Negative Pressure Wound Therapy Could Save Billions in Healthcare Costs

Treating the more than 2.8 million patients with chronic wounds costs billions of dollars per year, just in the United States, posing a continual challenge in medicine. One approach, negative pressure wound therapy, presents the medical device industry with an opportunity to meet that challenge.

Wound healing is a complex, dynamic process that follows an immediate sequence of cell migration leading to repair and closure. The healing sequence entails a specific series of events: debris removal, infection control, inflammation clearance, angiogenesis, granulation tissue deposition, contraction, connective tissue matrix remodeling, and maturation. When wounds fail to undergo this sequence of events, a chronic open wound without anatomical or functional integrity results.

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Clinically, chronic wounds may be associated with pressure, trauma, venous insufficiency, diabetes, vascular disease, or prolonged immobilization. Treating chronic, open wounds is variable and costly, demanding lengthy hospital stays or specialized home care requiring skilled nursing and costly supplies. Rapid healing of chronic wounds could result in decreased hospitalization and an earlier return of function.

Therapy Shows Potential

A product that improves the healing process could greatly decrease the risk of infection, amputation, length of hospital stay, and has the potential to save billions of dollars in annual healthcare costs. Negative pressure wound therapy, or NPWT, is such a product. It is a topical treatment intended to promote healing in acute and chronic wounds by applying negative pressure to the wound bed.

NPWT are thought to promote wound healing through several actions including the removal of exudates from the wound to help establish fluid balance, provision of a moist wound environment, removal of slough, a potential decrease in wound's bacterial burden, a reduction in edema, an increase in blood flow to the wound, an increase in growth factors, and the promotion of white cells and fibroblasts within the wound. Negative pressure brings tissue together, encouraging the tissues to stick together through natural tissue adherence, which increases healing.

Efficient Alternative

Vacuum therapy is an efficient alternative to conservative wound care and creates new possibilities for the treatment of a variety of chronic and acute wounds. Some appropriate applications of NPWT are acute wounds, partial- and full-thickness burns, surgically created wounds and surgical dehiscence, neuropathic or diabetic wounds, venous or arterial insufficiency ulcer unresponsive to standard therapy, traumatic wounds, and pressure ulcers.

Emerging research suggests there may be economic as well as clinical advantages to using NPWT for chronic wound management. Faster healing rates and reduced dressing changes, nurse time and hospital stays with NPWT may offset higher acquisition costs. TNP therapy may also reduce costs associated with adverse advents.

In the United States, two equipment systems are commonly used: V.A.C. Therapy (vacuum-assisted closure), offered by Kinetic Concepts, and V1sta and EZCare wound vacuum systems by Blue Sky Medical, now a part of Smith and Nephew.

Not All Types of Wounds are Treatable

Although many reports exist on the treatment successes with the application of V.A.C. therapy, there are several cases for which vacuum therapy is contraindicated. The European Wound Management Association recently published a position paper on V.A.C. Therapy (available at http://www.ewma.org), saying that topical negative wound therapy is contraindicated in instances of direct placement of NPWT dressings over exposed organs, blood vessels or tendons; wound malignancy, and non-enteric or unexplored fistulae. It also urges cautions when treating patients with difficult wound hemostais or active bleeding and patients who are taking anticoagulants.

Used in conjunction with conventional treatments and professional wound assessment, NPWT, when used appropriately, is a valuable tool for the clinician and the patient. The area of non-healing chronic wounds is an area with great potential for alleviation of suffering, improvement of quality of life, as well as the need to reduce the cost of treatment. As the technology advances, it is likely that this market will expand, creating opportunities for newcomers and legacy companies alike.

Negative Pressure Wound Therapy Could Save Billions in Healthcare Costs

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