Wound Dehiscence Management with Negative Pressure Wound Therapy (NPWT)

Introduction

Wound dehiscence occurs when the edges of a surgical incision reopen due to poor healing, infection, or excessive tension on the wound. It is a serious complication of both traumatic injuries and surgical procedures that can lead to increased pain, delayed healing, reoperation, hospital readmission, and higher treatment costs.

Negative pressure wound therapy (NPWT), also known as vacuum‐assisted closure (VAC), is a system that aids healing of these complex wounds by keeping the wound sterile, reducing tension across the incision, removing excess fluid, lowering the risk of infection, and promoting new tissue growth.

How Does NPWT Help?

NPWT facilitates wound healing through several key mechanisms:

Wound edge approximation to promote faster closure
Fluid removal to reduce swelling and fluid accumulation
Gentle tissue stretching to stimulate new tissue formation and wound contraction
Preventing bacterial growth to lower infection risk

NPWT Modalities

Continuous NPWT: Provides consistent fluid removal, ideal for heavily draining, infected, or painful wounds.
Intermittent NPWT: Uses alternating cycles of suction and release, suitable for wounds with persistent fluid accumulation.

Why Use NPWT for Traumatic and Surgical Dehiscence?

NPWT offers several advantages for traumatic and surgical dehiscence, including:

Faster Healing: Promotes tissue repair by creating an optimal healing environment.
Reduced Complications: Lowers infection risks and prevents fluid buildup (seromas).
Improved Comfort: Minimizes frequent dressing changes and reduces pain.
Controlled Healing: Provides consistent pressure for stable wound healing.

Cost-Effective: Shortens recovery time and reduces additional interventions.

When is NPWT Recommended for Wound Dehiscence?

Traumatic Dehiscence:

Open Fractures/Exposed Tissue: Injuries with significant soft tissue damage and exposed bone or tendons are prone to contamination and infection. NPWT helps by removing debris, reducing swelling, and promoting blood flow for healing.
High Contamination/Infection Risk: Contaminated traumatic wounds with dead tissue or foreign bodies are at high risk of infection. NPWT helps by facilitating exudate removal and reducing the bacterial load.

Surgical Dehiscence:

Postoperative Wound Separation: NPWT helps bring edges together, promoting granulation tissue formation in surgical wounds that have partially or fully reopened.
Abdominal Dehiscence: NPWT stabilizes the wound, reduces edema, and protects the organs until closure in surgical wounds where the abdominal wall layers separate, often exposing organs.

The NPWT Procedure

Wound Preparation:

Careful assessment of wound size and type.
Debridement (removal) of any dead or damaged tissue.

Dressing Application:

Placement of a specialized dressing onto the wound bed.
Sealing the wound with a sterile drape to create an airtight system.

Sealing & Suction:

Connecting the drainage tubing to the NPWT device
The pump generates the prescribed suction.
Maintaining the appropriate negative pressure settings (typically 50-125 mmHg).

Monitoring:

Regular dressing changes (usually every 48-72 hours, but this can vary).
Daily assessment of exudate volume, signs of infection, and tissue response.

Optimizing NPWT Outcomes

Daily Monitoring: Check device function and wound progress daily; change dressings as needed.
Infection Watch: Monitor for signs of infection (redness, swelling, discharge).
Custom Pressure: Adjust pressure based on wound type and exudate levels.
Other Supportive Treatments: Use NPWT alongside debridement, antibiotics, or grafts when necessary.
Patient Guidance: Educate patients on device care and the role of nutrition in healing.

When NPWT is Not Recommended

NPWT is not suitable for all patients. Contraindications include:

Active bleeding in the wound.
Exposed arteries, veins, nerves, or organs.
Presence of necrotic (dead) tissue in the wound bed.
Malignant (cancerous) wounds.
Untreated osteomyelitis (bone infection).

NPWT: A Comparison with Standard Treatment

Feature	NPWT	Traditional Wound Care
Speed of Healing	Faster	Slower
Risk of Infection	Lower	Higher
Dressing changes	Less frequent	More Frequent
Pain Level	Reduced	Higher
Cost	Higher initially but more cost-efficient in the long term	Lower initially but higher long-term

Research Findings on the Use of NPWT for Dehisced Wounds

A study by Ryan M Naylor (2020): NPWT decreased dehiscence and Surgical site infection (SSI) rates in patients undergoing lumbar fusion through an anterior approach.
A Meta-analysis by Indri Lakhsmi Putri (2022): NPWT use was associated with fewer complications, including Surgical site infection (SSI), seroma, hematoma, dehiscence, and readmissions. It is beneficial for promoting healing in cancer surgical wounds.

Frequently Asked Questions (FAQs)

1. When should NPWT be used for dehisced wounds?

NPWT is recommended for dehisced wounds with excessive drainage, tissue loss, or poor healing. It is particularly useful when conventional wound care fails.

2. How long does it take for a dehisced wound to heal with NPWT?

Healing time varies based on wound size, depth, and patient health, but NPWT often accelerates the process compared to traditional wound care.

3. Can NPWT be used at home

Portable NPWT systems can be used at home, but proper training and follow-up with your care team are essential.

4. What should I do if my NPWT dressing becomes loose on a dehisced wound?

If the dressing becomes loose, it may compromise healing. If possible, reapply the seal or contact your healthcare provider for assistance.

5. Are there any risks of using NPWT for wound dehiscence?

If not properly managed, minor bleeding, skin irritation, and infection can occur. Regular monitoring and following medical guidelines minimize these risks.

6. Can NPWT be used on infected dehisced wounds?

NPWT can be used on infected dehisced wounds when combined with appropriate antibiotics and wound debridement. Your doctor will assess suitability based on the severity of the infection.

7. What pressure settings are ideal for NPWT in wound dehiscence?

The optimal pressure setting typically ranges between 75-125 mmHg, depending on wound characteristics. Your healthcare provider will determine the best settings.

8. How often are the dressings changed?

Dressings are typically changed every 2-3 days, but this may vary based on the wound and treatment plan.

9. Does NPWT help with pain relief in dehisced wounds?

NPWT can help reduce pain by minimizing swelling and stabilizing the wound environment, although some patients may initially experience mild discomfort.

10. Can I move around while on treatment with NPWT?

You can continue moving around depending on the wound location and overall condition. The portable battery backup allows for 3-5 hours of mobility.

Take the Next Steps in Wound Healing

If you or a loved one is struggling with wound dehiscence, NPWT may be the solution you need. Consult a healthcare provider today to learn more about how NPWT can accelerate healing and improve wound outcomes.