A further five trials were included in this second update resulting in a total of seven trials involving 205 participants.

The seven trials compared TNP with five different comparator treatments. Four trials compared TNP with gauze soaked in either 0.9% saline or Ringer's solution. The other three trials compared TNP with hydrocolloid gel plus gauze, a treatment package comprising papain-urea topical treatment, and cadexomer iodine or hydrocolloid, hydrogels, alginate and foam. These data do not show that TNP significantly increases the healing rate of chronic wounds compared with comparators.

Data on secondary outcomes such as infection rate, quality of life, oedema, hospitalisation and bacterial load were not reported.

Authors' conclusions:

Trials comparing TNP with alternative treatments for chronic wounds have methodological flaws and data do demonstrate a beneficial effect of TNP on wound healing however more, better quality research is needed.

This record should be cited as:

Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2

Assessed as up to date:

December 14, 2007

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Primary Review Group:

Wounds Group

Health topics:

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Topical negative pressure therapy for treating chronic wounds

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