Clinical Applications and Benefits of Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management: A Novel Approach for Comorbid Wounds

Abstract

The principle of negative pressure technique dates back to the earliest civilizations; during the Roman era, the technique of using dome-shaped cupping glasses was used to create the suction needed to promote healing. This technique was used throughout the 19th century. In 1821, a British physician named Dr. Francis Fox invented the "glass leech" technique. Thereafter in 1952, an innovative approach was introduced to the treatment of serious, complex wounds through the use of sub-atmospheric or negative pressure known as "negative pressure wound therapy" (NPWT). Later, the "vacuum-assisted closure", or VAC therapy system founded by Dr. Louis Argenta in 1990 revolutionized the advanced wound care market, and still remains the most clinically proven alternative for the treatment of complex, hard-to-heal wounds. These therapies utilize a foam dressing that is conformed to the wound bed. When sealed and placed under negative (vacuum) pressure, the system creates a unique wound-healing environment that has been shown to promote the wound-healing process, reduce edema, prepare the wound bed for closure, promote the formation of granulation tissue and remove infectious materials. The negative pressure therapy system addresses patient quality of life through an easy-to-use system designed to assist surgeons in the management and treatment of comorbid wounds, and open abdomen and other wound complications to help achieve primary fascial closure. Comorbidities can be defined as a concurrence of multiple chronic diseases in the same patient. Closed-incision negative pressure therapy (CINPT) has revolutionized the way in which caregivers treat the most serious, complex wounds or comorbid wounds. Wound healing can be achieved by the host's innate and adaptive immune defence mechanisms as in an uninfected simple surgical incision through the skin or by combination of the host's defence mechanisms and therapeutic modalities. It has been confirmed in some clinical researches that growth factors exert amazing effects on wound-healing promotion and skin function restoration without any obvious side effects. In this review, we have hypothesized a novel modality, focusing on the treatment of wound complications secondary to comorbidity by a combination of negative pressure therapy followed by a positive pressure infusion with growth factor concentrates.